11050122CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20900 HOMESTEAD RD BLDG 75
CONTRACTOR: MONTEREY
PERMIT NO: 11050122
CONSTRUCTION COMPANY
OWNER'S NAME: PROMETHEUS
88 MONTEREY- SALINAS HWY STE
DATE ISSUED: 05/27/2011
OWNER'S PHONE: 6509313400
SALINAS, CA 93908
PHONE NO: (831) 601-2659
LICENSED CONTRACTOR'S DECLARATION
r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class If Lic. #
f— I— F_
MECH RESIDENTIAL COMMERCIAL
� '
Contractor/�� lDate
I hereby affirm that 1 IJ -
am licensed under the provisions of Chapter 9
JOB DESCRIPTION: BLDG 75 UNIT B- REMODEL 50 SQ FT TO KITCHEN,
INSTALL NEW WASHER/DRYER HOOKUP AT EX. CLOSET, A/C
(commencing with Section 7000) of Division 3 of the Business & Professions
(M,E,P)
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
Sq. Ft Floor Area:
Valuation: $20000
performance of the work for which this permit is issued.
1 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
APN Number: 32609072.75
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAY ROM LAST CALLED INSP CTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Issued by: Date: 7
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulationo per the Cupertino Municipal Code, Section
9.18.
/
RE -ROOFS:
_
Signatur Date
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with Iicensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California health & Safety Code, Sections 25505, 25533, and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date:
permit is issued..
1 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 Worker's
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, 1 must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
I certify that I have read this application and state that the above information is
correct. 1 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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO BUILDING PERMIT„
BUILDING ADDRESS: 20900 HOMESTEAD RD BLDG 75
CONTRACTOR: MONTEREY
PERMIT NO: 11050122
CONSTRUCTION COMPANY
OWNER'S NAME: PROMETHEUS
88 MONTEREY-SALINAS HWY STE A
DATE ISSUED: 05/27/2011
OWNER'S PHONE: 6509313400
SALINAS, CA 93908
PHONE NO: (831) 601-2659
❑ LICENSED CONTRAC/T"�OR'S DECLARATION
BUILDING PERMIT INFO: BLDG'ELECT r PLUMB r-
_2 -7
Class G _") Lie. #
COMMERCIAL
/MECH
all_1
RESIDENTIAL
Contractor ( Date
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: BLDG 75 UNIT B- REMODEL 50 SQ FT TO KITCHEN,
(commencing with Section 7000) of Division 3 of the Business & Professions
INSTALL NEW WASHER/DRYER HOOKUP AT EX. CLOSET, A/C
(M,E,P)
Code and that my license is in fill force and effect.
10/4/2011- REV#1- ADD NEW BATHROOM TO EXISTING 1 BATH UNIT -11/14/2011
I hereby affirm under penalty of perjury one of the following two declarations:
REV#1 ISS'D
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
permit is issued.
Sq. Ft Floor Area:
Valuation: $20000
APPLICANT CERTIFICATION
APN Number: 32609072.75
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
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
PERMIT EXPIRES IF WORK IS NOT STARTED
costs, and expenses which may, accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non -point source regulations per the Cupertino Municipal Code, Section
180 DAYS FROM LAST CALLED INSPECTION.
9.18.
'/` // � <
�r—
Signature gn i �` Date
Issued by Date//—/ --
(,
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
RE -ROOFS:
the following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
1, as owner of the property, or my employees with wages as their sole compensation,
installed without first obtaining an inspection, I agree to remove all new materials for
will do the work, and the structure is not intended or offered for sale (Sec.7044,
inspection.
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
Signature of Applicant: Date:
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance, as provided for by
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
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(x) should I store or handle hazardous material.
permit is issued.
Additionally, should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued, I shall
contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Compensation laws of California. If, after making this certificate of exemption, I
Health & Safety Code, Sections 25505, 25533, and 25534.
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
Owner or aut agent:
4 Date:
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
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
I hereby affirm that there is a construction lending agency for the performance of «ork's
to building construction, and hereby authorize representatives of this city to enter
for which this permit is issued (Sec. 3097, Civ C.)
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Lender's Address
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
_____ CITY OF CUPERTINO
W . FEE ESTIMATOR - BUILDING DIVISION
r
ADDRESS: 20900 homestead rd.
DATE: 10/04/2011
REVIEWED BY: bobs.
Plan Check Fee:
APN:
BP#:
VALUATION: 1$5,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: Multi -Family Dwelling
Buildina is
>3 Stories 0 Yes 0 No
PENTAMATION
PERMIT TYPE: 1 GENRE
WORK
multi -family revision add new bathroom.
SCOPE
Suppl. Insp. Fee:) Reg. 0 OT
A,Iech, Platt Cheek phinrb. Flat kc. Plu,a Ow, ,
lJ<celr, Pt�+,rart tr ,e; phw? a, Pcrmil rt:[r: i,t,',, t'<-raft%l f'cr
(hh�-, 1{�-r�it, f�a.;p. � ltira�tP�'atrrrt> Iirr,'z ;idl,<rr r;'1a'c. hzti,ta,
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitaty Seiver District, School
District. (!t C. %. These fHe.0 are haml on the nrelindnart/ information availahle and ore ank an estimate. Contact the Dent for addn'l into.
FEE ITEMS (Fee Resohrtton 11-053 L ': 7�
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Mise Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OT
0.0
1 his
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:) Reg. 0 OT
0,0
his
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C'on4trucli"m 7tax
11dl7Pilds-Iralt ."Feye;
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential G)
Building or Structure 0
(TL7Vt'I T)Ot'tf377C'�'IIL771(577 n�'E:;':
Strong Motion Fee: 1BSEIS1IICR
$0.50
1 # Revision
$783.00 1REVSFDWL SFDWL
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$1.50
$783.00
TOTAL FEE:
$784.50
Revised: 10/01/2011