11100197CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20900 HOMESTEAD RD BLDG 79
CONTRACTOR: MONTEREY
PERMIT NO: 11100197
CONSTRUCTION COMPANY
OWNER'S NAME: PROMETHEUS
88 MONTEREY-SALINAS HWY STE A
DATE ISSUED: 11/14/2011
OWNER'S PHONE: 4086881581
SALINAS, CA 93908
PHONE NO: (831) 601-2659
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
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BLDG ELECT PLUMB
License Class , j Lic. # �
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MECH RESIDENTIAL `
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(4 '�
COMMERCIAL
Contractor AAA 6� � Date 1 / f ('
I hereby affirm that I am lice esn d under the provisions of Chapter 9
JOB DESCRIPTION: UNIT 79-H, CONVERT 45 SQ FT OF SPACE TO 2ND
(commencing with Section 7000) of Division 3 of the Business & Professions
BATHROOM
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: $5000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
APN Number: 32609065.79
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
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 ry Date 6
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
RE -ROOFS:
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
1, 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:
1 have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
2ompensation, 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
ierformance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
[ 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.
permit is issued.
Additionally, should I use equipment or devices which emit hazardous air
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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
iot employ any person in any manner so as to become subject to the Worker's
Health & Safety Code, Sections 25505, 25533, and 25534.
ompensation laws of California. If, after making this certificate of exemption, I
recome subject to the Worker's Compensation provisions of the Labor Code, I must
Owner- or orized gent:
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'orthwith comply with such provisions or this permit shall be deemed revoked.
f Date:
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
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 Nwrk's
;orrect. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
o building construction, and hereby authorize representatives of this city to enter
Lender's Name
ipon the above mentioned property for inspection purposes. (We) agree to save
ndemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
:osts, and expenses which may accrue against said City in consequence of the
;ranting 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
U 8.
1 understand my plans shall be used as public records.
>ignature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
INADDRESS: 20900 homestead rd #79H
DATE: 10/28/2011
REVIEWED BY: bobs.
] APN:
BP#:
"VALUATION: 1$5,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi-FamilyDwelling
USE: g
Building is
>3 Stories 0 Yes 0 No
PENTAMATION
PERMIT TYPE:
WORK
R-2 complex add 2nd unit bathroom
SCOPE
A,fei if milli,, # ?, J,
t fI{ii7 ,. r r,.'r t,. .if,->{
r. t...'. z'frTt7 �''6ii (r�
ED
NOTE: This estimate does not include fees due to other Departments (t.e. Planning, Public Works, Pire, Sanitary Sewer District, Scnoot
District etc These ees are based on the relintinar information available and are only an estimate. Contact the Dept for addit7 info.
FEE ITEMS (Fee Resolutio 111-053 Eff. 711 IU1
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Mise Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. 0 OT
0.0s
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? Q Yes 0 No
$0.00
Suppl. Insp. Fee:Q Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
0
Work Without Permit? 0 Yes (D No
$0.00
Advanced Planning Fee:
$0.00
= hours Inspections
$260.00 ISTINSP Inspection, Hourly
0
Strong Motion Fee: IBSEISMICR
$0.50
0.5 hrs Admin./Clerical Fee
$41.00 IADMIN
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:''
$1.50
$301.00
TOTAL FEE:
$302,50
Revised: 10/01 /2011