04050051 CITY OF CUPERTINO �*'�•% u c x
BUILDING DIVISIONPERMIT CONTRATOR NFORMATIONC �„
9
BuILDINGADDRFSS: JERRY & NINGNING LIN PERMIT N84050051
D661 CARITT4R DR
OWNER'S NAME: PERMIT ISSUEDATE
4
ONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BO ELECT PLUMB MEQCH
too LICENSED CONTRACTOR'S DECLARATION JobDescri [ion
YwF I hereby affirm Nat I am Iitx¢d under provisions of Chapter Y(commencing P
S Zry with Section 70(X))of Division 3 ofthe Business a no Professions Code,and my license is I�p,��n❑ II {�
^<oyin full ionic and effect. REPLACE MAIN WATER LINE
,n Z License Class Lic.as
=o Da¢ Contractor V
�s ARCHGOl DECLARATION ^,�g)Y
re a I undersand my plans shall M used ax public records MAY X 2004,
eau
3 n I-' Licensed Profeaion.I
s'ms OWNER-BUILDER DECLARATION WILDING
11 n sa
<M I kmhy affirm Nal 1 am exempt fmm the Contractors License Law for tk � ��t^ LDIII�Osf w,
a O fallowing mason.(Section 7(n 1.5.Business and professions Cale:Any city or county Y V Vl/1
X which requires a Permit to construct,alter.improve,demoiah,or repair any structure $300
y prior m its issuance.also mquims the applicant for such permit to rile a signed statement
` < Oat he is licensed pursuant to the provision ofNcContractor's License lsw(Cheprer9 Sq.FL Floor Area Valuation
5�G (commencing with Section 7000)of Division 3 of the Business and Profeaions Cnle)or
i Nat he at exempt therefrom and dm basis for use alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit objects the applicant 10 a civil penalty of 3 7AHN N&ffie0 0 Occupancy Type
nut mom than fiva hundred dollars($500). P Y YP
0 1,as owner of the property,or my employees with wages as their sole compensation,
will do the wart,and the struauo is not intended Or offered for sale(Sec.7044,Business
and Professions Code:Tim Contractors Licanu law docs arl apply m an owner of Required Inspections
limitary who builds or improve thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended in offered for sale.If.
however.Ne building or improvement is sold within one year of corepledon,the owner.
build.,will have the burden Of moving that he did not btild of improve for purpose of
sale.).
t¢I.as owner of the property,am exclusively contracting with licensed contractors to
construct 0,project(Sec.7()14.Burin.and Professions Cade:)This Cuirassiers Li
cense law docs not apply in an Owner of property who builds or improves daemon,and
who contracts for such projects with a contracwr(s)IicemeC pursuant to the Contractors
License Law.
0 1 am cxemp undeZc. .B i P Cfo Nis mason
Owner_ Dem
/N//� CER'S COMPENSATION DECLARATION
I he y oflmin under penalty of perjury one of the fallowing declarations:
1 have and will maintain a Cer i(cam of Consent to self-inaum for Workci xCompen-
extion,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
J]W of the labor Code,for Ne performance of the work for which this permit is issued.
My Workers Compensation Tnoran¢corrin and Policy number am:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tau onion need not k completed if the Permit isforam hundred dollars($100)
or leas)
I unify that in the Performance of the work for which this Permit is issued.I shall not
employ any Peron in any manner an as to become subject o the Workers Compuuadon
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Certificate or Exemption.YOU should
became subject to the Worker's Compensation previsions of the Iskr Cods,YOU must
.J O forthwith comply with such provisions or this permit sMil k deemed mvaked.
Zs" CONSTRUCTION LENDING AGENCY
[-+� I hereby affirm that them is a construction lending agency for the Performance of
(3: the work for which this Permit is issued(Sce.309],Ci,C.)
