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10090126 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11440 GARDEN TERRACE DR CONTRACTOR:GREENERBLU JDHM,INC PERMIT NO: 10090126 OWNER'S NAME: ONOZAWA RESIDENCE PO BOX 612048 DATE ISSUED:09/16/2010 4ER'S PHONE: 4082574299 SAN JOSE,CA 95161 PHONE NO:(408)418-2000 ❑ LICENSED CONTRACTOR'S DECLARATIONr BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# ILi 1.0 3 MECH f— RESIDENTIAL F COMMERCIAL � Contracto" Date 9 Ilk, ZO 1 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SIDING&TRIM REPAIR&REPLACEMENT,STUCCO (commencing with Section 7000)of Division 3 of the Business&Professions REPAIR, Code and that my license is in full force and effect. STUCCO 68,SIDING 40 1 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 permit is issued. Sq.Ft Floor Area: Valuation:$1585 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:36230084.00 Occupancy Type: correct.I agree to comply with all city and county ordinances and state laws relating to building constriction,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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signatur atel Issued l Date:` LI OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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. I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain 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. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. 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. ner or autho ' a ate: J zd to I 6VZ4 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 relatin€ I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name unify and keep harmless the City of Cupertino against liabilities,judgments, .,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 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 1PARTIR<=30 RETAINING WALL(CONCRETE OR MASONRY 1RETSTN Standard(up to 50 ft) B IRETSP310 Special D-,sign, 3-10' high(up to 50 `) B 1RETSPIO Special D-,sign,over 10' high(up to B 50' 1RETCRB< Gravity/Crib Wall, 0-10'high(up to B 50 ft 1RETCRB> Gravity/Crib Wall over 10' high(up to B 50 ft SIDING 1SIDESTBK Siding, Stine&Brick Veneer B interior/exterior 1SIDEOTHER Siding all other B y�, SKYLIGHTS 1 SKYL<10 SF Skylight 1-ss than 10 sf B 1 SKYL>l OSF Skylight€reater than 10 sf or B structural 1STAIRS Stairs-firs.flight/ea addt'1 B STORAGE RACKS 1SRACKS<=8 Storage Racks 0-8' high(up to 100 sf) B 1 SRACKS>8 Storage Racks over 8' high(up to 100 B st of 5 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 1 WINREP Replacement windows/sliding glass B door ea.3 windows 1 WINMEWSTR New Window-structural shear B wall/masc includes plan ck fee IEPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanic it Permit Fee M 1PPERMITFEE Plumbing Permit Fee P I ELCPLNCK Stand Alone Electric Pin Ck(hourly) E 1 MECPLNCK Stand Alo tie Mechanical Pin Ck(hrly) M IPLMBLNCK Stand Alone Plumbing Pin Ck(hrly) P 1 STPLNCK-(3 W Min Standard flan Check(when no E/M/P) B when not over counter) hourl -sta ad alone 1BCBSC Cal Bldg'>tandards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1 B SEISMICO Seismic C ammercial B 1TRAVDOC Travel&Documentation B IBUSLIC Business License B 5 of 5 CITY OF l V� O CITY OF CUPERTINO GENERAL, BUILDING C U P E RT I N O PERMIT APPLICATION FORM APN# 3(-P,-)- (-P,-)- O 0g� Date: q / 7 / 7 b Building Address: /I qqo Carc%n lerrac-e ,G�lix � nv oJ Mailing Address(if different from building address): 1.210 S. c.,scon-) Pve. ;;� gyp. S64n�05eCA 615 i--D Are Hazardous Materials being used as part of this project? Yes ❑ No ®' HOA: (Exterior work only) Yes [ErNo ❑ If yes,provide letter from HOA Owner's Name: Phone#- Contractor: Phone: q0� �//e, -�c)0:� �-e L 11 '' �1.#. 1`l(�l C. Fax: 1;, - q/6 -200i Contractor License#: Cyd 3a Cupertino Business License#: Cont a t• Phone: l-(�G1 L L-i�) Fax: - Residentia 2' Commercial ❑ Job Description: at-1 i +1 O-N Building Pe it Info- Bldg Elect ❑ F lumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: 1-A, I-B ❑ I RI/V-A ❑ WHI B,IV-HT,V-B Res ( cle—f)� 5T2--s Valuation: Square Footage: Project Size: Express Standard ❑ Large E Major ❑ Green Building:Please complete relevant portion o:?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.builditgreen.org Revised 07/14/09 CITY OF CUPERTI NO BUILDING PERMIT BUILDING ADDRESS: 11452 GARDEN TERRACE DR CONTRACTOR:GREENERBLU JDHM,INC PERMIT NO: 10090125 OWNER'S NAME: ANAND GHALSASI&SAYALI DHARMADHIKA PO BOX 612048 DATE ISSUED:09/16/2010 ;ER'S PHONE: 4087927772 SAN JOSE,CA 95161 PHONE NO:(408)418-2000 ❑ LICENSED CONTRACTOR'S DECLARATION ` BUILDING PERMIT INFO: BLDG I— ELECT I— PLUMBr License Class Lic.# (� l �1 MECH r RESIDENTIAL r COMMERCIAL Contractor l Q Date 1 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 18,SIDING 40 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:36230085.00 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 constriction,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. rIssued by:' --� Date: Signature CL to � I�f/U L, 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: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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& 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 or authorCd ager forthwith comply with such provisions or this permit shall be deemed revoked. ' ate' APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 proposes.(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 9.18. I understand my plans shall be used as public records. 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 1 PARTICOMM Partition Interior Commercial B IPARTICOMM 1PARTIR Partition Interior Residential B 1PARTIR<=30 RETAINING WALL(CONCRETE OR MASONRY) 1RETSTN Standard(L p to 50 ft) B IRETSP310 Special Deign,3-10' high(up to 50 `) B 1RETSPI0 Special De;ign,over 10' high(up to B 50' 1RETCRB< Gravity/Crb Wall, 0-10'high(up to B 50 ft 1RETCRB> Gravity/Cr b Wall over 10' high(up to B 50 ft SIDING 1SIDEST/BK Siding, Stone&Brick Veneer B interior/ex terior 1 SIDEOTHER Siding all ether B �C SKYLIGHTS 1 SKYL<10 SF Skylight le 3s than 10 sf B 1 SKYL>l OSF Skylight gz eater than 10 sf or B structural 1STAIRS Stairs-first flight/ea addt'l B STORAGE RACKS 1SRACKS<=8 Storage Racks 0-8' high(up to 100 st) B 1SRACKS>8 Storage Racks over 8' high(up to 100 B st 4 of 5 CITY OF CITY OF CUPERTINO GENERAL BUILDING APPLICATION CUPERTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Apr lications(up to 400 sf) B additional:tucco a lication •J 1 WINREP Replacerna It windows/sliding glass B door ea 8 windows 1 WINIVIEWSTR New Window-structural shear B wall/mason includes plan ck fee IEPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit Fee P IELCPLNCK Stand Alone Electric Pln Ck(hourly) E IMECPLNCK Stand Alor e Mechanical Pln Ck(hrly) M IPLMBLNCK Stand Alor a Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check(when no E/M/P) B when not over counter) hourly- d alone 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISNIICO Seismic Commercial B 1TRAVD0C Travel&Documentation B IBUSLIC Business Hcense B 5 of 5 CITY OF its CITY OF C UPERTINO c) GENERAL BUILDING C U P E RT I N O PERMIT APPLICATION FORM APN# 2 0 O V�S�--' Date: q 7! Building Address: <J 11 y5Q G"cler,iecca.ce )rive Cu.pec-hoz>, CA g5u)L Mailing Address(if different from building address): Are Hazardous Materials being used as part of this project? Yes ❑ No ©' HOA: (Exterior work only) Yes [+ No ❑ If I es,provide letter from HOA Owner's Name: Phone#-. Contractor: Phone: i•-��(j Y/�-2000 C • Fax Contractor License#: 94/64-38 Cupertino Business License#: Conta t: Phone: �ja&' �rl-l`��� ,t C( L-);arc. Fax: Residential, Commercial ❑ Job Description: r- I%1.1 % r e I� Building Pe4Wit Info: Bld C3 Elect ❑ Plumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: II/VI I/VI B,IV-HT, V-13 c� Res)dem 1-A, 1-B ❑ ❑ Valuation: Square Footage: Project Size: Express[ Standard ❑ Large[] Ma•or El Green Building: Please complete relevant portion )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 rl!en.or Revised 07/14/09