Loading...
05050086' L CITY OF CUPERTINO 'z'' ' a p a� w Z� k4ej h "- WIN BUILDING DIVISION PERNIIT PERMIT "d LSus ti4," "?fes? au1LOINCADDRFss: KEITH G FROST PERMIT NO. OWNER'S NAME: KP.TTTI r. FpnqT 10280 STERN AVE PERMIT ISSUE DATE ONE: SANITARY OL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG Bt.ECI' PLUMB MECH I� = 0 i� R'SDEC..fCON LICENSED CONnsed Job I I mod I ton that 1 an licensed under, oe Cluper 9 (mmmense SLE® W Prooa is who section 701k0af DivialonJOfde Business mW Profcuiou Coke,nd my license is 7 ) of f �z in full rode end effect License Clue LM.8 TEMP ELECT. D!M Contractor DECLARATION \ 2005 nd my plainshall be used 1 understand s publirecords iLicenser 9I Professional n OWNER -BUILDER DECLARATION B0 I q I hereby .Iliad that 11. uempl form ante Cashes Licoase taw for Ibe U L I N I0 Co dc: Any tiny or county dam Co Ruda. IND IS,Bualauand d .} which Permit improve, dconu e mr i Ile a sig any .wood a pe Iho re constuires Me, pike. improve, h permit which its issue., Me, Application for wchpctoitbnles Law (chapter hppkr9 Sq. Ft. Floor Area Vanua on CC thiarbiLLccrumrp,rsantto the o $ (commedkcuedpumrantlpthepmvivionoflkConuianicemliesel (commencing with Sation 70110) of Division J of the Business Any ns Cube) per t on. enmpnm. Any in of Sul therefrom and aper for edexemption. u u1.5 ,,Iv 3 �E•dero O Occupancy Type l pen Section b (a • permit subjects the applicant m a civil penalty of o by or bj cts the hMy undred won more nClmoR thn five M1undRd d011an (JJDE). 0 I, u owner of ilia proKny. m my emPloycu wird wgu u dnir mac c=p maim. e ns Required Inspections will do Meanest, and the structure rnotimcnded conflicted mrsale(See. IDµ Business and Professions Code: The Cann ernes License law does not apply b an net of q p property who buildsperimproves thereon, and who does uchworkhimselfor through his awn employ=, Provided Nal such improvednu art not Intended OrofleRd furcula. IL however. be holding or Improvement is Bald within one year of completion, Ne owner builder will have the burden of proving That he did con build or improve for purpose of sale.), ❑ 1, as Owner of the property, am exclusively connecting with licensed comancred to cautmet Ne pmjeci (Sec. 7044. Business and Professions Code:) The contractor' Lt. cc. Law d= not apply in.. owner of property who builds Or Imprimatur Merton, sed who Contract, for such pmjcm with a connuctor(s) licensed pursuant in the Comacloh Lkeme Law. ❑lam a psemdu Spec. ,BkPCfarthrmaon Owner1 DIMa � WORKER'S CO IDECLARATIONI S 1 hemby afron under penally of perjury one of the fallowing deduelioa: 1 haw and will maintain a Certificate of Consent in selr-Inum for Workefa Compen. Mian. u provided tar by Seen. 3700 of the lana Code. Id the performance of de work for which this permit is issued. ❑ I have and will maintain WorkeYs Compensation In tmnm, as required by Section 3700 of the Labor Code. for the performance of the work for which this permit is issued. " My Worker's Compensation Inndnce tamer and Policy number am: Carver: Policy NO.: CERTIFICATE OF EXEMPTION FROM WORKERS' ' COMPENSATION INSURANCE missomen used ntaecanphed dome Permit Isfurmse hundred dollars (SIM) t or less.) 1 anify that In the performance of Ne work for which this permit is issued. I shill not employ any person in say mammrw as In became subject in the Worked CompeuNOn Law 6 ofCalif Dae . APPNOTlkICE nt.(-4MUMo IL dung thflims Exemption. You uhmum subject Me of Met IaMu Coke, you mull Woste vismpenadon pmvit C Co ' Obecome forthwith comply west such provisions or this permll shdlbe deemed revoked.' y it iso sha CONSTRUCnON LENDING AGENCY 1 homey annum that there Is a construction lending agency for the performance of the work for which this permit is issued (Sus. 3097. Civ. C.) ' QLender's Name Lemur's Address Q I minify that I have rad this applicedim nd sum Mol the W. uforni I. ca1L'CL 1 a jRe he (amply WIMI all Clly and Cannly ardlMlltts.nd mile lam relating to ru building consction.and hembyadhonRePMMflMLiWIofthis city bcrier upon the W above-mendaned property for Inspection pwpmet gy (We) agree to sero. indemnify and keep harmless the City of CuPCIM0 against cq Ilabilitipe,judgmenu, cape and expenses which may in any way acme against mid City In consequence of the granting of this permit, APPLICANT UNDERSTANDS AND WILL COMPLY WITH A" NON -POINT Issued by: Date SOU EGULATIO Re -roofs 1�D silatuRaf_A�pplia on to, T HAZAR US MATERIALS DISCLOSURE Type of Roof Will the applicant or futum building Occupant core or harrdle hazardous material u donned by the Culandoo Municipal Cade. Chapter 9.13, ato thus Health and Safely codO,en:ss3z(.)7 All roofs shall be inspected prior to any roofing material being installed. 0 Yes ON. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant Or fduR building occupant use equipment or devices which Mil ha'rudous air contaminants u dcnned by the Bay Area Air Quality Management all new materials for Inspection. District? ❑Yes (:IN. I haw mW the hamdas mw:ridskquiremenu under ClupMr6,95 oflhc Califar. nr Health h Safcty Cada, SwU=25505.15533 mu125534.1 undm and thnlf the building dues not currently hew a Mount, that II r my Raporobility to notify Me =upmt or the rcu Is which must be darty lssssunce on Ccninak of Occupancy. Signature of Applicant Date "B" All roof coverings to be Class or better Owner anahariYad agent k Dart I 4 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: 103m O 'D �e� 4V� PERMIT # OWNER'S NAME: PHONE # Lco2> GENERAL CONTRACTOR C, FAX # I am not using any subcontractors: _� � SignatuAe Date Please check applicable subcontractors and complete the following information Owner'/(2'o actor SiAnature SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner'/(2'o actor SiAnature OWNER -BUILDER VERIFICATION 1. (Check one) I or my imme ' family (parent, spouse or child) will perform 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) a Contractor Address/City. Phone # State License # Type of work to be erfo 3. _ I 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 erformed 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: Date: 6� Job Address: Permit # oC-C) �Dnnc9% Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. Dear Property Owner: City of Cupertino Building Department 10300 Torre Avenue 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 liauted 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 pdrded ori Recycied Paper �CITY OF CUPERTINO CITY OF CUPERTINO TEMP POWER PERMIT APPLICATION FORM APN #1 � c) -?—G � Building Address: D ELECTRICAL (,-, Business License Owner's Nam �:i w /�Phone #: tic l S Contractor: Phone: License #: Contact: Phone: Cupertino Business License #: Building Permit Info: Eleq--fl� Job Description: Residenti4-ff� Commercial ❑ Cost of Project: l©c9z� Qty. if Applicable Fee ID Fee Descrintion Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING