10090147 CITY OF CUPERTIP40 BUILDING PERMIT
BUILDING ADDRESS: 20685 GARDEN MANOR CT CONTRACTOR:GREENERBLU JDHM,INC PERMIT NO: 10090147
OWNER'S NAME: AMARENDRA&SUSHMITA VERMA PO BOX 612048 DATE ISSUED:09/16/2010
NER'S PHONE: 7752326600 SAN JOSE,CA 95161 PHONE NO:(408)418-2000
❑ LICENSED CONTRACTOR'S DECLARATION
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2 BUILDING PERMIT INFO: BLDG r ELECT I— PLUMB r
License Class Lic.# �'i lP\ J
MECH r RESIDENTIAL r COMMERCIAL r
Contractor �Z\_Date Z ci 1 V
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SIDING&STUCCO REMOVAL&REPLACEMENT,STUCCO
(commencing with Section 7000)of Division 3 of the Business&Professions REPAIR,STUCCO 44,SIDING 88
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 Sq.Ft Floor Area: Valuation:$1585
permit is issued.
APPLICANT CERTIFICATION APN Number:36230078.00 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 constriction,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.
Signatu &A.A.4ate_�L_�kt0 Issued by: �--�� Dater
U OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of .5,11 roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: nstalled 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, 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 -
constnuct 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 1 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. I 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 `afety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. f kdditionally,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 r iaintain 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 lealth&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 w er or authorial a
(.rte s
forthwith comply with such provisions or this permit shall be deemed revoked. Date:—T I 2C'/l)
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 for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter I ender's Name
unon the above mentioned property for inspection purposes.(We)agree to save
mnify and keep harmless the City of Cupertino against liabilities,judgments, I ender's Address
s,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. 1 lnderstand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF `
CITY OF CUPERTINO
GENERAL, BUILDING
C O P E RT I N O PERMIT APPLICATION FORM
APN# Date:
3� a- 3o v'7S q /7 lid
Building Address:2 D(PS Garcler) Il)an or CaireCuperfin v, Cl g5vl y
Mailing Address(if different from building address):
Are Hazardous Materials being used as part of this project? Yes ❑ No ['
HOA: Exterior work only) Yes ElONo ❑ If yes,provide letter from HOA
Owner's Name: 5L'skro"oa Phone It.
Contractor: Phone: (3 200✓
G fie—e l a r d �Li �1 1-10) T CN C • Fax 0,1� - q16 v i
Contractor License#: 94a,l-3n
Cupertino Business License#:
Cont a�st• Phone: yO&- v q
r(! L"")ar J Fax: l 1
Residentia � Commercial ❑
Job Description: r- ,.
-�f cl n 0-c)J +f1,111 I`zinwc,I anc� rel,
Building Pe it Info:
Bldg Er", Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
1
1-A, 1-B ❑ IUIII/V-A ❑ IMII B,IV-HT, V-B KeS C�2n 1 R-
Valuation: Square Footage:
Project Size: Express[T Standard ❑ Large❑ Ma•or ❑
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 reer.or
Revised 07/14/09
CITY OF
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
CUPERTINO FEE SCHEDULE
Quantity/Sf Fee ID Fee Descri ption Fee Permit Type
Group 1GENRES or
1GENCOM
PARTITION WALLS
1PARTICOMM Partition Interior Commercial B 1PARTICOMM
1PARTIR. Partition Int,-rior Residential B 1PARTIR<=30
RETAINING
WALL(CONCRETE
OR MASONRY
1 RETSTN Standard(up to 50 ft) B
IRETSP310 Special Design, 3-10' high(up to 50 `) B
1RETSP10 Special Design,over 10'high(up to B
50'
IRETCRB< Gravity/Crib Wall, 0-10'high(up to B
50 ft
1 RETCRB> Gravity/Crib Wall over 10' high(up to B
50 ft
SIDING
1 SIDESTBK Siding, Stone&Brick Veneer B
interior/exterior
1 SIDEOTHER Siding all otter B �V LT
SKYLIGHTS
1 SKYL<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'l B
STORAGE RACKS
1 SRACKS<=8 Storage Rack 3 0-8'high(up to 100 sf) B
1 SRACKS>8 Storage Rack;over 8' high(up to 100 B
st
4 off
CITY OF
CITY OF C'UPERTINO
Im GENERAL BUILDJ[NG APPLICATION
CUPERTINO FEE SCHEDULE
Quantity/Sf Fee ID Fee Deser iption Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications(up to 400 so B L/additional,tucco,application '�
1 WINREP Replaceme tit windows/sliding glass B
door ea 8 windows
1 WINMEWSTR New Window-structural shear B
wall/masor includes plan ck fee
I EPERMITFEE Electrical F ermit Fee E
IMPERMITFEE Mechanica Permit Fee M
1PPERMITFEE Plumbing F ermit Fee P
IELCPLNCK Stand Along Electric Pln Ck(hourly) E
1MECPLNCK Stand Along Mechanical Pln Ck(hrly) M
1PLMBLNCK Stand Alon;Plumbing Pln Ck(hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check(when no E/M/P) B
when not over counter) hourl -stand alone
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
IBSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
1TRAVDOC Travel&Documentation B
1BUSLIC Business Li-,ense B
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