02070102 CITY OF CUPERTINO - •- - - n
BUILDING DMSION pE Ifl' CONT RACTOXINTFORMA - ON:`'\
BUILDING ADDRESS:
7655 DUMAS DR PERMITN�2070102
o'VeW ": PAUL W AND TERRY N APPLICAT6sYBIG`T7 2 0 0 2
PHONE:
SANITARY NO. CONTROLNO.
C-z ARCHITECT(ENGINEER:
O
F ------BUILDING G PERMIT WFO
`j BLDG C
ELECT PLUMB MECH
�« u _I L. I u
Z LICENSED CONTRACTOR'S DECLARATION
I hereb (Tem that l am l immuld underprovisim.,of Ch,,er 9 leommeneing
R with 5atorceand affect. n3 of ilia Business end Profcszions Cale.end my license R RCUIT FOIi°�Lhgi100V-GAS WITH DOWND
is ce ran force ana,ece.
0za License cross Lia ,
O i 0 Date Contractor /
o.O G ARCHITECT'S DECLARATION ...
1 understand my plans shall be used as public records a -
y 7
rc O O Lt«nicd Profastonal
•�„ OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor s License Law for the
C3< following reason.(Section?0313,Business and Professions Code:Anycityorcouncy72S
F O which requires a permit to construct,alter,improve,demolish.or repair any sweturt
no prior to its issuance,alu requires the applicant for such permit to file,signed statement 1�nn^ni�� �pnn __
tHai heuficemial lletsuant 16 the provisions of the Contractors License Law(Chapter 9 . . 3s Zl'6 BItpVl lf['aL;
(commencing wit)(Section IWO)of Division 3 of the Business and Professions Code) z z' Valuation
m that lie is exempt therefrom and the basis for the alleged f sorption.Any violation - 'ww' -np
'-Of Smiom103I3 by any.pplicam for a pemm mbjms the applinm to e civil pcnilry 1 Q 11--iV--1
of not mdse than five hundred d.n.rs 0500). Occupancy Type
C1 1.es.mer of the property,or my employec with wages us their sale compensation, 102 — PIERS
will do the workfnnd'the structure is not dmnded'.r hfferkd'for all Isecs]614,
Business and Proftexions Code:The Contractor's License Law does not apply to an — Required Inspections '
owner of progeny Who builds or improve:thereon.and who does such wadBA
e himself 104 - RER
or Wough his own cmployces.yro,ded that such improvements ate not intended or
oR red for ula,IL however,the wilding or'intpmvemmm is sold within one your or 105 — ANCHOR' BOLTS - -
completion,thc owner-builder will have the burden of proving that he did not build or "
impmve for pm,asa or sale.). 106 - SEWER & WATER
" ' `— - ' 202- -- UNDERFLOOR PLUMBING-
_ I:as owner ofthe Progeny amesdusivdyconimaing with licensed contractors to - - ..-_ . .. .
wet the project(See.7044,Businee and Profusion:Code:)The acct rs tors 2 03 - UNDERFLOOR MECHANICAL..
and-h.summer not far such toanowne,of with mny who wade sed unuou menton, .20.4 - UNDERFLOOR FRAME
.ark who conmzw for such projecu with a comrectogx)licensed pursuant to ma
Convanor's Liccnu Law.
Olamcc..exeto unde//r Sessefr: ' BA.PCformirreason 205 - UNDERFLOOR :INSULATION
own Dole - Z (t7loz 301 - ROUGH PLUMBING
� RKER'B CmQ/�1kydPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby affirm under pe Of kduN ane onhe following detlantou: 303 - ROUGH MECHANICAL
❑ 1 have dad will maintain a Cemifieate of Canaan 1.aejr-imum ref Warkera 304 — ROUGH ELECTRICAL
•(s._ compensation, as naviced for by Section nob of the Labor Code. for tha 305 — FRAME
pefomme,mof the work rmi
for which this pet,ie issued.
0 have am will'msinuin Werku'sCut.'petwtion Insurance.a required by.Section 306 - HOLDOWNS
3700 of the Labor Code,for th,performance of top work for which this punkt is 3 0 7 - INSULATION
issued.My Worker's Compensation hownance came and Policy number arc:
308 - SHEETROCK
" CERTIFICATION OF EXEMPTION MOKWORT KERS ",309 •EXTERIOR .LATH "
CO PE SAnoNB±SOIUNCE ",". - -INTERIOR-LATH'... ._.................. .
?fns::eetenneed not beeampleedinnePermit isfmone hrMrtdaml.rs 31I - SCRATCH COAT ' ... .
ISI00 or less.)
_-... :.
