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10090213 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21230 HOMESTEAD RD BLDG 2 CONTRACTOR:VALLEY GREEN PERMIT NO: 10090213 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.# MECH r RESIDENTIAL r COMMERCIAL r Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:APT 9-24-INSTALL 32 NEW BEDROOM OM (commencing with Section 7000)of Division 3 of the Business&Professions TO MEET EGRESS RE TO MEET EGRESS REQUIREMENTS PER 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 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:32605085.2 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, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 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. -2?-� Issued by: Date: ature Date OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one 01 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 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 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: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worke' Compensation,as provided for by Section 3700 of the Labor Code,f f 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. I will maintain I have and will maintain Worker's Compensation Insurance,as provi ed for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& 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,sh d I use equipment or devices which emit hazardous air permit is issued. contaminant 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 pliance 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 Healt afety Code,Sectio 5505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption, become subject to the Worker's Compensation provisions of the Labor Code mug r or orized agent: {� z forthwith comply with such provisions or this permit shall be deemed 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.) t�building construction,and hereby authorize representatives of this city to enter Lender's Name r the above mentioned property for inspection purposes.(We)agree to save Damnify and keep harml the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses wh' may accrue against said City in consequence of the granting of this pe Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-pointes ice regulatio Ni _Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Z171O Licensed Professional Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: ,.. �5zj� 1+r) �.. PERMIT# OWNFICS NAME: l,�' j'r`i.; s. �S e : PHONE# G7�S' -?c' �"5-:� 17 6F,NI:ItAL CONTRACTOR: J �� BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: 5 D 1 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. / '� -- I am not using any subcontractors: SLynature 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 CITY OF CUPERTINO 3 ITEMS OF 21 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk : Lot: APN 32E05085 .2 DATE ISSUED. . . . . . . : 09/27/2010 RECEIPT #. . . . . . . . . BSC00011566 REFERENCE ID # 1OC90213 SITE ADDRESS . . . . . : 21,:30 HOMESTEAD RD BLDG 2 SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA OWNER . . . . . . . . . . . . : VALLEY GREEN ASSOCIATES ADDRESS 13:_ E DANA ST CITY/STATE/ZIP MOUNTAIN VIEW, CA 94041 RECEIVED FROM BRIAN AVERY CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : VA::,LEY GREEN ASSOCIATES ADDRESS . 13L E DANA ST CITY/STATE/ZIP . . . : MO:JNTAIN VIEW, CA 94041 TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY kMOUNT 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 CITY OFCUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: "VALUATION: 1$15,000 R-PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY '107.fir. PENTAMATION 1 GENRES USE: SFD or Duplex 1,0 0R r'i:�r: PERMIT TYPE: WORK SCOPE < P.4�i0 F"Co _Ld. f ww/", F-1 _L_ 0 Li NOTE: Theseees are based on the prelinWinatry in ormatior, available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS(Fee Resolution 09-051 a. 7,%1,'10) FEE QTY/FEE MISC ITEMS Plan Check Fee: :30.00 32 # Window/Sliding Glass Door _—]Suppl. PC Fee: Reg. OT 0.0 hrs 50.00 $758.00 1 WINREP Replacement PME Plan Check: 50.00 Permit Fee: 50.00 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs 50.00 PME Unit Fee: 50.00 PME Permit Fee: 50.00 C.'o11S0'11c'ti017 T I Acoustical Fee: 0 Yes 0 No 50.00 Work Without Permit? 0 Yes 0 No :30.00 0 Planning Fee: $0.00 Select a Non-Residential E) Building or Structure 0 Ii-trie!L)cct�}rt<��tr�tir,n I��c,4: � Strong Motion Fee: IBSEISMICR :61.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC 61.00 SUBTOTALS: $2.50 $758.00 TOTAL FEE: $760.50 Revised: 9/14/2010 ' CITY OF CUPERTINO CITY OF CUPE1ZTINO GENERAL, BUILDING PERMIT APPLICATION FORM APN �., � � �� .� ,} j � ,� Date: #,, o Building Address: Mailing Address (if different from building address): (1 n T C;, _, Are Hazardous Materials being used as part of this; project? Yes No HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA Owner's Name: Phone#: C�`S 7 `i - <.�--7; Contractor: Phone: Fax: `�� -U - ':'h 3 '1 Contractor License#: Cupertino Business License#: Contact: �' Phone: 15 , -A (� j,'; Fax: Residential Commercial Job Description: ► �s �`-�� , 2 `�`''� `'' �"�-� `� �-�'s T�, Building Permit Info: Bldg K� Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy T e: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-:3 _ Valuation: Square Footage: Project Size: Express D Standard ❑ Large ] 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. omts Achieved: For help, contact Build it Green at www.bujldit2r!en.org Revised 07/14/09 3