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031201183OCC �t tL�e Y�• ;y[ w 50, �ot Kmf Y�r YCi ii .7. z F a rn U U w 0 U CITY OF CUPERTINO ZNaRMt�.'Nr'-x.: BUILDING DIVISION PERMID ,,Co,;it BUILDING ADDRESS: PERMI'N"03120118 NOO3120118 OWNER'S NAME: PERMIT ISSUE OATS HONIG RODNE 2 JE: SANITARY CONTROL N0. ARCHFIECrIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION lob Description u under ndPr Profession,Coder 9 (commencing 1 hcrchy affirm mat i am if Me Business with Becrcea0efecDivision3 of me 6osinesand Prufcuiuns Code. andmylianseis C ® a�{p�� rlN�` ® mfeBsClaan, effect. SOLAR PANEL/UPGRADE License Class Lic. tr Dale Contractor. ARCHITECT'S DECLARATION - APR 1 4 2004 1 understand my plans shall he used az public rccnrds 11 1 L 9 BUILDING. ' Liccn$cd Pndcssimnal ON j OWNER -BUILDER DECLARATION Contractors 1 hereby affirm that I am exempt hum the @nirecmo Liana law far the • • 'tl _ i 1.5, and Pfafcuinns Calc: Any city nr county massa (Scctiuto which pmmit co 1, alter, which m cnnamm, pike improve, demolish, or repair any Structutatemem Sq. Ft, Floor Area Valuation its isrs n re forruch a gnedsmmmem a prior 0a incensed law9 C.ut,C,.r'S t...filo pni,is osofnt 9thatshc is licensed pursuanunthe provisionsnftheCommcmr's License (Chapter pursuant (commencing with Section 7") of Division 3 Of the Business and Professions Code)ser ( that he is exempt therefrom and me basis for me alleged exemption. Any violaton of 3 MN200i1err Q O Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more Iran rive hundred dollars (s50B). 1, as owner of the property, or my employees with wages as their sole compensation. - Required Inspections 9 P will do the work, and the swcium is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law docs not apply in an owner of pmpeny who builds or improves thereon, and who does such work himself or through his Own emptoyccs, provided that such improvements are not intended or oRened for sale. If. however, Ne building ar improvement is sold within one year of completion. Ne owner - builder will have the burden of proving mm he did not build or improve for purpox of sale). ❑ 1, as owner of Ne property, am exclusively convecting with licensed contractors to consumer the project (Sec. 7044, Business and Professions Codd:) no Cm n.etor's Li. cense law does not apply to an owner of prepeny who bailers or improves thereon. and w(h�0 contracts ch projects with a contractor(s) licensed purmanil to the Contractor's en Clit Law. L1 am axe mile Sec. _ B & P C for this reason I Date 'ZI4 it[(! I/ WOR 'S COMP ATIO ECLARA IBZ I hereby affirm under penalty of perjury one of me following declarations: I haw and will maintain a Cenipcate of Consent o self-insum for Worker's Compcm atimm, as provided for by Section 37M of me Labor Code, for the Performance of the ' work for which this permit is issued. 1 new and will maintain Worker's Compensation Insunntt, az required by Section 37W of the Libor Code. for the Performance of Ne work for which this permit is issued. My Worker's Cum pensumber Insurance carrier and Policy number are: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (leis section need nothccm sides d if the permit Is fur enc hundrcd,mllare(51(10) '. or Icss.) I certify thin in the a rfmmence of the work for which this permit is issued. I shall not employanypCracnlnany meT w az�ll Co}�C aubjC'I IQ I he WOrkcrs'CnmpCnsum. Laws of Qehfmn'Ie�D) 5. C"" - (.f%" - Applima nor UJ//V/ V AAAAAA /�I'al N0TIC APPLICANT: If, after making this Cenifream of Exemption, you should become $Object to the Worker's Compensation provisions of the Ichor Code, you must forthwith comply with such provisions or this permit shall he deemed rewind. - CONSTRUCTION LENDING AGENCY --I hereby affirm Met there isamm agency I'nr the Performance of > (S.C.3nlending fur which this permit is issued (Sec. J097, Civ. CJ Lenderk Lenders Namc � Lender's Atltlrcss D 1 minify mat 1 have read this application and stem that me above information is correct. 1 agree to comply with all city and county On inances and state laws relating to building construction, and hereby authorize representatives of Otis city to enter upon the for inspection above-mentioned property purposes. / l (We) dance to save, indemnify and keep harmless the y ac of Cupcnsts against swhie may in any the liabilities, judgments,)rtoemu indemni Py n meeg.inusaid City / z in nonsequ of the graining of this permit. '-1 APPLIC UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT /1•., Issued by: Date SOUREGU ATIONS. K ��3 1 7e, �, Re -roofs - Type of ROOF �F� JU mf Applica Conmcmr _b Dam S(/ AZARDOUS MATERIALS DISCLOSURE Will the applicant or future building Occupant store or handle havarsous material - .. az