13020086 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20620 HOMESTEAD RD CONTRACTOR:SOUTH BAY PERMIT NO: 13020086
CONSTRUCTION,INC
OWNER'S NAME: THE SOBRATO ORGANIZATION 1711 DELL AVE DATE ISSUED:02/142013
OWNER'S PHONE: 4084480700 CAMPBELL,CA 95008 PHONE NO:(408)379-5500
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL
License Class_415 Lie. REMOVAL OF INTERIOR LIGHT FIXTURES
Contmctor�� Dat,A
I hereby affirm that I am lice[sed 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. Sq.Ft Floor Area: Valuation:$500
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 APN Number:32610066.20620 Occupancy e:
permit is issued. p y Typ
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building concoction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY ROM LAST CALLED INSPECTION.
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. Ad '' nally,the applicant understands and will comply Issued by: Date:
with all non-point sot ations per the Cupertino Municipal Code,Section
9 I8.
1�y� j RE-ROOFS:
Sign D.. _ 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.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that[am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
concoct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safe ode,Sections 25501—
, 5533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized a
permit is issued. age
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner$o as to become subject to the Worker's
Compensation laws of California. If after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the tabor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CONSTRUCTION PERMIT APPLICATION, U
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIION n
10300 TORRE AVENUE•CUPERTINO.CA 95014-3255 V
C (408)777-3228•FAX(408)777-3333•buildinci( cuoertino.org \
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFEEBED ORIGINAL PERMIT#
PROJECT ADDRESS APN#
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STREET ADDRESof ", � CITY.
CONTACT
CITY,BTATEyP ,�( Y�
XOWNER ❑ owNER-BULDER ❑ OWNER AGENT ❑ CONTRACTOR . ❑CONTRACTOR AGENT ❑ ARCKIT c ❑ENGINEER ❑ DEVELOPER ❑TENANT
JQ9IACENSE NUMBER�, LICENSE'I`YPEB BUS.LIC#56
COMPANY NAM AI
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ARCHfTECT/ENGMEERCFjr`TO QrO GI/S'� LICENSE NUMBER G` m BUS.LICA T
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DESCRIPTION ofWORK
EXISTING USE 1
PW
U$E CONSTR.TYPE NSTORIES
Y om/ �] ;/ / USE TYPE OCC. SQ.FT. VALUATIONS)
EXLSTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NETAREA
BATHROOM KRCHEN OTHER
REMODELAREA REMODEL AREA REMODELAREA
PORCH AREA DECK AREA T0TALD6CX/P0RCHAREA I GARAGEAREA: DETACH
ATTACH
NDWELINGUNDS: IS A SECOND ON11' 13YES SECONDSTORY YES
BEING ADDED? ONO ADDITION? 0 N
PRE-APPLICAMN OYES WYES.PROVEDECOPYOF ISTHEBLDGAN OYES RECE TOTAL-VALUATION:
PIANNINGAPPL# ONO PLANNING APPROVAL TETTER EICHLERHOMEF ONO ��))
V.
BY my signature below,l certify to each ofihe following: 7 em the property owner or authorized agent to ac on a property 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
ordinaDces and slate Taws relatiD ' g coTlsvtleti
Is oriu Lives of Cupertino to enter the abovdoideDU qPd prepary for inspection purposes.
Signature ofApplicant/Ag Date:
SUPPLEMENTAL INFORMATION REQMED pI;Ag CHECKR: ROUTING SUP
_New SFD or Multifamily dwellings: Apply for demolition permit for 1�iCbVEtt_THE-COUNTIIA 1;4�11.DING PLAN REVIEW
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 WORxs
Tom— if any Hazardous Materials are being used as part of this project .❑ Ptµg DEPT
�❑ LAnce.
Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR .❑ SANITARY SEWER DTSTRILT
submittal of Building Permit application.
i
❑,.ENVIRONMENTAL HEALTH
BldgApp_201 Ldoc revised 06/2111/
.. . ,r;n•r^dT DEPARTMENT
AREA OF WORK �'eul'ol ""Dr;-i;;N-CUPERTINO
fir
Pk' -_may
HOMESTEAD SQUARE RETAIL °
SOUTH BAY �+pia.^s end specifications MUST be kept at the
CONSTRUCTION l constwcton. It is unlawful to make any
•axxrnnxx.mu xx rrvm.
- a -u ns on same, or to deviate II
I, a v ithout pproval from the Building ff_I�j' .
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PLANNIN DEPT• �
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DATE vi `iC
Regulation 11, Rule 2
o COMPLIANCE &
ENFORCEMENT Acknowledgement of
„R_A Y A It E A Notification and
-:SRQUALI1Y DIVISION Payment of Fees
MANAGEM ENr
D l s 'r R 1 C T
1/30/2013
Jakela Inc. Job No:3Y747
32I{amilion Dr,Suite A invoice No:3BR54
Novato,CA 94949
The Bay Area Air Quality Management District(BAAQMD)acknowledges receipt of your payment and
your Asbestos Removal or Demolition Plan described as: Renovation
Site address 20620&20580 Homestead Rd
Cupertino,CA 95014
Start Date February 11, 2013
Completion Date Manch 31,2013
Removal amounts of triable ACM 0 linear feet 34 200 square feet 0 cubic feet
Should it become necessary to revise this plan,please do so in the spaces provided below and immediately
copy the District by fax or by mail.
REGULATION 11-2 REVISION BAAQMD J# 3Y747
REVISION# START DATE COMPLETION DATE;
I
2
4
5
NOTE. T his form is not intended as a verification of eidjer the completeness of your original notification
m•of its compliance with BAAQMD Regulation 11-2.If you have any questions about this
acknowledgment,.please-call our office at(415) 749-4762.
Al Regulation 71, Rule 2
4:
COMPLIANCE &
` ' ENFORCEMENT Acknowledgement of
-DA Y AREANotification and
. RCiUALITY DIVISION payment of Fees
MANAGEMENT
D I S T R I C T
1/30/2013
Jakela Inc. Job No:3Y748
32 Hamilton Dr, Suite A Invoice No:3BR55
Novato,CA 94949
The Bay Area Air Quality Management District(BAAQMD)acknowledges receipt of your payment and
your Asbestos Removal or Demolition Plan described as:
Site address 20620&20580 Homestead Rd
Cupertino,CA 95014
Start Date February 11,2013
Completion Date March 31,2013
Removal amounts of friable ACM Q linear feet 74,000 square feet 0 cubic feet
Should it become necessary to revise this plan,please do so in the spaces provided below and immediately
copy the District by fax or by mail.
REGULATION 11-2 REVISION BAAQMD J#3Y748
REVISION# START DATE COMPLETION DATE
1 ---
2 - ---t--
3 --
4 --
5
NOTE. This form is not intended as a verification of either the completeness of your original notification
or-of its compliance with BAAQMD Regulation 11-2. If you have any questinns about this
acknowledgment,please call qui office at(415) 749-4762.