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10090214 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21230 HOMESTEAD RD BLDG 5 CONTRACTOR:VALLEY GREEN PERMIT NO: 10090214 .SSOCIATES ` "NER'S NAME: VALLEY GREEN ASSOCIATES 131 E DANA ST DATE ISSUED:09/27/2010 v vJNER'S PHONE: 4082045367 MOUNTAIN VIEW,CA 94041 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT r PLUMB License Class Lic.# MECH r— RESIDENTIAL r COMMERCIAL r Contractor Date .fOB DESCRIPTION:APT 45-60-INSTALL 32 NEW BEDROOM WINDOWS, I hereby affirm that I am licensed under the provisions of Chapter 9 "RIPLE (commencing with Section 7000)of Division 3 of the Business&Professions 'ANED 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 Valuation:$15000 Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: permit is issued. APPLICANT CERTIFICATION APN Number:32605085.5 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 regulations per the Cupertino Municipal Code,Section 9.18. Date: Issued b . c,-"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 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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed co tors 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 followin �ree declarations: HAZARDOUS MATERIALS DISCLOSURE 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. 1 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 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 co4afCode ce 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& Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exempti O a iz; rt: become subject to the Worker's Compensation provisions of the Labor Co e,I ust Date:-?ZZ '4P forthwith comply with such provisions or this permit shall be deemed revok . 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 relatinl; 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 Lender's Address .unify and keep less the City of Cupertino against liabilities,judgments, costs,and expenses ich may accrue against said City in consequence of the granting of this pe t.Additionall licant understands and will comply ARCHITECT'S DECLARATION with all non-poi so ations per the Cu rtino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Signatur Date �/ Z /�� Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION Its ADDRESS: DATE: REVIEWED BY: APN: BP#: `VALUATION: 1$15,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex If1t,I1. PENTAMATION 1GENRES USE: p hI UC1/� ht_�{: PERMIT TYPE: WORK SCOPE _T_F 55{{ T fly f f IiC LiI ! l.iri J NOTE. Thesefees are based on the preliminary in ormatior available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS['Fee Resolution 09-051 Ej'. 7,%1.�IDj FEE QTY/FEE MISC ITEMS Plan Check Fee: 50.00 L__12_j # Window/Sliding Glass Door Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs 50.00 $758.00 1 WINREP Replacement PME Plan Check: :>0.00 Permit Fee: CS0.00 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs 50.00 PME Unit Fee: 50.00 PME Permit Fee: CS0.00 ('1I7,ti11-11(`1i017 -/-(IX [_ Acoustical Fee: 0 Yes (F) No 50.00 0 Work Without Permit? 0 Yes E) No 50.00 0 Planning,Fee: 50.00 Select a Non-Residential 0 Building or Structure Strong,Motion Fee: 1BSEISMICR $1.50 Select an Administrative Item BldP_Stds Commission Fee: 1BCBSC 61.00 SUBTOTALS; r 32.50 $758.00 TOTAL FEE: $760.50 Revised: 9/14/2010 CITY OI' CUPERTINO 3 ITEMS OF 21 PERM=:T RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B:.k: Lot: APN . . . . . . . . . 32605085 .5 DATE ISSUED. . . . . . . : 0`.x/27/2010 RECEIPT #. . . . . . . . . : BS000011566 REFERENCE ID # . . . : 10090214 SITE ADDRESS . . . . . : 21230 HOMESTEAD RD BLDG 5 SUBDIVISION . . . . . . . CITY CUPERT I NO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : VALLEY GREEN ASSOCIATES ADDRESS . . . . . . . . . . : 1:31 E DANA ST CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94041 RECEIVED FROM . . . . : B:2IAN AVERY CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY VALLEY GREEN ASSOCIATES ADDRESS 131 E DANA ST CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94041 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 15, 000 . 00 1 .00 0.00 1. 00 0 .00 1BSEISMICR VALUATION 15, 000. 00 1.50 0. 00 1.50 0. 00 1WINREP EACH 8 32 . 00 758 .00 0 .00 758. 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 760 .50 0.00 760 .50 0 . 00 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-333.3 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 1, _73Zj' ., :_ �i� dA PERMIT# OWN[;IZ'SNAME: �r l�r`,7 r,.+--�� . �sa � PHONE# 5_,3� _ G[ N[?RAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: q So t *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY' INSPECT WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBC ORS HAV OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. am not using any subcontractors: '-ignature Date 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 r� C� L.a Lac Ll CITY OF CUPERTIlvO CITY OF CUPS TING GENERAL BUILDING PERMIT APP11CATION FORM APN # .�� P G, � Date: Building Address: Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes No HOA: (Exterior work only) Yes ❑ No es,provide letter from HOA Owner's Name: Phone#: / /, Contractor: Phone: Fax: Contractor License#: Cupertino Business License#: Contact: , - Phone: Fax: -1 3 6 . Residential Commercial Job Description: i ,.�s �� 3 Z °.�� z.3_ �..,.�:,-�� T{.P�- eL-�L--� cJ C- Building Permit Info: Bldg Ef' Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ U=-A '❑ II/VI B, IV-HT,V-B � ,, f Valuation: Square Footage: Project Size: Express [g-"Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicable, include in plan set & the sheet index. oints Achieved: - For help, contact Build it Green at www.builditgreen.orig Revised 07/14/09 a