08070003 .�CITY OF CUPERTINOst,K-ea :.:i `�'^- �'
•BUILDING DIVIwoN -- PERMIT CONTRACTQR+INFORMATION
BUILDING ADRESS: PERMIT NO.
10465 BREWER AVE SUMAN KOLACHALAM 08070003 .
OWNER'S NAME: PERMR ISSUE GATE
•
SUMAN KOLACHALAM 10465 BREWER AVE 07/01/2008
aNE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
' 0 0 C 0
Too LICENSED CONTRACTORS DECLARATION Job Description
fw 1 hereby allirm that I am licensed under provisions of Games 9(commencing
z„26 with Secttion7000)a'fDivision 3 of the Business and Professions Code,and my license is RMDL BTHRM(144 SQ)NON-STRUCTRL INC LD
y• in full forte and effect
Sqi License Class Lie.• PLMB/ELCTRC/&
Contracto-e,F,g Date .ARCHITECT'S DECLARATION TILNG & MOVE WTRHTR;TNKLS WTR HEATR&NEW GAS
L I understand my plans shall be used as public records
Dal LINE;ADD PLMB, ELECTRC,TILE
t G Licensed Professional
y3 OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
r 2 following reason.(Section 7031.5.Business and Professions Code:Any city or county
which requires a permit to construct,alter.improve,demolish.or repair any structure
Z y prior to its issuance,also requires the applicant for such permit to file a signed statement
Y2,1 that he is licensed pursuant to the provisions of to Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
IQ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $15000
e R2.1 that he is exempt therefrom and the basis for the alleged exemption Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of Number Occupancy Type
not more than five hundred dollars(SSW} 32641062 . .
I,as owner of the property.or my employees with wages as their sale compensation, •
will do the work,and the swcture Is not intended or offered for sale(Sec.7041.Business
and Dore[dons Code:The ComrKlnoa License Law doesnot apply ban owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employees.provided that such impmsenlenu are not intended or offered for sale If, •
however.the building or improvement Is.mid within ane year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
'u I.as owner of the property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Cade:)The Connor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contracmr(s)licensed pursuant to the Contractor's
License Law.
❑lam exempt u r See. ,B&P C for this reason
Owner Date o t a
ER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
■ I have and will maintain a Cenilute of Consent to self-Insult for Worker'sDampen- '
nation,as provided for by Section 3700 of the Labor Code,(or the performance of the • '
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance.as required by Section
3700 of the Labor Cade,for the performance of the work for which this permit is issued. ' •
My Worker's Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
•
(This section need not be completed if the permit is for cee hundred dollars 13100)
or less.)
•
I certify that in the performance of the work foe which this permit is issued,I shall not
employ any person in any man r •asb• •• re subject to the Workers'Compensation '
LW]of California.Date • I •t
Applicant SNA nil G(/t V” A G Mil
NOTICE TO APPLICANT:If.after making this Cenircae of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
.J Z forthwith comply with such provisions or this permit shall be deemed revoked.
'Z,..'gn CONSTRUCTION LENDING AGENCY
FI hem*affirm that there is a construction lending agency for the performance of
Ci.7the work fur which this permit is issued(Sec.3097,Civ.C.)
I:,)5 Lender's Name
:14z Lenders Address
o Q I certify that I have read this application and sue that the above information is •
F comm.I agree to comply with all city and county ordinances and state laws relating to
•a U building consuuction.and hemby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes. ill / •
F o (We)agree to ase,indemnify and keep harmless the City of Cupertino against
(el liabilities judgments.costs and expenses which may in any way accrue against said City �j�
fJ Z in consequence of the granting of this permit. 7
— APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: �- / ' Ib At VolDate 4 _ ( y��
SOURCE REGU TIONS. ry (Jy(a/f/y
'if dr `' / U
Signature of App can ontr• 0 ase Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant stout or handle hazardous material
as defined by the Cupenino Municipal Code.Chapter 9.12,and the Health and Safety .
