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10090118 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20730 GARDEN CREST CT CONTRACTOR:GREENERBLU JDHM,INC PERMIT NO: 10090118 OWNER'S NAME: LUCIDO MICHAEL P PO BOX 612048 DATE ISSUED:09/16/2010 NER'S PHONE: 4085465833 1 SAN JOSE,CA 95161 PHONE NO:(408)41&2000 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class Lic.# "/ /(o fJ r( MECH r r-RESIDENTIAL COMMERCIAL r Contractor SL¢-vim{.r�NO Date t 51 t Zo i lam. JOB DESCRIPTION:SIDING(110SQ)&TRIM REMOVAL&REPLACEMENT. I hereby affirm that I am licensed under the provisions of Chapter 9 STUCCO(40SQ)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:36230056.00 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. (� Issued by:< Date: Signature Date 7A id LI 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 o F 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 compensatior,, will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: Business&Professions Code) 1,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. 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. 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 Compensation laws of California. If,after making this certificate of exemption,I er or author' ag become subject to the Worker's Compensation provisions of the Labor Code,I mu;t Date: 'L 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 relatir g 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 vmify 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 k c)CA 0 k k n Wl. atr CITY OF CJPERTINO CUPEkTINO GENERAL BUILDING PERMIT APPLI+�ATION FORM APN# /'_ Date: 9 f 0 �� Building Address: 95U1 I/ Mailing Address (if different from building address): I Z1O S- BGI..SOITI I9i� e• .ZZv 15MT65e1 Are Hazardous Materials being used as part of this project? Yes ❑ No ©' HOA: (Exterior work only) Yes eNo ❑ If a;, provide letter from HOA OwnersN1 6one e� ,p J � Ph #: � 0 acl / • Zuel;5lo W- 57 Contract r: I Phone: / '2� ( 6& �Q�m� 1 C� Fax: Contractor License#: 9y( 13 Cupertino Business License#: '7ontact: Phone: Fax: Residential ED> Commercial ❑ Job Description: c� •��' �f lr�i m �e m DVCJ .540 C,CAC); yL � S rQrr�C�• � � Building Permit Info: ' Bldg (i.' Elect. ❑ Plh imb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A'❑ II/III B, IV-HT, V-B 1 ,. �S I, � 1'3 �- j Valuation: Square Footage: � 15 s' Project Size: Express 2-11" Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of-:he Green Building/LEED Checklist& attach it to the application or if applicable,viclude in plan set& the sheet index . oints Achieved: For help, contact Build it Green at www.builditgreen.or Revised 07/14/09 3 CITY OF CITY OF CUPERTINO GENERAL BUILDING APPLICATION CUPERTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Desci iption Fee Permit Type Group 1GENRES or 1GENCOM PARTITION WALLS 1PARTICOMM Partition Interior Commercial B IPARTICOMM 1PARTIR Partition Interior Residential B 1PARTIR<=30 RETAINING WALL(CONCRETE OR MASONR B 1 RETSTN Standard(jp to 50 ft) IRETSP310 Special Dosign,3-10' high(up to 50 `) B 1RETSP10 Special D4-sign,over 10' high(up to B 50' 1RETCRB< Gravity/C.-ib 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/e xterior 1SIDEOTHER Siding all other B 1/0 �f SKYLIGHTS 1SKYL<10 SF Skylight less than 10 sf B 1 SKYL>10SF Skylight greater than 10 sf or B structural 1STAIRS Stairs-first flight/ea addt'1 B STORAGE RACKS 1 SRACKS<=8 Storage Racks 0-8' high(up to 100 sf) B 1 SRACKS>8 Storage Packs over 8' high(up to 100 B st tof5 CITY 0* CITY OF C UPERTINO GENERAL BUILDING APPLICATION CUPERTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco App ications(up to 400 sf) B additional sl ucco application d d 1 WINREP Replacemer t windows/sliding glass B door ea 8 windows 1WINMEWSTR New Window-structural shear B wall/masom includes plan ck fee IEPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit Fee P IELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 Fir Min Standard Pla 1 Check(when no E/M/P) B when not over counter) hourly-stand alone 1BCBSC Cal Bldg Sta ldards Commission Fee B ALL PERMIT TYPES 113SEISMICR Seismic Resi3ential B IBSEISNIICO Seismic Commercial B 1TRAVDOC Travel&Documentation B 1BUSLIC Business Liconse B 5 of.i