10090143 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20702 GARDEN CREST CT CONTRACTOR:GREENERBLU JDHM,INC PERMIT NO: 10090143
OWNER'S NAME: SCHEEL ERIC E PO BOX 612048 DATE ISSUED:09/16/2010
SAN JOSE,CA 95161 PHONE NO:(408)418-2000
NER'S PHONE: 4082555172
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r PLUMB r
License Class Lic.# `� �3`d MECH r RESIDENTIAL r COMMERCIAL r
Contractor 2 0^.. L�! Date `<4 CZ c�t.�
JOB DESCRIPTION: SIDING(78SQ)AND TRIM REMVAL&REPLACEMENT.
I hereby affirm that I am licensed under the provisions of Chapter 9 STUCCO(88SQ)REPAIR.SEE PERMIT#10090089 FOR FEES
(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:$1585
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. APN Number:36230052.00 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
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 5:7,
9.18. Issued by Date:
Signatu 4Date ) Zd 1 O
❑ 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 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. 1 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 Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,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 contaminants 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 Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's l
Compensation laws of California. If,after making this certificate of exemption,Ii or authoyl�ed }It: Date: / (s �- J
become subject to the Worker's Compensation provisions of the Labor Code,I mus c (/�
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 relatin Y Lender's Name
to building construction,and hereby authorize representatives of this city to enter
u-nn the above mentioned property for inspection purposes.(We)agree to save Lender's Address
unify and keep harmless the City of Cupertino against liabilities,judgments,
..,,s,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF
CITY OF CUPERTINO
GENERAL, BUILDING
C U P E RT I N O PERMIT APPL[CATION FORM
APN# „ Date: n / O
> 7
- t 3�P,91
�'
Building Address av7 6U (36r dei) Cres 1 L f, n vl C/4 q_60/y
Mailing Address(if different from building address):
Are Hazardous Materials being used as part of this project? Yes ❑ No Q'
HOA: Exterior work only) Yes [+'No ❑ If,,res,provide letter from HOA
Owner's Name: Phone#:,
ric Sc h e&l LlO'�J _ ,
Contractor:
Phone: Ll 0& - L//v-20
C_�,�ec?1e� �l r” _ i-1(11 . C-1G Fax: 0i - q)6 -200i
Contractor License#: CN .3
Cupertino.Business License#:
Conta t: 7Fax:
one: 11 r�' `/
l t7�1 � Ct t G�
Residentia Commercial ❑
Job Description: f-)1 Gj w -�-f e co WCL-1 e f l G/
Building Permit Into:
. Bldg .L7 Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A F] V-'.
II/lII B,IV-HT, 3 (l�
Resp jen �-3 2 3
Square Footage:
Valuation:
Project Size: Express[?r Standard ❑ Large 1:1 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.buildit roen.or
Revised 07/14/09
CITY OF
CITY OF C'UPERTINO
wl GENERAL BUILDING APPLICATION
CUPERTINO FEE SCHEDULE
Quantity/Sf Fee ID Fee Descl iption Fee Permit Type
Group 1GENRES or
1GENCOM
PARTITION WALLS
Comm Partition hiterior Commercial B IPARTICOMM
1PAR'� Partition Interior Residential B 1PARTIR<=30
RETAINING
WALL(CONCRETE
OR MASONRY
1RETSTN Standard(up to 50 ft) B
1RETSP310 Special Dosign, 3-10' high(up to 50 `) B
1RETSP10 Special Dosign, over 10' high(up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high(up to B
50 ft
1RETCRB> Gravity/Crib Wall over 10' high(up to B
50 ft
SIDING
1SIDEST/BK Siding, Stane&Brick Veneer B
interior/exterior
1SIDEOTHER Siding all other B
SKYLIGHTS
IS VL<I)SF Skylight less than 10 sf B
1 SKYL>l0SF Skylight greater than 10 sf or B
structural
1STAiRS Stairs-first flight/ea addt'1 B
STORAGE RACKS
1S CKS<---8 Storage Racks 0-8' high(up to 100 sf) B
1 SRACKS>8 Storage Packs over 8' high(up to 100 B
st
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CITY AF
CITY OF CIUPERTINO
GENERAL BUILDING APPLICATION
CUPERTINO FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
IST UCOAP Stucco Applications(up to 400 sf) B
additional s ucco application
1 NREP Replacement windows/sliding glass B
door ea 8,vindows
IVIINMEWSTR New Window-structural shear B
wall/mason. includes plan ck fee
IEPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanica? Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alore Electric Pln Ck(hourly) E
IMECPLNCK Stand Alor e Mechanical Pln Ck(hrly) M
1PLMBLNCK Stand Alor.e Plumbing Pin Ck(hrly) P
I STPLNCK-(3 W Min Standard Plan Check(when no E/M/P) B
when not over counter) hourl -stat A alone
IBCBSC Cal Bldg'Standards Commission Fee B ALLYPESDT
IBSEISMICR Seismic R:sidential B
IBSEISMICO Seismic C:)mmercial B
1TRAVDOC Travel&Jaoentation B
cum
1 BUSLIC Business License B
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