Lenders Name
z Lenders Address
V C) I comfy 0.11 have mad this application and sure Nn the akve information u
Lf.F' correct 1 agree to comply with all city and county ammonites and sum laws relating to
0V building construction,and hereby auditors,mpresenudms of this city to enter upon the
.true-menummd P.,rty for inspeclien purposes
�I31
C (We)agree to sass,indemnify and keep harmless dueCity of Cupertino against
N liabilitirujudgmena.eosts and exNnsa which may in any way acctue against said City
! U in consequence of the granting of this Permit
APPLICANT UNDERSTANDS ANDg1'ILL COMPLY WITH ALL NON-POINT Issued by:S44Date
SOURCE REGULATIONS. A / a
2
b/0 if
Re-roofs
Signature of ApplicarturZonorfunr12
HAZARbous
MATERIALDISCLOSURE Type of Roof
Will the applicant or future building occupaa nt varc or handl[hvardaus material
az defined by tk Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
ode.Section 25532(.)? All roofs shall be inspected prior to an roofing material being Installed.
C]Yes E�N P P Y g g
Will the applicant or future building Occupant as,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hatmdous air contaminants az defined by the Bay Am.Air Quality Management all new materials for inspection.
Dison?
O Yes
1 have read Ne aasatdOus materials requirements under Clupmr 6.95 of the Cab or-
isH.Il aSarcdy Ce ,Sa6ons25505.25533md25N.1undcrsu if Oe Wilding
dos trot curmndy hast a tenant Nat it u my msMmibility w nouly tk a upam ofd¢
requirements which tanTL poor to issuan«Ora ccnifcam or act y Signature of Applicant Date
` 0 0`F
C
wner or authoris ag D,m All roof coverings to be Class"B" or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
SUPEkTINO
Building Department
JOB ADDRESS: �� i In PERMIT # b c Os5
00
OWNER'S NAME: V l ,, �1 f/ PHONE # -36C-(gs-q
GENERAL
6C-(gs-
GENERAL CONTRACTOR: FAX #
I am not,using any subcontractors: alb zo
tgnature 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
sX 016
Contractor Signature Date
Community Development
p }' I
0300 Torre Avenue
Cupertino
CA 95014
P
L, Telephone(408) 777-3228
r CITY OF Fax(408)777-3333
UPEkTINO
Building De artment
JOB ADDRESS: , O�6 / r�r In PERMIT # b voS 00T l
OWNER'S NAME: b rr C t V Y PHONE # t 0 -XC-
GENERAL
XC-GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Fignature Date
Please check applicable subcontractors and complete the followinginformation
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
L x/016
OO n2r/Contractor Signature Date
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent,spouse or child) will perform
A. V 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
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 Owner's Signature:: Date: J
Job Address: 10461 car vet" Dr. Permit# 0 �6 0 0
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
Imo• .
City of Cupertino Building Department
CITY OF 10300 Torre Avenue
C' 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 peiaut 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
Pnnled an Recycled Paper
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 2
Sec : Twp: Rng : Sub: Blk: Lot :
APN . . . . . . . . . 37534050 . 00
DATE ISSUED. . . . . . . : 05/10/2004
RECEIPT # . . . . . . . . . : 25489
REFERENCE ID # . . . : 04050051
SITE ADDRESS . . . . . : 10661 CARVER DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . :
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : JERRY & NINGNING LIN
ADDRESS . . . . . . . . . . : 10661 CARVER DR
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : JERRY LIN
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : JERRY & NINGNING LIN
ADDRESS . . . . . . . . . . : 10661 CARVER DR
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- - - - ------ ------------- ------- --- -- -- ---------- ------- - -- --------- -
BPERMFEE VALUATION 300 . 00 77 . 00 0 . 00 77 . 00 0 . 00
BPWSVCS WATER SERVICE 1 . 00 8 . 33 0 . 00 8 . 33 0 . 00
PPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00
TOTAL PERMIT 120 . 85 0 . 00 120 . 85 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
--------- - - - -- - -- ----------- - -------- - - - -------
OTHER 120 . 85 M/C
TOTAL RECEIPT 120 . 8S
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB & OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN # ✓ Date:
3 2s 3y os'O s/2 /o�
Building Address: /Ob 6 / Ca
�w,eA l7r�
C
Owner's Name: Phone#:
Contractor: Phone: License#:
< se 7
Contact: Phone: Cupertino Business License#:
Building Permit Info:
Bld e Plum
Job Des iption: vwtiti o,o heti y��
Residential 9J r
Cost of Project: 300
Qty. if-
AppRtPkFee ID Fee Description Fee Group
PPERMPUFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPERMFEE Bldg. Permit Fees BUILDING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING