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10090210 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21230 HOMESTEAD RD BLDG 11 CONTRACTOR:VALLEY GREEN PERMIT NO: 10090210 ASSOCIATES 'ER'S NAME: VALLEY GREEN ASSOCIATES 131 E DANA ST DATE ISSUED:09/27/2010 OWNER'S PHONE: 4082045367 MOUNTAIN VIEW,CA 94041 PHONE NO: 13 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r— PLUMB License Class_ Lic.# MECH r— RESIDENTIAL r COMMERCIAL Contractor Date JOB DESCRIPTION:APT 111-117-INSTALLATION OF NEW DOUBLE PANE I hereby affirm that I am licensed under the provisions of Chapter 9 WINDOWS;18 BEDROOM WINDOWS TO MEET 2007 CVC (commencing with Section 7000)of Division 3 of the Business&Professions 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:$5400 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:32605085.11 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 by: ��-��-� Dater Z7-� 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 of 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 contra rs to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following thr 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. Additionally,shoal use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as �ned by the Bay Area Air Quality Management District I will permit is issued. maintain co rice with 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& f Code,Sections 25505,25533,and 25534. 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, Ow or riz ent: cl 7 become subject to the Worker's Compensation provisions of the Labor Code,I s: Date: f forthwith comply with such provisions or this permit shall be deemed revo 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 t�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 _cmnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses ch may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of e= p ditionally,the applicant understands and will comply with all non-poi t regulatio e i n ino Municipal Code,Section I understand my plans shall be used as public records. 9.18. / Licensed Professional Signature_ Date CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: 1$5,400 *PERMIT TYPE: Building Permit PLA v CHECK TYPE: Alteration/Addition/ Repair PRIMARY �fC,II. PENTAMATION 1GENRES USE: SFD or Duplex I�1 r)(1!z . �, „< PERMIT TYPE: WORK SCOPE h,”, i ttic- rir, C),r p t i„ ', �, tic';,_ )„z NOTE. These fees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolytion 09-051 Eff 7/1-4 j FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 18 # Window/Sliding Glass Door Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 $632.00 MNREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. ® OT 0.0 __ hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C t117sW1Wlion 7'cLk, Acoustical Fee: B Yes (E) No 10.00 Work Without Permit? 0 Yes G No 90.00 Planning Fee.: $0.00 Select a Non-Residential E) Building or Structure 7i-<, cll)o�.tr�xt�nf�ztir�r; 1�`e�es: � Strong,Motion Fee: 1BSEISMICR `;0.54 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC . 1.00 SUBTOTALS: :;1.54 $632.00 TOTAL FEE: $633.54 Revised: 9/14/2010 CITY OF CUPERTINO 3 ITEMS OF 21 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN 32605085.11 DATE ISSUED. . . . . . . : 09,'27/2010 RECEIPT #. . . . . . . . . BS000011566 REFERENCE ID # . . . : 10090210 SITE ADDRESS 21:230 HOMESTEAD RD BLDG 11 SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : VALLEY GREEN ASSOCIATES ADDRESS . . . . . . . . . . : 13L E DANA ST CITY/STATE/ZIP . . . : MO:JNTAIN VIEW, CA 94041 RECEIVED FROM . . . . : BRIAN 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 5, 400 . 00 1 .00 0 .00 1. 00 0 .00 1BSEISMICR VALUATION 5,400 .00 0 .60 0 .00 0 .60 0 . 00 1WINREP EACH 8 18. 00 632 . 00 0. 00 632 .00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 633 .60 0 .00 633 .60 0 .00 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3.333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# OWNI R'SNAME: PHONE# — (;FNERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: i S-0 1 "Our municipal code requires all businesses working is 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 n==NED A CITY OF CUPERTINO BUSINESS LICENSE. __... 1 am not using any subcontractors: T S 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 A� CITY OF C.UPERT INO Cl""OF CUPEIZT]NO GENERAIJ BUILDING PERMIT APPLICATION FORM APN # � � Date: Building Address: 7,, 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 ['' If yes, provide letter from HOA Owner's Name: Phone#: Contractor: Phone: F, �'� s-l� -- `:-�, ��- 3 (" Fax: Contractor License#: Cupertino Business License#: Contact: ) Phone: `5 } k t' ;t( jC)i Fax: %Jq Residential Commercial Job Description: Building Permit Info: Bldg C?' Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: �\ 1-A, 1-B ❑ II/=-A ❑ II/III B, IV-HT,V- Valuation: f Square Footage: Project Size: Express Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicabl:, include in plan set & the sheet indeac. oints Achieved: For help, contact Build it Green at www.buRditgr!en.org Revised 07/14/09 s