3,13 ROOF NAIL
Yan1 thatmthe perfonny—ofthearkforamenthio - R CAL
.•. - .._-_._............
pentdtlai"red,i 501 - FINAL ELECTRIGALENERGY -
shatl n'a employ any perzan in any manner an a to bcrome subject to Ne Workcn
Compaffir,nIowaorcaliremia.Date 502 - FINAL PLUMBING ENERGY
APPlie.nt � ..
NOTICETO t PLICANP.If,after maWngrots Ccmficrte of Excmpton you en.me 503 - FINAL MECHANICAL ENERGY
ZZ become mbjcc 10 the sorkc sCompensationpmvisionsofthe Lawr Code,youmust
p rannwithe.mplywimsu,hpmvilionaorthis Parmitshanba(Seemed mvoked. 504 - FINAL BUILDING ENERG�,
F.t
CONSTRUCTION .. �.:. .. .-
ucnoNLErvD�NcnceNCY 505 - FINAL ELECTRICAL -
ar. 1 hereby atfirin that theac is a conswnion(ending agency for tw peAommnce 506 - GAS TEST
W1. of the work for which this permit is issued(Sec.3o9T.Civ,C.)
L.z Lender'shame..:...•.•-.. ..._. ...__ .._:_...... ... ... .. 507 - - FINAL- PLUMBING _ .. _..
Leaded.Names< _
ge
, I comity that 1 have mad this application and smte ton the above information is 508 - FINAL MECHANICAL
m:t~ correct.l agree to comply with ell airy ilkom
cm,ordinance and sum laws reining 509 - F I NAL GRADE
O'U to buildingmnawelion.and hereby.mhonicmpesenulivesofeiscitymcnmrmpon 510 - FINAL PLANNING
w.W
the above-mentioned property for inspect..purposes:
[~'m Nh)lgree m save,Indemnify and loops harmleas the City of oapenino against 514 - FINAL PUBLIC WORKS
CQ liabilities,judgmenu,costs and expanses which may in any way accrue,again"said
U Zi City ineogsequcnce of the grmWgpf this permit.; `
APPLICANT UNDERSTANDS AND WILL COMPLY W71711 ALL NON-pOIN't Issued by:
SO 'CE- GULATIO
�—'� O Dale
angamre of Applicgppyyttbnwoar Dsm .
;: .. "' ' FtA1.3RD0US MA RIAL9DISCLosukE Re-roofs
Will the appiic.nt'or from,building occupant wore or handle lonowdatis mstefial
u Type of Roof
dcBnW by the Cupcmioo Munitipal Code,Clidoic 9.12 ark the Heald,and Safety
eada Seaton 25533(.1?.,.: _. .. . . - • : - 666 6 .
All roofs shallbe inspected prior to any roofing material being installed.
. Wdltheapplicantorfuture building occupantuse cquipmcm0rdeviceswhich If a roof is installed without first obtaining an inspection;I agree to remove
itha -dmfs air ctmsmammes ss defined by the Bay Area Air Quality Management
" all new materials for inspection. Applicant understands and will comply with
No
'< all non-point source regulations.
"1 have rcad'the parirdaua ma rials rcquirtmenu under.'CTapter 6.95 of the
Cslifdmis Heelth k Safety CodCSedtions35505;35533 and 15534.i undersmnd that
if Ntprom P ng dams fid cvn,ndy have s must
be that it is to stanmibi A msmtfy the
avpant of Ne'rtquirtmenti which must be met prior to iuumce of p Cenific.te of
Pars' '
o y Signature of Applicant Date
ow�er...mtna�lant •` Date All roof coverings to be Class "B"or better
O'vNER-BUILDER VERIFICA*N
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
be performed
210 - - 2
3
• ,WU 24
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: Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
• Department.
City of Cupertino 13uildi*g Departm
CITY OF 10300 Torre Ave*
CUPEI�TINO 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 compensatit�
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 Pepe,
asCITY OF CUPERTINO
CITYOF PERMIT APPLICATION FORM
•
CU
PERTINO
APN
Building Address:
ck inn L 1
Owner' ame: l ,e.rr Phone#���
Contractor: j License#: b 5 6
Contact: Phone#:
A li o tractor: Fax #:
Building Permit Info:
Bld Elec Plumb Mech
Job Description: tar e v cL&i f vv-f[F q k I i V —WW ;-I(,� oww
Residential: V Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
oU
Architect/Engineer: V v EValuatioEn:14 ype ofConstruction: G up:
uanti Fee ID Fee Description Fee Group
BAPPLOTHER Other—Appliances MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX hid/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Res JMobile BUILDING
BELEC1000 Elec 600V<= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=20 AA ELECTRICAL
BENERGY Energy LDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investi ation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BNEWMULTI New Multi-family Res ELECTRICAL
BNUCOMME New Comm Electric . ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
1 of 3 (�
CITY OF CUPERTINO ' -'BUILDING DIVISION PERMIT CONTRACTOWINFORMATION:
BUILDING ADDRESS: PERMIT N62070102 2 O 7 O 1 O 2
7655 DUMAS DR U
t •ryW' �ri06": PAUL W AND TERRY N APPLICATLOh:SYEM2002
ONE: SANITARYI/NO../ l ,/ CONTROLNO.
