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10090100 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20715 GARDEN PLACE CT CONTRACTOR:GREENERBLU JDHM,INC PERMIT NO: 10090100 OWNER'S NAME: DR.S BODAPATI PO BOX 612048 DATE ISSUED:09/16/2010 iER'S PHONE: 4089811197 SAN JOSE,CA 95161 PHONE NO:(408)418-2000 ❑ LICENSED CONTRACTOR'S DECLARATIONr 1�v BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.#!ff Le l i � MECH r RESIDENTIAL I— COMMERCIAL Contracto �, `J Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SIDING(80SQ)&TRIM REMOVAL&REPLACEMENT. (commencing with Section 7000)of Division 3 of the Business&Professions STUCCO Code and that my license is in full force and effect. REPAIR(24SQ)-SEE PERMIT#10090089 FOR FEES 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 permit is issued. Sq.Ft Floor Area: Valuation:$1585 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:36230067.00 Occupancy Type: 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. f Signatu Date Issued by: ZSR Date: Li OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. 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. er or author' Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name inify and keep harmless the City of Cupertino against liabilities,judgments, ,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional C.'iTY OF CITY OF CIUPERTINO 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 1 pARTTR Partition Im erior Residential B 1PARTIR<=30 RETAINING WALL(CONCRETE OR MASONRY 1 RETSTN Standard(up to 50 ft) B IRETSP310 Special Design,3-10' high(up to 50 `) B 1RETSPIO Special De;;ign,over 10' high(up to B 50' 1RETCRB< Gravity/Cr b Wall, 0-10'high(up to B 50 ft 1RETCRB> Gravity/Cr_b all over 10' high(up to B 50 ft) SIDING 1 SIDESTBK Siding, Stc ne&Brick Veneer B interior/e�.terior 1 SIDEOTHER Siding all other 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 IST URS Stairs-first flight/ea addt'l B STORAGE RACKS 1 SRACKS<=8 Storage R;icks 0-8' high(up to 100 sfl B 1 SRACKS>8 �_StorageRacks over 8' high(up to 100 B st z.of 5 CITY OF CITY OF C:UPERTINO GENERAL BUILD-ING APPLICATION CUPERTINO FEE SCHEDULE Quantity/Sf Fee ED Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Ap plications(up to 400 sf) B additional stucco application 1 WINREP Replacement windows/sliding glass B door ea 8 windows 1WINMEWSTR New Window-structural shear B wall/maso: includes plan ck fee IEPERMITFEE Electrical ?ermit Fee E 1 MPERMITFEE Mechanic,Il Permit Fee M 1PPERMITFEE Plumbing Permit Fee P IELCPLNCK Stand Alo le Electric Pln Ck(hourly) E 1MECPLNCK Stand Alo ze Mechanical Pln Ck(hrly) M 1 PLMBLNCK Stand Alo:ie Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 Hr Min Standard flan Check(when no E/M/P) B when not over counter) hourly- and alone 1BCBSC Cal Bldg;standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMIC0 Seismic Commercial B 1TRAVDOC Travel& Documentation B IBUSLIC Business:'license B :iof5 0U � CITY OF its CITY OF CUPERTINO GENERAL -BUILDING CUPERTINO PERMIT APPLIC_�ATION FORM APN# 0 r 1 Date: ' r Building Address:D�'� QIGC� Orf � (_h; v CASd�c� Mailing Address(if different from building address): �_� � � � -210 . i ��c � Ave. . �► � San � Are Hazardous Materials being used as part of this project? Yes ❑ No [L]' HOA: Exterior work only) Yes [ENo ❑ If ycs,provide letter from HOA Phone#•, y�1- /i Owner's Name: G1,�"1 L100 Df. S • O C�Q Contractor: Phone: � �j ' L//c,_,, 20 G�e I\ � , 1,�. 1��►l C Fax Contractor License#: oil-161-11-300 Cupertino Business License#: Conta t: Phone: Gf(!G( L21)CL, Fax: Residential][]' Commercial ❑ Job Description: <:�: i i v,\ -e(1°1 v` &J a.n(_/ 'STuccz) r e_6L% e 1�tl;kL c> 2 H Buildin�g�p�el�nfo: L� Elect ElPlumb ❑ Mech El Bld Type of Construction (Usage Class): Occupancy Type: ReS ►*Clen� 1-A, 1-B. 0 IUIII/V-A ❑ II/III B,IV-HT,V-B ❑ Valuation _ Square Footage: � IS�� Project Size: Ex ress[Standard ❑ Large[] Major ❑ Green Building:Please complete relevant portion of the Green Building/LEED Checklist&attach it to the application or if applicable,include in plan set&the sheet index. Points Achieved: For help,contact Build it Green at www.buildit reen.or Revised 07/14/09