06020087 CITY OF CUPERTINO sea* @ �.d 'x+s+.r.. aL��
BUILDING DIVISION pERMTT A#4ONT�CTOR%Il FOR..MATI(-)N.-,
BUB.DINGADDRFSS: BY ROVEGNO PERMTTNo.06020087
10497 CHACE DR
-OWNER'S NAME: PERMIT ISSUE DATE
BYRON ROVEGNO 02/14/2006
ONE: SANITARY NO. CONTROL NO,
ARCHITECTIENGINEER: BUILDING PERMIT INFO
pp BO EO PLO ME�CH
30G LICENSED CONTRACTOR'S DECLARATION ]�t 1pe$C!1 ttTD�
ee 1 hereby affirm Net 1 am licensed under provisions of Chapter 9(commencing D q POS
n '
with section 7000)ofDiwlsion 3rlthc Businessland Profesdam Code.and myliceueW REMODEL BATH (NEW S HOWERf�TI1I,IE,"' il'' B.
w in fell to=and effect. tau}%"
;Nz DatcLiceClara Com FIXTURES IN TIILET & ,SUOWER AR A
$ Date Contractor
3E ARCHITECTS DECLARATION `5(� Q
Q I understand my plana shall be used u public records �10� YOG6T
k C t�, Licenced Professional
a y g OWNER-BUILDER DECLARATION {/ j0 TIP+ w
0 0 I hereby
affirm that 11. exempt from tM Crningtora Code:A n ny c Law for tbe L(/7 �-1 p Y b1
p�V followwhich ing maaoa(eal Ito oD I.S,Bduess and ve,dem u h.or e air m muclum U (i\`/r1/'
which requires a permit m ennsweL elms Improve,demolbh,or repair any semcrum
� prior b its issuance,also acquires We applicant for such Permit m rile.signed alatemenr
2�< Nei he is licensed pursuance the provisions of Ne Contractor's License Low(Chapter 9 Sq,Ft. Floor Area Valuati
$ (commencing with Section 7(W)or Division 3 of the Business and Professions Code)or
that be Is exempt therefrom and We bub Its the alleged exemption.Any violation of
Section 7031.5 by airy applicant for a permit Subjects Ne applicant 10 a civil penalty ofOCCU P y Type
not mom than firs hundred dollen($500). 3�V "'0 0 araC
O 1,u roma of Mae property,or my employers with wages as their x10 compensation. C 1
will de the wrrk,md do.nontum Wool intended or offered pounds(Sec.700,Buiors. Required Inspections
and Profession Cox:The Contractors Liceue Law don out apply to an owner of 9 .
property who bol Ids or improves thereon,and who doe s s uch work himself or through his
own employees,provided that such improvements are not intended orrBend funk.If.
however.the building or improvement is said within one year of completion,Ne owner•
builder will have the burden of proving Most he did not build or improve for purpose of
tile.).
❑1.as owner of the property,am esclusively contracting with licensed contractors to
com mct the project(Sec.7110,Business and Profeulam Code:)The Contractors Li.
cc=law does not apply 0 an owner of property who builds or Improves thereon.and,
who contracts for such pmjec%with acomrxmr(s)licensed porwent to the CWtorctors
Lacs.Law.
❑lam stamps un Me S[e/p. ,B St P C for this mason
Owner�t n1 L6���t7D Data f d
WORKPA8C0 ENSATIONDECLARATION
I hereby Maine under penalty of perjury arc of the following xcbntiou:
1 here and will maintain a Certificate of Consent to self-insure for Workers Comp e-
satian,uprovided for by Section 3'1(10 or Um Leber Cox,for the peAunnence of We
work for which this Permit is Wood.
❑1 basin and will maintain Workers Compensation Insurance,u acquired by Section
3]00af the labor Cox.for Me performance of Ne work Im which Nis permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This cec0mt need not xcompkxd lithe permit is as one hundred dollars(Slav)
or leas.)
1 certify Not in Ne performance of Mc work for which this permit is issued,I shall out
employ any person I.my manor utob omci em to the Worken'Compenation
Lawsot Calif I Dal+ V
Applicant AMC
NOTICE TO APPLICANT:If.airs, m.king this Certificate of Esemption,you should
become subject to the Worker's Compensation provisions of the Later Code,you muse
.JO foMwirh n m comply with such provisions; this permit shall be deemed matted.
Z CONSTRUCTION LENDING AGENCY
[+� Ihereby at..Ms.them is a emoductirn hodinpgency for Meperformance or
C the work for Which this Word,is inued(Sec.3097.Civ.CA
Lenders Name
z Lenders Address
f,Q 1 certify that 1 Mw tud thb application and sum Nal the me.information b
ly^ cooed 1 agree to comply with all city and county ordinances and sum laws relaing to
C)SV': building convection,and hereby authorize repressommoat of this city Is color upon We
LU above-mentioncl property for impecImn purposes.
LL (We)agree to save,indemnify and keep hsrmless the City of Cupertino against
AI liabilities,judgments,cnu and expenses which may in try any amus against said City
t)7 in consequence of the granting of this permit.
