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11110017 L i CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20800 VALLEY GREEN DR CONTRACTOR:MORROW-MEADOWS PERMIT NO: 11110017 CORPORATION OWNER'S NAME: 20800 VALLEY GREEN DR 385 OYSTER POINT BLVD DATE ISSUED: 11/032011 AMER'S PHONE: 4082530200 S SAN FRANCISCO,CA 94080 PHONE NO:(6501634.0682 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT � � PLUMB License Class C Lic.#_230 e t- —C ,}' �� MECH r RESIDENTIAL r COMMERCIAL r Contractor /W7Y m W Nate //-6)d 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:APT 450-WASHER/DRYER HOOKUP (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 1 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 permit is issued. APN Number:32609040.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply 9wilhh all non-point source regulations per the Cupertino Municipal Code,Section Issued by: Date: Signani 7^/ '_ Date a,21-- /7 RE-ROOFS: OWNER-BUILDER DECLARATION All roofs shall be inspected prior many rooting material being installed.If a roof is thereby affirm that 1 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 inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Dale: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Cade) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(See.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should 1 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 defined by the Bay Area Air Quality Management District 1 will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 1 certify that in the performance of the work for which this permit is issued,l shell Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's O:n k or euth "izedpg I t: Compensation laws of California. If,after making this certificate of exemption,I Data& . — 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save "1W mfy and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION 16Fand expenses which may accrue against said City in consequence of the g . mg of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ® 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 C!JP> RY MIVQ (408)777-3228 • FAX(408)777-3333•buildino(@cuoertino.orG ❑NEW CONSTRUCTION ❑ ADDrr1ON ❑ ALTERATION/T1 ❑ REVISION/D D OLNALPERMIT'. PROIECTADDRES" !f 00 QD APNA 3z 6 4 9G OWNER NAME PH W E-MAII. STREET ADDRESS /t 1> CrrY STATE,ZIP O ! FAX / CONTACT NAME o^ PHONE ' E-MAIL i STREET ADDRESS Y STATE, ZIP N OI! FAX OwfBR ❑ Owt ERB EDEtt 1�,OwNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHTTECr ❑ENGINFHt ❑ DEVELOPER ❑TENANT CONTRALTO 'N - LICENSENUNMER. 13CENSETYPE HUS.LICq Z �a COMPANY NAME ^^ J �1 N' A 16 S . E-MAB FAX STREET fUIS TATE,Zu, 4hNE ARCIRTECIDENGR4EER NAME LICENSE N[TN.eEA BUS.LIC!2 3 COMP ANY NAME n E-MAB.- FAX •C 1. I AA6 STREET AD§ 5 /I ��� CrrY.STA ZIP PH TLE/D S v S/ SCRIP'17ON OF WORM f ,/ �) / l Q� .Je—1 E.XIY[iNGUSE PROPOSID ISH CONSIA TYPE 0SrORres _.ORIn11C.i_73_Rd1N'IY - VALUATJON S) EXLSrO NEW FIDOR DEMO TOTAL AREA AREA AREA NETAREA _.C- EATHROOM FITCFItN OTHER REMODEL AREA REMODEL AREA REMODLT-ASIA POPCHAREA DECKAREA TOTAL DECKNORIM AREA GARAGEAREA;O DETACH -_-- - - -- - ❑ ATTACEt YDWEILpIOIAJpS Ia A SECOND i1ri1T �WO EECOMISTORY �yas aEII Anrzzl E]Np ADDMOPo MNO PRE-APPLIGnON ❑ yE9 7YE9.PROVIDECOPYOF PWT SNAN@ RE(:ENFD nY ) / TOTALVAIINATIDN /J PLANNINO APPLY n NO PLANNWOAPPROVALLEREIt ` }N J , / �� By my signature below,I certify to each of the following: I am the pro erty owner or authorized agent to Set on the property owner's behalf. I have read this I- \ application and the information I have provided is correct. I have rf'ad a Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating ung construct! . I Sethprlae representatives of Cupertino to enter the above-identified property for inspection purposes. SignatureofApplicant/Agcntt— U Date: SUPPLEUi=AL INFORVfATION REQUIRED rL,t.OtrECNn re Ronrlx<:st.m New STD or Multifamily dwellings: Apply for demolition permit for uFR.