12100174CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21230 HOMESTEAD RD
CONTRACTOR: CLADDAGH
PERMIT NO: 12100174
CONSTRUCTION INC
OWNER'S NAME: VILLAGE GREEN ASSOCIATES
1438 LUPTON AVE
DATE ISSUED: 10/24/2012
OWNER'S PHONE:
SAN JOSE, CA 95125
PHONE NO: (408)294-2924
❑ LICENSED CONTRACTOR'S DECLARATION
r r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class 3Z, Lic. k�s o" . •
�
F r—
MECH RESIDENTIAL COMMERCIAL
Contractor Date � t2
I hereby affirm that 1 s licensed under the provisions of Chapter 9
JOB DESCRIPTION: UNIT 114 -REMOVE AND REPLACE FIRE DAMAGED
(commencing with Section 7000) of Division 3 of the Business & Professions
ROOF
TRUSSES, SHEATHING, AND ROOFING; INSTALL NEW (2)
Code and that my license is in full force and effect.
HOUR FIRE WALLS ABOVE PARTY WALLS IN THESE
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: $25000
permit is issued.
APPLICANT CERTIFICATION
APN Number: 32605085.00
Occupancy Type:
I certify that 1 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
PERMIT EXPIRES IF WORK IS NOT STARTED
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non -point source regulations per the Cupertino Municipal Code, Section
180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Date �d �{'112—
Issued by: �EJ�lyG Date:
❑ OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of
RE -ROOFS:
the following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
1, as owner of the property, or my employees with wages as their sole compensation,
installed without first obtaining an inspection, I agree to remove all new materials for
will do the work, and the structure is not intended or offered for sale (Sec.7044,
inspection.
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
Signature of Applicant: Date:
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
declarations:
1 have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
1 have read the hazardous materials requirements under Chapter 6.95 of the
1 have and will maintain Worker's Compensation Insurance, as provided for by
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
Section 3700 of the Labor Code, for the performance of the work for which this
compliance with the Cupertino Municipal Code, Chapter 9.I2 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
permit is issued.
Additionally, should 1 use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued, I shall
contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Compensation laws of California. If, after making this certificate of exemption, I
Health &_Safety Code, Sections 25505, 25533, and 25534.
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
Owfier.or anth• y gegt
Date:_ /�' /
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
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
I hereby affirm that there is a construction lending agency for the performance of Hork's
to building construction, and hereby authorize representatives of this city to enter
for which this permit is issued (Sec. 3097, Civ C.)
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Lender's Address
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 21230 Homestead Rd
DATE: 11/08/2012
REVIEWED BY: Sean
APN:
BP#: 12100174
`VALUATION: 1$8,000
xPERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY Multi -Family Dwelling
USE:
Buildina is
>3 Stories Q Yes O No
PENTAMATION 1 R2ROOF
PERMIT TYPE:
WORK
Revision #1: Reroof the entire building with an addition 2700 sq ft with composition roofing.
SCOPE
FEE ID
ROOF AREA
s.f.
