10090137 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20720 GARDEN MANOR CT CONTRACTOR:GREENERBLU JDHM,INC PERMIT NO: 10090137
OWNER'S NAME: LAI TERRY K AND LAI-CHEANG PEG PO BOX 612048 DATE ISSUED:09/16/2010
4ER'S PHONE: 4082530862 SAN JOSE,CA 95161 PHONE NO:(408)418-2000
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class Lic•Aa 4 6 ( > MECH r RESIDENTIAL r COMMERCIAL r
ContractorDates
I herebyaffirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SIDING&STUCCO REMOVAL&REPLACEMENT,STUCCO
REPAIR,STUCCO 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
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:36230071.00 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.
Issued by: �'�J...''--�. '"`----�—_"_.._._ Date: J lcsr l
Signature Date k\o % 0
[J OWNER-BUILDER DECLARATION RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one 01 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 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
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
Compensation,as provided for by Section 3700 of the Labor Code,for the I 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&
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 ter or authorize ent:
become subject to the Worker's Compensation provisions of the Labor Code,I mu.t y / �tG!U
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 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 Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
unify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
.,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
s'..
CITY OF CUPERTINO Oo2ITYCOF �00C
CUPS TINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN# Date:
q11 0
Building Address:
av�oo C ardeo mangy- Cf: , eaper�10
Mailing Address (if different from building address):
121 D S"SaCU-n 0 w- -Y -aid 5anJo---y1 CA
Are Hazardous Materials being used as part of this project? Yes ❑ No
HOA: (Exterior work onl ) Yes [�rNo ❑ If yes, provide letter from HOA
Owner's ame: Phone#:
e gal �err Lai
Contractor: Phone: yD� C,f 1 a UAB
-7 rpeACL )q Sb RfnInc. Fax: 06- 411
Contractor License#: N.13
Cupertino Business License#:
Contact: Phone:
f 64 5a (-laq Fax: l ' 3S"5- 1196
Residentia Commercial ❑
Job Description: 5l GI( n 96Yn-\/0v(sJ
s
s C('0
Building Pe it Info:
Bldg El--- Elect. ❑ P:umb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B II/III/V-A ❑ II/III B, IV-HT, V-B []� ReS G� f '3
e-3
Valuation: Square Footage:
Project Size: Express �tandard_E] Large El Major ❑
Green Building: Please complete relevant portion of the Green Buitding/LEED Checklist& attach it
to the application or if applicable, include in plan set& the sheet index .
Ants Achieved:
for help, contact Build it Green at i.oriz
Revised 07/14/09
-CITY.OF
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
CUPERTINO FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Ap.lications(up to 400 sf) B �
additional stucco application
1WINREP Replacement windows/sliding glass B
door ea 8 windows
1WINMEWSTR New Window-structural shear B
wall/masojincludes plan ck fee
IEPERMITFEE Electrical Permit Fee E
IMPERMITFEE MechanicEI Permit Fee M
1PPERMITFEE Plumbing:?ermit Fee P
IELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M
1PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P
1 STPLNCK-(3 Hr Min Standard F Ian Check(when no E/M/P) B
when not over counter) hourly- id alone
1BCBSC Cal BldgEl tandards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic R;sidential B
IBSEISNIICO Seismic Commercial B
1 TRAVDOC Travel&Documentation B
1BUSLIC Business 1,icense j B
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