10090133 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20718 GARDEN CREST CT CONTRACTOR:GREENERBLU JDHM,INC PERMIT NO: 10090133
OWNER'S NAME: MICHAEL THOMAS PO BOX 612048 DATE ISSUED:09/16/2010
AER'S PHONE: 4089458465 SAN JOSE,CA 95161 PHONE NO:(408)418-2000
10 LICENSED CONTRACTOR'S DECLARATIONIr
/n+ BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class t Lic.# _l,{(o L5-0
/ MECH r RESIDENTIAL r COMMERCIAL r
Contractor�(-.X.em,�,��1� DateS'1(e 1 201 0
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SIDING(90SQ)AND TRIM REMOVAL&REPLACEMENT.
(commencing with Section 7000)of Division 3 of the Business&Professions STUCCO(38SQ)REPAIR.SEE PERMIT#10090089 FOR FEES
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:36230054.00 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
9.18. �- --- —-Z _. d
l Issued by:�=� Date:
Signatur rA 0
LJ 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.
1,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
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. I 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.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
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
Compensation laws of California. If,after making this certificate of exemption,I er or author' ag 9
become subject to the Worker's Compensation provisions of the Labor Code,I must ate: I f;��o!a
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 relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon 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,
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
its CITY OF C+UPERTINO
GENERAL, BUILDING
C U P E RT I N O PERMIT APPLICATION FORM
APN# r Date: 7 //0
Building Address:20-7/8 Cardeo Cres f Coad) Caper�i-)v, eA 95`'1y
Mailing Address(if different from building address):
CA
Are Hazardous Materials being used as part of this project? Yes ❑ [�]
No '
HOA: xterior work only) Yes [+rNo ❑ If yes,provide letter from HOA
Owner's Name• Phone#
mj6hGf'l Thomas
- _ Phone: iA0 j " x/13-Li v✓
Contractor:
�l'.-C? a6�U -7, D i-1�l , .I.,.(1 Fax: C:� q 16 2 v
Contractor License#: Gy&; 3 S
Cupertino Business License#:
Contact:
7hone-_,qax:
Residential, Commercial ❑
Job Description: <:�:)1 Cj 1 tl (�it(� 9 ►l'l Z 111� t 1 (,�-jl�� I� ( G C /l�c' �'
s%o NwLN u _
Building Pe it Info-
Bldg L7 Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
1-A, 1-B ❑ I1AIIN-A ❑ II/III B,IV-HT,V-]3 ❑ Res ld(f
Valuation: Square Footage:
15
Project Size: Express 0-1-- 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 ;en.or
Revised 07/14/09
CITY OF
CITY OF C UPERTINO
GENERAL BUILDING APPLICATION
CUPERTINO FEE SCHEDULE
Quantity/Sf Fee ID Fee Desei iption Fee Permit Type
Group 1GENRES or
1GENCOM
PARTITION WALLS
Comm Partition Ir terior Commercial B IPARTICOMM
1PARTIg partition Interior Residential B 1PARTIR<=30
RETAINING
WALL(CONCRETE
OR MASONRY
1 RETSTN Standard(lip to 50 ft) B
1RETSP310 Special De sign,3-10' high(up to 50 `) B
1RETSP10 Special De sign,over 10' high(up to B
50'
1RETCRB< Gravity/Ci ib Wall, 0-10'high(up to B
50 ft
1RETCRB> Gravity/Cj-ib Wall over 10' high(up to B
50 ft
SIDING
1 SIDESTBK Siding, Stene&Brick Veneer B
interior/e:cterior
1SIDEOTHER Siding all other B vel
SKYLIGHTS
1 SKYL<10 SF Skylight loss than 10 sf B
1 SKYL>10SF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-firs:flight/ea addt'l B
STORAGE RACKS
1SRACKS<=8 Storage Racks 0-8' high(up to 100 sf) B
1 SRACKS>8 Storage Racks over 8' high(up to 100 B
st
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CITY OF
CITY OF C'UPERTINO
is GENERAL BUILD[NG 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
additional ;stucco application 3�5`�
1 WINREP Replacement windows/sliding glass B
door ea 8 windows
1WINMEWSTR New Wind,)w-structural shear B
wall/masor includes plan ck fee
IEPERMITFEE Electrical Fermit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Fermit Fee P
IELCPLNCK Stand Along Electric Pin Ck(hourly) E
1MECPLNCK Stand Along Mechanical Pin Ck(hrly) M
1PLMBLNCK Stand Alonf;Plumbing Pin Ck(hrly) P
1 STPLNCK-(3 Hr Min Standard Pl,,Ln Check(when no E/M/P) B
when not over counter) hourl -stanc.alone
1BCBSC Cal Bldg Sidards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Res idential B
1BSEISMIC0 Seismic Con imercial B
1TRAVDOC Travel&Documentation B
1BUSLIC Business Lic;nse B
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