kmO OZ ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u
S u i
LICENSED CONTRACTOR'S DECLARATION
Z�o Ihar,byaffm"BalI.mlieensedunderprovisionsofCM1file,9(commencingRUN CIRCUIT FOI�° Ltlg°OOV-GAS WITH DOWND
yrs witn Seclloa]ODOI of Division 3 ofthe Businessand Professions Code,and my license
m2; is in full force and aliwt." License Clus tr
'puD,1ARCTDECLARATION LI—O B V Ltt�
Su Liv.
.u co
O 1 understand my plans shall ba used as public records eft Q
i y cep 0 Licensee Professional NOV 2 I 20061
so o E OWNER-BUILDER DECLARATION
I¢o 1 hereby affirm that I am exempt from the Co muclor's License Law for the $725
_a following rzuoa(Seaton 7011.5,Business dna Professions Code:Any city or county ���®'��
Xa which requires a permit m canawn,alter,improve,demolish, fie.repairanystmaurz
u.u3m -prior to irsiuunnenelsius uildtes PM1Dii5)ic Dff COntMtWt to file. Law smtament -
- (commencing
ad ttdectioi to00)ofDsiou of the Commcmri Liccna law(Chaga9 ..n .,ro..,.•,^-3 6BI�('l.Y[tSL - __ --- -
rt>_4t 4 - - '- Valuation
(commencing wiQiSmion 7000)of Division sof the Business aM fessions Code S s • ( "^ s'
Pro 1 _!: . ..'\.a 1.'_•:'� 1 41 `
order lie is deinpi theicfrbin•and the basis for alleged d'eFnPtioo.Any riol-tion
-:off nw mo c1 th3 n Oive ahnuyndrprtd doll frsor(a55p0en)n.ii mbjccts Uc epplieam m e evil penalty- lOAPN WO
"• '•""""` Occupancy Type
❑1,es owner of the propcny,or my employees with wages us their solecompensation. 102 - PIERS
will-do-the work,and the scrudturrt is-net ntehaM or bRered'for sale(S-C,]Rid,-
'Bumma.a'and Professions Co le:The Cnntma°r'e License law does not app],to an - Required Inspectioiig ''''"'f'O:'`
owner or pmpeny wn°balms or imrmves merzon,ana woo doe,such work himulf
104 - REBAR
or through his con empl y provided that h iropmovInuarns on,not intended or
offered snow the "lane
cimprovementi, me tones year or. ...... .__. -."1 .05 ANCHOR- BOLTS ...;'���.-ir. ..,. _----- .
'mpla on,the owner W Ider w II have the burden of proving thin he did not build or `dt
improve for Purpose of,me.). 106 - SEWER & WATER t
_- _. 203 - UNDERFLOOR MEUMBING
1:alio c of n- to exclusively - _ .._ .,....._ ...
property, ely cot t g with d contractors 't t
st a theproject(S ]060 Business d Professors Cod j Th Colossi
- HAN I CAL
Fand,whes
ense Law does not apply to an owner of property who builds or improves thereon i F
.. conwas for.such,projects wd,.a caitractout IloasaE eursuain to the .....___ _ 2.0-4..__-.._UNDERFLOOR. FRAME- __: tracto/s License Law..b CFl.i of"' _-_._ __.-_ __.._......-__.__,___a ptuderSec " `�''"B@PCfonhsauon205 - UNDERFLOOR, :3NSULATION -
ne ' Date Z 1'111'o'LI ., 301 - ROUGH PLUMBING
RKERSC PENSATIONDECLARArON 302 - TUB & OR SHOWER
Ihercbyaffirmudrpcn �fperin of theranowngd hrati ' 303 - ROUGH MECHANICAL
0 1 neve and will'mainteib'a�CeniBcac of Consent io elf-imine far worker's 304 - ROUGH ELECTRICAL
Compematien,-u-provided for by-Scaion 3700 or he tabor work Code, 1, 1, 305 — FRAME
petfomm c ri Ne I r h ch th s perm t sxW
01 have d- n'mainu worker coinpenat 'r sumrice,u rtquimd by Saciion 306 - HOEDOWNS
3700'of tM Liboi Cod forthe Pedurrpopce !thework Tar which this permit is 307 - INSULATION
rued My Wo kels Co pensat on IUMmnc a aid Policy mber ""
