The URL can be used to link to this page

10050153 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20800 VALLEY GREEN DR APT 453 CONTRACTOR:UBS PERMIT NO: 10050153 OWNER'S NAME: UBS 20800 VALLEY GREEN DR DATE ISSUED:05/19/2010 NER'S PHONE: 4082530200 CUPS RTINO,CA 95014 1 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F' ELECT r— PLUMB License Class Lic.# MECH F_ RESIDENTIAL f- COMMERCIAL Contractor Date JOB DESCRIPTION:INSTALL WASHER/DRYER UNITS INSIDE COMM'L APT I hereby affirm that I am licensed under the provisions of Chapter 9 BLDC S (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:$100 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:32609040.453 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 :,80 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. Issu:d by: Date: Signature Date OWNER-BUILDER DECLARATION RE-ROOFS: All r)ofs 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, Sign iture of Applicant: Date: Business&Professions Code) — I,as owner of the property,am exclusively contracting with licensed contractors 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 three 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 Safi ty Code,Section 25532(a)should I store or handle hazardous material. Adc itionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this con:aminants as defined by the Bay Area Air Quality Management District I will permit is issued. 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 Hea Ith&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,I Ow ner or author zed agrut, become subject to the Worker's Compensation provisions of the Labor Code,Imust — 1nn ^ ^�'" �► 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 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 relating Let der'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 Lei der's Address in-lPmnify and keep harmless the City of Cupertino against liabilities,judgments, ,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION t,jting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I ui derstand my plans shall be used as public records. 9.18. Licensed Professional Signature f��\ Date� � V CITY OF CUPERTINO 8 ITEMS OF 32 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32609C40 .453 DATE ISSUED. . . . . . . : 05/19/2010 RECEIPT # . . . . . . . . . BSOOOC10443 REFERENCE ID # . . . : 10050153 SITE ADDRESS 20800 VALLEY GREEN DR APT 453 SUBDIVISION . . . . . . CITY CUPER-INO IMPACT AREA . . . . . . OWNER UBS ADDRESS 20800 VALLEY GREEN DR CITY/STATE/ZIP CUPER-INO, CA 95014 RECEIVED FROM KAVIT11A PENDYALA CONTRACTOR LIC # *OWNER* COMPANY UBS ADDRESS 20800 VALLEY GREEN DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOJNT PD-TO-DT THIS REC NEW BAL ---------- ---- ------ ---- 1BCBSC VALUATION 100 .00 1. 00 0 . 00 1 . 00 0 . 00 1BREMRECEP NO. OUTLETS 1 . 00 42 . 00 0 . 00 42 . 00 0. 00 1BSEISMICR VALUATION 100 . 00 0 . 50 0 .00 0 .50 0 . 00 1EPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1MPERMITFE FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0 . 00 1PPERMITFE FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0 . 00 1PREPPIPE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0 .00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 253 .50 0 . 00 253 . 50 0 . 00 1 `1 CITY OF CUPERTINO CUPEI�TINO GENERAL BUILDING PERMIT APPLICATION FORM APN# 53 Date: Building Address: ` �O �� G%e« u-� YJ Mailing Address (if different frre—t building address): &-,L Owner's Name: S Phone#: U e HOA: (Exterior work only) Yes U No If yes, provide letter from HOA Contractor: Phone: T96 Fax: Contractor License#: T- 6 Cupertino Business License#: Contact: Phone: Lf og, 2_5-2--76q.3 Fax: L(c,8-- q73- 1025 Residential Commercial Job Description: C> LAA V-t e fGt.� l �-�i v�c��-� 13,j Jd �u�s P Building Permit Info: Bldg V Elect M111, Plumb Mech I� Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B Pr /4- 2— Valuation: - 2— Valuation: / Square Footage: Project Size: Express ❑ Standard 2 Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicable, include in plan set & the sheet index. Points Achieved: For help, contact Build it Green at www.builditgreen.or Revised 02/05/09