12030068 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20800 HOMESTEAD RD CONTRACTOR:MONTEREY PERMIT NO:12030068
CONSTRUCTION COMPANY
OWNER'S NAME: VILLA SERRA APTS 88 MONTEREY-SALINAS HWY STE A DATE ISSUED:06/12/2012
OWNER'S PHONE: 4086881581 SALINAS,CA 93908 PHONE NO:(831)601-2659
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT F PLUMB
License Class_ Lic.# 7
MECH RESIDENTIAL COMMERCIAL
Contractor O 1pN �°�atel Z/12
I hereby affirm that I am Oensed under the provisions of Chapter 9 JOB DESCRIPTION:R-2 COMPLEX REMODEL IN PHASES,WORK INCLUDES
(commencing with Section 7000)of Division 3 of the Business&Professions KITCHEN,BATH,ADD A/C AND WASHER/DRYER HOOKUP-
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
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 APN Number:32609073.20800 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 regulat' S per the Cupertino Municipal Code,Section
9.18.
Issued by: Date:
Signature5�- Date !� /Z /Z
❑ 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 fust 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(See.7044,
Business&Professions Code) Signature of Applicant: Date:
I,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 Own or thor' e t.
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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 work'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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,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
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
CONSTRUCTION PERMIT APPLICATION 1 2-o3 c)c )
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO, CA 950143255
CUPERTINO (408)777-3228-FAX(408)777-3333-buil ding(dcuperdno.org
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESSZ o g� a APN#
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OWNER N 70�` r PHO 0�i� ��Q^I J ^I E ri �byHCt1A.S T m
STREET ADDRESS �SwCIT
: Y,STATE ZIP Q a FAx(;J&931—.SS-71
l�t� s. N� '�� , ` �►c �, e�.. 9yYa.
CONTACT NAMT�O`V PHONE O�'(�C`J ��5��� W f i Y10' t aMG I✓<S C L iM
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STREET ADDRESS DO �• _rb f� .�I4'C.� STATE.ZIP��I yyo3 F^'�S��g 3����
OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑.CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME e 0. LICENSE �9
ME LICENSE TYPE BUS.LIC#2 7S
COMPANY NAE-MAL &e4 eM ryC,,Wv 'hyo.GO/K FAX ����
STREET ADDRESS�i/„O I;IKS ✓�A CI�'1 n ZIP oN• 7 l 7o� PHG`NEJ�3�
ARCHTTECTIENGINEER NAMEJ IMM
LICENSE NUMBER - / BUS.LIC#
OF I
COMPANY NAME n Gl E-MAn. FAX C�
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STREET ADDRESS i I�/. __ I CITY,STATE,ZIp/�
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v�v Sr PHONE
DESCRIPTION OF WORK Q IIS 1� W OVA(,
om AbnC 10 "'•Y•, Qc. ///�S 40 be "(/&'°`f 1 14A s04 �t
K 5 Vt J4J fK -D�GeJe l S t�
I'll 62EXLSTIN SEPROPO D U CON TYP #STORIES
rfj USE TYPE OCC. SQ.FT. VALUATION(S)
E CISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA L/
i ) �
BATHROOM KITCHEN OTHER N
REMODEL AREA i REMODELAREA REMODEL AREA
PORCH AREA DECK AREATOTAL DECK/PORCH AREA REA. DETA
GARAGE ACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT []YESSECOND STORY ❑YES
BEING ADDED? 17.N0 ADD11'ION? �1J0
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOTAL V UATION:
PLANNINGADPL# �JNO PLANNING APPROVAL LETTER EICHLMROME?".EaNO / a
J If Off/
By my signature below,I certify to each of the following I am the property owner or authorized agent to act on the prppertyowner sbehalf. i have read this
application and the information I have provided is correct Jhave read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relator ding construction. 11alkthorize representatives Of Cupertino to enter the above-id fed perry for inspection purposes.
Signature of Applicant/Agent Date:
SUPPLEMENTAL INFORMATIO Q=D PLAN CHECK TYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for ❑ ovER-THE-Coumm B-Bum nvG PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS L'J PLAINNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 1510,5°1"ANDARD
form if any Hazardous Materials are being'used as part of this projectLAR❑ GE Fm bm
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ sA`�NrrARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp 2011.doc revised 06/21111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 20800 homestead rd. DATE: 03/15/2012 REVIEWED BY: bobs.
APN: BP#: *VALUATION: 1$15,000-�
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
PRIMARY Multi-Family Dwelling Buildino is • PENTAMATION 1 R2REM
USE: 3 Stories O
Yes No PERMIT TYPE:
WoRK R-2-complex remodel in phases, work includes kitchen bath add A/C and W/D hook up.
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. S-
R-2(Apartment) 11-B,111-B,IV,V-B 0 $0.00 $0.00
TOTALS: 0 $0.00 $0.00
MECH,HOU , Y £1'es'' n, ,,p .r.;0 ' it, ` 'Yes No ELE+C, ouRLY Yes • ,No.
z;, Li -1- E3__L_ 1 t t'=;°3,
Li
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta . These ees are based on therelimfna information available and are only an estimate. Contact the De t or addn7 info.