1REROOFMRES
2,700
'• !r'
3 t 4 y
IM 0
e i`,' •�7s•Me t .,,r:• •.,i.:s"r�' ,s7-'•a't•.:';` 4,:�:., ;.�r•r`ic"•,ti;.. 7,. i...-,'
= • 7 Y 7 �•:�°j,�1 � S CS. :jr.� '�'�,� i;f,.:: �•'s , �� ('` ).�.' fi Sia � i 'Tr-.1 . s�,,y� •. 3 i31`• k `:5 , 2:� 1� � i ,r, . Y i Y �`r. S ) S, /S S��`� C � {SS ;�\ n `t �F%� l2�'m�fJ its �" � .t�s , i . s•:I+�.S..s"sis�;': -a+i f'•(t tr �..,.i '•? 3;a. y{zi.;] 4$rr• r •1t,.1S''; , ;:;a,.,i ...4,; lj. �.1, s SS. e ?�r i 3 r {}}]i
�� i '4 a '�,� .�. , y ]sf;��'��Lel.:.o-�,4 .�.� ��,•,�'r;�•�,� t,.�: - .` SrI�?�`sf'F..�l�, : {:7�s13',� �, � � t'F7tir !f )!.''.�-�;'J: r' aty' :3 !i=�i ?' � s j;yY' :l�� � `Y � � r' �r;, � �e� � � [ ��. \ yy �i ����fry}! i::
} ;c£�rl �t� t •w! � �, �N.,s,;.,j, � ��Js f,!�:�r%�����r�:FS,• • IS�., i •l. f�j), ,� t if L��„ fs�, �\�S:=.• � . �• r� ��1���)!'...�..t s:: �M�.sS.�.��::� s-�M•il �;
.�f�,4t. --- ��•` 1 .. � � ff : r•: 3'S:S.r •a� � ✓ '-�t:.; }_ 3i5 0 �r s:i�, �.�::.3 � -r.a��
Ifech. Plan Check
Plumb, Plun Check
Elec. Plan Chuck
lfeclY- Permil Fee.
Plumb. Permil Fee:
F.lec. Permit Fee:
Other Mcch. Insp.
0/her Plumb Insp.
Other fac�c, Insp. Li
.Ilech, Insp. Free:
plumb. Insp. Fee:
Elec. Insp. Fee:
NOTE. This estimate does not inchide fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 711112)
FEE
QTY/FEE
MISC ITEMS
Plan Chock Fee:
Suppl. PC: Fee
Plumb.1illech./Elec
Permit Fee:
$4 .00
Suppl. Insp Fee
.Plurn&Allech.; Etee
Plumh./Meeh./Elec Permit Fee:
Conslr action Tax:
F-1
Administrative Fee:
Work Without Permit? 0 Yes Q No
$0.00
Advanced Planning Fees:
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICR
$0.80
Select an Administrativy,Item
Bldiz Stds Commission Fee: IBCBSC
$1.00
a
'' a , 3j . �� ;fs.;:✓{� ',fly i�t.7l• : v • t p ;;.:., z ,, �•..�:.;�,"Y$',<=,r�l�
t .. .:
r }. L: ,5- k::.x_ } j�; � � � � CiLtt,i�S/�)'\\i7Y`.)! : 's ,• - Si
:�i - . -•:- .. s � 'i .V.�..� .t l.i f - IC:.�
$406.80
�•`11� �„ �> ;� ., ,'!. x !J} �.;
0.00z,�
$ i� �G ••1 �.✓' i
� ��� (f.0 s�V4 ��'...t �i::5 s:�.� i. •.GIs. f.:i l .s.�::� .-�.3
06.80
Revised: �10/01 /2012
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21230 HOMESTEAD RD CONTRACTOR: CLADDAGH l74
CONSTRUCTION INC
OWNER'S NAME: VILLAGE GREEN ASSOCIATES 1438 LUPTON AVE DATE ISSUED: 10/24/2012
OWNER'S PHONE: SAN JOSE, CA 95125 PHONE NO: (408)294-2924
❑ LICENSED CONTRACTOR'S
rZ
DECLARATION
License Class / Lic. # J 0
/
Contractor w lti l B Nate
I hereby affirm that I licensed under the provisions of Chapter 9
(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
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point sou 'ons per the Cupertino Municipal Code, Section
9.18.
Signature Date 1 O Z
❑ OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
1 hereby affirm under penalty of perjury one of the following three
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
permit is issued.
I certify that in the performance.of the work for which this permit is issued, I shall
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
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
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
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.
