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04010044 (2) ' Ato CITY OF COPERTINO *' _. N PER ar BUILDING DIVISION — --- BU I LDING ADDRESS: JOHN KAVENY PERMITNO.04010044 779A OBSIDIAN OWNER'S NAME: PERMIT ISSUE DATE PH ONE: SANITARY NO. OCONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 �oo LICENSED CONTRACTOR'S DECLARATION- IOb Descriptionu❑ 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing mW withSection 70ll'J)ufDivision 3 of the Business and Professions Code.and my license is n infulleffect. SOLAR PANEL UPGRADE j Z License Class Cuo Cbp Dam.CSDECr _ d0d ARCHITECTS DECLARATION L� 1 understand my plans shall he used as public records - Jyu OwLicensed Pmfcssionnl O OWNER-BUILDER DECLARATION Contr DN K a f 1 hereby.('firm that 1 1. exempt s an the Cssions o :License Low for the ' -o O following reason.Permit t 71D str Business and improve, di sinus Code:Any city or runty Which rcyuiras a permit m cnrevuct alter,improve,Jcmnlish,or.pair any..Tuan. 5iy pri.rum its issuance,also requires the applicant for such ptnopho Glc a signed nammem o that he is itemand pursuant to the provisions of the Conuriefor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation (commencing with Section 7")of Division 3 of Business and Professions Code)or that he is exempt donefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3TYI �beT00 Occupancy Type not more than five hundred dollars($51X1). ❑1,as owner of the property,or my employees with we,.as their sale compensation, will do the work,and the stanua is not intended or offered for sale(Sec.7044,Business Required Inspections and Formational Code:The Coulnelora License Law docs not apply to an owner of q p pmpenywho builds orimproves thimprove who does such work himstlfor edNmurm his wn employees,provided her such improvements are not arofintended m Deere,for sale. r. builder the avetebding rden of pmenrsssold hathe did not year of completion,the owner. builder will have the burden of pmvins that he did not build or improve for purpose of - .ala.). ..L as owner of the property,,Beaton.exclusively Formations with:))heed man opors t. C-.me a thoes not apply to an Ownofand op property wh ions Code:)proves the m.r's fid VU who C Law,ons not apply a an owner of papery who builtls or improves Contra,and who convacu for such projects with a contractor(s)licensed pursuant m the Convenor's i cru Law. .m canmp,under See B. P C for it aassort Cavric, Door I b DY - W NEWS PENSATION DECLARAT 1 hereby amum der penal( of perjury otic of the folio tledarations: I he.and will maintain a t mate of Consent In s1f.tmuaTorWorkcr'sCompen- satian,as provided for by Section 37W of the Labor Code,for fire performance of the work for which this permit is issued. ❑I have and will maintain WorkerY Compemsalien lasuance,as required by Section 37W of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insu ence carrier and Policy number am: Cann,: Policy Na.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Code uclion need ma tatiomplemd if the permit is fnronc hundad drdlats(SI W) or lest.) . 1 c""y Nat in the If, .ace of the work for which this permit is issued.l shot(Out empioyarypersoni .finer sass N` c6ti Ijbjcct to the Wolams Campeoratlon taws of Calif.ria. APPIic ft. �- NOT : APPLICANT:If,af¢r making this Cenificam a(Escmption,you should becom jeer to the Worker's Compensation provisions of the Labor Code.you must ,J C vok forthwith comply with such provisions or this permit shall W deemed reed, z ti CONSTRUCTION LENDING AGENCY [r.�-i Ihemhy affirm that from is a consvueinn lending agency for the performance of ai the work for which this permit Is issued(Sec.3097,Civ.C.) W�Q Lender's Name z Lender's Address U Q 1 certify that I have read this application and slate that the above information is D. moment.1 agree to comply with all city and county ordinances and state laws relating to V building construction.and hereby outhorin mpresentmives of this city m enter upon the W above-mentioned property for inapenion purposes. y (We)egme to save,indemnify and keep harmless the City of Cupertino against f // h liabilities,judgments.costs and expenses which may In any way accrue against said City UZ in mmuccrmoso of the gmading of this permit. ^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINT Issued by: Date SO RCE REGULATIONS. Re-roofs afA liceytraaor__ ZAPopOUS MATERIALS DISCLOSURE Type of Roof Will thcappliea if um building occupant store or handle havardoes material a defined by the Cupen a unicipaTCode,Chapter 9.12.and the Health and Safety Code,Section 25s3z(a)1 �Ycs �yNV All roofs shall be inspected prior to any