11060158 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20900 HOMESTEAD RD BLDG 75 A-L CONTRACTOR:MONTEREY PERMIT NO: 11060158
CONSTRUCTION COMPANY
OWNER'S NAME: PROMETHEUS 88 MONTEREY-SALINAS HWY STE A DATE ISSUED:06/20/2011
C R'S PHONE: 6509818400 SALINAS,CA 93908 PHONE NO:(831)601-2659
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ' ELECT r- PLUMB r-
License Class 6 Lic.# � � r
I //� MECH f— RESIDENTIAL COMMERCIAL r
Contractor Date -�1 I
I hereby affirm that I aftAcensed under the provisions of Chapter 9 JOB DESCRIPTION:BLDG 75,UNIT K,REMODEL KITCHEN,50SF,ADD
(commencing with Section 7000)of Division 3 of the Business&Professions WASHER/DRYER HOOK-UP AND A/C UNIT.
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$20000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. •)A/��
APPLICANT CERTIFICATION APN Number:32609029.75 Occupancy Type:
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulati s per the Cupertino Municipal Code,Section
9.18. /z /_
J �
Issued b Dater"
Signature 0' Date
G OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons:
inspection.
1,as owner of the
property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date:
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I Own r r� t
become subject to the Worker's Compensation provisions of the Labor Code,I must Date: 411
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of"ark's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
'inify and keep harmless the City of Cupertino against liabilities,judgments,
,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Signature Date Licensed Professional
CITY OF CUPERTINO
7 ITEMS OF 21 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32609029. 75
DATE ISSUED. . . . . . . : 06/20/2011
RECEIPT #• . . . . . . . . : BS000013832
REFERENCE ID # . . . : 11060158
SITE ADDRESS . . . . . : 20900 HOMESTEAD RD BLDG 75 A-L
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : PROMETHEUS
ADDRESS . . . . . . . . . . : 1900 SOUTH NORFOLK ST STE 150
CITY/STATE/ZIP . . . : SAN MATEO, CA 94403
RECEIVED FROM . . . . : RICHARD REGA
CONTRACTOR . . . . . . . : BEN REGA LIC # 32275
COMPANY MONTEREY CONSTRUCTION COMPANY
ADDRESS . . . . . . . . . . : 88 MONTEREY-SALINAS HWY STE A
CITY/STATE/ZIP . . . : SALINAS, CA 93908
TELEPHONE . . . . . . . . : (831) 601-2659
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BAPPLOTHE NO OF APPLIAN 2 . 00 126. 00 0. 00 126 .00 0. 00
1BCBSC VALUATION 0. 00 1. 00 0 . 00 1 .00 0. 00
1BREMAIRHA NO.UNITS 1. 00 63 . 00 0 . 00 63 . 00 0. 00
1BSEISMICR VALUATION 0 .00 2 . 00 0. 00 2 . 00 0.00
1MPERMITFE FLAT RATE 1 .00 42 . 00 0. 00 42 . 00 0. 00
1REMRESKIT SQ FEET 1. 00 570. 00 0 . 00 570. 00 0. 00
1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 846. 00 0. 00 846 . 00 0 . 00
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
IM Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS:,'�1?0Q ► 1 PERMIT# '
OWNER'S NAME: 2V PHONE# )-S
GENERAL CONTRACTOR: �` , BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum /Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Ow Contractor Signature Date
152>1
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20900 homestead rd. Bldg 75#K DATE: 06/16/2011 REVIEWED BY: bobs.
APN: BP#: *VALUATION: $20,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi-Family Dwelling Building is PENTAMATION 1R3SFDREM
USE: 3 Stories Q Yes E) No PERMIT TYPE:
WORK remodel kitchen add W/D hook-up, A/C unit.
SCOPE
Mech.Plan Check0.0 hrs $0.00
Mech.Permit Fee: 1 MPERMIT
Other Mech.Insp. 0.0 hrs $42.00
NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh7 info,
FEE ITEMS (Fee Resolulion 09-051 Lff 711,'10,) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.f. Remodel,Kitchen(<=300 sf)
Suppl. PC Fee: E) Reg. Q OT 10.0 hrs $0.00 $570.00 1REMRESKIT
PME Plan Check: $0.001= # Mechanical
Permit Fee: $0.00 $63.00 1BREMAIR A/C Units(<=10K cfm)
Suppl. Insp. Fee-0 Reg. 0 OT 0.0 hrs $0.002= # Mechanical
PME Unit Fee: $0.00 $126.00 1BAPPLOT Other Appliance/Equip
PME Permit Fee: $42.00
Acoustical Fee: ® Yes (E) No $0.00 Q
Work Without Permit? Yes E) No $0.00
Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Fee: ITRA VDOC $42.00 Building or Structure 0
Strong Motion Fee: IBSEISMICR $2.00 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $87.00 $759.00 TOTAL FEE:' $846.00
Revised: 03/01/2011
06/16/2011 15 : 14 (FAX) P. 003/004
I
CONSTRUCTION I—ER1Y11T APPLICATION
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I COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION i \
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO � (408)777-3228• FAX(40 )777-3333•buildirl a)cuaertino.oro-
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AREA - AREA
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PRF.-APPYJCAIIO:f ❑ YF.S rP YES.FROYIDE copYOP PLANNER'S IM1e; jtrp(:tYE171 c{. - ��+ j �(T01,h4�VAfa .Tl(I'•r`
YLANNL�fi.APPLE NO PLANNWU APPR(NAL LI;ITPk ` \ RIs'
By try.signature'he1mY,I certify to each of the following: l am t�1e property owner or authorized agent to act on the prope}ty owner's behalf�1 ha a read this
appticahon grid the inrormntion I Nave provided is correct. I have jead the Description of Woik and verify it is accurate. I agree to comply with all applicable local
ordindyces and state iaws relating trhAt`fdil{g construction: I nu on=Teprrseutatives of Cupertino to enter the above-idegtlhetl property;(e inspectiDn purpose;.
♦ : . ,1
Signature of Applican[iAgene'•...f.r'f. Daie:_
SUPPLEMENTAL INFORMATION REQUIRED .a���c��t cis rxFr .; •< .t>�t Tllvrszm
_New SFD or Multifamily dwellings: Apply for demo Ilion pennit for
existing building(s): Demolition permit is required prior t issuance of building ��JF � I�(�Ylit,f4FR i InigDfal,ILAN R>i)Itch
permit for new building..
1 XPRC53y •v ❑ Y)A'AAEIIYfi Yr q1�t ii)t)nK4)r
I 3 v
_Commercial Bldgs: Provide a completed I-]azardous l/Raterials Disclosure ❑ ST\ttpAR» ❑ (7JeLu )titpttlFs
form if any Hazardous-Materials are being used as Bart of kfiispro,iect.
Cl i 4RC'.r `'"' ❑ i;,tleJ;Dgrrl'
_Copy of Planning Approval.Letter or Meeting with Pl ming prior to `
submittal of Building Permit application. �
r-
;,. 7 tsrt.4)tAMIJ!^'z fsHE,lsrli r
B1dgApp 2011.dnc revised 03116/11
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