10090130 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11422 GARDEN TERRACE DR CONTRACTOR:GREENERBLU IDHM,INC PERMIT NO: 10090130
OWNER'S NAME: NGUYEN TRUNG-KHAC ET AL PO BOX 612048 DATE ISSUED:09/16/2010
IER'S PHONE: 4088471567 SAN JOSE,CA 95161 PHONE NO:(408)418-2000
❑ LICENSED CONTRACTOR'S DECLARATION r— F
'` BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class7�7 Lic.#� 3 V
l MECH RESIDENTIAL COMMERCIAL
Contracto �(- p t).�.L V Date 010
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SIDING&TRIM REMOVAL&REPLACEMENT,STUCCO
(commencing with Section 7000)of Division 3 of the Business&Professions REPAIR,STUCCO 38,SIDING 82
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:36230081.00 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: !_ 1��9
Signatu Date 6I) o
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
I,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,
Business&Professions Code) Signature of Applicant: Date:
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. 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.
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 er or authored
forthwith comply with such provisions or this permit shall be deemed revoked.
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
-mify 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 AF
CITY OF C'UPERTINO
GENERAL BUILD)[NG 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 1PARTIR<=30
RETAINING
WALL(CONCRETE
OR MASONRY
I RETSTN Standard(xp to 50 ft) B
IRETSP310 Special Dc sign, 3-10' high(up to 50 `) B
1RETSPI0 Special Dc sign,over 10' high(up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high(up to B
50 ft
1RETCRB> Gravity/0-ib Wall over 10' high(up to B
50 ft
SIDING
1 SIDESTBK Siding, Stene&Brick Veneer B
interior/e:cterior
1 SIDEOTHER Siding all other B �2
SKYLIGHTS
1SKYL<10 SF Skylight lo=ss than 10 sf B
1 SKYL>l OSF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-firs:flight/ea addt'l B
STORAGE RACKS
1SRACKS<=8 Storage Racks 0-8' high(up to 100 sf) B
is KS>8 Storage Racks over 8' high(up to 100 B
st
4of5
CITY OF
CITY OF CUPERTINO
GENERAL BUILD[NG APPLICATION
CUPERTINO FEE SCHEDULE
Quantity/Sf Fee ID Fee DeseAption Fee Permit Type
Group 1GENRES or
IGENCOM
1STUCOAP Stucco Applications(up to 400 sf) B � i
additional stucco application
I WINREP Replaceme snt windows/sliding glass B
door ea 8 windows
1 WINMEWSTR New Wine,ow-structural shear B
wall/masoary(includes plan ck fee
IEPERMITFEE Electrical Permit Fee E
IMPERMITFEE Mechanic�.l Permit Fee M
IPPERMITFEE Plumbing-?ermit Fee P
IELCPLNCK Stand Alone Electric PIn Ck(hourly) E
1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M
IPLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P
1 STPLNCK-(3 W Min Standard F Ian Check(when no E/M/P) B
when not over counter) hourl -stagy Id alone
IBCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Rcsidential B
IBSEISNIICO Seismic Commercial B
ITRAVDOC Travel&Documentation B
IBUSLIC Business L icense B
5 of 5
CITY OF
is CITY OF C UPERTINO ( 00qO
GENERAL BUILDING
C U P E RT{N O PERMIT APPLICATION FORM
APN# � /_a„ � Date:
Building Address: lU /
11 y22 C?arc%r)Terrac•e Crfvr, CU, 2rfin v X1501 y
Mailing Address(if different from building address):
i 10 . poalscu nve. . Dog,. Saun �_
� CA (151
Are Hazardous Materials being used as part of this project? Yes ❑ No Ll
HOA: (Exterior work only) Yes QQ rNo ❑ Ifes, rovide letter from HOA
Owner's Name• ho,-C, Phone#
Tr
Contractor: Phone: q05 L//6-2i��
G,�-e_L1eg' _77 D1-iM Fax: 4/08 -, q/6 -2>00i
Contractor License#: ctIto j 30
Cupertino Business License#:
Contact:
Phone:
Fax:
Residential]21 Commercial ❑
Job Description: 1 G' �•fl (;��'1 C ►1'1 Cerill��,�6_l L-1_.n C/
Building Pe it Info:
Bld Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
1-A, 1-B ❑ ILg11 V-A ❑ IT/iiT B,IV-HT,V-B [�
des i•clen�- 3 2-3
Valuation: 415!3s
5!3Square Footage:
Pro'ect Size: Express[ Standard ❑ Lar e[] 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 �n.orp.
Revised 07/14/09