Code,5c Yes II Nu
25532(a)a
❑Yes All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant ore equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants as defined by the Bay Area Air Quality Management allmaterials for inspection.P
istrict
❑Yes pit No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Codc,Sections 25505.25533 and 25534.1 urdenurn that if the building
does not currently have a tenant that it is my responsibility to notify the occupant of tie
requirements which must be Ie lssuana of a Catificae of Oc tiny. p Signature of Applicant Date
Owner or authorized agent 73 Dal O8 . All roof coverings to be Class"Er or better
4
CITY OF CUPERTINO
-S
• 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN • 32641062 . 00
DATE ISSUED • 07/01/2008
. RECEIPT # • BS000005304
REFERENCE ID # . . . : 08070003
SITE ADDRESS • 10465 BREWER AVE
SUBDIVISION
CITY • CUPERTINO
IMPACT AREA
OWNER • SUMAN KOLACHALAM
ADDRESS • 10465 BREWER AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1306
RECEIVED FROM • SUMAN KOLACHALAM
CONTRACTOR LIC # *OWNER*
COMPANY • SUMAN KOLACHALAM
ADDRESS • 10465 BREWER AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1306
TELEPHONE
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
1BSEISMICR VALUATION 15, 000. 00 1 . 50 0 . 00 1 . 50 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1MPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0. 00 40 . 79 0 . 00
1REMRESBAT SQ FEET 144 . 00 429 . 00 0 . 00 429 . 00 0 . 00
1STPLNCK HOURS 1 . 00 122 . 00 0 . 00 122 . 00 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
TOTAL PERMIT : 715 . 66 0 . 00 715 . 66 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
CREDIT CARD 715 . 66 VISA
TOTAL RECEIPT : 715 . 66
•
v &o7 0003.
CITY OF CUPERTINO
• ADDITION/REMODEL
• CUPERTINO PERMIT APPLICATION FORM
APN# Date:
(� t} to (oa . 63
Building Address: /oil 6 5 A w /� vR (l� ll �(� itp
Mailing Address (if diffrent from building address):
Owner's Name: Suurn Otpl IC U q o\ , I c4 140111 Phone # : 0g_ 2 % Si /
Contractor: M"v V n ^ • /1 I_� it Phone #:
IWv (ilA kit
Fax #:
Contractor License#:
Cupertino Business License#:
Contact: Phone#:
Fax #:
Building Permit Info: �'.c® rclaynd.¢.A
•
Bldg. r4 Elect. Plumb. ICI--- Mech. — Hillside ❑
'lob Description:
Addition (adding sq footage): p L1.A.vvi / E' j� C 7 'TA t e
What is being remodeled? 0y'49Ze$a'1i Ae,lAkerld
'1 ' Act so ' CI ee /
I cls W %< kia '
Remodel Incl des Re-Roof: Yes ❑ No Z. If yes list number of squares .119
Remodel Includes Structural: Yes ❑ . No E.
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen Bathe_ Other
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B
Valuations I S d O 0 Please check this box if the project is a
second-story addition ❑
Project Size: Express Iq—Standard ❑ Large ❑ Major❑
Please complete relevant portion of the Green Building
•Checklist & attach it to the application or if applicable, Green Building Points Achieved:
include in plan set & the sheet index.
***For Office Use Only*** 0i/X2 L4 C01.^^- o
Over-the-Counter 111 Revised 6/16/08
CITY OF CUPERTINO •
ADDITION/REMODEL
cu!WINO FEE SCHEDULE •
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
ADDITIONS 1R3SFDADD
PLLONGRNGR Long Range PL
Planning/Residential
1R3INSP Dwellings Inspections B
1R3PLNCK Dwellings plan check B
1R3REPINSP Dwellings Repeat B
Inspection
1 R3REPPLNC Dwellings Repeat Plan B
Check
1R3HINSP Dwellings Hillside B
inspection
1R3HPLNCK Dwellings Hillside plan B
check
1R3HREINSP Dwellings Hillside B
Repeat Inspection •
IR3HREPLNC • Dwellings Hillside B
Repeat Plan Check
1R3ALTINSP Dwellings Alternate B
Materials Inspection
1R3ALTPLNC Dwellings Alternate B
Materials Plan Check
1PCESS Cesspool P
1PPRSEWG Ea. Private Sewage P
, Disposal System
1PRSEWER Sewers P
1BPSPRINK Lawn Sprinkler/Backflow P
1BPWSVCS Main Water Service P
1BSEISMICRE SeismicResidential B
DECKS 1R3SFDADD OR
1R3SFDREM
1DECKWOOD Deck (Wood)-Each B
(Each) •
1DECKRAIL Deck Railing-Each B
(Each)
CITY OF CUPERTINO
ADDITON/REMODEL
• FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft _
GARAGES 1R3SFDADD OR
1R3SFDREM
1GARDTW<=1K Wood Frame up to B
1,000 SF
1GARDTM<=1K Masonry up to 1,000 SF B
BCONSTAXR Construction Tax Res
(new detached garage)
PATIO'S OPEN 1R3SFDADD OR
1R3SFDREM
1PATIOWOOD Wood Frame up to 300 B
SF
1PATIOMETAL Metal Frame up to 300 B
SF
1PATIOOTHER Other Frame up to 300 SF B
PATIO'S CLOSED 1R3SFDADD OR
• 1R3SFDREM
1PATIOENCLW Enclosed Wood up to 300 B •
SF
1PATIOENCLM Enclosed Metal up to 300 B
SF
1PATIOENCLO Other Enclosed Patio up B
to 300 SF
ICOVPORCH Porch Covered-Each B
(Each) •
1REROOFRES Residential Re-roof Each B
100 SF
REMODELS 1R3SFDREM
IREMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan
300 SF check)
,/IL/ 1REMRESBAT Bath Remodel up to 300 B «
SF
1REMREOTH Other Remodel up to 300 B LL
•
SF
REMODEL PLNCK
1STPLNCK (1-3 for Standard Plan Check B NOT FOR OVER THE
remodel) COUNTER PLAN CKS.
3 of 3
•
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE •
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
WINDOW/SLIDING 1R3SFDREM
GLASS DOOR
1 WINREP Replacement windows B
(ea 8 windows)
1 WINNEWNSTR New Window (non- B
structural)
1 WINMEWSTR New Window (Structural B
Shear Wall/Masonry)
1 WINBAYSTR Bay Window (Structural) B
SKYLIGHTS 1R3SFDREM
1 SKYL<10 SF Skylight less than 10 sf B
1SKYL>1OSF Skylight greater than .10 , B
sf or structural
1STAIRS Stairs-first flight/ea addt'l B
•
1EPERMITFEE Electrical Permit Fee E •
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
1ELCPLNCK Stand Alone Electric Pln E
Ck (hourly)
1MECPLNCK Stand Alone Mechanical M
Pln Ck (hourly •
1PLMPLNCK Stand Alone Plumbing4 P
Pln Ck (hourly)
1BSEISMICRE Seismic Residential B
(• 1TRAVDOC Travel &Documentation B
•
/ IBUSLIC Business License B
4 of 3
Green Building Plan Check
• Index of Green Building Points/Categories
. A. Category Example of an Index or Table of Green Plan Sheet or Page Points
Building Points Categories that must be
shown and referenced on the Project
S .._ .
Plans See below)
Mf ! 'kp:4 ... uM fi„4q--(,,:it
,Y C0z19,c•-&t kef,w4 . .
. B. Site 9. Install H.E. Irrigation, (details/spec)' L-1 2 points
11. Permeable Paving, (Note) L-1 2 points
C. Foundation 1. Use 15 % Flyash Concrete, (note) 5-1 _ 5 points
D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2 2 points
5. Use Truss with heels, (detail) 5-2 2 points
6. B. OSB Sheathing, (detail) S-2 2 points
E. Ext. Finish 1. Composite Decking, (Note/Spec.) A-3 2 points
4. B. Fiber Cement Siding, (Note/Spec.) A-4 • 2 points
F. Plumbing 1. Insulate all H.W. pipes, (Note/Spec.) P-1 2,•oin
5. Tankless W.H., (Note/Spec.) A-2 p0fij
11.A 2500 Gal. Tank, (Note/Spec) L-1 1�T po its
G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 4 points
H. Appliances 1. Energy Star Dishwasher, (Note/Spec.) A-3 1 point
3. Energy Star Refrigerator, (Note/Spec.) A-3 1 point
P. Other 1. List Green Features on Plans A-1 1 point
as` ri14C='.y. .',.v'",i C�
TOTAL POINTS 40 points
•
••
•
• •
Plan Review Process Work Book Page-12-Revised 3/25/08
Green Points Rating System for Remodeling Projects
Due to the diversity of remodeling project types,assigning a'total points°value to a project to be considered environmentally friendly is •
not feasible.However,25 measures have been highlighted to signify that every effort should be made to incorporate them into your
projects. These items have been chosen based upon their impact on the environment and the health of the home in coordination with
ease of implementation and relative low cost. These measures can be used as a starting point for'greening°your project.
