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10090215 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21230 HOMESTEAD RD BLDG 4 CONTRACTOR:VALLEY GREEN PERMIT NO: 10090215 ASSOCIATES `VER'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 r– License Class Lic.# MECH r— RESIDENTIAL r COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:APT 29-44-INSTALL 32 BEDROOM WINDOWS TIPLE (commencing with Section 7000)of Division 3 of the Business&Professions GLAZE Code and that my license is in full force and effect. BEDROOM WINDOWS TO MEET 207 CVC 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:32605085.4 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 relatinl 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: ate: ature Date ' 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 compensatior,, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed cont rs to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1 hereby affirm under penalty of perjury one of the following t ee 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. 1 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 efined 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 co rance 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 He�r4gCul lth& ety ode,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 m t md a 7/D forthwith comply with such provisions or this permit shall be deemed revoked. Date: J--t CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION 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 relatin; 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 the above mention property for inspection purposes.(We)agree to save nnify and keep h ess the City of Cupertino against liabilities,judgments, Lender's Address costs,and expense ch may accrue against said City in consequence of the granting of this it.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non- t source re Cupertino Municipal Code,Section 9.18. ' I understand my plans shall be used as public records. i T Signature Date ( �� Licensed Professional CITY OF C UPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: $15,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY 7CJf,�I TPENTAMATION 1GENRES USE: SFD or Duplex �.�001?,4Rt'I, PERMIT TYPE: WORK SCOPE lI<' ` 1'(, Ytt('A TI MC,r MU, i,cc" NOTE: These fees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Fee Resolution 09-051 Elf. ?%7%10} FEE rl:WINWREP MISC ITEMS Plan Check Fee: $o.00 indow/Sliding Glass Door Suppl.PC Fee: 0 Reg. OT 0.0 hrs $0).00 Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-.0 Reg. () OT 0.0 hrs $x).00 PME Unit Fee: $x.00 PME Permit Fee: $x.00 't�trstt rrz rrc>�t Ta,y Acoustical Fee: Yes No $0.00 ==A Work Without Permit? n E) No $0.00 $0.00 ESelect a Non-Residential E) Planniny,Fee: Building or Structure Trrtie,j Oocnlnwrrf;ztiort Fc'cs. IBSEISMICR 151.50 Select an Administrative Item Strong MotionFee: Bldg Stds Commission Fee: 1BCBSC 51.00 SUBTOTALS: 52.50 $758.00 TOTAL FEE: $760.50 Revised: 9/14/2010 CITY OF :!UPERTINO 3 ITEMS OF 21 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32605085 .4 DATE ISSUED. . . . . . . : 09/27/2010 RECEIPT #. . . . . . . . . BSC00011566 REFERENCE ID # JOC90215 SITE ADDRESS . . . . . : 21,'.30 HOMESTEAD RD BLDG 4 SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : VALLEY GREEN ASSOCIATES ADDRESS : 13:L E DANA ST CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94041 RECEIVED FROM . . . . : BRCAN AVERY CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : VA-jLEY GREEN ASSOCIATES ADDRESS : 131 E DANA ST CITY/STATE/ZIP . . . : MO;JNTAIN VIEW, CA 94041 TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC --NEW-BAL- ---------- ------------- ---------- ---------- ---------- ---- 00 1BCBSC VALUATION 15, 000 . 00 1. 00 0. 00 1. 00 0 • 1BSEISMICR VALUATION 15, 000 . 00 1.50 0. 00 1.50 0 .00 32 . 00 758 .00 0 .00 758 .00 ------0_00 1WINREP EACH 8 - --------- ---------- --- ------ TOTAL PERMIT : 760 .50 0 .00 760 .50 0 . 00 Building Department City Of Cupertino 10300 Torre AVCnuC Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: .! _� %?�� PERMIT# Q 0om( 0 Z�s __ OWNER'SNAME: PHONE# — GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: S t Our municipal code requires all businesses working iii the city to have a City of Cupertino business license. NO 13UILDING FINAL OR FINAL OCCUPANCY INSPECT WILL BE SCHEDULED UNTIL THE (:ENF,RAL CONTRACTOR AND ALL SUBCORS HAV OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Z) S gnature Date Please check applicable subcontractors and complete the following information: V 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 V S.Ktn- CITY OF CUPERTINO Ury OF CUPEKT1NO GENERAL BUILDING PERMIT APPIACATION FORM APNDate: # � C'N Building Address: Mailing Address (if different from building address): F Are Hazardous Materials being used as part of this project? Yes No ' HOA: (Exterior work onl Yes ❑ No l=1 1j' es, provide letter from HOA Owner's Name: Phone#: Contractor: Phone: J Fax: s-b - > � 3 �2 -/ Contractor License#: Cupertino Business License#: Contact: f Phone: Fax: � -A Residential Commercial EJ Job Description: Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupanc Type: 1-A, 1-B ❑ E=-A ❑ II/VI B, IV-HT,V-B t Valuation: l �G v v Square Footage: Project Size: Express [��Standard ❑ Large Major ❑ Green Building: Please complete relevant portion of the Green B iilding/LEED Checklist& attach it to the application or if applicable, include in plan set & the sheet index. Ants Achieved: For help, contact Build it Green at www-builditgr aen.or Revised 07/14/09 s