roofing material being installed. - r Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove ends harardous air conmmina e;as defined by the Bay Area Air Quality Management all new materials for inspection. - District? E3 You I have read the hmenhars materials requirements under Chaplcr 6.95 of the Califon ria Hcalth A,Safety Code,Sections 25505,25533 and 25534.1 understand the if the building docs not cumen0y have a tcmnt pool it is my responsi hil try to norify the occupant of the requirements which most tat met p6.rmovatiorme of a Cenlficam.f Ocmpiarnyy. Signature of Applicant .Date l 12 0 Gw .utha, no.gem ate All roof coverings to be Class "B" or better CITY OF CUPERTINO •em 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . . 36218027 . 00 DATE ISSUED. . . . . . . : 01/13/2004 RECEIPT #. . . . . . . . . : 24205 REFERENCE ID # . . . : 04010044 SITE ADDRESS . . . . . : 7728 OBSIDIAN CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER JOHN KAVENY ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4111 RECEIVED FROM . . . . : JOHN KAVENY CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : •FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ENERGY PERMIT FEE 257 . 00 77 . 10 0 . 00 77 . 10 0 . 00 BPERMFEE VALUATION 20 , 000 . 00 257 . 00 0 . 00 257 . 00 0 . 00 BELEC200 METERS 1 . 00 27 . 25 0 . 00 27 . 25 0 . 00 BPLANCHK PERMIT FEE 257 . 00 218 . 45 0 . 00 218 . 45 0 . 00 EPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 BREMPOWER POWER UNITS 1 . 00 44 .40 0 . 00 44 . 40 0 . 00 BSEISMICRE VALUATION 20 , 000 . 00 2 . 00 0 . 00 2 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 661 . 72 0 . 00 661 . 72 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 661 . 72 VISA TOTAL RECEIPT 661 . 72 OTJER-BUILDER VERIFICATJW 1. (Check one) I or my immediate 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) Contractor Address/City, Phone # State License # Type of work to be performed 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 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 Signa tu — Date: 3 Job Address: 772 OR` I C Permit# d Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. City of Cupertino Building Department CITY OF 10300 Torre Avenue C U P E IST I N O Phone: (408)777-322$4 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 CUPERTINOO � � � �-a CITY CUPEI�TT INO PERMIT APPLICATION FORM APN# Date: Building Address: �i ZS t D 1 GT c 6 P L 1�sD Owner's Name: ©J 1' ` � Phone#4t b rZ 1Og Contractor: TT,V License bwn►Ci-> uJ t p Contact: I Cupertino Business License#: Building Pe' it Info: BI Elect Plumb ❑ Mech ❑ 7ob-Description: Residential orcial Sq.Ft. Floor Area: $/Sq.Ft.: r i Cost of Project: Occupancy oup: Type of Construction: • Quanti Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> IOOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V <= IOOOA ELECTRICAL BELEC1001 Elec 600V> IOOOA ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation feeBUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING Iof3 / � �/, 72, 20 BP SX J=Q 150 WATT SOLAR FANEL.S L LI LISTED CEI JN1 O t ftp til � t � EQU1IaEd 7f1ZS—�� R It RATEDSUNLO-rr ![ RESISTWT ' ' �uNe E tcmt et~x C- 1- SMA AM. C UCA to-#10 YMIF SSi 29t SBD NEMA.M t-#8 GP2'R A" 244 VOLT Urt'rra30 R O TW aft R — VME 21 ,4T it9 giS(mNN€CT t t MOCOKNECT DA- �. t } zits C.B. Si4F1FS1 AT SERYtC E This sit of plan SJB PAF!!E— oe kept Gn t' rn.«A pod MUSt - _II times and it is un 4 6M volt ul to make any changes or alteti NON- nn acme without writtons en permissioq ration- 11°ERIA-3R the building Dept„ City of Cupertino. 30B SITE: The s tampiv of this plan and specifications john Kaveny 'H NDT be held to permit or to be ar, 7728 Obsidian Covet ppm"I of Um violation of any provisions �WE ORTH ELECTRICCupertino,CA 95©14 r aqy D�Qlnenty or State Law, (408) "6-11155 dansary 4,2004 37 Cr7GL 'IAVS#333 nIGAL&No.CA 92316 r5739j862-1r?2 356-33951 F3; I3C,t 638IiFi 9532iR CITY OF CUPERTINO BUILDING DIVISION PERMIT CQNTI2ACTQRINFQRMATI01 auBAiNG ADDRESS: JOHN KAVENY PERMIT No.04010044 OWNER'S NAME: - PERMIT ISSUE DAM JOHN KAVRNY .)NE: SANITARY NO. CONTROL NO. ARCH] NEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 :00 LICENSED CONTRACTOR'S DECLARATION u❑ 1 hereby affirm that I am of the under provisions ofChapterC.dc, 9(commencing Job DOSCrlptl0 �W with Seccend1efecDivixion7 of the Businms and Professions Codc.entlmylicense is e�y in tern faceslass effect. zqz u.enm cline Lm.g SOLAR PANEL UPGRADE Dale Contractor ARCHITECTS DECLARATION w. 2 eX, I understand my plans shall be..it..public mcards q� 2 ; 00pin Licensed Professional (/ S OWNER-BUILDER DECLARATION �fth f I hereby affirm the 1 oro exempt from Ne Contractors License c Law for the �B4n o O following reason.