11030081 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20900 HOMESTEAD RD BLDG 78 CONTRACTOR:MONTEREY PERMIT NO: 11030081
CONSTRUCTION COMPANY
OWNER'S NAME: PROMETHEUS 88 MONTEREY-SALINAS HWY STE A DATE ISSUED:03/16/2011
1 ER'S PHONE: 6509313400 SALINAS,CA 93908 PHONE NO:(831)601-2659
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
t� �7 MECH f— RESIDENTIAL COMMERCIAL
Contracto 9A7?___"
I hereby affirm that I am �censed under the provisions of Chapter 9 JOB DESCRIPTION:BLDG 78,UNIT C-INSTALL NEW WASHER/DRYER AT
(commencing with Section 7000)of Division 3 of the Business&Professions EXISTING NTNG UCLOSENIT;
REM INSTALL NEW AIR
Code and that my license is in full force and effect. CONDITIONING UNIT;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 //r5' 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.
Issued by �`- Date:
Signature Date
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 ora Date:
hor' a
forthwith comply with such provisions or this permit shall be deemed revoked.
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%ork's
correct.I 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
mnify 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
giar:ing 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. I 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 # . . . : 11030081
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
03/15/2011 16 : 05 (FAX) SI P. 002/011
CITY OF
CITY OF CUPERTINO
ADDITION/REMODEL
CUPERTINO FEE SCHEDULE
APN#
Is a 2° unit being added? Yes ❑ No If yes, please fill out the permit application for 2" unit.
Is this a 2"d story Addition? Yes ❑ No
Is this house all Eichler? Yes ❑ No 0 If yes, needs Planning approval.
Building Address:
20900 Homestead Road Building Unit# C
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
Monterey Construction Company Fax/e-mail:(831)455-7986/thalia@mryconstructii)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. M . Elect. Plumbing M Mechanical LJ Hillside
Project Size: Counter ❑ Ex press ❑ 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 M
Do you have the pre-application planning approval? Yes ❑ No ❑
If 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: 2-
1-A, 1-B II/III/V-A ❑ II/IIl B, IV-HT, V-B Valuation:$ 7� bv6
Please complete relevant portion of the Greets Building
Checklist & attach it to the application or if applicable, Green Building Points Achieved:
include in plan set& the sheet index.
i
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20900 homestead rd bldg.78 c TDATE, 03/16/2011 REVIEWED BY: bobs.
APN: 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 (F) No PERMIT TYPE:
WORK remodel kitchen and bath add ac unit to exisitin R-2 complex.
SCOPE
Mech.Plan Check0.0 hrs $0.00
Mech.Permit Fee: IMPERMIT
Other Mech.Insp. 0.0 hrs Li
$42.00
NOTE: These ees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 info,
FEE ITEMS (Fee Resolution 09-05.1 E;tf. 7/1.,'70) 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 1 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-G Reg. OOT 0.0 hrs $0.00 = # Mechanical
PME Unit Fee: $0.00 $63.00 IBREMAIR A/C Units(<=10K cfm)
PME Permit Fee: $42.00
'-P,^
' ILI
I F
Acoustical Fee: 0 Yes (D No $0.00 Q
Work Without Permit? Q Yes E) No $0.00
Plannin r Hee: $0.00 Select a Non-Residential E)
Travel Documentation Fee: ITRA VDOC $42.00 Building or Structure
i
Stronp,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