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12050143CITY OF' CUPERTINO BU LDING PERMIT BUILDING ADDRM: 20650 VAI I-EY GREEN DR OWN IE R'5NAME, SI50LLC OWNER'$ PHONE: Q LICENSED cow.{ nn nEcL"ATImN License C1pU [�„ Lie. Contractor rx!c v f E)ale 1 hereby affirm that I am Iteemsed under the 1provisloia. ofCbmpter 9 icomIneueingwith Section 70(e) of 1)ivision 3 of the Busisearr & Pro ressiDOS Code and that my license is in full force and cticcl. I hereby affirm under penalty of perjury une of Ihr following two declarations: have and will maintain a certificate (if consent to scif-insure for Worker's Compensation, as provided for by Section37Wol the LahorCndc, forthe perl'urmancc of the work for whichthis permit is issued. I have and will mainmin Worker's Compensation Insurance, as provided fur by Section 370D of the Labor Code, 1'4r the performance of the work fir which this permit 6 issued APPLICANT CERTIFICATION i certify that t have rend ffis uppllcatkon and stoic that the aWvc lnfamption is corma. I agrer to comply with a]I city and county ordinanocs and Statc laws retating to building COFWAhctiort, and hereby authorize representatives of this city to enter upnn the above mentioned property for inspection purposes. (We) a_um to save hndtmnhfy and keep hurtnicss the City of Cupertino against liabilities,,judgmnnt,5. costs, and expenses which may accrue against stud City in conscqucnce of dhc granting of this permit. Addifiqgy. the applicant understands and will comply with ail no point source re atirns per the Cupertino Municipal Code, Section 9.18. f 4i,nP1WFr f f}NIt I! I hereby affirnn that I ant tempt f1-atn the Cnalraetor'a lacertae I.aw for one of thr fallowing two reasons; 1, as owner of tht property, or my ernptoyet-s with wages as their sole oomp•nsatton, will do the work- and the structure is not intended or offered fir sa.k (S".7D44, Business & Professions Code) 1, as owner ofibe prupoity, am exclusively cantracting with licensed contractors lu wrtsirurA the projed (Sec.7044, Business & Professions Code). 1 hereby alllrm under penally of perjury one of the fallowing three deelmrtttisas: I have and will maintain a Ccrtiriieatc ufCnnscnt to self -insure for worker's C'ornpensation, as provided for by Section 37o0 of the LabuT Codc, for the performance of the work for which this permit is tssued. have and will maintain WcA-cr's Compensation Insurance, as provided for by 5Cwon 3700 of the Lidxx{:adc, for the perrarmancc nftfhe work forwhich this perrnii is issued. certify that is the performance of the work for which this permit is issued, I shall not employ any person nnany manner so as to become -&abject to the Warkef'5 Cnrnpcnsation Jaws ofC'alifornia. If, after making this certificate ofexernpliunr become subject w the Worker's Compensatjan provisions of the Leber Code, I must forthwith comply with such provisions or this permit shall he deemed revoked. A PP LI CANT C ER TIFI CATION eertify lhei I have read this application and stale that #Ite above information is correct. I agree to comply with all city and county ordinances and state laws relating to building constntcllont, and hereby authorize representatives of this city ID enter upnn the above mentioned property for inspection purposes. (We) agree In save indemnify and keep hrrrntcss the City of Cupertino against linhilities. judgments, costs, and expritscs which may accrue against said City jn oonsequencc of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulatims per the Cupertino Municipal t;odc, Section 9.18. CONTRACTOR: DEVC ON PERMrt NO: 12050143 CONSTRUCTION INC 690 QTBRALTAR DR DATE ISSUED: 081170.012 MILPITAS, CA 95035 PRONE NO: (4DR)947.3200 JOB DESCRIPTION- RFSIDENTIAL "�l COMMERCIAL CONSTRUCT (APPLE) 24 FT BY 8"S TALL CMUr SOUND Iit4+ALL Sq. Fit Floor Area: E Velits tlon: $50000 APN Number: 32610053.00 1 