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05080225 ICITY OF CUPERTINO - • ' ;°.-•-&;i.-: _' .:.i. .:f:.zx:, x,,;— --- ' BUILDING DIVISION PERMIT .CONTRACTOR I,NFORMATION'. (BUILDING nppREee, rj2�2_ RICHARD & TRACEY MENG PERMIT NO.05080225 AT.rATTTI•F Ail OWNER'S NAME: PERMIT ISSUE DATE RTCHARn i4 TRACRY MRN(7 -_ __ --__ -oA /9S_/7_nnc; NE: SANITARY NO. CONTROL NO ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH X00 LICENSED CONTRACTOR'S DECLARATION Job Descri UonO O O .m❑ 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing P zw wit Section 7")of Division 3 of the Business aM Professions Code,and my lmeive is Conllur in full fosse and efect ueenuclas L a 2 WALL FURNACES 470 Date � �tl 1 i !N .ARCHITECTS DECLARATION SOOZ 9 to I undemanJ my plan shell W used as public rtenrJS L as 7e U /I ;tut"' Lmcnuil Professional �p5 OWNER BUILDER DECLARATION Q .�<I 1 hereby affirm that 1 L exdmpt from the Carers;Co License Law county rite � "�,.7(�Q� If fl po which requires Permiun](DLS,Business mpr Professions Code Any mymmuime (uf «�!;/Il,�l lNp1 y= whmh myuites a prnnn m<nnstmn,alter.rmpmvc,dcmnlmh,or repair any swmum s o o o t-¢y pnor to its issuance,also ruptures the applicant for such Permit to rile a signed statement < NathcishednuJpursuamso(beprovisionsofNCContractoriLicenseLaw(Chapter9 Sq.Ft. Floor Area Valuation ��o (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y $ that W is exempt therefrom and the basis for die alleged exemption.Any violation of q Section 7031.5 by any application applicant t for a permit subjects the applicano a civil penalty of 3 AL$$M&Ber 0 0 not mom than five hundred dollars(M). Occupancy Type yW I,as owner ofthe property,or my cmploydes with wages u their sold compensation. l do the work.and f W structure is not murbad Or offered to,We(Sec.7064,B.. and Prefesmons Code:The Contractor's Liana Law does not apply to an owner of Required Inspections property who builds or improves thereon.and who doessuch work himself or through his own employees,provided Nat such improverecros art not intended at offered for We IL however,the budding or improvement is sold whin one year of compleuon,the owner- Wrider will have de burden of prowng that he did not Wild or improve for purpose of sale.). ❑1,as owner of the property.am exclusively comadefing with licensed convectors to consumes the project(Sec.7044.Business and Professions Cude:)The Contracmr's Li- cense law does not apply to an owner of property who Wild;of improve,thereon,and who canuacts for such prolecu with a contracm(s)licensed pursuant to the Com actoh License Law. ❑I am exempt under See '��/y .B&P�Cato,this MWO Owner fir" r z / Date S sv d WORKER'SCOMPENSATI6N ECLARATION 1 herby grim under penalty of perjury ore of the following declarations: I have and will mamuin a CcNfieam of Consent to self-insure for Worker's ConI ion,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 1 have and will maintain Workers Compensation Insurance,as required by Section 37W of the labor Code,for the performance of the work for which this permit is issued My Wcolmea Compeivadim Insurance caner and Policy member am Comer. Policy N. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This ucbsm need not W completed rf f W permit is prime hundred dollars($100) or lass.) 1 cemfy to in the Performance of the work for which this Permit is issued.l shall not employ any person in any manner am as to became subject to the Workers'Compensation Laws of Calif(D' App y�%—Applicant NOTICE TO APPLICANT.V.inti,making s�cntncatc the bar d you shaust .J Obecome subjoin m the Worker's onv Compensation us r dus onnaons of die rded Code.you must fanlwM Comply with such pmvmniu or Nn permit shall W deemed avakdd. 'Z i--' CONSTRUCTION LENDING AGENCY 4�.. Ihereby aMo.that them is a mnstrucumi binding agency tmr ft performance of D$ the work for which this perm is issued(Sec.3(197,CO,C) UJ A Lenders Nam- ra7 lenders AMAm U O 1 eemfy that 1 have read this application and sum flat dm above information u - fr correct 1 agree to comply with all city and county accounted;and sum laws renting to 0U building consuucmon,and hereby autharire repfeunuuves of this city to enter upon the a,ove menuuned p.,ny for inspection purpmes F y We)agree to save.Indemnify and keep harmless the City of Cupertino against N liabdnlu,judgmcnts.cosu and eapmaces which may many way all.aPlnstsmd City U in consequence of the granting of this Permit. '—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Q Signamm of Apphcmt Cammm p -1.