INPUT Resources Energy IAO/Health
A.Site
1.Recycle Jpb Site Construction&Demolition Waste .
65%=1 point;75%= 2 points;80%=4 points up to 4 Resource pts 0
2.Salvage Reusable Building Materials 4 Resource pts y=yes 0
3.Remodel for Mixed Use,Adaptive Reuse,and •
Historic Preservation 4 Resource pts y=yes 0
4.Protect Native Soil 2 Resource pts y=yes 0
5.Minimize Disruption of Existing Plants&Trees 1 Resource pt y=yes 0
6.Implement Construction Site Stormwater Practices 2 Resource pts y=yes 0
7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0
8.Design Resource-Efficient Landscapes and Gardens 4 Resource pts y=yes 0
9.Reuse Materials/Use Recycled Content Materials
for Landscape Areas 2 Resource pts y=yes 0
10.Install High-Efficiency Irrigation Systems 2 Resource pts y=yes 0
11.Provide for On-Site Water Catchment/Retention 2 Resource pts y=yes 0
0 0 0
B.Foundation
1.Incorporate Recycled Flyash in Concrete •
25%Recycled Flyash=2 points;Add 1 point for every 10% •
increase of flyash,up to 5 points up to 5 Resource pts 0
2.Use Recycled Content Aggregate 2 Resource pts y=yes_ 0
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes_ 0
0 0 0
C.Structural Frame
1.Substitute Solid Sawn Lumber with Engineered Lumber 3 Resource pts y=yes 0
2.Use FSC Certified Wood for framing
(For every 10%of FSC lumber used=2 points,up to 10) up to 10 Resource pts. 0
. 3.Use Wood I-Joists for Floors and Ceilings 2 Resource pts y=yes 0
4.Use Web Floor Trusses 2 Resource pts y=yes 0
5.Design Energy Heels on Trusses 6"or more 2 Energy pts y=yes 0
6.Use Finger-Jointed Studs for Vertical Applications 2 Resource pts y=yes 0
7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes 0
8.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0
9.Use Structural Insulated Panels(SIPS)
a.Floors 3 Energy pts y=yes 0
b.Wall 3 Energy pts y=yes 0 •
c.Root 3 Energy pts y=yes 0
10.Apply Advanced Framing Techniques 4 Resource pts y=yes 0
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes 0
12.Use OSB
a.Subfloors 1 Resource pt y=yes D •
b.Sheathing 1 Resource pt y=yes 0
0 0 0
INPUT Resources Energy IAQIHealth
I. rndows
1.Install Energy-Efficient Windows
• a.Double-Paned 1 Energy pt y=yes 0
b.Low-Emissivity(Low-E) 2 Energy pts y=yes 0
c.Low.Conductivity Frames 2 Energy pts y=yes 0
2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 0
0 0 0
J.Heating Ventilation and Air Conditioning
1.Use Duct Mastic on All Duct Joints 2 Energy pts y=yes 0
2.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0
3.Vent Range Hood to the Outside 1 IAO/Health pt y=yes 0
4.Clean all Ducts Before Occupancy 2 IAO/Health pts y=yes 0
5.Install Solar Attic Fan 2 Energy pts y=yes 0
6.Install Attic Ventilation Systems 1 Energy pt y=yes 0
7.Install Whole House Fan 4 Energy pts •y=yes _ 0
8.Install Sealed Combustion Units
a.Fumaces 3 lAO/Health pts y=yes 0
b.Water Heaters 3 IAO/Health pts y=yes 0
9.Replace Wall-Mounted Electric and Gas Heaters with
Through-the-Wall Heat Pumps 3 Energy pts y=yes 0
10.Install 13 SEER/11 EER or higher AC with a TXV . 3 Energy pts y=yes 0
11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yes 0
12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Fumace 2 Energy pts y=yes 0
• 13.Retrofit Wood Burning Fireplaces
a.Install EPA certified wood stoves/inserts 1 IAO/Health pt y=yes 0
b. Install/Replace Dampers 1 Energy pt y=yes 0
c.Install Airtight Doors 1 Energy pt y=yes 0
14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0
15.Install High Efficiency Filter 4 IAD/Health pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAO/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAOMealth pts y=yes 0 .
