02070104 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT -CONTRAGTORiEWORMATIOM,i
BUILDING ADDRESS: PERMITN .
7514 FALLENLEAF LA BROOKE RAHN 82070104
W TWSNAME
BROOKE RAHN APPLICAnl1O / Df72002
t - PHONE: SANIIARYNO/. 1 / CONTROL No.
e x zARCHITECf/ENGINEER:
{u
00 BUILDING PERMIT INFO
<U�i BLDG ELECT PLUMB MECH
y i LICENSED CONTRACTOR'S DECLARATION Job Description
I hemby affirm that l am licensed ander p isions of Chapter 9(commencing KITCHEN REMODEL P
res with Scnion]ODD)of Division3 ofthe Business a5O Professions Code.and my license
m Z j is in ful fort and ellen. c g/
0 a Licenu s Lion a
sts(((vvv"'
3 _1- a ARCHITECTS DEC TION
O I undersmnd my plans shall be used as p lie records
dc,ce Licensed Professional
oLL OWNER-BUILDERDECLARATION
=' 1 hereby (Scan that 11. exempt(sate me Convenor's a Any c Law for the
t z a following reason.permit
gat IDnstruBusiness dnaProfessionsveldeli Code:Any city or county $25000
go G which rets ig a e,alsom give,aper,improve,demolish, file
rcpaigany svurtm,
requires
a3°�-° pnor toisaiuuance,al-ionot0;pheaplons O for such Charmrm,I License
Law(ogur uhaptert _ _
(commencing
with
Wrsuint tome pro,ofDilomof the the Busters Leen a Law(Chapter9 - �-�'��--'-""`""' -'
(rommencing witp•Sersiw]Og0)of Division3 of Nc Business and Prgfesaions Code) r%3il•C�2oEI�1b�r.AT'@a,.', ; Valuation
os that he is exEmpi mcie(rom and the basis for Ne alleged exemption.Any violation
of Section 70316 byany epplieam far.Permit subj"Ne applicom m a civil pcmlry
.roof is.than five hundred dancers(55M), 10 14PN 1 ➢3biDAT I ON Occupancy Type
❑I.sa owner oflh.property,or my employees with wage,as their tele compensation. 102 - PIERS
will-do the"worC and em shoetbre'fs not intendedorofferedfdr-ole(See:7044,'
Bulinus"mid Pmfeasions Code:The Convenor's License Law does not apply su.n - Required Inspections
owner of property employees,
builds or improves Neeson,dna whomen eon such work himself 104 - REBAR
o Wad for
his own employers.provided that such vementrmems art not one y ear or
r
-:e0e.edforule." nowrvciethiWdvetcarimenOfprovngoldhemi°oneWeldor - 105 -- " ANCHOR BOLTS .... ... . . ....
domrrovo fm me ownrnbuildcr will neve the burden of proving ten he did not build or
improve dor padpo:ear:ale.). 106 - SEWER & WATER
_ .owner h. .. . .... _.._. ont
202- '- UNDERFLOOR PLUMBING-
❑1,u owner of the property,am exclusively contracting him licensed convenors to �
answet th<proven(Sec.]oa4,Baainna dna Pmressiona eoe<:)Tate Commanota 203 - UNDERFLOOR MECHANICAL',,`.. ..
License Low does not apply loan owner of proprvy who builds or improves thereon,
.and.who.con°aerk for.such pmjeru with a commcmr(s)licev a pumaam.to the -. .. 2 O4. .— UNDERFLOOR FRAME-
.. " .0 tremors License Law _ -. .....__._....
' lam Pt der I4 P C for this..on 205 - UNDERFLOORS INSULATION
Dave' 301 - ROUGH PLUMBING
R'S COMPENSAW DECLARATION I"-`f_ 302 - TUB & OR SHOWER
I hereby M.order penalty of perjury am oft he following Aerlamaom: 303 - ROUGH MECHANICAL
} 0 1 have and'win maintain a comilcate or consent m self-insure for Workers 3 04 - ROUGH ELECTRICAL
/ Ccmpena.tian,-n provided for by Section 3700 or he Labor Code. for the
305 — FRAME
_ = performance.(the work for which this Permit is issued
❑l have and willm'alabor WOAer i Compcitvikm lnsaroven.as required ble Section 306 - HOLDOWNS
37M of the UWr Code.for the performance of that work for which Nis parrop is 3 07 — INSULATION
issued.My Worker's Compensation Insurance carrier and Policy number arc:
308. -. SHEETROCK_ .
Cam `• l ••Policy No.:" ..
cERT1P1cnnDN of ExEMPnoN FROM.WORI(ER8' 309-* l-, EX'TER'IOR LATH
. COMPENISATIONINSURANCE" "'•.' ` 1
310...-....,INTERIOR. LATH_.
— .... -- ..: (.:..: -...
•' tTni;:dio��reanorberainple;ealrmepermirararon<wneredaon.rs 311 SCRATCH COAT
(3100)or leu.)
., , ,. , .
': `i«nify set in dm perfoem;nre of date"A res:which this permit is iasuea,] ... ...._ ...ROOF .NAIL
hr0 her empl y Any p {oo c t berg a sub en to Na Weekeri 501 - FINAL ELECTR-I CAL"ENERGY
CAampr 1 t IW f s D `m /7 Z -
w 502 FINAL PLUMBING ENERGY
NOII�f To La ANT if art maksgMsCemBoteorExempuom.yggsAomd 503 - FINAL MECHANICAL�ENERGY
z beWSers b uo the Warkeu Co pc'sahon pros estate of the Labor Code,you must
OO ten."g,mplywithsuchpreviadnaormaPermitshahbedeomedrevo_ked. 504_ - FINAL BUILDING ENERG`,;'.
•CONSTRUCTION LE1NDWOAGENCY - 5.05 - FINAL ELECTRICAL-
;4 > l hereby affirm Nru ghem'is a Eonswaic n leadin' n for(he .
g,C.) p °"°" 506 - GAS TEST
rr of the wok for hap dol permit rs issued(sec:309],pv.C)
,'.r'.G Iaguie fAa 507 - FINAL PLUMBING
40d sAddass _ .. .._. .... ...
GOo Z 508 - FINAL MECHANICAL" Q
r I certify mat I have rtad Nis application end state than the above information is
W r f+ coffee,.I egma to comply w;m all usy'gia cowry ordinances aM sum laws rthGng 509 - FINAL GRADE
O'U mWildingconnrvciiomaMheabyaumorivaprcmnuuve,o ddacirymemrupv° 510 - FINAL PLANNING
r�'xkd the above-mentioned! for inspection purposes..
a; (We)eg tosave,mdemNfy Id keep habNnineCity ofCupeunoaliment 514 - FINAL PUBLIC WORKS
h 'iabilitin,judents,others and e-xpemes which may in any way accrve agairw said
U.� Ciry•in consegtome fthe ting is pcdm4..'
_„ APPUCMT"N STAN 5 q. COMPLY WItH ALL NON-POMIT
soviicERF, p"s: ...'.... . . ......: n �1 2 Issued by: Date
rco �:HtlAZnRDoIIS MATERIA DISCLOSURE ' Re-roofs
-' Ne appltceoi or forme W)ding oawpant sone bag herardoes ntume Type of Roof
as d f by dm Cupeni o M pal Code Clash.9 12 and th Health and Safety - - - -
Code:Section 25532(e)7 . ..
❑Ye,
NO
All roofs sball be inspected prior.to any roofing material being installed.
Wdttheapplmamo roma W let goerap.nt ,drop pmemord.wces which If a roof is installed without first obtaining an inspection,I agree tokemove
emu hewaous av eontamsvann n defined ny the Bay Arc.Air Qu jiiy Management
Disdict?. ,, y
. . _ .P"°. all no -p m[sourceregulations. _ . tan .. . . comply. 1 . . .
❑ye, all new materials for inspection. Applicant unders ds and willwith
t .' . . .. n o' .
'1'hNi.ead'mc luzirdous'm.creak requiainenu under Chapter 6.95 of and
Celifomfa He '&Sefay Cad echdns 25505,25533 and 25534.1 undrrsreM that
if ily Etiildijyyppp un urdcvs) Crete Vasitis my respomibilirymhosify Ne
°CCP tt lg'som prior w usuaoes of a Cron,It or
w Om
Signature of Applicant _ Date
'
Or e m z d agcn - . .
'"i Date,,,, _ All roof coverings to be Class,"B" or better '
AVER-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
• 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 si
Property Owner's Signature: Date: 2I'-716Z
job Address: 72 7 /—i4Ler [Le F L,4 t J 2 Permit# 0-07010
Any changes to the information Provided on this form shall be submitted to the City of Cupertino Build
Department.
•
City of Cupertino Building Departrrc
CITY OF 10300 Torre Aver
C O P E IST 1 N 0 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 compeusatic
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
gay
SKETCHADDENDUM File No. 3017
' losrywerlCliant KAHN '
-P+oyartyAadrou 7514 FALLENIFAF LANE .-.
aey
CUP ERTINO N=ty SANM CL"ARA state CA v ce 95014
A[")ERIIKAC EOUIFIRST"N�R'IC,AGE
'nemarn
�l✓/� ,O F /�es,dei
fA
16 (,.'�.. [-' :
�Ijl JUL 1 7 2002
v
MASTER BEDROOM 10.5
PA
I l i l��
. FP UU U U UU L= u
"DINING HALF -
MASTER BATH ROOM BATH
.:ic` BEDROON -:LIVING ROOM
- 43
"• LAUNDRY
27.5
HALL BATH
KITCHEN NOCK FAMILY ROOM
n ENTRY _. ! L y/
. �,• BEDROOM ,BEDROOM 3.5 GU. 2v FP
th
APPROVED
29 IN ACCORDANCE WITH THE CITY Ofi
CUPERTINO D NO RDI NCES
.t' DA MAIN L1V1 G REA• 23
GARAGE 23
SIGNED
k
This set;of,pian, d specifications MUS7
be kept.tiri'the:job at all times and it is un
'1
lawful to make any changes or alMrationS
on same without ,writtenpetmissicn from
' the building Dept., City of C'1p^thin.
The stamping of this plan rr :•r,,"r'CationS zo
SHALL NOT be bed to pe t., ; '.r ;: r;; an
tpproval of the wolatiin of
of ony Citv O.d;nanra or
LIVING AREA' '�`: """"""««`a'"^`•H „»,�,��,,,� .
.10.5 x 16 168 -
24 x69 = 1656 "
3.5 x 24 = 84
8.5 x 29 a 246.5 '
Subtotat' 2154.5 SF -
r
iY 00 P U ,
F1
,fn
JUL 17 2002 Li . .a
57 48' 31
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W18421 fI' 0 o W2142R WMSC271Pw
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U WR3624: ' ' ' f
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A6'PRO d J~i-
IN'ACCORDANCE:•tllTH '(HE uu . _
CtIP NO ^,ODES ��'•c)INANCL .
DATA
s SISREU. u
cf This set of pl7 .1p . specifications 'MUS) d`'
be kepton the 10'lat.all times and it is un
lawful 1P melee,any chenges or alterations
on samor iyithout written permission from
the huitdlne Dept-, Clty of Cupe-hno.
The stem%•ng of this pan nd specifcations
SHALL NO be hd d i'1 pe mit ar t re an
ippiT3l of the vv latom of any pr. •r i�nr
Aa Ahnensle,p b alae deslyugons .' .
)wan are sublea to vedlwdon on THE This it an original design end must 7100A2FA kyle:rtuz4rarm Design:oni0102 )n , .
" Iob sbe and aayasbnen o)Ipb HOME DEPOT net be released er gepled unless Data :07,15102
m1010oru. - apWhsble fad bas been paid or Job BROOKEAKELLT RAHN
a=' :order placed,' 7514 FALLENLEAP LANE Designer
CUPERTINO CA ANTONIA
T
r
•
1 JUL 17 2002 .
164 —
t 12 .
X Zy r� TV
' • 84
9®6
11 El
52 45
APP6a6Ut61Et
IN ACCORDANCE WITH THE CRY ul
CUPERTI _ pand
ND .RDINANCES
DATE CTt.
SI;PIED
1 This sa of planspecifications MUST
. t be ttert on ttrc job at all times and it is un
lawful to mala any ctanges or alterations
on Famewitnnm written nermission from
6i. i wlding Capt., Ciry' a: ;upertino.
Ti, stamping ^i t6,q clac and specifications
• S .'ALL f'!!- 1 'u ,rrrrit ar to be an
a : •,"c ., r ,u,., qi 3ny provision-
All dimensions 8 size des verification
This Is an original design and must Scale:maximum g no.
given are subject to verificaFlon on H' TME not be released or copied unless w
I(
consite ditions.
adjustment to Flt Job' 0"E DEPOT applicable fee has been paid or job 8510 FALLENLEAF LANE ANTONIA
order placed.
CUPERTINO CA WaIUC Line# 1
I •
(g
- CITY OF CUPERTINO Z 7 0`
CUPo
1 kT
F O PERMIT APPLICATION FORM
APN# Date:
3592 1 OZ
Building Address: 11
� S`I ' � f-a��e � L-e-gF L AtJv
Owner's Name: /� Phone#:
' 1J" Roo Ke- RA 14,J yf78-Zs-s"-076�t
Contractor: License#:
�L r
Contact: Phone#:
Applicant/Contractor: Fax #:
3QooKc QR�..I 6ot—�:3 - y ' G�i'4'D
m
uildermit Info: lect
Bldg Plumb Mech
ob cription: I
Residential: 1 — Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architec.UEngineer: Valuation:
ypeofConstruction:
I /
Occupancy u
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances 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
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
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