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CITY OF CUPERTINO L
BUILDING DIVISION PERK UT
BUILDING ADDRESS: PERMIT NO.
11670 TIMBER SPRING CT BROTHERS HOME IMPROVEMENT 08090156
OWNER'S NAME: PERMIT ISSUE DATE
YOUNG STEVEN H AND JEANINE L 2510 DOUGLAS BLVD 09/24/2008
PHONE: SANrrARY NO. CONTROL NO.
(408)295-0680
ARCHITECrfENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 o a o
u p a LICENSED CONTRACTOR'S DECLARATION
C 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
°oy nfull
REPLACE 16 WINDOWS & PATIO DOORS LIKE FOR LIKE
Z license Cl s 'g( Lick gad
f- Date Contractor Pa'"
ARCHITECTS DECLA ATION
Gtr< 1 understand my plans shall be used as public records
�yU
uo-t' Licensed Professional
a OWNER-BUILDER DECLARATION
/r y
1 hereby affirm that I am exempt from the Contractors License Law for the
00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
K,tea which requires a permirto construct alter,improve,demolish,or repair any structure
roe Z iy- prior to its issuance,also requires the applicant forsuch permit to file a signed statement
that he is licensed pursuant to the provisions of the Conuactur's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
y H$ (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or
$11738
y -. that he is exempt therefrom and the basis for the alleged ezemption Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Number Occupancy Type
not more than five hundred dollars(5500). 3 6 6 5 4 0 9 2 )V64
❑I.as owner of the property,or my employees with wages as their talc compensation,
will do the work and the structure is not intended or offered forsale(Sec.7044,Business
and Professions Code:The Contractors License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
awn employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the pcopeny,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractors Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
❑1 am exempt under Sec ,B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 haw and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Coowmpensatio�nInsurance carrier and Policy number am:
Carrier. /7 c Cnyr • Policy No.: '98 —07 6 Q O d b 3 S
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is foronc hundred dollars($100)
or less)
1 certify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner so as to bccomcsubject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,you must
.J O forthwith comply with such provisions or this permit shall be deemed revoked.
Z affirm
LENDING AGENCY
Z
1 hereby arm that there is a construction lending agency far the performance of
the work for which this permit is issued(Sec.3097,Civ.C.) -
a Q Lenders Name
Lenders Address
U Q 1 certify that 1 have read this application and state that the above information is
VL"" carted.I agree to comply with all City and county ordinances and stare laws relating to
CV building construction,and hereby authorize representatives of this city to enter upon the
U above-mentioned property for inspection purposes
VJ
ly (We)agree to save,indemnify and keep harmless the City of Cupertino against
►F-c liabilities,judgments,costs and expenses which may in any way accrue against said City J
I>Z in consequence of the granting of this permit.
APPLI NDERSTA A D WILL COMPLY WITH ALL NON-POINT Issued by: Date
S EGUL �`\
I t
Re-roofs
ore of Applicant/Contractorarc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
code, es f�.No
zss3z(a)7
0 Yes All roofs shall be inspected prior to any roofing material being installed.
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
emit haiardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
13 yes I&No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand shad(the building
does not cv have a(errant that it is my ru nsihility m notify the occupant of the
re ire nice m be car tr ce a a reatu of Oc - Signature of Applicant Date
6 2e
r or authamed agent Dare All ass
All roof coverings to be Cl '']`'or better
+-►'
.1
CITY OF CUPERTINO
CUPE�1N0 GENERAL BUILDING
PERMIT APPLICATION FORM
APN # I O Date:
9 IA qf08
Building Address: j ib"f p 'T,,ber :5pr`in
95014
Mailing Address (if different from building address):
11 y1
Owner's Name: Phone#:
Cuda as ��
Contractor: rUre } arc Phone:(46Ef, 0'745•-ob$o
Fax:Cgbfb� a95- 3 `7 a
Contractor License#: (qq po9 _
Cupertino Business License#:
Contact: Phone:
Seat. F. (�►0 'L) 59�- 3 659
Fax:
Residential ® Commercial ❑
Job Description: �eplxe+�.��-�. o� lb w%,,A1D10 . ' 1 P" b Door-
Building
oorBuilding Permit Info:
Bldg tK"- Elect ❑ Plumb ❑ TMech ❑ .
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B p---�
Valuation: Square Footage:
Project Size: ExpressM/1"Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of 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 7/01/08
CITY OF CUPERTINO
CI OF.
CUPEKFINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee . Permit Type
Group 1GENRES or
1GENCOM
1BBOILERI For the installation or relocation of ea M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h(29.3kw)
1BBOILER2 Installation/relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
1BBOILER3 Install ation/relocation of ea M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
1 BBOILER4 Install ation/relocation of ea M
boiler/compressor over 30 hosepower
to &incl 50 horsepower, or for ea
absorption sys over 1•,000,000 Btu/h to
& incl 1,750,000 Btu/h
1BBOILER5 Install ation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea,absorption sys over
1,750,000 Btu/h
1BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed-
in other appliance categories, or for
which no other fee is listed in this-
code.
hiscode.
1 ELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other.Mechanical Inspections (per M
hour)
1 PLMBINSP Other Plumbing & Gas Inspections P .
(per hour)
1 MEETINGI HR Application Meeting B
kW Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: 1X6170 T; b - SP PERMIT #
c,,.pe..+i..o ca, 460 060 _,Z9
OWNER'S NAME: S4-.rer. qc�k,., PHONE #('-i 6 2t5 S- 159-1
GENERAL CONTRACTOR: 9miHers l�►,.,e rb,,p; AX#�1b6� ass-3 Z�a
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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/Contractor Signature Date