10090121 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11476 GARDEN TERRACE DR CONTRACTOR:GREENERBLU JDHM,INC PERMIT NO: 10090121
OWNER'S NAME: SATYAJIT CHOWDHURY&OINDRILA DHAR PO BOX 612048 DATE ISSUED:09/16/2010
4ER'S PHONE: 4083078480 SAN JOSE,CA 95161 PHONE NO:(408)418-2000
❑ LICENSED CONTRACTOR'S DECLARATIONF r
rr BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class 3 Lic.# �P 3C� MECH r RESIDENTIAL r COMMERCIAL r"
Contractor('��n11 n `IJ Date el I I1.e
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SIDING&TRIM REMOVAL&REPLACEMENT,STUCCOR
(commencing with Section 7000)of Division 3 of the Business&Professions REPAIR,SRUCCO 38,SIDING 148
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:36230089.00 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:
Signatu &4te��
U 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,
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 107ner or authgr' ed a `
forthwith comply with such provisions or this permit shall be deemed revoked. (� Date: t 0
CONSTRU ION 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 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 BUILD-ING APPLICATION
CUPERTINO FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
PARTITION WALLS
1PARTICOMM Partition Irterior Commercial B 1PARTICOMM
1 PARTIR Partition Ir,terior Residential B 1PARTIR<=30
RETAINING
WALL(CONCRETE
OR MASONR
1 RETSTN Standard(t_p to 50 ft) B
IRETSP310 Special Deign, 3-10' high(up to 50 `) B
1RETSP10 Special DeAgn,over 10' high(up to B
50'
1RETCRB< Gravity/Cr;b 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, Sto ie&Brick Veneer B
interior/exterior
1SIDEOTHER Siding all other B L ,;� OK
SKYLIGHTS
1 SKYL<10 SF Skylight le:,s than 10 sf B
1 SKYL>l 0SF Skylight gr�;ater than 10 sf or B
structural
1STAIRS Stairs-first:Yight/ea addt'1 B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high(up to 100 so B
1SRACKS>8 Storage Racks over 8' high(up to 100 B
st
4cf5
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 0
1 WINREP Replacement windows/sliding glass B
door ea 8 windows
1 WINMEWSTR New Window-structural shear B
wall/masor, includes plan ck fee
IEPERMITFEE Electrical Fermit Fee E
1MPERMITFEE Mechanical Permit Fee M
IPPERMITFEE Plumbing Fermit Fee P
IELCPLNCK Stand Along,Electric Pln Ck(hourly) E
IMECPLNCK Stand Along;Mechanical Pln Ck(hrly) M
1PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P
1 STPLNCK-(3 Hr Min Standard Pl;In Check(when no E/M/P) B
when not over counter) hourly-stand l alone
IBCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
IBSEISMICR Seismic Residential B
IBSEISMICO Seismic Corlmercial B
1TRAVDOC Travel&Dc-cumentation B
IBUSLIC Business License B
5o15
CITY OF r ,
Ov011
1
Im CITY OF C UPERTINO
GENERAL BUILDING
C U P E RTI N O PERMIT APPLICATION FORM
"N# a► 3� O� Date: n/7//v
Building Address: Pg7b (�arden l errac,- Drl vti, Cttperhi )oj CA -i5 DIV
Mailing Address(if different from building address):
1.21 o S G.Scoro Ove. ;DQ DS6.n J�
Are Hazardous Materials being used as part of this project? Yes ❑ No
HOA: (Exterior work only) Yes [�J'No ❑ If y0s,provide letter from HOA
Owner's Name: Phone#
S at a"\i� 0 if n 6 171la C h aT �/dd
Contractor:
Phone: iA lJ j Z//v-2 0 0
G�e LU 7 D H 01 T Fax:
Contractor License#: 3 u
Cupertino Business License#:
Conta t: Phone: LJO&- u4
(C r eL�c! r&) Fax:
Residentia Commercial ❑
Job Description: 1(� 1 n (�i1(, -,-('p ►1'1 2111�� 1 cu)C
1 L4Building Pe it Info: `
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
1-A, 1-B ❑ IUIIIN-A ❑ II/VI B,IV-HT,V-B R eS)d e�
Valuation: Square Footage:
Project Size: Express[ Standard ❑ Large[] Major ❑
Green Building: Please complete relevant portion o 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.buildit ree n.or
Revised 07/14/09