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11030082 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20900 HOMESTEAD RD BLDG 78 CONTRACTOR:MONTEREY PERMIT NO: 11030082 CONSTRUCTION COMPANY OWNER'S NAME: PROMETHEUS 88 MONTEREY-SALINAS HWY STE A DATE ISSUED:03/16/2011 ER'S PHONE: 4089313400 SALINAS,CA 93908 PHONE NO:(831)601-2659 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lie.# MECH f RESIDENTIAL COMMERCIAL Contracto � � -- I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:BLDG 78-UNIT D-INSTALL NEW WASHER/DRYER AT (commencing with Section 7000)of Division 3 of the Business&Professions EXISTING (I O E INSTALL NEW AIR Code and that my license is in full force and effect. CONDITIONNINGTNG UNIT NIT&REMODEL EXISTING 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 Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$15000 permit is issued. APPLICANT CERTIFICATION 0,f---- APN Number:32609065.78 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 upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. J j Issued by-: ��" Date: Signature Date �7 L OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 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 Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. 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 I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Owner o uthori forthwith comply with such provisions or this permit shall be deemed revoked. Date:--��-!/ APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of mrk's correct.1 agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save i- ' -unify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the g,—ging 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 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 7 ITEMS OF 14 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32609065 .78 DATE ISSUED. . . . . . . : 03/16/2011 RECEIPT #. . . . . . . . . BS000012926 REFERENCE ID # . . . : 11030082 SITE ADDRESS 20900 HOMESTEAD RD BLDG 78 SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : PROMETHEUS ADDRESS . . . . . . . . . . : 1900 SOUTH NORFOLK ST STE 150 CITY/STATE/ZIP . . . : SAN MATEO, CA 94403 RECEIVED FROM . . . . : MONTEREY CONST. CO 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 ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 15, 000. 00 1.00 0. 00 1. 00 0. 00 1BREMAIRHA NO.UNITS 1 .00 63 . 00 0. 00 63 .00 0.00 1BSEISMICR VALUATION 15, 000 . 00 1. 50 0 . 00 1.50 0. 00 1MPERMITFE FLAT RATE 1 .00 42 . 00 0. 00 42 .00 0. 00 1REMRESBAT SQ FEET 10 . 00 570. 00 0. 00 570. 00 0. 00 1REMRESKIT SQ FEET 50 .00 570. 00 0. 00 570 .00 0. 00 1TRAVDOC FLAT RATE 1 .00 42. 00 0. 00 42 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 1289.50 0 . 00 1289.50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 2, 579. 00 #4407 --------------- TOTAL RECEIPT 2, 579.00 03/15/2011 16 : 07 (FAX) P. 007/011 0cag� CITY OF CITY OF CUPERTINO ADDITION/REMODEL CUPERTINC) FEE SCHEDULE APN# ��(P 0 q 0 -d_/9 � G Date: � i Is a 2" unit being added? Yes Yes ❑ No [N if yes, please fill out the permit application for 2" unit. Is this a 2"" story Addition? Yes ❑ No Is this house an Eichler? Yes ❑ No ® If yes, needs Planning approval. Building Address: 20900 Homestead Road Building_ Unit# Mailing Address (if different from building address): 88 Monterey-Salinas Hwy., Suite A, Salinas, CA 93908 Owner's Name: Phone# Prometheus Real Estate Group 650 931-3400 Contractor: Phone#:(831) 455-7931 Monterev Construction Company Fax/e-mail: 831) 455-7986/thalia@mryconstructi n.com Cupertino Business License: State Contractor License#: 32275 885297 Contact: Phone#:(831) 455-7931 Thalia Tardivet/Ben Rega Fax/e-mail:(831)455-7986 Landscape Ordinance Compliance: Landscape area in sq. ft. (includes all irrigated areas): If 2,500 sq. ft. or less,compliance with the Landscape Water-Efficiency Checklist is required. If more than 2,500 sq. ft.,a complete Landscape Project Submittal is required. Compliance Method: ❑ Plant Type ❑ Water Budget Building Permit Info: Bldg. E Elect. Plumbing ® Mechanical Hillside Project Size: Counter ❑ Express ❑ Standard ❑ Large; ❑ Major ❑ Job Description: Addition-What is being added?(Be Specific):Install new washer/dryer at existing closet(10sq ft);install new air conditioning unit What is being remodeled (not including addition)?Remodel existing kitchen (50 sq ft) cabinets, lights Remodel Includes Re-Roof, Yes ❑ No ® If yes list number of squares Remodel Includes Structural: Yes ❑ No Do you have the pre-application planning approval? Yes ❑ No ❑ Il yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen 50 Bath Other. 10 Type of Construction (Usage Class): Occupancy Type: — i-A, 1-B ❑ IUIII/V-A ❑ lI/III B, IV-HT, V-B Valuation:$ L'c � Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, Green Building Points Achieved; include in plan set& the sheet index. CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION MDDRESS: 20900 homestead rd bldg. 78 D DATE: 03/16/2011 REVIEWED BY: bobs. PN: BP#: "VALUATION: Iso —� 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1 R3SFDREM USE: 3 Stories 0 Yes 0 No PERMIT TYPE: WORK remodel kitchen and bath add ac unit to exisitin R-2 complex. SCOPE Mech.Plan CheckOA hrs $0.00 Mech.Permit Fee: IMPERMIT Other Mech.Insp. OF-01hrs $42.00 LLJ NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info. FEE ITEMS (Fee Resolution 09-05./ I;ff. 7/1.110) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel,Kitchen(<=300 sf) Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $570.00 IREMRESKIT PME Plan Check: $0.00 = s.f. Remodel,Bath(<=300 sf) Permit Fee: $0.00 $570.00 IREMRESBAT Suppl. Insp. Fee-0 Reg. 0 OT 0.0 hrs $0.00 0 # Mechanical PME Unit Fee: $0.00 $63.00 1BREMAIR A/C Units(<=10K cfm) PME Permit Fee: $42.00 Acoustical Fee: 0 Yes 0 No $0.00 O Work Without Permit? 0 Yes 0 No $0.00 0 Planning Fee: $0.00 Select a Non-Residential 0 Travel Documentation Fee: ITRA VDOC $42.00 Building or Structure 0 A Stronf Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS $84.00 $1,203.00 TOTAL FEE: $1,287.00 Revised: 01/15/2011