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR EREGU//tL/JATIONS.
�f�6M..�/k'tA c i0 6
S umofApliMC tor a/ /Dan, Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant Mom orhandic hazardous material
as,deMW by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safely
We, e75s3z(a)7
0 Yes ON.
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
It haaardou air conuminanu as defined by Me,Bay Area Air Quality Management all new materials for inspection.
isvicry
❑Ye. 0N
Is ave mad the hvardnusmatesials acquirements under Cheper6.95 orthc Califon
nla NcOhh&SafciyCode,Seetiom25505.75533and25534.1unde "thuiftc building
Jaes no.curtcnrly bass a lonane Wt it b my mapouibilily to notify the oaupanr of the
myui a wmlmnalbemelprirrtoinnanmrrace nteurOcmpaney. Signature of Applicant Date
! 14
wner anmhomcd egcm Dam All roof coverings to be Class"B"or better
O
Ma.
' RESIDEN�T �ROJEC COYER SI3EE�T
CUPEIsTINO d yl, ;tii x 3F_0
Assessor's Parcel
�N7umber:3-Lkn —\3—%z�4-7-1
Nameofowner.
Projectaddress.
1
Contact person.7aa-4 r1 2� � Phone. '� �S 3� ,
�. � - y � r�
Net square footage of lot.
Existing �ProDosed C'J
Square footage: First floor: Z?—I
Second floor:
Garage:
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces inside the garage? N
Is privacy protection planting required for the project? Y
On what floor(s) is work being done? \ t�
Brief description of work. y-,"
Code editions:2001 CBC (DN)2001 CFC (Y-N)2001 CMC (Y-N)
2001 CPC N)2001 NEC (Y -N)
Effective 11/1/02
Plan Review Process Work Book Page-8-Revised 4/28/04
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CI OF Fax(408) 777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: PERMTr#
o � cgprGE DR, 060,;?-008�
OWNER'S NAME: 3Xror, Rove o PHONE #qo5 :1-3s- l l /
GENERAL CONTRACTOR: viFAX #
I am not using any subcontractors: Feb. 1 Zoo 16
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. 1G 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-eur 1.0ormn d
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.
Persor�Fnm Address/City Phone Number. Type of work to be
1041 G t)r erformed
No )n
ti l2
.....................................................................................................................................................................................
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: 7(t &2w- Ind Date: F2b. I �, zoo,6
Job Address: }mak a cP Drove- Cluj2p Yrs na Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
City of Cupertino Building Department
410 10300 Torre Avenue
CUPERTINO Phoma `x'77'-32M
Dear Property Owner.
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements spedfied.
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 trey 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 Incensed as
contractors or subcontractors,then you may be an employer.
If you are an employer,you must register with the state and federal goverment as an employer and
you are subject to several obligations including stag and federal income tax withholding,federal social
security taxes,workers' compensation insurance,disability insurance costs,and unemployment compensati
01
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 US.Small Business
' ' dministration).` 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
1.Board in your community or at 1020 N Street Sacramaito,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 pm=dt will not beissued until the verification is returned.
Very truly yours,
Building Department
City of Cupertino
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r CITY OF CUPERTINO
CUPEf�TINO PERMIT APPLICATION FORM D ��� F-7
N# Date:
^ \ ^b-l 'j — D� Date2 (\ -5 ob
uilding Address: Mailing Address (if different from building address):
Owner's Name: Phone#:
��(to rJ Q. \ D = \-\o 'er 5- ( l-? 1
Contractor: License#:
Contact: F} elreon- _\7�\Lt , A2 'Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb)k Mech ❑
Job Description: NrvJ
Residential SaCR_ Commercial ❑
Sq.Ft. Floor Area: q.Ft.: d
Z:7-7 �; o u-,.
Cost of Proi ect: Occupancy Grouv:
��DO —
Type ofConstruction: Please check this bog if the project is a
W o o� second-storyaddition: ❑
ro'ect Size: Standard ❑ Laze 1:1 Major El
Quant Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERl Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K 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 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<= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
/ BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of 3
3� 6 �
_ CITY OF CUPERTINO
_�
CUPERPERMIT APPLICATION FORM
Quantity Fee ED 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
BPLANCEIK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUAOING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUAOING
BPSPRINK Lawn S rinkler/Backflo 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 PLUABING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREhLkl1 HAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY .. Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Fumace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMIiEAT Heater Installation MECHANICAL
BREAE[NMOOD Installation of Hood MECHANICAL
BRENDMC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Deviee/Apparatus ELECTRICAL
BREMRECEPT Rc tl Switch & Outlets ELECTRICAL
BRENMLOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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CITY OF CUPERTINO
CUPEkTINO 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 BUTT DING
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
MPER N FEE Mechanicals . foot MECHANICAL
MPERMTTFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Commel Multi-Fam PLANNING
PLLONGRNGR Plannin Lon Range Residential PLANNING
ZADDCHG Address Chane BUELD1NG
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