0 0 0
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes 0
2.Install Solar Water Heating System 10 Energy pts y=yes 0
3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0
4.Install Photovoltaic(PV)System
•
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=18 points) Up to 18 Energy pts 0
•
6.Select Safe and Durable Roofing Materials 1 Resource pt y=yes 0
7.Install Radiant Barrier 3 Energy pts y=yes 0
0 0 0
L.Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy pts y=yes 0
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts . y=yes 0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0
• 0 0 0
• 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. '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
r S Cnw
Ce77t ch
Ebe performed
i5Sn.n') (Era K `�SKn n y U 91 e _444)3P�-t-4',Ati 75369'3 fiu�1S/J 9
— C/61-0a1_,g (��et, P I :'40 friewf ern
`ter W° afca1Li( od)hcc7S90 22-ti / f pr:n.ie.._
• 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(rev rse sid,).
Property Owner's Signature: Date: 81/a/oc
Job Address: I 0 if OS gat KJ QA, 141/t r, Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
•
Department.
tat
CITY OF City of Cupertino Building Department.
10300 Torre Avenue
CU PEI�TIN0 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 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
, • RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number: 3 2.6 L////o 62.
uc)
Name of owner. SAM(/lia/ki ,L.G h ci,odoot !yJ
Project address. (01 (4 LS- /5Ag vt)� ke_ , �-Q tfpyit—6;PLO O ( q - cSQ/I,
Contact person. '-1" lL VL-e-A- Phone. /408/ - ay ) - S i O 7
( _ Ak_ou., ) Fax.
• Net square footage of lot.
•
Existing Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
Ore there at least two 10 foot by 20 foot clear spaces inside the garage?
Is privacy protection planting required for the project? -'--'11
On what floor(s) is work being done?
Brief description of work. S We / _ I l
0 a IA _ Lu1 1. . ni 1 /, G / . l
Code editions:2008 CBC 0- N)2008 CFC 8_N)2008 CMC 4-N)
2008 CPCCO-N)2008 NEC -N)
Effective 1/1/08
JUL 01 2000 COP\
TVICA
t
•
Plan Review Process Work Book Page -8-Revised 1/1/08
7 . .'• ' ,
IP.137.
1 NC,. 1 ) /40o41iIC segvei e_.)-
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• RESIDENTIAL PROJECT COVER SHEET
1 ji/p
Assessor's Parcel Number: ?Z6/'7''L a 7 - 06
Name of owner. CwwlGt,1� ILGGr 6- a ,(�n
Gi ky? �j
Project address. /0 �i/bS /`j Ae ViJ�, ke- , ( C,LAW ( — 5-0//,
Contact person. AfrItte ®'(A)V -t't Phone. /4OR - 2Lj 5 — SI 06)/
T
• ( Ctil.f/Vptiv, j Fax.
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor:
Garage: /_
TOTAL:
lire there at least two 10 foot by 20 foot clear spaces inside the garage?
Is privacy protection planting required for the project? .
On what floor(s) is work being done?
Brief description of work. S 4,1A ' „ads,. At:/ We / I `yin '' ' .4, 1
� .- I
Code editions: 2008 CBC 0- N)2008 CFC 0 - N)2008 CMC p-N)
2008 CPC N)2008 NEC 101 -N)
Effective 1/1/08
JUL01 ` U
•
Plan Review Process Work Book Page-8-Revised 1/1/08
1 mos. . St Si-ea e_ - Ate C'22.cA>_,6Y I
C.
J `rem�_24,Qn ��/',4 94-0-
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Community Development
10300 Tone Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
•UPERJINO
Building •
/ _ Department
JOB ADDC of 6,S kj W e,„ ' kie PERMIT #
ti] Ogo 7000 3
OrAME NAME: .gt.01 (a it jc o( cl, AI PHONE # ° -2 - o9
GENERAL CONTRACTOR: FAX # /
I am not using any subcontractors: i'Le . o(�i� 7, °/ I 0
Signature Date
Please check applicable subcontractors and complete the following information:
0 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
4 .. p/ 02
Owner/ • ‘. actor Signature Da e