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10090218 CITY OF CUPERTI NO BUILDING PERMIT BUILDING ADDRESS: 21230 HOMESTEAD RD BLDG 9 CONTRACTOR:VALLEY GREEN PERMIT NO: 10090218 ASSOCIATES NER'S NAME: VALLEY GREEN ASSOCIATES 131 E DANA ST DATE ISSUED:09/27/2010 OWNER'S PHONE: 4082045367 MOUNTAIN VIEW,CA 94041 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB License Class Lic.# r r MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:APT 91-106-INSTALL NEW DOUBLE PANE WINDOWS 32 (commencing with Section 7000)of Division 3 of the Business&Professions BEDROOM WINDOWS TO MEET 2007 CVC 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:$9600 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:32605085.9 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued b Date: ! 2? iture Date OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one o!' installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. I,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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed co ctors 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 followi ree HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants efin by the Bay Area Air Quality Management District I will permit is issued. maintain co lianc ith the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health& fety de,Sections 25505,25533,and 255 . not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I O er o ' ager become subject to the Worker's Compensation provisions of the Labor Code,I a e: Z i forthwith comply with such provisions or this permit shall be deemed revoked CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relatin.; Lender's Name to building construction,and hereby authorize representatives of this city to enter the above mentioned property for inspection purposes.(We)agree to save Lender's Address mnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses w ' h may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this pe dditio ally,the applicant understands and will comply with all non-poin o er the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. i q/Z, Licensed Professional Signature Date CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 3 ITEMS OF 21 COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32605085 .9 DATE ISSUED. . . . . . . : 09/27/2010 RECEIPT #. . . . . . . . . BSO()0011566 REFERENCE ID # 10090218 SITE ADDRESS 21230 HOMESTEAD RD BLDG 9 SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER VALLEY GREEN ASSOCIATES ADDRESS . 131 E DANA ST CITY/STATE/ZIP MOUNTAIN VIEW, CA 94041 RECEIVED FROM BRIAN CAVERY OWNER* CONTRACTOR . . . . . . . COMPANY VALLEY GREEN ASSOCIATES ADDRESS . 131 E DANA ST CITY/STATE/ZIP MOUNTAIN VIEW, CA 94041 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY ��MOUNT PD-TO-DT THIS REC- --NEW-BAL ---------- - ---------- ------------- 1 .00 0 .00 1. 00 0 . 00 1BCBSC VALUATION 9, 600 . 00 1.00 0 .00 1.00 0 .00 1BSEISMICR VALUATION 9, 600. 00 1WINREP EACH 8 32 .00 758 .00 0 .00 758 . 00 ------0_00 TOTAL PERMIT 760 .00 0 .00 760 .00 0 .00 REFERENCE NUMBER AMOUNT METHOD OF PAYMENT ----- -------------------- ---------- CREDIT CARD 4, 942 .90 VISA --------------- TOTAL RECEIPT 4, 942 .90 vidl age green GARDEN APARTMENTS 21230 HOMESTEAD ROAD CUPERTINO,CALIFO NIA 95014 • TELEPHONE 408-738-2500 FAX 408-738-1302 3 2 0 e5 69 67 65 63 61 58 n E s6 7531 175 POOL 7L797 [ 81 L 8 85 S 4 1 4877FK90 F 39 A 3 36 q93914 O 35 P 3 32 96, 95 CENTRAL 31 97 COURTYARD 2 199 99 /j !02 2 v` 28 27 26 25 ,J 103 15 24 !O7 108 109 110 21 20 18 FRONT 15 115 COURTYARD 118 9 u9 lzo lzl l2z L F56 REN"A OFF VILLAGE GREEN A F A 2 T M!N T f HOMES 7EAD ROAD LEGEND S Social Room A Saunas F Cardiovascu ar Fitness P Spa L Laundry CITY OF C'UPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: $9,600 *PERMIT TYPE: Building Permit PLAT CHECK TYPE: Alteration /Addition / Repair PRIMARY 7 r ; , PENTAMATION 1 GENRES USE: SFD or Duplex I,I_00b�' ��; .�: PERMIT TYPE: WORK SCOPE {!;til C h"'C Ali F/I Pc;w71!'0 . of U,' Ci rr i" r izc,» �> r ah<f lov) I v), Pcc' NOTE: These fees are based on the preliminary information,mailable and are only an estimate. Contact the Dept TEMSor addn'l info. FFEEITEMS (Fee Resolution 09-051 Eff ''1'll)j FEI; r$758.00 MISC I_: Fee: $).00 Window/Sliding Glass Dooree: Reg. 0 OT 0.0 hrs $).001 WINREP Replacement PME Plan Check: $).00 Permit Fee: $0.00 Suppl. Insp.Feer' Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 CTCD 7:�= Acoustical Fee: Q Yes (F) No $0.00 Work Without Permit? Yes No :>0.00 `i0.00 Select allon-Residential Planning Fee: � Building or Structure 0 lrwcli FB1dR EMotionee: 1BSEISMICR '60.96 Select an Administrative Item tds Commission Fee_: IBCBSC $1.00 F_ SUBTOTALS: X1.96 $758.00 TOTAL FEE: $759.96 Revised: 9/14/2010 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SL BCONTRACTOR LIST I013 ADDRESS: =5 E ` - PERMIT# OWNIR'SNAME: PHONE# _ GENERAL CONTRACTOR: .!S BUSINESS LICENSE,# ADDRESS: CITY/ZIPCODE: `'1 S D -,our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO 13UILDING FINAL OR FINAL OCCUPANCY INSPECT WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBC ORS HAV ♦ OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. / � — Mo am not using any subcontractors: Date Signature Please check applicable subcontractors and complete the following information: &/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF C UPERTINO CUPElZT1NO GENERAL BUILDING PERMIT APDL-(CATION FORM APN # h Date: Building Address: Mailing Address (if different from building address): t ` C• Are Hazardous Materials being used as part of this project? Yes No HOA: (Exterior work only) Yes ❑ No If gyres, provide letter from HOA Owner's Name: Phone#: Contractor: Phone: Fax: y 1 7/ lam' Contractor License#: Cupertino Business License#: Phone: p1!1 i_- AFax: Residential Commercial Job Description: 3 Z Building Permit Info: ' Bldg 3' Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ H/=-A ❑ UJM B, IV-HT,V-] Valuation: 9600Square Footage: Project Size: Express [5�— Standard ❑ Large (7 Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicably:, include in plan set & the sheet index. pints Achieved: For help, contact Build it Green at www.bufflditgreen-orig Revised 07/14/09