BUILDING PERMIT INFO: BLDG r ELECT r— PLUMB r
MECH r— RESIDENTIAL r— COMMERCIAL r—
JOB DESCRIPTION: UNIT 114 - REMOVE AND REPLACE FIRE DAMAGED
ROOFTRUSSES, SHEATHING, AND ROOFING; INSTALL NEW (2)
HOUR FIRE WALLS ABOVE PARTY WALLS IN THESE I I/08/12-REV#1- REROOF THE
ENTIRE BUILDING WITH AN ADDITION OF 2700 SQFT WITH COMPOSITION
ROOFING- 11/8/12 REV#I ISS'D
Sq. Ft Floor Area: I Valuation: $33000
APN Number: 32605085.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: , ��& �f� Date: // 9 '/C —
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should 1 store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health &Safe coons 25505, 25533, and 25 /4.wner zed agent- r/ �
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
Signature Date
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 21230 Homestead Road
DATE: 10/24/2012
REVIEWED BY: Sean
APN:
BP#:
'VALUATION:
1$25,000
TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
Multi -Family Dwelling
I
Buildino is
3 Stories 0 Yes 0 No
PENTAMATION 1GENRES
PERMIT TYPE:
nit #114: Remove and re lace fire dams ed roof trusses sheathin and roofin • install new 2 hour
ire walls above party walls in this building (units 111-118).
f.r! I"r, t4>7>>
t�1 ,,�[::
��{•III 3.�r t� i�t'r'y f �'
f�j�`l � rt�i ;�,�a�f>, Sy�s�
}[•� 'S� �� (�]1tt�els��1��5"
r � a 1. -,.,;...".• I 3
r•. ::1r r7 n� !! .� r
J
,. F.., /.•.. .. 1.^-:l/: c.1Lr.i.. t:lill. r. �. 1.,� ..[�F:\`:
Lleclr. lYluf, r': h s.k.
P/rret1-b .. ,r: t:.i<<: c/
C'lec:. Plan Check
Llerh. Permit l c'[°:
PlIonh, Pei mil Fre:
P/cc. Perinit Fee:
Chhel A'fcc.11. In..' Li
I Olhur Plumb Insp.Lj
Mier Elec. /nsp.
rllech. Insp. Fee:
Plncnh. Msp. Fee:
Occ. Insp. Fee. -
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District.etc ). These fees are hosed on the Dreliminary information availahle and are only an estimate. Contact the Dent for addn 7 info.
FEE ITEMS (Fee Resolution 11-053 E . 711112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No
$0.00
F__07 hours Plan Check, Hourly
$0.00
Suppl. PC Fee: 0 Reg. 0 OT
1-0-.0-1
hrs
$0.00
PME Plan Check:
$0.00
90 ss.f. Re -roof
$135.00 IREROOFMRE
Permit Fee: Hourly Only? 0 Yes Q No
$0.00
Suppl. Insp. Fee-0 Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Administrative Fee:
0
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee:
$0.00
® hours Inspections
$532.00 ISTINSP Inspection, Hourly
Travel Dociiinentution Fees.
Stroniz Motion Fee: IBSEISMICR
$2.50
Select an Administrative Item
Bldg_Stds Commission Fee: IBCBSC
$1.00
cif •.r .;:.&:::','•.i: i . ?:. .....
rfi{:z. �'kiY, :.-1�%;t '/>'<,:•..'✓;r./9�'1';rr>`rf%' . i�,:-�•'
��� i�✓r ['•: / -i :%) t�.',iJ is/. , �:
°°>>:•<. ::: r[:..f.=< :�. `''
.1.,.��?t..::r:::i:szE:->.?:.r.::..: r:e:?::::.-::',.::: r::4r?.:::.'.n•.�?:•:;'.'-�l.-..{?.':=!< i?. ".r:n:::. •r.,'.4G`.I.,�, ir.ir::�:r.rh.
..
350
?'M1ti ' r r i /: i r ' • •i_\1 i M1 '' i ..Tii
66700 >• .._-.::
/. ,�_'•__"_____'_k:, �:.:n..:::r.:: t:•.:.:.,..:)::�::::)rr::::
$670.50
Revised: 10101 /2012