(Smit in](131.5, (,elecas and improve, dcrio li Code:Any tiny or county Km which requires a pemso ra ui consume(,alien improve,dcermitt orrepaira sig any structure hothoits tensed e.pursuant tote previsions evisionof for such Contractors toicenic Law ned(Chapter (Commencing ecingwid pSection 7th.pro visions of the Convenor'snd Professions Code) Sq.Ft. Floor Area Valua[Ion (commencing with Seniors]!and of Division 3 of the Business and Professions COJc)ser $ that m is exempt therefrom and Ne hues for the alleged exemption.Any violation of Secnot omthan by any hpplicarm undred epemtin objects Ne applicant toacivil penalty of 3612R101B*TO0 Occupancy e not more In.n foe n.nared aonara(ssoo). P Y TYP ❑1,az owner of the property,or my employees with wages as their sole compensation, will do the work.and mo structure is not mounded or offered for sale(See.]044,Business and Profeazlons Code:The Convadetori License Law does not apply m an owner of Required Inspections property who builds or improves themon,and who does such work himself or through his own employees,provided than such improvements are not amended oraRered for sale.if, however,the building or improvement is said within one year of completion,dee owner- builder will have Ne burden of proving Net he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7Od4,Business and Professions Code:)The Contractor's Li. _ came Law does not apply to an owner of propcny who Wilds or improves Hereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's i an.Law. am exempt under Sec. B A P C far th rcuon ter Dem OY W KER'S PENSAT]ON DECLARATI I hereby aRran "Pen er Pcnaln of perjury one of the folio ' dedarationa: I ban and will marimm ¢am of Consent to self-insum for Workers Camper. "iation,u provided for by Section 37W of the Inbar Code.for Ne performance of Ne work for which this permit is issued. C I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Ube,Code.for the Performance of the work for which ads permit is issued. My Workers Compensation Insurance cerci.,and Policy mark,art: Cartier: Policy No.: _ CERTIFICATEDFEKEMPTION FROM WORKERS' ' COMPENSATION INSURANCE . (The ssclion need not hecomplemtl if rho permit is for enc hundred dollers($100) or less.) 1 certify Nat in the "a atm of the work/for which this permB is issued,I shall nm employ any personi anncruaz�\'7cI0 tYbject to the Workeri Compensation Lawso Calif.at., c _ Applic t k NOTI APPLICANT:If,after making this Ccnificam of Exemption,you should beam Jcn to nhc Worker's Compensation provisions of the L ahor Csdc,you must ., Z foMwi to comply with such provisions or this Permit shall he deemed revoked. .ztO CONSTRUCTION LENDING AGENCY P N 01 Ifar hereby ch affirm Nat thc,e is cad(Sec.construction lending Ca,agency l'nnhc performancc of 4 thaLe work fur which This pertnil is issued(Sat.709],Civ.CJ 0.. Q Lender's Name i`�3. z Lender's Address U Q I certify than 1 have read this application and nam than the above information is U. E' correct.1 agree no comply with all tiny and county ordinances and statt,laws relating to 0U building construction.and hereby amborise representatives of Nis city to enter upon the W ahovomenti.ned property for inspection purposes. y (We)agree to save,indemnify and keep hnmlem the City of Cupertino against ` py liabilities,judgments,costs and expenses which may in any way aceta.against said City U z in consequence of the granting of this permit. ^t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALI NON POINT Issued by: Date SO RCE REGULATIONS. ONS. 3 ORe-roofs I o A lice trumr m A OUS MATERIALS DISCLOSURE Type of Roof Will Ncapplics orf sere building uccupanumrc or handle herardous meurial as defined by thc Cupen uniciled Coke,Chapter 9.12,and the Health end Safety Code,Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed. " �YC9 rt.ZRU Will the applicant or future building occupant vu equipment or devices which icaumIf a roof is installed without first obtaining an inspection,I agree to remove it hno.air contaminants u ntaandefined by the Bay Arca Air Quality Management all new materials for inspection. iatr (? ❑Yee I have mad the havaNnus materials rompemcnls under Chap e,6.95 of the Califar. ma Hcalthdt SafetyCotic,Sections 25505,25533 and 25534.1 understand thatifnhe building docs not cermally have a¢rent that it is my rmpouibility m notify Ne acupant of the rcyuircmcros which musk be mm pfjg ' van cc of a Ceniicate of Occup y. Signature of Applicant pate or autho 'nJ agent 1 a,� All roof coverings to be Class 'B"or better