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10090154 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20717 GARDEN CREST CT CONTRACTOR:GREENERBLU JDHM,INC PERMIT NO: 10090154 OWNER'S NAME: WEIHONG ZHANG PO BOX 612048 DATE ISSUED:09/16/2010 YER'S PHONE: 4089304756 SAN JOSE,CA 95161 PHONE NO:(408)418-2000 LICENSED CONTRACTOR'S DECLARATION 1 r BUILDING PERMIT INBLDG ELECT PLUMB License Class Lic.# �-C MECH r RESIDENTIAL F COMMERCIAL (Y_f � Contractor ►/UC 6L J Date ��?CAU I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SIDING(]08SQ)&TRIM REMOVAL& (commencing with Section 7000)of Division 3 of the Business&Professions REPLACEMENT.STUCCO(48SQ)REPAIR.SEE PERMIT Code and that my license is in full force and effect. #10090089 FOR FEES 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 Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$1585 permit is issued. APPLICANT CERTIFICATION APN Number:36230059.00 Occupancy Type: 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 upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Signatur Date LI 1z�i() Issued by:,/�_ __ —�,�cCZ Date: �., ��L- Li OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one ofRE-ROOFS: kll roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, i nspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) !signature of Applicant: Date: 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: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this S afety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall in raintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's I[ealth&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must lyvner or aut rized a / ` forthwith comply with such provisions or this permit shall be deemed revoked. Date: /fG /2G/U APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating fr,r which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save inify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address ,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I inderstand my plans shall be used as public records. Signature Date L censed Professional CITY OF CITY OF CUPERTINO GENERAL BUILDING C U P E RT I N O PERMIT APPLICATION FORM APN# s, ) �� Date: / Building Address.,-?0-717 Carden Cres l Ct , Caper- IIoo, Mailing Address(if different from building address): CA S Are Hazardous Materials being used as part of this project? Yes ❑ No L'-:' HOA: (Exterior work only) , Yes [ErNo ❑ If ves,provide letter from HOA Owner's Name: Phone#•, �, e� h Z►�_a_ 1-/i _ �3 an--�— --- 0 2 Contractor: Phone: iA L%'(j �� L G�ee 1 ,� Fax: Q, - Contractor License#: /L/&;/3 S Cu ertino Business License#: Conta t: Phone: 4Jt�, " WC ((�Cj IrCi.��=) C Fax: J _ 1 Residential" Commercial ❑ Job Description: f: 1%N•1 e in WCL. <S TUCZ) Gju LL Building P/rmit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: 3 IIB V-:3 �eS I c1e17 s 1-A, 1-B ❑ IUIII/V-A ❑ Illi ,IV-HT, Valuation: IS35Square Footage: Project Size: Express Er" Standard ❑ Large 1:1 Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist&attach it to the application or if applicably:,include in plan set&the sheet index. Points Achieved: For help,contact Build it Green at www.builditgr,-en.org Revised 07/14/09 CITY OF CITY OF CUPERTINO wi GENERAL BUILDING APPLICATION CUPERTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM PARTITION WALLS 1PARTICOMM Partition Ilterior Commercial B 1PARTICOMM 1 PARTIR Partition I iterior Residential B 1PARTIR<=30 RETAINING WALUCONCRETE OR MASONRY 1 RETSTN Standard(up to 50 ft) B IRETSP310 Special D.-sign, 3-10' high(up to 50 `) B 1RETSP10 Special Di.-sign,over 10' high(up to B 50' 1RETCRB< Gravity/Crib Wall, 0-10'high(up to B 50 ft 1 RETCRB> Gravity/C rib Wall over 10' high(up to B 50 ft SIDING 1 SIDESTBK Siding, St ane&Brick Veneer B interior/e derior 1SIDEOTBER Siding all other B 6� SKYLIGHTS 1 SKYL<10 SF Skylight 1,-ss than 10 sf B 1SKYL>10SF Skylight€reater than 10 sf or B structural 1STAIRS Stairs-firs L flight/ea addt'l B STORAGE RACKS 1SRACKS<=8 Storage Racks 0-8' high(up to 100 sO B 1SRACKS>8 Storage Racks over 8' high(up to 100 B st iLof5 CITY OF CITY OF CUPERTINO GENERAL BUILDING APPLICATION CUPERTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications(up to 400 so B G d additional stucco application 1 WINREP Replacement windows/sliding glass B door ea 8 windows 1 WINMEWSTR New Winc ow-structural shear B wall/maso: includes plan ck fee I EPERMITFEE Electrical?ermit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit Fee P IELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 Hr Min Standard F Ian Check(when no E/M/P) B when not over counter) hourl -stagy id alone 1BCBSC Cal Bldg c tandards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Rosidential B 1BSEISMICO Seismic Commercial B 1TRAVDOC Travel&Documentation B 1BUSLIC Business License B 5 of 5