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10090151i i CITY OF CUPERTIr O BUILDING PERMIT I BUILDING ADDRESS: 20729 GARDEN CREST CT OWNER'S NAME: ERICA NELSON 4ER'S PHONE: 4156992774 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # q l 13 o [, Contractor �,�� rV (� Date /G ko I hereby affirm that I am licensed under the provisions of Chapter 9 (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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, 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 9.18. Signature a Date A � few 6 V OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 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 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 permit is issued. I certify that in the performance of the work for which this permit is issued, I shall 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 upon the above mentioned property for inspection purposes. (We) agree to save ,unify and keep harmless the City of Cupertino against liabilities, judgments, ,, 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 9.18. Signature Date CONTRACTOR: GREENERBLU JDHM, INC PERMIT NO: 10090151 PO BOX 612048 DATE ISSUED: 09/16/2010 SAN JOSE, CA 95161 PHONE NO: (408) 418-2000 BUILDING PERMIT INFO: BLDG r ELECT r— PLUMB MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: SIDING(240SQ)&TRIM REMOVAL & REPLACEMENT. STUCCO (56SQ) REPAIR. SEE PERMIT #10090089 FOR FEES Sq. Ft Floor Area: APN Number: 36230057.00 Valuation: $1585 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: `'�--�,. �---- Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. or authof' ed rnt,-h C!, h4zz Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constriction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional C1TY Of CUPS T1NO CITY OF CUPERTINO GENERAL ]BUILDING PERMIT APPLII�ATION FORM fLt�%`� v►> � APN # Date: n//0// Building Address: <907- 9 7 Mailing Address (if different from building address): 12! o S • 3 G sof Rt'y • - ZZv Are Hazardous Materials being used as part of this project? Yes ❑ No HOA: (Exterior work only) Yes eNOE] If ye s, provide letter from HOA Owner's Name:/sem Phone #: 'P C", � N Contract r: Phone: Q / '2 r 15& s M m C. Fax: y0`B' Contractor License #: 9y( 13 Cupertino Business License #: Contact: Fax: tcesidential ED> Commercial ❑ Job Description: SAik G(�o .'6�0 cc 56 s1 i Sk�'Iv-%' Building Permit 'Bldg 19/11' Elect . ❑ P [umb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-B II/III/V-A ❑ II/III B, IV -HT, V -B [+� �S� "3 - �- 3 1-A ' ❑ Square Footage: Valuation: Project Size: Express z/ Standard ❑ Large [] Major ❑ Green Building: Please complete relevant portion o f the Green BuidinglI,EED Checklist &attach it to the application or if applicable, include in plan set & the sheet index. T c )LLL1.J U. u. r or help, contact Build it Green at n ww.builditgrel n org Revised 07/14/09 3 -7 CITY OF CITY OF CUPERTINO 91 GENERAL BUILDING APPLICATION CUPERTINO FEE SCHEDULE Quantity/Sf 4 of Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM PARTITION WALLS 1PARTICOMM Partition Interior Commercial B 1PARTICOMM 1PARTIR Partition Interior Residential B 1PARTIR<=30 RETAINING WALL(CONCRETE OR MASONR 1RETSTN Standard (u ) to 50 ft) B IRETSP310 Special Design, 3-10' high (up to 50 `) B 1RETSP10 Special Design, over 10' high (up to 50' B 1RETCRB< Gravity/Cri ) Wall, 0-10'high (up to 50 ft B 1RETCRB> Gravity/Cri) Wall over 10' high (up to 50 ft B SIDING 1 SIDEST/BK Siding, Stolle & Brick Veneer interior/exterior B 1 SIDEOTHER Siding all o :her B 4� SKYLIGHTS 1 SKYL<10 SF Skylight less than 10 sf B 1 SKYL>10SF Skylight grc;ater than 10 sf or structural B 1STAIRS Stairs -first Ilight/ea addt'l B STORAGE RACKS l SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B 1 SRACKS>8 Storage Racks over 8' high (up to 100 t -St)- B 4of5 CITY OF CITY OF CUPERTINO 1W GENERAL BUILDING APPLICATION CUPERTINO FEE SCMEDULE Quantity/Sf Fee ID Fee Des cription Fee Group Permit Type 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) addition', Ll stucco application B 1 WWREP Replacement windows/sliding glass door ea 8 windows B 1WINMEWSTR New Wuidow-structural shear wall/masonry includes plan ck fee B IEPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechani ;al 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 when not over counter) Standard Plan Check (when no E/M/P) hourl -sty Ind alone B 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel & Documentation B 1BUSLIC Business ;.license B of 5