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11110026 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10201 TORRE AVE CONTRACTOR:VALLI CONSTRUCTION, PERMIT NO: 11110026 INC OWNER'S NAME: I&G DIRECT REAL ESTATE 21 LP 100 ALBRIGHT WAY STE D DATE ISSUED: 11/04/2011 OWNER'S PHONE: 4086560289 LOS GATOS,CA 95032 PHONE NO:(408)377-5000 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class B Lie.# 7 57Z, 71 L, MECH r RESIDENTIAL F_ COMMERCIAL r Contractor %//*L41% OCT"5m/!_ Crate 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:LAB 126-ADD 3 HEAT PUMPS,PROCESS PIPING FROM (commencing with Section 7000)of Division 3 of the Business&Professions ROOF TO 3RD FLOOR,INCLUDES ELECTRICAL 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:$195000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36941005.00 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: Date: Signature Date ❑ OWN ER-BUILDER.DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1 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. 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, S ignature of Applicant: Date: Business&Professions Code) 1,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 1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous matcrials 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(x)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 maintain compliance 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&Safety 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,1 0 cr or a horized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must ate: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of%%ork'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 relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address 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 ARC)I ITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licenscd Professional Signature Date CONSTRUCTION PERMIT APPLICATION Is COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333• building-5cupertino.or4 ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED`' ORIGINAL PERMIT# PROJECT ADDRESS /0 / -7-01,9'e-4 (v rN# �q + ( D OWNER NAME / 2� Id / -�-�QN PHONE E - � D Cj 0 E-MAIL STREET ADDRESS/\/T O` (p CITY,STATE,ZIP FAX /D ox 7-0/2/?.E C 175-01471 CONTACT NAME PHONE E-MAIL nom A-5A c —17-0 f/2"81 STREET ADDRESS CITY,STATE, ZIP - FAX t O 02 -7-b✓✓ /-�-u OWNER ❑ OWNER-BUn.DER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CO OR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# Y-44-'� ; C/" CDMPA Y NAME E-MAIL FAX V c-C r GC 17 5 p-le-✓�'ri►7 STREET ADDRESS t CITY,STATE,ZIP PHONE r)U iAZ 7 Z0.5 Gov-nes G/3 AR CHITECT/ENGWEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK Q f/h-v /��a e� S / !�✓�r G / �j EXISTING USE PROPOSED USE CONSTR TYPE #STORffS USE TYPE OCC. SQ FI. VALUATION(S) E=G NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL.AREA L PORCH AREA I DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: LJ DETACH []ATTACH #DWELLING UNITS: IS A SECOND UNTr []YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO -7 PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN [I YES RECEIVED BY: TOTAL GV�ALUATIION: PLANNING APPL# ❑NO PLANNING APPROVAL LEITER EICHLER HOME? E]NO / 3-- 'a By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prpperty owner's behalf. I have read this application and the information I have provided is correct I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUERED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for �rBFrcouNTER �s4�arG PLAN REVD w existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. El LARGE ❑ Fm DEPT _Copy of Planning Approval Letter or Meeting With Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp 2011.doc revised 06/21/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C O P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: C PERMIT# OWNER'S NAME: PHONE# Ce-577— S-00 ' GENERAL CONTRACTOR: ALL � BUSINESS LICENSE# ADDRESS: I oo CITY/ZIPCODE: Q *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: l Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical eco 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