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05080118 - CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOWANFORMATION BUILDING ADDRESS: MARTY ZIMMERI°IAN PERMIT NO.05080118 OWNER'S NAME: PERMIT ISSUE DATE NE: SANITARY NO. CONTROL NO. ARCHITECr/ENGINEER: BUILDING PERMIT INFO BLDG EIFCi PLUMB MECH uoo LICENSEDCONTRACTOR'S under SDEConsof CON uq I ion 7 )tu' tiut I am licensed under and Pouom of Chapter 9(mmmcndng Job Description with Scnce.rui10)nf Diviaion7of me Business and Prvfcssiens Code.and myliccnm is off mmumraanaerfecL INSTALL TRANSFER PANEL & SERVICE j a z License Clan Lk.p Dam ContractorENTRANCE BRAKER FOR FUTURE STANDBY GENERATOR Z� ARCHITECTS DECLARATION DEC at U I understand my Plans shall he tirertck d az public cnr a kap Liccnud Pntfcssiunal g OWNER-BUILDER car Ce Conu ON P I Lamar moon. affirm that 1 1. exempt sins an the fa nuns Co :Any c law for me o following mazon.Permit t 9113 su Business and w.de o demolish. Code:Any city or county 5 m which requires a Permit re uirs,teL pike imprvw.h Permit t fi repair any unumurt _z a that X, its issuance,e,also mquima lW appvision Of for sons Pcrnr's 1-mento Law(hmmcm E e (commecingwJpursuantmmcofDivionsnofsheBlsinessndPoclaw(Cod¢r9 Sq.Ft.Floor Area Valua[io$200 yF (come is tractor,determine Section?and she Diasisfr of me Business and Professions Coda)or i�$ Net K u eacmpt thmefrom and Ik bazu far the allegrA exemption.My violation of Section 7031.5 by my applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy net mem man RK hundred damrs($5(n). Type K1.aOwner ofine ro r employees gra compensation. 31621050 . 00 �/.1 p Pcnyarm of 1 wide az.tov sole til Pr me wens,end e; swcturt is not intended,Law dos not a(Sec.o in weer of y r and Professions Code;The me;the ori Litems law dors not apply to ri owner of Required Inspections,''GI,fJ' e pmpenywho buildsoded thawsch imprandwho em not ihwork himulformrvugh hisOwn howemployeWildin orimrswment isowmentsamne ear of completion, foe owner- bowewq Ne Wildinguimpro nervi.sulde did et year or completion,Ne owner- builder will have the burden of Proving that W did not Wild Or improve for PUTou of rak.). ❑1.as owner of the pec.704 ,Bexclusivelysieand contracting with )licensed contractors i- (t oo✓ cans,Lr the project(Sec.he i x,Business and rty,who Code:)The m the cors Li- by ✓ come Law dos not apply roe loan owner orpmpeny,who builds rte imprvws Norton.and whencecontractsLafor such projects with acanlranor(s)licenudpursuemmlW Contractor's a 0 ..law. (]lama uncle Sec. �,B&P.0 far mu rector Owner Da¢ S l LARATION I hereby afR Ick ..try of perjury ane of be following declarations: I ham and will maintain a Certificate ofComent mulhimure fm WarkefsCompen- >ation,az provided for by Section 37M of the Labor Code.for the prop mance of me - work for which this permit is issued. 0 1 hale and will maintain Worker's Compematien Insurance,as required by Section 37W of the Later Code,for the performance of the work for which this permit is issued My Worker's Compensation last.earner and Policy number aa: Cartier. policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu rection need not W eomplcmd irthe Permit is for one hundred dollars(STUD) nr less.) 1 xnify that in the perrmmarae of the work for which this Permit is i eacd,I shall net employ any person in any manner azo W me subjectmmc Workers,Compensation of Cali 'a.D Applicant NOTICE TO APP,IQ If cr making this CcniOcam of Escmption,you should become sobJen m mens'h ompcnrasian prvvisions of the lahnr Codc,you Nun , ,z feMwith comply wi nine PmvisiOmormuNmitshn]Wdccmcdmvokcd. Z'O CONSTRUCTION LENDING AGENCY [—� I hereby arlime that mere is a construction lending agency for the Performance of D: the work for which this permit is issued(Sec.3099,Civ,CJ 0.A Undch Name n z Lender's Address U Q 1 certify mat 1 have read this application and tam that the above information is LL;: career,I agree to comply with all city and county ordinances and stem laws misting to 0U building construction.and hereby authority represensuises of this city m enter upon the H4[l shove-menuunad property for inspection purymus 6 (We)agree to rave,indemnify and keep harmless the City of Cupertino against UzfA incOns,qunce of tts.cesaand eapenscswhich may in any way seethe against said City in consequence of me gnrtting of this permir, ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /.�-61— Sig 2` SOU REG LATIONS. 9 sr Re-roofs / LL Sign urea APp for ek RDOUS MATERIALS DISCLOSURE Type of Roof Will mea tm(umrt building omupant Hort or handle hanNous material az defined by he Cupenino Municipal Code.Chapter 9.12.and the Health and Safety Cork,Section 25532(.)? All roofs shall be inspected prior to any roofing material beim Cy" g 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 it havardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. strict? ❑Yes (�Vu I banmW the haardouss materials mquimmena under Chapter 6,95 of the Cali(or Iia Halm&Safety Cock,SCNons 25505.25533 and 25534.1 understand that ifdm Wilding does not curendy have a mmna that it u my asponsihility w notify IW mropam of me mquimwhk un W met pilar m issuv¢c of a Cenificam of ek Signature of Applicant Date owner r atno ec se Dam All roof coverings to be Class"B"or better r Community Development 6 10300 Torre Avenue 1' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building De artment JOB ADDRESS: ' O I loS V`i c L ✓d PI' 1 C'Ct • FIERmrr# s a ( l( OWNER'S NAME: H-" PHONE # Ljok - 7'77- 9T4 y GENERAL CONTRACTOR FAX# `f I am not using any subcontractors: — g 1 i e Date Please check applicable subcontractors and comp t the following information 60 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 OWNER-BUILDER VERIFICATION 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 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). f Property Owner's Signature: Date: job Address: U 1 i I ��c C(� Permit# Any changes to the information vrovided on this form shall be submitted to the City of Cupertino Build Devartment. City of Cupertino Building Department CITY OF 10300 Torre Avenue C 1 I P E kT I N O Phone: (408)777-3228 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 vourself 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 CUPEI�T(NO PERMIT APPLICATION FORM %PAPN # / Date: �� b Z �. asv g ( SoS Building Address: Mailing Address (if different from building address): I01(os ►MLARCw PL � P �fNo , CA 9 So�Lf Owner's Name: Phone#: Q�AJYR T Y t wwv`k Rw� c�vJ 40T- Contractor: a$-Contractor: License#: SF�F Contacl: I / Phone: Cupertino Business License#: M01- a� Fax: Building Permit Info: -jR"rFF.,Z FAtJGA- � ERv\16 Folz 5 V'r URC STAWoOy 6rNGk-AcrVx Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential 91 Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: 2 cyz�:) Occupancy Group: Type of Construction: L Please check this box if the project is a second-story addition: ❑ ro'e�Size.- Standard ❑ �Lare MaiorO Quanti Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM 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/ uasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Ener Add Multi BUILDING BINVESTIGA Investi ation fee BUILDING 307s -T' 1 of3 I/C-) / CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water EIE14 ING BPTRAP Kitchen Tr a ING BPVENT Alt of Drain &Vent ING BPWATER Install/Alter Water Pi a ING BPWHEATER Water Heater/Vent ING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIIZHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI A liance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Li ting Fixtures ELECTRICAL BREEMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res A liance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rept], Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT R air/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSVTIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL - -- -- PPERNHTFEE— I --Plumbin-PermifIssue PLUMBING --- PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING 3of3 CITY OF CUPERTINO �m 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31621050 . 00 DATE ISSUED. . . . . . . : 08/15/2005 RECEIPT # . . . . . . . . . : 30755 REFERENCE ID # . . . : 05080118 SITE ADDRESS . . . . . : 10165 MC LAREN PL SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : MARTY ZIMMERMAN ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2335 RECEIVED FROM . . . . : MARTY ZIMMERMAN CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : MARTY ZIMMERMAN ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2335 TELEPHONE . . . . . . . . : *EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BREMMISC FLAT RATE 1 . 00 27 . 58 0 . 00 27 . 58 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BSEISMICRE VALUATION 200 . 00 0 . 50 0 . 00 0 . 50 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 101 . 31 0 . 00 101 . 31 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 101 . 31 M/C TOTAL RECEIPT 101 . 31 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL