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10090135 Y OF CUPERTINO BUILDING PERMITEDHM,INC PERMIT NO:10090135 �ONTRACTOR:GRE BUI;ijEjjjjZHEjNG jCIENjENGZIE DATE ISSUED:09/16/2010 10 BOX 612048 OWNER'S N PHONE NO:(408)418-2000 c,AN JOSE,CA 95161 ,NER'S PHONE: 4089723211 ELECT I— PLUMB r LICENSED CONTRACTOR'S DECLARATION WILDING PERMIT INFO: BLDG r r ❑ 61, �,�k-5� MEC r RESIDENTIAL COMMERCIAL License Class Lic.# \ DJ Y � � JOB DESCRIPTION:SIDING&STUCCO REMOVAL&REPLACEMENT,STUCCO Contractor SIDING 24 I hereby affirm that I am licensed under the provisions of Chapter 9 REPAIR STUCCO 36, (commencing license Section s m fu)ofll fo cvision 3 of e and effect a Business&Professions Code nd that my I 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. provided for by Valuation:$1585 1 have and will maintain Worker's Compensation Insurance,as p Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Occupancy Type: permit is issued. APPLICANT CERTIFICATION APN Number:36230070.00 ation is I certify that I have read this application and state that the ran es and stabove te laws relating correct.I agree to comply with all city and county F WORK IS NOT STARTED to building construction,and hereby authorize representativs of(We) rit to avterEXPIRES upon the above mentioned property for inspection purposes. .agree PERMITIT 180 DAYSIOF PERMIT ISSUANCE OR P harmless the City of Cupertino against liabilities,Judgments, WITHIN indemnify and keep costs,and expenses which may accrue againslsaid City in cons cant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the app � , d with all non-point source regulations per the Cupertino Municipal Code,Section Date: 9.18. ( Issued b to C \U `ZG�U Signa TION RERE�S' � OWNER-BUILDER DECLARATION P roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for 1 hereby affirm that I am exempt from the Contractor's License Law for one A All roofs shall be inspected to any p the following two reasons: ,or my employees with wages as their sole compensation, inspection. Date: I,as owner of the property, Signature of Applicant: will do the work,and the structure is not intended or offered for sale(Sec.704 , Business&professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors t construct the project( Sec.7044S"A ,Business&professions Code). ALL ROOF COVERINGS TO BE CLAS "OR BETTER I hereby affirm under penalty of perjury one of the following three HFARDOUS MATERIALS DISCLOSURE Chapter 5 of the declarations: I have and will maintain a Certificates of oConsent ton 3700 of the LaborrCode or the Worker's I have read the hazardous materials re ui ements under and 25534.9I will maintain Compensation,as provided for by S California Health&Safety Code, Chapter and and the Health& performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code, p provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as p Area Air Quality Management District I will 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 permit is issued. nuance of the work for which this permit is issued,I sh ill maintain Safety Code,Sections 25505,25533,and 25534e'Chapter 9.12 and the unicipal Cot I certify that in the performance H not employ any person in any manner so as to become subject to the Worker's l flus certificate of exemption,I N er or authorjzgd age Compensation laws of California. If,after making ((�� Date: 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. 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.) 1 with all city and county ordinances and state laws rt lating Lender's Name correct.I agree to comply atives of this city to er ter to building construction,and hereby authorize representPurposes (We)agree to say a Lender's Address ,,non the above mentioned property for inspection pulp 'emnify and keep harmless the City of Cupertino against liabilities,judgme its, ,sts,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 coral ly I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Sect on 9.18. Licensed Professional Date�— Signature ` ` CITY OF CUPERTINO 00\0 �v�� GENERAL BUILDING PERMIT APPLICATION FORM APN# Date: f O /� (] 3� a 30 ��o Building A �arddress: e��7 Y1 J 9 of y Mailing Address (if different from building address12,10 Are Hazardous Materials being used as part of this project? Yes ❑ No HOA: (Exterior work only) Yes [rNo ❑ If i;s, rovide letter from HOA Owner's Name: Phone#: /77 zh yrs.. V Z Phone: yD3-CY 105 aG— Contractor: Fax: _ �/ �u S��fn nC. Contractor License#: gqj�13 Cupertino Business License#: Phone: ~ontact: Fax: ' . �e Residentia Commercial ❑ l Job Description: I' `�n -T`I IY 1 I� U� ��L l6��frvA G C('0 rel tuC�� 36 Building P it Info: Elect. ❑ Plumb ❑ Mech ❑ ' Bl C�� Occupancy Type: Type of Construction(Usage Class): R2S(-Clea f '3 _ 2 3 1-A, 1-B ❑ II/III/V-A'❑ II/III B, IV-HT,V-J3 D _ Square Footage: ' Valuation: `j I��S Project Size: Express �tandard ❑ Large Major ❑ Green Building: Please complete relevant portion of the Green Bums m he sheetii index. & attach t et & tthe application or if applicable, include m plan joints Achieved: LFor help, contact Build it Green at www.builditgr een.or Revised 07/14/09 CITY OF CITY OF C'UFERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE CUPERTINO Fee permit Type Fee Description Group 1GENRE5 or Quantity/Sf Fee ID B 1GENCOM LT A Pplications(up to 400 sf) (f' 1STUCOAP additionEI stucco a lication B Replacement windows/sliding glass ISP door ea 8 windows B New Wiadow-structural shear I�WSTR walVma;o includes Ian ck fee E IEPERMITFEE Electrical Permit Fee M INV FEE Mechanical Permit Fee P IPP TFEE Plumb ng Permit Fee ERMI IELCPLNCK Stand Alone Electric Pln Ck(hourly) E Stand Alone Mechanical Pin Ck(hrly) M IMECPLNCK P 1PLMBLNCK Stand Alone Plumbing pin Ck(hrly) 1 STPLNCK-(3 Min Stan,lard Plan Check(when no E/MN) B when not over counter hour l -stand alone Bldg Standards Commission Fee B ALL PERMIT Cal g TYPES 1BC$SC B 1BSEISMMICR Seismic Residential B IBSEISMIC0 Sei3mic Commercial ITRAVOOC Tr vel&Documentation B B 1BUSLIC Business License 5 of 5