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10090142 CITY OF CUPERTIN O BUILDING PERMIT BUILDING ADDRESS: 20709 GARDEN MANOR CT --ONTRACTOR:GREENERBLU JDHM,INC PERMIT NO:10090142 OWNER'S NAME: HEMADRI ANANTA PO BOX 612048 DATE ISSUED:09/16/2010 NER'S PHONE: 4084463204 SAN JOSE,CA 95161 1 PHONE NO:(408)418-2000 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r- ELECT[— PLUMB r License Class Lic.# '""1 l� 1 i MECH r RESIDENTIAL[— COMMERCIAL r Contractor �2fe: Dated 1�e - JOB DESCRIPTION:SIDING&STUCCO REMOVAL&REPLACEMENT,STUCCO I hereby affirm that I am licensed under the provisions of Chapter 9 REPAIR,STUCCO 24,SIDING 54 (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 Valuation:$1585 Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: permit is issued. APPLICANT CERTIFICATION APN Number:36230075.00 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, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 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. Date:�-��il�c�a Issued byr'� Signature ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All 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, inspection. will do the work,and the stricture is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: Business&Professions Code) I,as owner�f tke 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: HAZARDOUS MATERIALS DISCLOSURE 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. 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& 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 permit is issued. 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 maintain 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 Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I ner or author' ed t: f become subject to the Worker's Compensation provisions of the Labor Code,I mus: Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a constriction lending agency for the performance of work's and state laws relatin; for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances to building constriction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address vrify 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 ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Signature Date Licensed Professional CITY OF 1 Y� 19 CITY OF C-UPERTINO vb GENERAL BUILDING C U P E RT I N O PERMIT APPLICATION FORM "N# 2 3 0-1 S_ Date: n / )/D Building Address:2 0`7 D � 6arc%n M Qn Or Coal- Mailing ourMailing Address(if different from building address):1-210 it ^ Are Hazardous Materials being used as part of this project? Yes ❑ No [L]' HOA: Exterior work only) Yes [�No ❑ If -,'s, ride letter from HOA Owner's Name: � Phone# o. �. - - y (� c: -l�emac�� nan��- �► ��'� Contractor: _ Phone: (J(dj �� 0J y , (,�r D i f 1l C, Fax: i;�' 113 `� v i Contractor License#: iqt /31S Cupertino Business License#: contact: Phone: L�C-�`-) Fax lid' ✓ - (I v Residentia Commercial ❑ Job Description: r cl 1 -ter 'n Building Pe it Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B ❑ I1/I1IN-A L IM11 B,IV-HT,V-I [t� P eS1 J eA T 3 '�_ ❑ Valuation; Square Footage: Project Size: Ex ress Standard ❑ Lar a[] Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist&attach it to the application or if applicablF,include in plan set&the sheet index. Points Achieved: For help,contact Build it Green at www.buildit rf en.or Revised 07/14/09 CITY of CIT'V OF CU PERTIN0 TION IL,DING AppLICA GENEPkL E CSEDVLE FEE s Permit Type Fee 1GENRES or C U P ERT IN� tion Group Fee Descri 1GENCOM QuantitylSf Fee ID PAR'T`ITION W�,LS B 1PARTICOMM partition IY►terior Commercial ip�T�<=30 1PARTICON�1 B partition 1 nterior Residential 1PART G WAJ..L,cUNC�TE B OR MASONR 5tandarc►(Up to 50 ft) STN B Special Design 3-10' high(uP to 50 ) l,�TSP310 over 10' high(up to B Specie.Design B 1RETSP10 50' all,0-10'high(up to B GravitylCrib W 1RETCRB� 50 ft Grity/Crib Wall over 10' high(up to av 1RETCRB> 50 ft) B SIDIlvG Brick Veneer Sidi I&I Stone& B u is IDESTBK intE xiorlexterior _ I Sid'ng all other 1SIDEOT�R SKYLIGHTS B SI ylight less than 10 sf B 1SKYl-<10 SF S ylight greater than 10 sf or OSF >IB 1 SKYI s.ructural ht/ea addt'1 <<tairs-first flig 1STAIRS CIS to 100 sf) B STORAGE e Racks 0-8'high(uP _ 5torag B 15RACK5�^8 h(up Racks over 8'hi gto 100 Storage 1SRACK57$ st 4of5 CITY OF CITY OF CUPERTINO F-01GENERAL BUILDING APPLICATION FEE SCHEDULE CUPERTINO Fee Description Fee Permit Type Quantity/Sf Fee ID Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications(up to 400 sf) B y additional stucco application B — IWR,MEp Replacem,;nt windows/sliding glass door ea!,.windows) B 1VaNMEWSTR New Window-structural shear wall/masc includes plan ck fee l EPERMITFEE Electrical Permit Fee E I MPERMITFEE ;al Mechanic Permit Fee M 1PPERMITFEE Plumbing;Permit Fee P lELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1MECPLNCK Stand A'.one Mechanical Pln Ck(hrly) M 1PLMBLNCK Stand A lone Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 Hr in Standar'i Plan Check(when no E/M/P) B when not over counter hourl ;.tand alone B ALL PERMIT 1BCBSC Cal Blc g Standards Commission Fee TYPES 1BSEISMICR Seismic:Residential B 1BSEISMIC0 Seismi;Commercial B 1TRAVDOC Travel&Documentation B 1BUSLIC Businc;ss License B 5 of 5