dcfne, by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code. Section 25532(.) - All roofs shall be inspected prior to an roofing material beim Installed. P P Y g g ❑Yeas If a roof is installed without first obtaining an inspection, I agree to remove win me applicant or future building occupant use equipment or devices which .mit hmartlnus air mnmminanis u defined by the Bay Area Air Quality Management all new materials for inspection. Dishin? ❑Yes �(Ju ' 1 have read me hazardous materials requirements under Chapter 695 of the Cahfor- riaHc.lm& my Cade, Secduns11505,25533 and 25534.1 understand mat if me building Jas not c m rely h Qr a mnar, mat it is my responsihilily to madly the a:mupant of me rcyit. whit must be met Cm.,munm,m`ICemIII FOC IF Y. Signature of Applicant Date z 3 &,'C-05 All roof coverings to be Class "B" or better ow marretl ant Date s -LoCKAbu 3oA 3P Rr F+lsfo 0�3 ,vvuTy� L�.ECT2/fistG Si',e(//C,�/}Yll�i I 5awwcx h l 1� it r — !1 � z/4•CD�owrT 1 1 Yrp IN✓QE7l+,IZ tI II It t AC 25O✓WOW-I-wfa — ZOAMI�Kcsst� 6cvp 3 a.,. `S✓aaYsor'4006L SWR ftlSLp j1 D/SC". ,rte, 2SDOU-SBD ?-#O✓ I.uukRTER �t 11 it ,II it tl a� Fie o-1. • �n NP xq I ( m I�-Tomo Ht_a am p GC " n\ �3 1?r5iDrvc& of Romey ! 4,welLL4- #OtVI6 2og-, Sco.-rrcD DiZlvf GKl°E2T/vo,6',¢ 9S0/¢ O 2 1 O.UC Ave FATCiRl e,4L nig o^ G±R 6-c IE E� 1,, Alow 5eewcF n u Z. AC 25OvoAt 30,4*,4 for p fusGO n s�oaa��l (F02 PGtE 4,1""ry SERV/C/ HFy� 3 A[ Z50voar r/OG-P4SE0 JOAaP �LiT/rn Dls�oa� if 4c 57ioff 0.. 4• af.C4.Ny /SOy 2500 1G,¢7T /N U/i/CTi%Q 6" D,C. 6p0 UOLT 30ANP IW?,fA F4sFp DI5LONa // 640--, , TIDO o i= /.vuK/Z7,w2) D• JFOOFpOp 50A.44 a-6&,`1[4TO9 eak5/5r)*& Q 124WOAAA4Y5 ToTAt/ac M/j10A4,,t/`S 71 CONDUIT 44,0 whiz¢ - }IA, 6.¢Rt-Ice TU jlw,"r $• C,'APulr*A o w1 a&.- ,DC S/OB Or' /NU�iryTE.t tO RvoF /42RAyr 7`yPIC4L sumer 5YSTE14Ir fog s�RP � ssE�u / - 62.x" W - 32044" 11-1025.11 1025.,, air-3F.s# DouBLE 5TR FPD ViEul— 5TP-U7, �eu6tr+ As ti�EoFv i{oaF S.rPPorzi B�ci«rs �q Doo3i-,e SrRur �E v KooF wl GASKET Lau � 5.0 PPo-e-T OWNER -BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform: • A. All the work authorized by tb3s 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 Owner -Builder Information (revep Property Owner's Signat}yg( Job Addr7: the above is true and correct. I have read and understand the DOI 2 3 Dp-e b 3 Permit # Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Devartment. 0 Dear Property Owner. City of Cupertino Building Department 10300 Torre Avenyr 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 m Recycled Paper CITY Of CUPERTINO r1 WITY OF CUPERTINOO PERMIT APPLICATION FORM o3iavllP NNAPN # � /� , �jj J" Date: Building Address: Mailing Address (if different from building address): Owner's Ne:, > �- .v/G Phone #: Contractor: License #: Contact: Phone: Fax:/pIll Cupertino Business License#: ildmg Permit Info: g'�\ El ct Plumb ❑ Mec Job escription: 'Itesidential ❑ o r Sq.Ft. Floor Area: /Sq.Ft.: �t Cost of Project:fryD Occupancy up: Type of Constructio Please check second -story this U ox if the project is a addition: ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERl Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > I OOK 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/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 fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING w 1 of 3 ,� z�i °-s- t,43,5 -?:- a'--- CI OF CUPEkTINO *ITY OF CUPERTINO, PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res 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 BP CEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Repipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BRENL IRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace > 1 OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL i.� 2of3 SIR, CITY OF CUPEkTINO CTY OF CUPERTINO* PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Sips 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 I BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection BUILDING BSWIM 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 PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 • CITY OF CUPERTINO - 77, "`rip L'+ 'L� per ♦ j-j��'T c�NTkk(ftbR14.24 ORMATIQN, . BUILDING DIVISION PERMIT . -.,., BUILDING ADDRESS: PERMIT ND. 03120118 OWNER'S NAME: PERMIT ISSUE DATE HONIG R DN E: - - SANITARY N0. CONTROL N0, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH a 0 0 0 LICENSED CONTRd..dmSDECLARATION 1 hereby affirm that I am licensed under provisions o(Cbader a (commencing with Section ID(Xy Division J of NC Business end Pmfcssinns Calc, entl my license is Job] 8�641's�•_,-_. C ff>U�lysslJ! ■ �� oIL��IL ec in full force and effect. SOLAR PANEL/UPGRADE - License Class LR. X Dae Gamrsrm APR 142004 ARATION DECLARATION understandARCHbe to useS I understand my plans shall 11 hed u PuM1lic mcnrds 13U1L DING Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affifm 1 oro exempt from Ne Contractors License Lew for the o on Profession, Cnde:Anylily at, wanly following mason.(Section IDnsu Business and improve. demolish, or silmygned which rcyuscs a permit re consumer, alley, nt e a statement poor In its lensed pursuant alw mquime the applicant s of thesuch permit m f Ic s signed ataumem for such that rer9 Sq. Ft. Floor Area Valuation menccensedSectiohors)ofDivision3theeBusiness ndProflaonsCodna (commencing with Section ]000) of Division J Business and Professions Code) or tof he al of that he is campy therefrom and the basis for the alleged exemption. Any it Penalty Seton any applicant fora permit subjects the applicant to a civil penally of 3 MI�I�83ber 0 0 OccupancyT e a than five not more than five hundred dollars ($50)), YP ❑ L as owner of property, or with Nei( sole Business will andr is intendedformat Nework,ands: sloOmisnot's (oracle(Sec.7 Inspections aBusiness and Pr The Contramars Law aces Dat apply to an owner or License Law ,Required ertywhianrldsor nd who gh his properlywhobuildsmemphasesmimprverwhodoesSuch omalred wn employees. provided orded for then avers improv arc not intended for mpleered however, the building or improvement is sold within one year of completion, On owe buildingori sold wit owrcL of builder will have the burden of proving Nat he did not build or improv for purpose of sale.). ❑ 1, as owner of the property, am exclusively contacting with licensed contractors to construct the project (See. 7W. Business and Professions Code:) The Comments' Li- crom! law docs not apply to an owner of property who Wilds or Improves thereon. and. who contracts f ch projects with a eantnneds) licensed pursuant v the Contractors Law. �nse 1 am doe ode Sec. B & P C (or Nis mason 1 WOR 'S COMP ATIOI ECLARA 1 hereby affirm under penalty of perjury, one of the following declarations: haw and will maintain aCenificato of Consent to self -insure far WorkersCompcn- Milan, u provided for by Section 3700 of the Labor Code, for the performance of the work for which Nis permit is issued. 1 have and will maintain Worker's Compensation Insurance, u required by Section 3700 of Or Labor Code, for dm performance of Ne work for which this permit is imudd. My Workers Compensation Insurance carrier and Policy number am: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' ' COMPENSATION INSURANCE (This se ntnn need not hecomPlmdd If the permit is farone hundmd dollars (SI00) or Ices.) 1 cradfy that in the performance of the work for which this permit is issued. I shell not employ any person in any mat�tCrdo asW aople�ubjccl to�he Workers Compensation Laws of QQaliforn'tryDa n , Applicaml n lC , NOTIC APPLICANT: IL after making this Certificate of Exemption, you should become subject to Ne Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this Permit shed! be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that Ram is a construction lending agency for the performance of the work for which this pertnil is issued (SIL. 3091. Civ. C.) tender's Name Lenders Address 1 certify that 1 have read Nis applic,am. and sum Net the above information is correct. l agree to comply with all city and county ordinances and auk laws minting to building construction, and hereby auNorim representatives of this city to enter upon the allow -mentioned property for inspection purposes. (We) agree to use. indemnify and keep harmless the City of Cupertino against liabilities. judgment. casts and expenses which may in any way across against mid City in conte c of the granting of this permit. APPLIC UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOUR EGU ATIONS. 2Za3 sswatur Re -roofs Type of Roof ig u olApplic AZARDOUSMATERIAfSD15CLO' R Data Will the applicant a, future building occupant more or handle hazardous material - u defined by the Cupertino Municipal, Code, Chapter 9.12, and the Health and Safety Code, Section an zss3xa7a - All roofs shall be inspected prior to any roofing material being installed. �11 If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant nsc equipment or devices which hazardous air momentums as defined by the Bay Area Air Quality Management all new materials for inspection. UI)IrtCl1 ❑YesU 1 have mad the meardous materials royuimments under Chapter 6.95 of the Califor. a aHcalth nyColc, Seen= 25505.25573 and 25570.1 understand thu if the building docs not c arty h W a Lenart, Nal it is my responsibility to nobly the occupant of the myuire whim must be mel priurm's Vance ofe Ccnifcauof Occupancy. Signature of Applicant Dale 23 nhZ-03 All roof coverings to be Class "B" or better Ow raathc(ized ant DaLe