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10090117 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20712 GARDEN PLACE CT CONTRACTOR:GREENERBLU JDHM,INC PERMIT NO:10090117 OWNER'S NAME: KURAM NARAYANA&MALINI TADIMARRI PO BOX 612048 DATE ISSUED:09/16/2010 VER'S PHONE: 4089969767 SAN JOSE,CA 95161 PHONE NO:(408)418-2000 ❑ c�LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT F PLUMB r License Class ]J ` Lic.# -/1/ID 15 0 MECH r RESIDENTIAL r COMMERCIAL r Contractor�f�ne_r 1�1 J Date r(r ZD 10 JOB DESCRIPTION: SIDING(88SQ)&TRIM REMOVAL&REPLACEMENT. I hereby affirm that I am licensed under the provisions of Chapter 9 STUCCO(88SQ)REPAIR (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 Sq.Ft Floor Area: Valuation:$1585 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36230061.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save 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 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 4 9.18. Issued by ' yf"'Z—`�' Date: Signature "ate Li OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. I,as owner of the property,or my employees with wages as their sole compensation, 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). 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. 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 Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I r or authorize ent become subject to the Worker's Compensation provisions of the Labor Code,I must Date: 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.) correct.I agree to comply with all city and county ordinances and state laws relatin€ Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address 7nify and keep harmless the City of Cupertino against liabilities,judgments, ,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 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. Licensed Professional Signature Date CITY OF CITY OF CUPERTINO 112 GENERAL BUILDING APPLICATION CUPERTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Descri ption Fee Permit Type Group 1GENRES or 1GENCOM PARTITION WALLS 1PARTICOMM Partition In-.erior Commercial B 1PARTICOMM 1 PARTIR Partition Interior Residential B 1PARTIR<=30 RETAINING WALL(CONCRETE OR MASONR 1RETSTN Standard(up to 50 ft) B IRETSP310 Special De:;ign, 3-10' high(up to 50 `) B 1RETSPI0 Special Deign,over 10' high(up to B 50' 1RETCRB< Gravity/Crib Wall, 0-10'high(up to B 50 ft 1RETCRB> Gravity/Crib Wall over 10' high(up to B 50 ft SIDING 1 SIDESTBK Siding, Stc ne&Brick Veneer B interior/e?_terior 1 SIDEOTHER Siding all ether B SKYLIGHTS 1 SKYL<10 SF Skylight It ss than 10 sf B 1 SKYL>l OSF Skylight g-eater than 10 sf or B structural 1STAIRS Stairs-first flight/ea addt'1 B STORAGE RACKS 1 SRACKS<=8 Storage R;icks 0-8' high(up to 100 s fl B 1 SRACKS>8 Storage R:icks over 8' high(up to 100 B st z of 5 CITY OF CITY OF CUPERTINO Im GENERAL BUILDING APPLICATION CUPERTINO FEE SCHEDULE Quantity/Sf Fee ED Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications(up to 400 sf) B additional:stucco application IEP Replacement windows/sliding glass B door ea 8 windows 1WINMEWSTR New Wind.)w-structural shear B wall/masor includes plan ck fee IEPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M IPPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Aloi ie Electric Pln Ck(hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M 1 PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 W Min Standard Flan Check(when no E/M/P) B when not over counter) hourly-stand id alone IBCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES IBSEISMICR Seismic R-,sidential B IBSEISMICO Seismic Commercial B 1TRAVDOC Travel&J documentation B 1BUSLIC Business license B of 5 CITY OF CITPERTINO CUFEKTIN0 GENERAL 13UILDING PERMIT APPLIt;ATION FORM Date: (] f O APN # I Building Address: o9v?/r,2 gardef) PI(ice �f Mailing Address (if different from building address):�� Are Hazardous Materials being used as part of this p roject? Yes ❑ No HOA: (Exterior work only) Yes ["/No ❑ If e:;,provide letter from HOA Owner's Name: Phone#: q06- Q_ �j(,, Y 7 C=7 U cr Naca, o0C% li Ic�►c ► rn�.c ;k 7 (� Co tractor: Phone: y0$- -c//S' 0-0 ` rCenr�lu G Fax: Contractor License#: 9 7��3 Cupertino Business License#: Contact: Phone: Z/06-(KI-1 (ire r3�r�l ./ Fax: �/Df3'X55-1!8� -sidential Commercial ❑ Job Description: 5 . ,//0 _/ �,/%d re,r) vUf.l ar2� rep lace,�� f 5 fu c cv repa J'r 'SO to Q k8 Building Pe it Info: Bldg Elect. ❑ P:umb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: Res rooen 1-A, 1-B ❑ II/III/V-A ❑ I EI B, IV-HT,V-B al", v- Valuation: Square Footage: Project Size: Express [✓]J Standard ❑ Large E Major ❑ Green Building: Please complete relevant portion oithe Green Buiding/LEED Checklist& attach it to the application or if applicable, include in plan set & the sheet index. Points Achieved: )r help, contact Build it Green at r".builditgreen.or Revised 07/14/09 3