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10090134 CITY OF CUPERTIr O BUILDING PERMIT BUILDING ADDRESS: 20710 GARDEN MANOR CT CONTRACTOR:GREENERBLU JDHM,INC PERMIT NO: 10090134 OWNER'S NAME: ONG RANDY AND EVA PO BOX 612048 DATE ISSUED:09/16/2010 1ER'S PHONE: 4089738288 SAN JOSE,CA 95161 PHONE NO:(408)418 2000 ,. LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT PLUMB r License Class _ Lie.# (qq U l3 MECH r RESIDENTIAL COMMERCIAL .1/_1�'`rp�^'�'�'��` J Date �O t Contracto JOB DESCRIPTION:SIDING&STUCCO REMOVAL&REPLACEMENT,STUCCO I hereby affirm that I am licensed under the provisions of Chapter 9 REPAIRSTUCCO 36,SIDING 24 (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 rAPNNumber: r Area: permit is issued. APPLICANT CERTIFICATION 36230069.00 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, 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 Date 9.18. :�� Issued by: Signatur, Date 6 U OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one �fFAshta inspected prior to any roofing material being installed.If a roof is first obtaining an inspection,I agree to remove all new materials for the following two reasons: p I,as owner of the property,or my employees with wages as their sole corn ensation,will do the work,and the stricture is not intended or offered for sale(Sec.7044, plicant: Date: Business&Professions Code)1,as owner of the property,am exclusively contracting with licensed contractors tc construct the project(Sec.7044,Business&Professions Code). L 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 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 shal I 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,l er or author'' ag lG l� U become subject to the Worker's Compensation provisions of the Labor Code,I n ust ((f�1 Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I herebyaffirm 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 rela ting p 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 unify and keep harmless the City of Cupertino against liabilities,judgment , and expenses which may accrue against said City in consequence of the ARC HITECT'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. Signature Date_ Licensed Professional �oi�� CITY OFO OF CU_PERTiN CITY L ►UILDING GENE (; UPEATION FORM RTIN� pEg1VIIT �'pLI D Date: APN# a� Ct ver Co ri Address 0710 6arc�6n - Building building address): ❑ No if different from yes Mailing Address( �r�`V�1v art of this,project 1. 10 41C=�. used asp from azardous Materials be1°g esu rovide letter Are H geNo 0_____1' Phone onl yes140 HOA; Exterior work �(�G� on i phone: 1 , • i f owner'sName:� � n r Contractor: ��j- UClJ Contractor License#: j y phone: y _ License F Cu ertino Business L' ax: Conta t: .�Ct.CC, � rl- Commercial ❑ I I Residential' Job Description: ,161 n �� ti� Meth o it Info: ❑ Building P Plumb Occupancy Type. 2 Elect ❑ Q es j C,I�� _ 3 �— Bid � Usage class)* '1 Type of Construction( Square Footage: Typ IIIIII B,I`r HT'VB 1_A' 1 B ❑ 1111.1IiV-A ❑ V aluatiou; r' ❑ Ma or ❑ attach it Lar e ED Check ist& • Ex ress Standard a of the Green Buildi�&be sheet index- pro ect Size: onion in Ian se complete releva ut p ►icable,include P •please lication or if apP Green Bull ding• to the app 4109 thieved: Green atw"w•buildit reen'Or Revised 0711 Points A 'contact Build it For hel , CITY OF OF CIJPEp NO TION CITY PPLICA BUIL�Diw�` A E GF E SO�EDUL' it Type FE Fee 1GEN"S or CuPERTINO Fee Descl'010n Group IGENCOIVI u to 400 sf ) Fee ID B = �` QuantitylSf Stucco A,)plications( B cco a lication IST UCO� additional stu slsliding glass geplacelcent WindB 1�JINltEP Ws door e�L S wln ctural shear New w.ndow-stru lan ck fee IV�IINMEwSTg includes walllm�iso E FEE Electr:cat permit Fee M IEPERMI ical PerFee Mecr an mit p 1MPEgMITFEE it Fee TFEE Plun gybing Perm 1PPERNII d Alone Electric Pln Ck(hourly) E Stan k hrlY) M IELCPLNCK echanical Pln C ( St end Alone M P CPL 0" bin Ph1 Ck(hrly) S sand Alone Plum g PL CK B 3 Min standar d Plan Check(When no E/�) ISTPLNCK-( hourl -stand alone B ALL pEgMIT when not over counter TYPES Standards Commission Fee Cat Bldg B 1BC13SC esidential ---�- Seismic R B IBSEISMICR -� SCommercial eismic 1BSBISIVIICo B Travel&Documentation B OC Business License IBUSLIC 5of5