Clcrupancy Type: PERMIT EXPIRES IF WORD IS NOT STARTED WITHIN 180 DAYS OIL PERMIT ISSUANCE OR NSPEECO180 DM LAST CALLED IN3 Issued by- , Date:t- u RE -ROOFS,. }ill roofs shall be inspected prior to any rooting maicried being insta'iled. If a roof is innstmilad without first obtaining art inspection, i agree to ttnnove sll rie+v rnatcrjals for inspection. S lgrtaturc of Appl i atnt: Rate; ALL ROOF COVERLNGS TO BE CLASS "A" OR REMR HAZALRDOUS MATERIALS D15C1.d5l'RF I Itave read the hazardous inatrriaLs requirtmenis audtr Chapter 6.95 of the C shfornia 140a1th & Safety Crttle, Sectiew I5-505. 25533, mad 255M. I will maintain costpliance ►pith tilt Cupertino Munieipal Code, Chapter 9.12 and the Health & SAfrty Code, Sec-CWn 255321[a) should 1 store or handle hazardous marerial. Additionally, should I use eyuipmrnl or devices which emit hazardous N ir can N in i nants as deemed by the Stay Area Air Quidity Management DistritI I will maintain complimnce with the Cupertino 4 unteipsiJ Code, Chapter 9.12 slid the Health & Safety Code, Sections M505, IW33, and 29334, Owner Ora "therind agtill: Doter l hereby Orinn that three is lk construction lending agency for the pfrfonnancc of work's for which this permit is issued (Sec. 107, Civ C.) 1.ender'n Name I.ender'4 ,Address ARCHITECT'S DEC1,ARA"fION I understand my plans shall be used as public records. Licensed Professional Date I CITY OF CUPERTINO BUILDING PERMIT I BI IILDING ADDRESS: 20650 VALLEY GREEN DR 0A VF.R'S NAME: SI 50 LLC OWNER'S PHONE: © LICMED CQNTP.ACT0Jt'5 )2Ei(;LARATTow License Class — Lic. b 3, 12 I Conntuctur 120C t fti n (f c.A~-J-- Date hsrtbv aQlrm that L am licensed under the provisions of Chapter 9 {eamr eating with Section 7000) of Division 3 of the Business & Pralessioas Cale and that my license is in full foree and effect. I liereby. oflLrm under pensity of fir rjun one of the follitwlog two 1 have and wili maintains a certificate of consent io self -insure € Compensation, as provided for by Section 37041 of the Labor I CIVW4 performanecofthe worst for which ibis permit is issued I has+e and will maintain Worker's Compci-miumn Insurance, as provided for by Section 3700 of the Dior Codc, for die performance of the work for which this pemiit is issucd. APPLICANT CERTIFICATION I ccrrily [hat 1. have read this application and stale that the above information is correct. I agree to wrnply with all city and county ordinmwes ad state iaws relating la building cnnstruction, and hereby authoruo ropresmtatives or this city to enter upon the ubovc mntioned property for inspection purposes. (We) agree to save mdemnify slid keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in conxsqumi;c of the granting of this peir»iL Additionally, the applicant un&rrsrands and will comply with all non -point sourc guistions per the Cupenino Municipal CAc, Seetiori 4 18 5 ignaturc Datc�r� d 0WNER-QUlLDI~ DECLARATION [ hereby affirm that I am exempt from the Coritraclor's Llreme Law for one of the fallowing two reasons: k as owner of the property, or my ernployces with wag= as their sole compensation, will do The work, and the structure is not intended or offered for sale (See.7W, Business & Professions Code) 1. as owner of the property, run excfusiycly Contracting with licensed contra aofs to conwao the project (Sec,7044, Busn*s & Professions Cade). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certif cafe of Consent to self -insure fflr Worker's Compewntion, as provided far by Section 3700 of the Labor Cade, far the performance orlhe-wa& for which this permit is issued. have arW will maintain Worker's Compensation Insurance, as provided for by Section 3700 ofdw Labor Code, for the pci fortnance of the work for which this permit is issued. I certify then in the performance of the work far which this permit is isstwd, I shall not employ any pin mo in any manner so as to become subject to the Worker's Compensation laws of California. 1C after making this certificate of exemption, I b9xnx.sub to the Worker's Compemauian provisions of the Labor Code, l must forthwith comply with such provisions or this permit shall be dterrrcd revoked. rIPPT KART C'_F.RTIFICATION I certify that I have road this application and stale that thr above: information is corned. 1 agrcc to comply with all city and munly ordinances and state laws itlating to building cimstuetion, and hereby ma kfirize representatives of thiscity to rntcr upon the above mantioned property for inspection purposes, (We) agree to save indemnify and keep harmless the City of Cupertino agninst. liabbiIitics, judgments„ costs. Intl expenses which may Iconic again A said City in conscyucncc of the granting of this permit. Additionally, the applicant undorstands and will comply with all non -point source regulations per the Cupertino Municipal Code, Stclion 9.1 a. CONTRACTOR: DEVCDN PERMIT NO: 12450143 CONSTRUCTION INC 690 GIBRALTAR DR DATF. TSU E0; 0&17/2012 MILPrrAS. CA 95035 PHONE NO: (408)942-8200 JOB DESCRIPTION, RHIDENTfAT: u COMMFRC'LALL-: CONSTRUCT (APPLE) 20 FT BY 8"S TALL CMU SOUND WALL Revision #1- Addition of closures A CMV wall- issd I11612013 Sq. Ft Floor ,urea; I ►'aliusidun: S5i10U0 AI'N Nuinher: 3261 %W53.00 1 Occupancy Type: PERMIT EXPIRES IF WORK1S NOT STARTED WITIHN 80 DAYS OF PERMIT ISSUANCE OR 180 DAYM LAST CALLED INSPECTION. Issued by: All ruols shall he inspected prior to any roofing material being installed if a roof i.s installed withota first obtaining an inspection. I agree to ren:ovr, all new materials Far inspwaaa. Signature of Applicant: Date: ALL ROOF COVERINGS TO HE CLASS "A" OR BETTER. 14AZLARDOUS MATERIALS DISCLOSURE 1 have read the hazardous malerials requirements ander Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the C'ulterthio Miudelpatl Cude,Chapter 9.12 and [tic Health & Sefrty Code, Section 25532(a) rhoultl I store or handle hazardous material. Additianwily. Anuld I use eguipmeot or devien which emit hazardous air conlarnlnanlc as tlefLoed by the Day Area Air Quailty Management Distritt I will mainlailti camplionte with the Ct[perti Municipal Code; Chapter 9.12 and ttie TTealtb & Safety Code, Sectia 553 and 29534, Owner.Or-aathorlmd agent; hate: r CONSNDING AGENO' ! hereby affirm that there is a construction lending agency for the perfomianct of wo-A's Ibr which this penuit is issued (Sec. 3097, Civ C'.) Lender's Name Lender's ARCHLTECIISD ECLA RATION I understand my plans shall be used as pout is records. Licensed PrufmL. Sion n[lwe Date CITY OF CUPERTINO ICI FEE ESTIMATOR -BUILDING DIVISION r ` ADDRESS: 20550 Valley Groan Dr DATE: 0511812012 REVIFWED BY: Sean APN: BP#: `VALUATION: $50,000 PERMIT TYPE: Building: ECK TYPE: Alteration. / Addition / Repair Piu74ARY Commercial Building USE: PENTAMATION 1 GFNCdM PERMIT TYPE: WORK SCOPE Construct}on of a 20 ft by 8'8" tall CMU sound wall. NOTE. This evd mate does not include fees fine to other Deltari enis (i.e. Planning, Public Works. fire, Sanitary Sewer District, School DLstr1c7 etc.i•. These fees are bused an the nreliminury information available and are anh, an estimam Contact the Dent for adfdn'l info. FEE ITEMS (Tge Rasofifoian 11-053 Eff - 1 i i FEE QTV/FEF M[SC ITEMS Plan Check Fee:: $0.00 20 i.f`, Fence $852.00 1FE�vcF-m.4s Ferice, Masonry>5' Suppl. PC Fee: Reg. 0 OT 0.0 ]trs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. F'eee its . 0 DT Q.Q his MOM PME Unit Fee: $0.00 PME Pennit Fee: $0.00 f 0 (F) Work Without Permit? 0 Yes (D. No $0.00 .Advanced Planning Fee: $0-00 Select a Non -Residential Building or Structure 0 „„r 1 r . Steong ,Malkin Fee: 1&8EISHICO $10.50 Selee! an Administrative Item Bldg Stds Commission Fee_ 1BCBSC $2.00 SURTOTALS- $1.2.50 $652.00- TOTAL FEE: 664.50 Revised: 04/01/2012