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10090108 CITY OF CUPERTI140 BUILDING PERMIT BUILDING ADDRESS: 20716 GARDEN PLACE CT CONTRACTOR:GREENERBLU JDHM,INC PERMIT NO: 10090108 OWNER'S NAME: BOYLE JACQUELINE E PO BOX 612048 DATE ISSUED:09/16/2010 BIER'S PHONE: 4084469184 SAN JOSE,CA 95161 PHONE NO:(408)418-2000 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT F PLUMB ` r License Class D Lic.# q LA& 130 r F r / ` MECH RESIDENTIAL COMMERCIAL Contractor(o;U r n L) Date q1 %,, 1 ZOl I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SIDING(46SQ)&TRIM REMOVAL&REPLACEMENT. (commencing with Section 7000)of Division 3 of the Business&Professions STUCCO(24SQ)REPAIR.SEE PERMIT#100990089 FOR FEES 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:36230062.00 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 accrete 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 9.18. f Issued b�y''� Date: Signature Date �1 1 / 0 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 1 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 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 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. 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 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 er or authoro a d___4VDate: become subject to the Worker's Compensation provisions of the Labor Code,I muse �' —&L L 1?6'I'�J 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 relating 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 unify 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 its GENERAL BUILDING APPLICATION CUPERTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM PARTITION WALLS 1 PARTICOMM Partition Im erior Commercial B 1PARTICOMM 1PARTIR Partition Im erior Residential B 1PARTIR<=30 RETAINING WALL(CONCRETE OR MASONRY 1RETSTN Standard(up to 50 ft) B IRETSP310 Special Del:ign,3-10' high(up to 50 `) B 1RETSP10 Special Design,over 10' high(up to B 50' 1RETCRB< Gravity/Crib Wall,0-10'high(up to B 50 ft 1RETCRB> Gravity/Cr:b Wall over 10' high(up to B 50 ft SIDING 1SIDESTBK Siding, Stone&Brick Veneer B (interior/exterior)3 1 SIDEOTHER Siding all other B SKYLIGHTS 1SKYL<10 SF Skylight less than 10 sf B 1SKYL>10SF Skylight ga-eater than 10 sf or B structural 1STAIRS Stairs-first flight/ea addt'l B STORAGE RACKS 1 SRACKS<=8 Storage R�cks 0-8' high(up to 100 SO B 1SRACKS>8 Storage R,cks over 8' high(up to 100 B st 4 of 5 CITY OF CITY OF C'UPERTINO GENERAL BUILDING APPLICATION CUPERTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications(up to 400 sf) B additional stucco application 2 1 V9NREP Replacemont windows/sliding glass B door ea f windows 1V;1NMEWSTR New Winclow-structural shear B wall/maso, includes plan ck fee IEPERMITFEE Electrical Permit Fee E IMPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit Fee P IELCPLNCK Stand Alo;ie Electric Pln Ck(hourly) E IMECPLNCK Stand Alone Mechanical Pin Ck(hrly) M IPLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 Hr Min Standard Flan Check(when no E/NVI/P) B when not over counter) hourl -stagy id alone IBCBSC Cal Bldg!'tandards Commission Fee B ALL PERMIT TYPES IBSEISMICR Seismic R;sidential B IBSEISMICO Seismic Commercial B ITRAVDOC Travel&Documentation B IBUSLIC Business I•icense B 5 of 5 0 CITY OF ` W9 CITY OF C'UPERTINO GENERAL BUILDING C U P E RT I N O PERMIT APPLICATION FORM APN# Date: 9 Building Address: ��/� �Ccrden Place C� Cu. er-hno , eA 950141 Mailing Address(if different from building address): 1-210 Are Hazardous Materials being used as part of this project? Yes ❑ No HOA: Exterior work only) Yes Q�No ❑ If es,provide letter from HOA Owner's Name: Phone#: L). ._ j - ��i 8 �� =�+ Contractor: Phone: 1 T °� CL,�-e—L-\u U. 7DH0) , Fax 03 - 2-v0i Contractor License#: ON66,/3 n Cupertino Business License#: Contact: Phone: L/� '- c� tree( bai c=l qFax: � Residential FL,? Commercial ❑ Job Description: 1 C� n c 1 �"(-1 ill 2 I Y 1�`v� 1 �i.jl�� r e l� Building Pe it Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: �2S �•d�n��3 1-A, I-B ❑ IVIIIN-A ❑ IMII B,IV-HT,V-E [� 2 Valuatiap.: Square Footage: Project Size: Ex ress[Standard ❑ Large[I Major ❑ Green Building: Please complete relevant portion c f 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.builditare,:n.or Revised 07/14/09