10090101 Y CITY OF CUPERTIN O BUILDING PERMIT
BUILDING ADDRESS: 20721 GARDEN PLACE CT -ONTRACTOR:GREENERBLU JDHM,INC PERMIT NO:10090101
OWNER'S NAME: JOHNNIE&RAQUEL VEGAS PO BOX 612048 DATE ISSUED:09/16/2010
;ER'S PHONE: 4084461626 3AN JOSE,CA 95161 PHONE NO:(408)418-2000
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Cl Lic.# `� J MECH r RESIDENTIAL r COMMERCIAL r
Contractor Date l)
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB SIDING(80SQ)&TRIM REMOVAL&REPLACEMENT.
STUCCO
(commencing with Section 7000)of Division 3 of the Business&Professions REPAIR(24SQ)-SEE PERMIT#10090089 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
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:36230066.00 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- int source regulations per the Cupertino Municipal Code,Section
9.18. Date: d
Issued by:
Signatur Date f (o G
V 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
1,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, Date:
Business&Professions Code) Signature of Applicant:
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
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
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,l O o uthoriz g
become subject to the Worker's Compensation provisions of the Labor Code,I must Date.1 (e 6 a(U
forthwith comply with such provisions or this permit shall be deemed revoked.
4
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 constriction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relatin€ 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
nnify 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
CITY OF
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
CUPERTINO FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
PARTITION WALLS
Comm Partition Irterior Commercial B 1PARTIC OMM
1 pARTIR Partition Ir terior Residential B 1PARTIR<=30
RETAINING
WALUCONCRETE
OR MASONR
1 RETSTN Standard(i ip to 50 ft) B
1RETSP310 Special Design, 3-10' high(up to 50 `) B
1RETSP10 Special De sign,over 10' high(up to B
50'
1RETCRB< Gravity/Cj ib 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, Stene&Brick Veneer B
interior/e:aerior
1SIDEOTBER Siding all ether B
SKYLIGHTS
1SKYL<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 RACK5
1 SRACKS<=8 Storage Racks 0-8' high(up to 100 sf) B
1SRACKS>8 Storage Racks over 8' high(up to 100 B
st
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-CIT: OF
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
CUPERTINO FEE SCHEDULE
Quantity/Sf Fee ID Fee Descri ption Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications(up to 400 sf) B
additional stucco application 29
IV4NREP Replacemejtt windows/sliding glass B
door ea 8 windows
1W STMEWSTR New Window-structural shear B
wall/mason includes plan ck fee
IEPERMITFEE Electrical Permit Fee E
1MI'ERMITFEE Mechanica: Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M
1PLMBLNCK Stand Alore Plumbing Pln Ck(hrly) P
1 STPLNCK-(3 W Min Standard P[an Check(when no E/M/P) B
when not over counter hourl -star d alone
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
ITRAVDOC Travel&Documentation B
IBUSLIC Business License B
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CITY OF
CITY OF CUPERTINO
10 GENERAL BUILDING
C U P E RT I N O PERMIT APPLICATION FORM
APN# �� G` Date:
Building Address:
CW90 �el Nee 6w,± Cu er�nv CA q5-v)
Mailing Address(if different from building address):
Are Hazardous Materials being used as part of this project? Yes ❑ No []'
HOA: (Exterior work only) Yes eNo ❑ If Ess,pride letter from HOA
Owner's Name: Phone#- �y _ ,z 4c,
�ohnni e, RQ
Veqas `a0`'
Contractor: Phone: iA 0?) - Y/13-2 0ID
Cjz Ne� _77 D O O) C. Fax
Contractor License#: eta/ o
Cupertino Business License#:
Contact: Phone: ya d- U q 1-1 y y
L CLFax: a "v
Residentia Li]e Commercial ❑
Job Description: < 1 o-N �-Z IY1 i��,,��i I 01.11 r
Building Pe it Info:
Bldg Elect ❑ P lumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
I-A, 1-B [_1 IUIII/V-A ❑ II/III B,IV-HT,V-B R e S I'd e—n
Valuation: S Square Footage:
I S S
Project Size: Express 2-1""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 ref:n.or
Revised 07/14/09