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10090120CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11482 GARDEN TERRACE DR CONTRACTOR: GREENERBLU ]DHM, INC OWNER'S NAME: CHO WON H AND YOON A PO BOX 612048 NER'S PHONE: 4085335228 SAN JOSE, CA 95161 L_. LICENSED CONTRACTOR'S DECLARATION .-icense Class Lic. # —1 U \3 c �ontracto&r-�, J Date5kk1 60 I hereby affirm that I am licensed under the provisions of Chapter 9 ;commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: [ 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 permit is issued. 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 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. Signa to iJ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 permit is issued. I certify that in the performance of the work for which this permit is issued, I shall 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 upon the above mentioned property for inspection purposes. (We) agree to save •mify and keep harmless the City of Cupertino against liabilities, judgments, , and expenses which may accrue against said City in consequence of the 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. Signature Date PERMIT NO: 10090120 DATE ISSUED: 09/16/2010 PHONE NO: (408) 418-2000 BUILDING PERMIT INFO: BLDG r— ELECT r— PLUMB r MECH r RESIDENTIAL r COMMERCIAL r— JOB DESCRIPTION: SIDING & TRIM REMOVAL AND REPLACEMENT, STUCCO REPAIR, 54 STUCCO, 50 SIDING Sq. Ft Floor Area: I Valuation: $1585 APN Number: 36230090.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. or author' ed a g / l b /ZG' G%✓1 _ Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CITY OF C'UPERTINO GENERAL BUILDING APPLICATION CUPERTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Deser iption Fee Group Permit Type 1GENRES or 1GENCOM PARTITION WALLS 1PARTICOMM Partition Interior Commercial B 1PARTICOMM 1PARTIR Partition Interior Residential B 1PARTIR<=30 RETAINING WALL(CONCRETE OR MASONRY 1 RETSTN Standard (up to 50 fl) B IRETSP310 Special De,,Jgn, 3-10' high (up to 50 `) B 1RETSPI0 Special De.,;ign, over 10' high (up to 50' B 1RETCRB< Gravity/Crib Wall, 0-1O'high (up to 50 ft B 1 RETCRB> Gravity/Cri b Wall over 10' high (up to 50 fl B SIDING 1SIDEST/BK Siding, Stade & Brick Veneer interior/ex erior B 1 SIDEOTHER Siding all other B S o E3' SKYLIGHTS 1 SKYL<10 SF Skylight lei s than 10 sf B 1 SKYL> I OSF Skylight groater than 10 sf or structural B 1STAIRS Stairs -first ilight/ea addt'l B STORAGE RACKS 1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B 1 SRACKS>8 Storage Racks over 8' high (up to 100 st B 4cf5 CITY OF CITY OF C'UPERTINO su GENERAL BUILDING APPLICATION CUPERTINO FEE SCEIEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM 1STUCOAP Stucco Apl,lications (up to 400 sf) additional :,tucco application B 5-) Ll 1VVINREP Replacement windows/sliding glass door ea 8 windows B IWINMEWSTR New Window -structural shear wall/masor includes plan ck fee B IEPERMITFEE Electrical Fermit Fee E 1MPERMITFEE Mechanica Permit Fee M 1PPERMITFEE Plumbing Permit Fee P 1ELCPLNCK Stand Alon.- Electric Pln Ck (hourly) E 1 MECPLNCK Stand Alon - Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand Alon,- Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min when not over counter) Standard Plan Check (when no E/M/P) hourl -stan i alone B IBCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Re;,idential B 1BSEISMIC0 Seismic Co umercial B ITRAVDOC Travel & Documentation B IBUSLIC Business License B 5cf5 CITY OF 1 bo IVI CITY OF CUPERTINO GENERAL BUILDING C U P E RT 1 N O PERMIT APPLICATION FORM "N # Date: 9/, bt) a O O O Building Address: ]1 -- y S2 Cure e� lerrac•e Drive) Cuper47na, A 95vJy Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes [I No [i]' HOA: Exterior work only) Yes [' No ❑ If ,:s, provide letter from HOA Owner's Name: M • ac Anne i a Phone #- Ll ZO-`��`��r�- Contractor: J 1 1,Phone: Ll 0?) - q/ 6 - 200—,> C-;, N-Lc\e" 01-10) 17Z CN -c. Fax 1/08- I//i3-200i Contractor License #:y&, j?, 00 Cupertino Business License #: Contact: Phone: yrs - �' l� 1 IL/ V ('eGj jV�aC C I Fax: ` L�_ � QS,- H 9 ) ResidentiaY 2- Commercial ❑ Job Description: f:) f C1 1, cl S cL,,N j 1 il'� - Z l�f 1 vvP I �i n �/ �� (�. e In e. n . Building Pe it Info: Bldg Croll" Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: LL Res (d en L 1-A, 1-B ❑ RMI/V-A ❑ IIIIII B, IV -HT, V -B ❑ Valuation: _ ,- Square Footage: Project Size: Express L'� Standard ❑ Large [] Major ❑ Green Building: Please complete relevant portion oi'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 reen.or Revised 07/14/09