06080256 (2) CITY OF CUPERTINOYs °* _
BUILDPNC DIVISION PERMIT I2COky'TRACTOR INFUT.tMATI a '
BUILDIrvc ADDRESS: MATTHEW LAWRENCE PERMIT N°'06080256
20674 CELEST
OWNER'S NAME: PERMIT ISSUEDATE
MATTHEW LAWRENCE 08/30/2006
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG 0 PLO MECH
lop LICENSED CONTRACTOR'S DECLARA71ON Job Description1 hereby affirm Nu I am limmcd under provisions of Chapter 9(mmmemin{
, Sermon 701)1)ofDlvlelan 3 ofdm Busimasand professlum Cado,and my linen is
inde full to.and affect. FRAME IN NON-LOAD BEARING ALL AT LOFT
;OZ Lkenac Clan —LIC-0
Date Comeanor
ARCHITECTS DECLARATION
I understand my plans shall he used he public records
c Licensed Pru@ssioml
OWNER-BUILDER DECLARATION
y I hereby affirm that I am exempt from the Contractors License Law for the
:00 following mason.(Section 7031.5.Business and Profession Cade:Any city at county
:26! which re ptims•permit to convect,alter,Improw,dental W,or repair any structure $100
�zs pdarm its ummac.Wu mmdoes due applicant for such permit to ilk a signed statement Valuation
G Wt he Lslkmssedpumtonwdue provisionoflheCmusectof'slhmmclaw(Chrrem9 Sq.Ft.Floor Area
I�8 (commencing with Section 70001 of Division 3 of the Business and Profession Cadc)of
that he is exempt therefrom and the threat for the alleged eanmptrm.Any Halation of
Section 7031.5 by any applicant for a permit Objects the applicant to a civil Penalty of f Occupancy Type
nut mom than five hundred dallan(3500).
0 1,Is swore of the property,ar my araplay.wide wages u Neth sole eompenuUon,
wit do the work and the ancume Is am intended W.Rexed for ande(Sec.7044.Busircaa Required Inspections
and Profesdona Cadc:77e Contractors License Law dues wt apply 0 an owner of q P
property who builds or imp sa ms deueon,and who docs such work himsel r or through his
ownemployces.provided thmauch improvements manut Intended moRefed fnuk.if.
however,Ne have
or Mpmmocnateal withinea )ear of improve far theowten
builder MO Nve Use hordes,of proving WI he did ret build or improve far pogo¢of
sale.).
(r1.as owner of the property,am exclusively contracting with licensed contractors m
emmmct the protect(Sec.TOO.Business and profession Code:)The Contractor
ns LI-
cane law does oat apply so
an owner of property who builds ar impmvm Iherem,red.
who contncu far such projects with a mnuaMrts)Ikmrtsed pursuant m dee Contractors
Lkeese law.
0 lamnem tuna B@PC for this moon
Owner / Dau
KEN'S COMPENSATION DECLARATION
I hemby affum uM r pen4ty of perjury aro of the following declaratiam:
I haw and will malnuln aCcnifimuof Consent toself-Wort far WarhrtCompen-
workf rprovided fpe mi is
issued.3700 0(the lather Code,far Ne pcAormanca of the
work for which this permit is issued.
0 I haw and will maintain Workers Compensation Instutnm,as required by Section
3700 of the Labor Code,for the per(ormmen of the wank for which this permit Is intrad.
My Worker's Compevsailon Wu ence carrier and Policy number sm:
Cartier'. Policy Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Nat section..deal he completed If the permit Is for.hundred dollen($too)
or Ices)
1 cenfy that in dee performance of tie work for which this Permit at issued,I shall net
employ any peon to my m P(/o a to became Object to Ue Workenr Campemadon
Lrvn of Cnifomi
of
NOTICE
NOTICETOct W the
er.after mating deo CertificatessOf of Exemption.Code.
should _
become comttothe Warhro Compensation provisions ofd elrhm Coln you rent
.,O forthwith comply with stth provision or Nu pennil Nall he decreed revoked.
Zr~y. CONSTRUCTION LENDING AGENCY
[-n I hereby alarm that then is a contmctinn Lending agency for the Performance of
a 5 the work far which this permit at issued(Sec.3097,Civ.C.) `
ELenders Name '
i`-1. z Lenders Adders
U0 I«aify that I have mad this applicadon and mulatto Uta show infarmadun is
LL P coned I agree to comply with all city and county ordinances and sum laws mlating m
DU building construction,and hereby authorim mpaccabrives of this city to enter upon the
r LSI show-memiuned Pmpcon for ex ecGon purpowhich s
(We)agme to save,indemnify and hep harmkss de City of C.Penfno ago=
,A liabilities,in
equnce or the jou and expenses;which may in any wyaocroc against Old Gty
U APPLICA4NT UNDERSTANDS ANDundog,or WILLWILL COMPLY WITH ALL NON-POINT Issued by: Date
50 O
Re-roofs
Signa m ff ApptmnUComanor Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future bullding omupaum ore orlondle hazardous material
u defend by do Cupertino Municipal Code.Chapter 9.12 an4 the Healed and Safety
Code.section 25532(07 All roofs shall be inspected prior to any roofing material being installed.
Cres BNa
Will de applicant or future building Occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree[o remove
mit hazardous air contaminants It defend by the Bay Area Air Quality Management all new materials for inspection.
District?
Ores BJu
1 have mad the bauNsmr maurialsmquimmenu under Chapter 6.95 of the Califor.
me Heulthk SafetyCode.Sec4mw25505.25533 md25534.1 undernmd thatifthe building
don nut coamnU haw a tenant Wt h is my mspaniMlity to notify the occupant oT Ue
require aft '
prior m Issuance of a certificate of Ocm�mey Signature of Applicant Date
)0 All roof coverings to be Class"B" or better
d
owner of Othanrsarim —�Dow
Community Development
10300 Torre Avenue
Cupertino CA 95014
"aloTelephone(408)777-3228
cl OF Fax(408)777-3333
16UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT #
0 o d 6
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: FAX#
I am not using any subcontractors: J
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
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
VC C11 V1L11CLL
• 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 Signature: // �" ' ! Date:
Job Address: ��7Y� V_e 4;49ZA1 a C9 Permit# 000 g"5,r�
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 S 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 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 uinless 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
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CITY OF CUPERTINO
am 1 of 1PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32658073 . 00
DATE ISSUED. . . . . . . : 08/30/2006
RECEIPT # • • . . . . . . . : 35848
REFERENCE ID # . . . : 06080256
SITE ADDRESS . . . . . : 20674 CELESTE CL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MATTHEW LAWRENCE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : MATTHEW LAWRENCE
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : MATTHEW LAWRENCE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BPERMFEE VALUATION 100 . 00 83 . 16 0 . 00 83 . 16 0 . 00
BSEISMICRE VALUATION 100 . 00 0 . 50 0 . 00 0 . 50 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 118 . 52 0 . 00 118 . 52 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CASH 118 . 52
TOTAL RECEIPT 118 . 52
•
4f CITY OF CUPERTINO
CUPEf�r PERMIT APPLICATION FORM W �
N# - Date:
y 6
Building Address: Mailing Address (if different from building address):
O `
Owner's Name: Phone#:
Contractor: 0l6 License#:
Contact: Qom - Phone: Cupertino Business License#:
Fax:
Building Permit Info: {'AA-e "t, A oAR Loa &,/M vtll&Vlrll
Bldg V Elect ❑ Plumb ❑ Mech ❑
Job Description:
Residential G( Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: Occupancy Group:
OZ!, r3
Type of Construction: Please check this box if the project is a
�' a t /' second-story addition: ❑
ro'ect Size: Standard Lar e ❑ Ma'or ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK 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 Incl/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> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Ener .Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of
(,`!S CITY OF CUPERTINO
CUPEf�T, PERMIT APPLICATION FORM
uanti 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 Pb1g 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 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 cfrn MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> I 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
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res App liance ELECTRICAL
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CITY OF CUPERTINO
CUPEI�F PERMIT APPLICATION FORM
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
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 Mechanical sq. foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
•
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