FEE ITEMS (Eee Resolution 11-053 Ly 7/1;'11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? Yes 0 No $0.00 8 hours Plan Check,Hourly
Suppl.PC Fee: Reg. 0 OT L.0j hrs $0.00 $1,040.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl.Insp.Feer Reg. Q OT El hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0,00
Ll
Work Without Permit? 0 Yes No $0.00 G
Advanced Plannine Fee: $0.00 Select a Non-Residential
Building or Structure 0
Strong Motion Fee: 1BSEISMICR $1.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
�S7«TBT $2.50 $1,040.00 �,, TOT! L FEET $1,042.50
Revised: 1/1912012
C'16
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IIx OF CUPERTINO "� ' "'
BUILDING DIVISION
PERNIIT 4 r.: :r : ,... ::.,>,zh. •..:
BUILDING ADDRESS: PERMIT NO.
20630 VALLEY GREEN DR CONSOLIDATED PLUMBING
OWNER'S NAME: PERMIT ISSUEDATE
'171TPT) _2�732 CHAR-TER PARK PR QT� 4:4 /2999
PHONE: S A CONTROL NO.
(408) 978-3093
ARCHr1ECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a o a LICENSED CONTRACTORS DECLARATIONJob Description
m 6 I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
Z with Section 7000)of Division 3 of the Business and Professions Code.and my license is
y in full force and e y -2—
TEMP PERMIT GOOD THRU 4/9/9;ORG #0 9 0 2 010 9; SEWER
j 2 License ass Lic•#
�4Fo Date Contractor LINE REPLCMNT
^ ARCHITECTS DECLARATION 1�,•�r
< 1 understand my plans shall be used as public records
JWd
4 c y Licensed Professional
OWNER-BUILDER DECLARATION
MI hereby affirm that I am exempt from the Contractors License Law for the
following mason.(Section 70315,Business and Professions Code:Any city or county
K which requires a permit to construct,alter,improve,demolish,or repair any structure
prier to its issuance,also requires the applicant for such permit to rile a signed statement
that he is licensed pursuant to the provisions of Tho Contractors Licct sc Law(Chapter 9 SQ.Ft.Floor Area Valuation
yF (commencing with Section 7000)of Division 3 of the Business and Professions Cade)er 8 O O 0 0
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 70315 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars($500). 32610054.01
❑L 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 forsals(Sec 7044,Business Required Inspections
and Professions Cade:The Contracmrs License Law does not apply m e an owner of 9 P
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended orolfered for sate.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of I Jl
sale.). n
❑I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code)The Contractors Li.
ccrose Law does not apply to an owner of property who builds or improves thereon,and,
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
❑I am exempt under Sec B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
U.P 1 have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which dols permit is issued
My Workers Compensation Insurance carrier and Policy number are:
Cartier f�L�,�etJr7• �)P'X�-��!�oliry No.:.
CERTIFICATE of EX ON FROM WORKERS'
COMPENSATION INSURANCE
(this section need not be completed if the permit is for one hundred dollars($100)
or less)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Workers Compensation previsions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
z" CONSTRUCTION LENDING AGENCY
QI I hereby affirm that there is a construction lending agency for the performance of
(x> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lendces Namc
�D Z Lenders Address
U O I certify[tat I have read this application and state that the above information is
LL H correct.I agree to comply with all city and county ordinances and state laws relating to
C U building construction,and hereby authorize representatives of this city to cmcr upon the
>4 a above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
tE"y liabilities,judgments,costs and expenses which may in any way accrue against said City
U 7-. in consequence of the granting of this permit
AP !CANT UND AN AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO CE RE( kL —
'p Re-roofs
Signature ofA Ticar Contractor Date .
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or,handle hazardous material '
as defined by the Cupertino Municipal Code.Chapter9.IZ and the Health and Safety
Cede,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes RI No
7� If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Qualily Management all new materials for inspection.
District?
❑Yes fSdNo
I have mad the hazardous materials requiromems underChapter6.95 of Ute Califor- -
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand thatif the building
d of cunendy ha a ten t that it is my responsibility to nodfy theccu
opant of the
'
reremen j whit et prior to issuance of Certificate of Occupancy. Signature of Applicant Date
All roof coverings to be Class''"or better
Owner or aulh ixc agent ate -
070302 -3
CITY OF CUPERTINO
aCROFTEMPORARY PERMIT
CUE - INO PERMIT APPLICATION FORM
APN # Date:
Original Permit#
Building Address:
Owner's Name: Phone #:
►A kN op,,pa C o gT4-io tj 4 -S - 7,qqS
Contractor: Phone#:
Cp0SDL I'D 0,1K t, t �'�c, Fax#: 41)$_1 - C3
Contact:C_A.p: G p NlA Phone#: q D g-97g--3 o'?3
.TemQoraa Permit
Contractor License#: issued prior to plan check completien
Contractor and/or Owner accept complete
re4ponsibility for correcting additions,
Cupertino Business Licen Z
Job Description: completed Blue Prints.
Permit good for(30)thirty days
From S. f� - 0
Valuation (cost of project)5ignature T e of Construction:
ic) D@d°—
te:
Project Size: Over the Counter
Quantity Fee ID Fee Description Fee Group Permit Type
1TEMPPMT Temporary Permit Good B 1TEMPPMT
(Flat Fee) for 30 days-Commercial -
only.
1BCBSC Cal Bldg Standards B ALL PERMIT
J Commission Fee TYPES
01/07/09