04020100 CITY OF CUPERTINO * ` ' ' " ' aK°u ^^' '• i `"
BUILDING DIVISION PERMIT .�CON'TRACTUR INk'ORMA.TIQN..
Q,
BUILDING ADDRESS: BOB KARR "'"'14020100
ERMIT NQ.4 0 2 0 10 0
PERMIT ISSUE DAIS
ONE:013 KARP SANITARY CONTROL NO.
1� uicxurso
CHITECDENGiNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u LICENSED CONTRACTOR'S DECLARATION
1 Wmby affirm Nat 1 em limned under provisions of Chapter 9(commencing Job Description
� h Seetion7")ofDivision 3ofdo BusinecsW Profession Cods.Arid my Ike=is �kfull form and cffem ,�gpclss Lic.0 REROOF ON"LE®
Z;: Dale Contractor
ARCHITECTS DECLARATION FEB )
',Z W< I understand my plans met be used u public=tech f L D 4 2004
�w
ta Licensed Professional
j.�
:1 OWNER-BUILDER DECLARATION
<F 1 hereby AIR.Net I em exempt from the Crntrumr'a License Law for the BUILDING
3:00 following mason.(Section 7031.5,Business and Pmfesduos Cak:Any city or county
$ which requires a permit to canLnmL alma improve,demolish,or rtpoir any structom
t..zi prior An its issuance.alsu mquims tMapplimul forsuch permit to flea sigredsummem
Nm he is licensed pursuant to Ne pmvision of the Contractors License Law(Chaptv9 Sq. Ft. Floor Area Valuation
ZF$ (commencing with Section 7000)of Division 3 of the Business and Profession Code)or
Mat he u exempt therefrom and the baso for the allcgcd eadmption.Any violation of
Section 7031.5 by any applicant for a permit Subjects the applicant to a civil penalty of
Amt mom than live hundred Million;(S500). - 36VV7?JW2b900 Occupancy Type
❑1,u awnv of the WopvtY•a mY cmploycu with wages u Neuroid mmpewJon, '
will do Ne won and Code:no Com u wr's Limns,Lando s not apply to an Owneren
and ProrwM W ld,m7Te CotMeectori License Law does not apply lf an owner of Required Inspections
propemploy b,pmAimprrvsuch improvements;
messochw tied oro lfvtNougn nf.
ownemployes,provior Itemvemimprovementsamne arofdoroaved foe Ower.
Invent,do building or improvement is hath within one yeti of mprove for Ne owncn
builder will nave the buNm or proving that k die art build or improve for purpo¢or
ukJ.
El I,as Owner of do property,am exclusively contracting with limned metractors to
construct the project(See.7049,Business and Profession Cade:)The Contractor's U.
cane law does not apply to an owner of property who builds or improves dmteon,and,
who contracts for such pmjccts with a contranor(s)licensed pursuant to Ne Contractors
Lim.Law.
❑1 un rdv$cc f� B d:P C fm this mason
TOR fS COM ENS 1DION' —
� � RYY�K S OMPEN PION
1 hereby aRnm under penalty of perjury oro of the following decimations:
I haw and will maintain aCeAOmm of Concm to self-insure for WorkersCampen-
sation.as pmvioco for by Section 3700 of Ne labor Code,for Nc performance of Ne
work for which this permit is issued
1 have and will maintain Workers Compenation Insuranm,as reyuimd by Section
3]00 Of the labor Code.for Ne perfmattr m of Ne work far which this permit is issued.
My Workers Confrontation Insurance carrier and Policy number tic:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE .
(r ds section need not be complcmd irthe permit is for One hundred dollars(SIM)
or less.)
I unify Nat in Ne performencc of the work far which this permit is issued,I shall of
employ any person in any mvmerso As to become subject to do Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:Ir,after making Nis CcniEexm of Exemption.you should
become subject to the Worker'&Compensation provisions of Ne labor Cndc,you mus
.J z forthwith comply with Such provision or this Permit nall be deemed revoked.
ZC7 CONSTRUCTION LENDING AGENCY
.N.. Ibeteb AM.Nat them is A construction lending
F Y S agency for Ne perrormanm of
C dm work for which this permit is issued(Sec.3097,Co,C.)
alandcri Name
z Lenders Aotlmu
U Q I certify Nat I have mad Nis Application and stain that Ne above information is
0 H bonding 1 agree to comply with all city and comms nuitim of and sum laws relating a
pU .1how-memilding amod Ant And for by impatiorirzmpreunutivu of this city tocnmrupon the
F 6 ahovcmentirned propcny for impaction purposes
(We)ag.to save,mccmmly And keep hadmless the City of CoNnum Against
Icy in
of M,grinning eapeeuamiich may in any way acrnovgerntuiO City
f,z A conmquencc of the UNDERSTANDS
of this permit. /
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC�*yGU�+TIONS
k�{nature Of APPoCwA COA-1Or V Dam Re-roofs
VV` HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or ruuou building occupant store or handle hisdam us material
As dented by Ne Cupertino Municipal Cods.Chapter 9.11.And the Health and Safety
rale. 0Yee CA 25s3zp1? All roofs shall be inspected prior to any roofing material being installed.
❑Yes AN.
Will the applicant or rumm building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hammous air contaminants u defined by tic Bay Area Air Quality Management all new materials for inspection.
District?
[3 Yes �o
Ihave Sgc,NehaStdmns,2555.255ls uimments 53,4.1 Chapter6.95.95 of Nc Wilding ����
or
nice HCLlth&SafnyhawAScnia,Oat itSmynvnJ25539.1 to Amory
cmuscnir Me [t1^/ C
docs not currently neve a mnanL Nat it u my mxpomibility m nrtifY Ne acupant of Ne 11�
require n¢ hi tont me prior m issuance ora CcmOcam of Omuprnc. - o
_ Si ature of Applicant Date
owner r arthro;:cd agent Dam All roof coverings to be Class"B"or better
• ; Community Development
10300 Torre Avenue
1 �y Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: r- ,j,5q ('e � PERMIT # o� / V-a
OWNER'S NAME:%� i PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractor
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
caner/Contracto ignature Date
10/28/03
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent,spouse or child) will perform:
A. X 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).
Property Owners Signature: R-4 Date:
Job Ad dress: 02LAI Pa111% QLLILpiC,2 Permit# b J Iro
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 Avenugft
C U P E kT I N O Phone: (408)777-322
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 an Recycled Paper
• Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
UPEI�TINO
CITY Of Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
• 3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed,a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: c Baa kl 0 I r6 (1-11" �
Job Site Address: U g t b�La vy C_L', /,Ix r?� 6/1 Q
V .
Roofing Company Name:
A phcant'sSignature: Date: ' (3^0�
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
as CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
Building Address: (346vq-t Owner's Name: (j Phone#:
Contractor: f7 i _f Phone#: License#:
0, .w mob- 1c7(�OW
Contact: (� C Phone#: $� $� J Cupertino Business License#:
p�PDQ 0 S j S
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
117. Asphalt Shingles kk Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
% To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Colm]21y With Cu ertino's Tear Off Policy: ❑
Job Description: I,
"
Residential Commercial ❑
Fire Zone: Yes ❑�_ ❑ Confirmed with Plannin et,-i
there are an restri ns: LJ
Cost of Proj Type of Constructi Occupancy gro
31 aco,a� .
Qty. if
A li a Fee ID Fee Description Fee Grou
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
*7 7. s