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10090138 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20734 GARDEN MANOR CT CONTRACTOR:GREENERBLU JDHM,INC PERMIT NO: 10090138 OWNER'S NAME: MAHMOUD&NAHID GHAVI PO BOX 612048 DATE ISSUED:09/16/2010 1ER'S PHONE: 6787774110 SAN JOSE,CA 95161 PHONE NO:(408)418-2000 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r- ELECT F PLUMB r License Class -Z> Lic.#q�la 1 //�� ^� 1 l MECH r r-RESIDENTIAL COMMERCIAL ContractorlaS(---e- JY 6A. Dated `,ko `ZU 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:36230072.00 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 9.18. ..�--� Date: � �� Issued by:��'` --"" Signatu ate G i v LI 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, Business&Professions Code) Signature of Applicant: Date: I,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. 1 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 Safety Code,Section 25532(a)should I store or handle hazardous material. 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 become subject to the Worker's Compensation provisions of the Labor Code,I must er or authorize gent: 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 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF y CITY OF CUPERTINO I �O GENERAL, BUILDING C U P E RT I N O PERMIT APPLICATION FORM APN# 2(P�'" 3 00-73- Date: q1 -7 / -7 l Building Address: '7 ,:9073y Carde-o man0(- Cf Cape rf7no, C4 c�so�y Mailing Address(if different from building address): Are Hazardous Materials being used as part of this project? Yes ❑ No [i-3' HOA: (Exterior work only) Yes M No ❑ If yes,provide letter from HOA Owner's Name: , Phone �J '_ �� 4,7�._ -777- Z f��C% CITY OF CITY OF (:UPERTINO GENERAL BUILDING APPLICATION CUPERTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM PARTITION WALLS 1PARTICOMM Partition Interior Commercial B 1PARTICOMM 1PARTIR Partition Interior Residential B 1PARTIR<=30 RETAINING WALLtCONCRETE OR MASONR 1 RETSTN Standard(up to 50 ft) B IRETSP310 Special D4-.sign, 3-10' high(up to 50 `) B 1RETSP10 Special Do-sign,over 10' high(up to B 50' 1RETCRB< Gravity/Crib Wall, 0-10'high(up to B 50 ft 1RETCRB> Gravity/C-ib Wall over 10' high(up to B 50 ft SIDING 1SIDEST/BK Siding, Stine&Brick Veneer B interior/e-cterior 1SIDEOTHER Siding all other Bl't SKYLIGHTS 1 SKYL<10 SF Skylight 1,.-ss than 10 sf B 1 SKYL>l0SF Skylight greater than 10 sf or B structural 1STAIRS Stairs-firs:flight/ea addt'l B STORAGE RACKS 1 SRACKS<=8 Storage R icks 0-8' high(up to 100 sf) B 1 SRACKS>8 Storage R icks over 8' high(up to 100 B st 4 of 5 CITY OF III CITY OF CUPERTINO GENERAL BUILDING APPLICATION CUPERTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Des cription Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications(up to 400 sf) B ;r u additional stucco application `� _/ 1 WINREP Replacement windows/sliding glass B door ea 8 windows 1WINMEWSTR New Wildow-structural shear B wall/ma,.o includes plan ck fee 1 EPERMITFEE Electrics 1 Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Al one Electric Pln Ck(hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 W Min Standarc Plan Check(when no E/M/P) B when not over counter) hourly- :and alone 1BCBSC Cal Bld€,Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Kesidential B 1BSEISMlC0 Seismic Commercial B 1TRAVDOC Travel&.Documentation B 1BUSLIC BusinesE License B 5 of 5