11120068CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21230 HOMESTEAD RD BLDG 3
CONTRACTOR: VALLEY GREEN
PERMIT NO: 11120068
ASSOCIATES
OWNER'S NAME: VALLEY GREEN ASSOCIATES
131 E DANA ST
DATE ISSUED: 12/12/2011
OWNER'S PHONE: 4082045367
MOUNTAIN VIEW, CA 94041
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
J_
r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.ft
r F r—
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: BLDG 3 - 8 UNITS(APT. 46-51) - DEMOLISH R2 COMPLEX
(commencing with Section 7000) of Division 3 of the Business & Professions
DUE TO FIRE DAMAGE (8,000SQFT)
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: $30000
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: 32605085.3
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
R.18.
/�7
Issued DateY L
Signaturere Date
L/ OWNER -BUILDER DECLARATION
RE -ROOFS:
All roofs 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,
Signature of Applicant: Date:
Business & Professions Code)
I, 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
I hereby affirm under penalty of perjury one of the following three
declarations:
HAZARDOUS MATERIALS DISCLOSURE
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. 1 will maintain
performance of the work for which this permit is issued.
compliance with theCupertino Municipal Code, Chapter 9.12 and the Health &
I have and will maintain Worker's Compensation Insurance, as provided for by
Safety Code, See 25532(a) should I store or handle hazardous material.
Section 3700 of the Labor Code, for the performance of the work for which this
Id I use equipment or devices which emit hazardous air
Additionally'sr
permit is issued.
contaminan efined by the Bay Area Air Quality Management District I will
maintain plianee 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
Healt afety Code 505, 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
w o t orized I
become subject to the Worker's Compensation provisions of the Labor Code, I t
Date:
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 Hork'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 pro for inspection purposes. (We) agree to save
Lender's Address
indemnify and keep harmle e City of Cupertino against liabilities, judgments,
costs, and expenses whic y accrue against said City in consequence of the
granting of this permit. itionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non -point so re t• unicipal Code, Section
I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO D
WE FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 21230 homestead rd #3
DATE: 12/12/2011
REVIEWED BY: bobs.
APN:
BP#:
"'VALUATION:
1$30,000
*PERMIT TYPE: Demolition Permit
' "
PRIMARY SFD or Duplex
USE:
PENTAMATION 1SFDWL-DEM
PERMIT TYPE:
WORK
demo r-2 complex due to fire dams e.8 units total
SCOPE
FEE ID FLR AREA
s.f.
1DEMORES 8,000
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 hayed on the nrelininary information availahle and are only an estimate_ Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711111)
FEE
QTY/FEE
MISC ITEMS
Permit Fee:
$783.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
Strong Motion Fee: IBSEISAI[CR
$3.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$2.00
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7 .
88 0
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Revised: 12/04/2011