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10090102 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20735 GARDEN PLACE CT CONTRACTOR:GREENERBLU JDHM,INC PERMIT NO: 10090102 OWNER'S NAME: TIMOTHY&IRENE TSU PO BOX 612048 DATE ISSUED:09/16/2010 1ER'S PHONE: 4084480104 SAN JOSE,CA 95161 PHONE NO:(408)418-2000 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT r— PLUMB r License Class A Lic.# n J Gf� MECH r RESIDENTIAL� COMMERCIAL r Contractor(�(p 0,►,at�f� Date � 1�L h-C,10 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SIDING(36SQ)&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. (24SQ)REPAIR-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 Sq.Ft Floor Area: Valuation:$1585 permit is issued. APPLICANT CERTIFICATION APN Number:36230065.00 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. Issued by:—'��_.-.----�'""'._-��._�-� Date: SignaADate /'LC�(� 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 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, Signature of Applicant: Date: Business&Professions Code) 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. 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,I become subject to the Worker's Compensation provisions of the Labor Code,I must O er or authorize age forthwith comply with such provisions or this permit shall be deemed revoked. Date: 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 CITY OF C'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 WARTIR<=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 Design,over 10' high(up to B 50' 1RETCRB< Gravity/Crib Wall, 0-10'high(up to B 50 ft 1 RETCRB> Gravity/Ci ib Wall over 10' high(up to B 50 ft SIDING 1 SIDESTBK Siding, Stene&Brick Veneer B interioAerior 1SIDEOTHER Siding all other B 36 SKYLIGHTS 1 SKYL<10 SF Skylight It ss than 10 sf B 1 SKYL>10SF Skylight g-eater than 10 sf or B structural 1STAIRS Stairs-first flight/ea addt'1 B STORAGE RACKS 1 SRACKS<=8 Storage Racks 0-8' high(up to 100 sf) B 1 SRACKS>8 Storage R-Lcks over 8' high(up to 100 B st 4 of 5 CITY OF CITY OF (;UPERTINO GENERAL BUILDING APPLICATION CUPERTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM ISTUCOAP Stucco Applications(up to 400 sf) B J additional stucco application Z y 1 WINREP Replacemi:nt windows/sliding glass B door ea f windows 1WINMEWSTR New Winslow-structural shear B wall/maso includes plan ck fee 1EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit Fee P lELCPLNCK Stand Alo le Electric Pln Ck(hourly) E 1MECPLNCK Stand Alo ie Mechanical Pln Ck(hrly) M 1PLMBLNCK Stand Alo le Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 Hr Min Standard Ilan Check(when no E/M/P) B when not over counter) hourl -sta id alone 1BCBSC Cal Bldg:standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic R,-sidential B 1BSEISMIC0 Seismic Commercial B 1TRAVDOC Travel&]documentation B 1BUSLIC Business License B 5 of 5 r CITY OF l a] CITY OF CUPERTINO GENERAL BUILDING C U P E RT I N O PERMIT APPLICATION FORM APN# Building Address: a0-735 Ccu-c Pla c� C cu �� 9� Mailing Address(if different from building address): i.2ib s. e5atiscon-% Ove. . D,;- pp 56n7 CA q5 k�f Are Hazardous Materials being used as part of this project? Yes ❑ No [J' HOA: (Exterior work only) Yes [Q"'No ❑ If y-.s,provide letter from HOA Owner's Name: Phone 0- T) l m v K4 .Sren�e i s�. Phone: q05 y/6-20 Contractor: G�-e-t?11 '` u. D 1-r 0) C Fax: q/6 -2 0 01 Contractor License#: oiw J j-30, Cupertino Business License#: Contact: Phone: LY1 C C'L ei Irk at"c- Fax: ��S- H C) Residential)[vr Commercial ❑ Job Description: �' 1 +'1 C� -I 9 ill ; e m wc�-I C1 n l r e l� �Tt,l C�..v t e-P Cd-� r� ��l�l;�,i7 Z Building Pe �itnfo: Bldg Elect ❑ F lumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: 1-A 1-B ILgHN-A ❑ II/III B,IV-HT,V-B ❑ Res i*cj e—n� Valuation: Square Footage: [P—roect Size: Express Standard ❑ Large[] Ma'or ❑ 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