-a°FIE.CrltfCi rPIR i tNF+PLAN�RPA'EE.w ' existing building(s). Demolition permit is required prior to issuance ofbuilding permit for new building. `_�_ Exvmss - ❑ PLAStvike PLAN RF.VMW i _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 17 ISTANaARD 'S .Q'RHai:rc^'vt©'hits . form if any Hazardous Materials are being used as part of this project ,`LARGE C-EIRP.DHEY , Copy of Planning Approval Letter or Meeting with Planning prior to nomittal of Building Permit application. :gAsLTARYkSF,WiIIRDiSTR((�i' ;{ t7 ENymDa;.iEea�:LL:>n.,,Lvx - _-i L Bldgilpp 2011.doc revised 03/16/11 • CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32609040. 00 DATE ISSUED. . . . . . . : 11/03/2011 RECEIPT #. . . . . . . . . : BS000015225 REFERENCE ID # . . . : 11110017 SITE ADDRESS . . . . . : 20800 VALLEY GREEN DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER 20800 VALLEY GREEN DR ADDRESS . . . . . . . . . . : PO BOX 130156 CITY/STATE/ZIP . . . : CARLSBAD, CA 92013-0156 RECEIVED FROM . . . . : VILLAGES AT CUPERTI CONTRACTOR . . . . . . . : KATHLEEN RICHARDS LIC # 28064 COMPANY . . . . . . . . . . : MORROW-MEADOWS CORPORATION ADDRESS . . . . . . . . . . : 385 OYSTER POINT BLVD CITY/STATE/ZIP . . . : S SAN FRANCISCO, CA 94080 TELEPHONE . . . . . . . . : (650) 634-0682 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 500.00 1.00 0. 00 1. 00 0 . 00 18REMRECEP NO. OUTLETS 1. 00 44 .00 0. 00 44 .00 0 .00 1BSEISMICR VALUATION 500. 00 0. 50 0. 00 0.50 0 .00 1PREPPIPE FLAT RATE 1. 00 44 .00 0. 00 44 . 00 0.00 1SUPINSFEE HOURS 1. 00 130.00 0. 00 130. 00 0.00 1TRAVDOC FLAT RATE 1.00 44.00 0. 00 44 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 263 .50 0. 00 263 .50 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 263 .50 #3824 --------------- TOTAL RECEIPT 263 .50 • CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION . ADDRESS: 20800 valley green dr. DATE: 11/03/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: $500 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFDor Duplex PENTAMATION P USE: PERMIT TYPE: WORK W/D hook-up SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Other Appliance/Equip 1BAPPLOT 2 # $130 TOTALS: $130.00 .1.' i7 ,,1 , yo• . i. Meeh.Plan Check 0.0 hrs $0.00 PlunA flan Cdeek Glen.Plan ChccA Mech.Permit Fee: IMPERMIT Plund" !'e"Ot Fee: li7ea Pe�ii Pee: Other Mech. Insp. 0.0 hrs $44 01"t o Plunil:Lr,:p. 07 Of"Ir., Elea, h,cp. wo(h.lnap. !'ee: Numb. hxgp. I^h<': Luer.Imp, 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 based on the Prelinadna Information available and are only an estimate. Contact the Dent for addn'l Info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1,111) FEE QTY/FEE MISC ITEMS Plan Checl, F'ec: 5t1/i r7. ly('Fc r PME Plan Check: $0.00 Perntir Pce: Suppl. Insp Pee PME Unit Fee: $130.00 PME Permit Fee: $44.00 Construction Tits Administrative Fee: !ADMIN $41.00 Work Without Permit? O Yes 0 No $0.00 Advaned Alanuing Fees: Travel Documentation Fee: ITRA VDOC $44.00 Stion&Motion Fee: IBSEISMICR $0.50 Select an Administrative Item • Bkl�Stds Commission Fee: IBCBSC $1.00 SUBTOTALS:' $260.50 $0.001TOTAL FEE;,,, $260.50 Revised: 10/01/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 U PE RTI N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# 1 1 O OWNER'S NAME: PHONE# GENERAL CONTRACTOR: (SW:& BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *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. ] L r I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: t/ 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