308. SHEETROCK_ .
Curim" u:^2PolicyN i. - _.-....._...__
CERTIFICATION OF E%EMP ON FROM,WORKER$ �' h' ji30.9 ;- .EXTERIOReLATH
1 - COMPENSATION INSURANCE 'S
orb s a non naenoi xTomplateJ if the patron i,for one hundred eonem 3 11' — �.S'GRATCH COAT
ISI00) rlessJ "r
3,13__:,-ROOF NAIL
Icon fy that n the pe I.
hh r16 o nth pe t s reel "' _"_ -•'-•"- --•- --- - -._ ...
sn511 templY gybe anymanne mbecome subject to 501 - FINAL ELECTRIGALIi�ENERGY ,'
CAp I, Irop . i awaorcalf ma D m"' 502 - FINAL PLUMBING ENERGY
'NOTICE TO APPLICANT if ftc maW gin sC nit u,.IE t you shmY2d - '- --
p r 503 - FINAL MECHANICAL. iENERGY_
z Te II 11 the Wok rs Co pc t°np os'of the labor Codeyouo
OO Tann n pay nn, npro ^on,orn,p tnanbe mea pkd. 504 - FINAL BUILDING .ENERGY
Z
"-"' CONSTRUCTIONLENDINGACENCIY 505- ---FINAL-ELECTRICAL"' --'
'lending
'z.
ai ' 'o' I hertby which @a t e rt is a roniwcuon 1 d ng agency for the psifarrnvec 506 - GAS TEST
I>J i.a of iho ork for which th permits sued(Se 309] p.C.1 "'
y.q Lander,Nme --'. - -.... ._.5.07- -...-FINAL-PLUMBING---.._.
Iciider s Atldrcss _ -' -- -----
-
--
a z 508 - FINAL MECHANICAL'- — -
J ceni(y Na 1 have s�this application and sum Nat rhe above information is 509 - FINAL GRADE
fir E+ Correct.l-gree to comply With ell add and county,ordinances and stem lows slating
0 io building mnamaion.end narctiyaahoriie&psimmusives otws city to enter upon 510 — FINAL PLANNING
�.rF-I Ne-bove,mamionad,property for inspection prrposes;•_�,,.•,.,•_
(we)egrzo tos°4.indemniry.and kap harmless the City of Cupertino egunst 514 - FINAL PUBLIC WORKS
`h liabilities,judgments,toss and aapeiiscx which may in any wry rCup,name geinn said
G M'
City in tonsequcnce of th gn t g of this'pa t -
APPL1CAiJTUNDER$T�J.TDS A'.D WII;I,COM PLY WITN AL: NON-POi�T'•' Issued by: to
Date
SO RCE OUL'ATItl
q/Cb�� `- TI 11 1 O
° ""°'°` ,4a'° .� '� Re-roofs
I'ne:f FMZARDOUSMA RIALS DISCLOSUREI Id
udcfNtheC MaNmrc building amupat rcobar ot beauteous teal Type Of Roof
goes rt pas
WII Nee
by penin Municipal Co 11 Chapter 912, d th Health and Safety
Code.S coon 25...Bd - y `.• '.. '•xs , s
..❑Yos
v ' All roofs shall be inspected nor to an roofing,
WJl th appbcam or fm sbor In oc , p p Y g material,being installed..-
All .........__
Ing pat A .Air equipment., Marreswhsh If a roof is installed without first obtaining an inspection; I agteeaoti'einove
nth wtlo sure numma is udefinetl by Ne9 yAe ArQ ally Managemem
all new materials for inspection. Applicant understands and will comply with
�I
ye, t,f No all non-p-ISourcereglatona,, p; - -
i I h's readi s,harardous ma orf the qu rzmMis unEa CTapt'r 695 of the f-
Califomia H ahh'@ Sikty Code,Seri ous 25505,25533 and 25530.1 urdemad Net
ifrhebsilding da,na haendy haveaiGhani.that ii is mYrapoiisibiliry io iioiilY int - - "' ..
occupans of N'e're9oirtmenti'which..at fix, a,prior�m uses..,of o CeniSibu.or
(f -0?i SignatureofApplicant Date
° "r°i "° " a I + Data All roof coverings to be Class `B or better
_ OFFICE - -- - _.-