� Dafe HAZARD S MATERIA- DISCLOSURE Type of Roof Will dm applicant or future budding occupamatore or handle habommus maenal as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety code.servo,255320)7 ❑Yes N,u All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hvaccous au contaminants u defncd by the Bay Arc.All Quality Managcmcm all new materials for inspection. iW¢t, byes 0`- 1 have real the hvaNimsmncnalsmgwmmems under Chafmr695 of the Califor- niaHmilih&Safely Code.sections 255(15.25533 and 255341 undemand that tf the Wilding Joel not currently have a tenant firm It is my nimm Udlifly m nobly the occupant of the reyutmmcne which muss EC met pin/r y`y' ce ar acwfmaid or Occur me Signature of Applicant Dale �""" �� Owner or authonmd egcm All roof coverings to be Class"B" or better /� �J Dam OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent,spouse or child) will perform: e A. All the work authorized by this permit B. A portion of the work C. None of the work If B or.C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. A portion of the work (complete section below) Contractor Address/City Phone # I State License # Type of work to i • 3. _ 1 will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be performed ..................................................................................................................................................................................... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information (reverse side). Property Owner's Signature: �pp�pp�c�c�Ji%� Date: $���-c- Job Address: 22 S GZ 4 r ,4/0 iQ_ �/p� � Permit# Anv chanees to the information provided on this form shall be submitted to the Citv of Cupertino Build Department. r f' City of Cupertino Building Department I CITY OF 10300 Torre Avenu' C U Pp[k'A'v O Phone: (408)777-322 Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner-builder you are the responsible party of record on such a permit Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself,you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work,with the exception of various trades that you plan to subcontract,you should be aware of the following information for your benefit and protection If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs)is$200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer,you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding,federal social security taxes,workers' compensation insurance,disability insurance costs, and unemployment compensation• contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law,contact the Internal Revenue Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your obligations under state law,contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale,property owners who are not licensed contractors are allowed to perform their work personally or through their own employees,without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder building permit,erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors'State License Board in your community or at 1020 N Street,Sacramento,California 95814. Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, City of Cupertino Printed on Recycled Paper CITY OF CUPERTINO -t,ms FURNACE/AC o 1--bp 2 Z� CUPERTINO PERMIT APPLICATION FORM APN # Date:( 6 094 Building Address: �� / 2 2 �`�z X11 11� o p( 1 Owner's Na e: Phone #: R 4 �ra� /� 4,�,J 4ob'— k7 ?— 99Z� Contractor: License #: Contact: Cupertino Business License#: Building Permit Info: 1 Bldg ❑ Elect Z Plumb © Mech Job Description: (+e !i€ /",- -.W 0 Q( 0- roa QQ 3, , avN KTte �4/✓NlCQC Residential J, Commercial F1 For Residential Installations: 1 Attic ❑ 1s` floor ❑ 2nd floor" Adhere to min set back requirement❑ For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction: Occupancy group: 4,�t Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement ❑ Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL 1 BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10, 000 cfrn MECHANICAL BREMRECEPT Recptl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING EPERMITFEE Elec Permit Issuance ELECTRICAL 1 MPERMITFEE Mech Permit Issuance MECHANICAL 1 / PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING 1 BPLANCHK Plan Check Fee BUILDING j BUSLIC Business License BUILDING