04100117 C CCY OF CUPEIi'flNp Pre +s§.
BUILDING DIVISION PERMIT CONTRA�Cy.�T� OR INFORM ION
BUILDING ADDRESS: CEVAN FORRISTT DESIGN PERMIT N94100117
0645 FELTON WY
OWNERS NAME: PERMIT WOE DATE
STEPHEN LING & APRIL HEVNG 345 S 19TH ST 10/18/2004
PHONE: SANITARY NO. CONTROL NO.
(408) 297-8538
ARCHITECTIENGINEER: BUILDING PERMIT INTO
BLDG ELLCT PLUMB MECH
0 0 0 0
uoa LICENSED CONTRACTOR'S DECLARATION
jF I hereby affirm that I am licensed under provisions of Chapter 9(ammcncio, Job Description
ZyVj with Section 9111Mpuf Division Sof NCBusinexsand Professions Cde.and on,license is
inbill force and effect. REVISION- -IN HOUSE USE ONLY
Z License Cl,. Lic,a
zw Dale Contractor
NEW PERMIT/ORIG. #0410034
^O-i ARCHITECTS DECLARATION
?6-a I understand my plans shall he used as public records
t C Licensed Pmfessinnor
g OWNER-BUILDER DECLARATION
.�a£ 1 hereby affirm that I am exempt from the Contractor's License Law Rn the
p O billowing reason.(Section 7W 1.5,Business and Prefusions Code!Any city or County
which requires a Permit m construct,eller.improve,demolish,or repair any structure
F_aprior to its issuance.also requires the applicant for such permil to Glc aligned statement
that he is licensed pursuant to the provisions of the contractors License law(Chamh.9 Sq. Ft. Floor Area Valuation 0
C,a (commencing with Section 7000)a Division 3 of the Business and Professions Code)or
y $
that he is exempt mcmfrom and the buffs for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit sobjcces the applicant to a civil Penalty of APN Number Occupancy Type
not mare man five hundred dollars n5Nd. 35918019 . 00
0 1,az owner of the property,or my employees with wages as their sole compensation,
will do the work,and me unctua is not intended or offered for sale(Sec.7w,Business
and Pmrcuions code:The comrzctms Liecnse Law them,not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employmu,provided that such improvements are not intended or offered for sale.If.
Lowever,the building or improvement is sold within one year or completion.the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with Iicept contractors to t
Cer se LA d project(Sec.PHA,Business and Professions its or i The Contractor's and.arae Wwdoea hot or such plro loan ithawner ofptopeny who
sedporlmpro ectthe Cmuna and (f+
who mntmets for such projects with a convacmr(s)licensed pursuant to the Convaeofs V
0 raw.
lam cScmpt ypdcr 5cc.` - .B&PCfonhis rcazon
y l V -J
Da!
wORKER/I'S COMPENSATION DECIe1$ATI
4�he icby affirm undcApcnalty of Perjury one mf the��fgp ing declarations:
® (]I have and will maintain aCati6caeof Consent taSClf ileum for Wmkcr'AComp,m .
sateen,as provided for by Section 37D)of the Labor Code,for the pcdoort of the
work for which leis pt'.i,is issued.
❑I ban and will maintain Worker's Compensation Insurance,As required by Section
37M of the Labor Code,for one Amro rembec of the work for which this Permit is issued.
My Wo liens Compensation Insurance carrier and Policy number am:
Cartier: Pal icy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Ormaxeconn need not be completed if the Permit is for one hundred dollars(SI00)
in,less.)
I eenlPo that in the performance of the work for which this permit is issued,I shall not
employ any Person in any manner so az m became subject ,the Workeri Cnmpenation
Laws of California.Date -
A:plicanl
NOTICE TO APPLICANT:If,after making this CcniGCme of Exemption.you should
become subject to the worker's Compensation provisions of the labor Code,you must
.,z forthwith comply with such provisions ar this permit shall M deemed revoked.
Z'O CONSTRUCTION LENDING AGENCY
I hereby affirm the there is a construction lending agency for the performance or
z thc work for which leis .it is coded(See.3097,Co,C.)
W Q Lenders Name
CL Lender's Address
=1z
U O 1 certify that I have read this application and stat,that the above information is
I,, P correct.1 agree to comply with all city and county ordinances and state laws misting to
0 holding Construction.and hereby awhoriee representatives of this city to enter upon the
r W above-mentioned ptopcity for inspection purposes.
(We).,me to save,indcmoi ry and kap harmless the City of Crani no against
HN Iiabl lines.judgments.costs and ex pt which may in any way accmc aGainsl,aid Ci ty S,
U 2 in consequence of the grand ng of this room it.
'^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /
SOURCE REGULATION . .� ry;j
� —� M t Re-roofs
A�
\ S' na'thcofApplicaHAZA SOUS MATERIALS DISCLOSURE. Date Type of Roof
Will the applicant or future building occupant store or handle hx'raNuus material
az defined by the Cupertino Municipal Code.Chapmr 9.12,and be Health and Safety
Chile.Seatoe 25532(a1'! \ All roofs shall be inspected prior to any roofinen material being installed.❑Yatce
Will mea Gcent on future buildin•occupant use e r ser devieca which If a roof is installed without first obtaining an inspection, I agree to remove
• pP b P aAirQn
,mil h;aarduus air contaminants u JCBncJ by the Bay Arca Air Quality Management all new materials for inspection.
D'svie?
0 Yea No
I have read mm haaardnus materials mquiremcnts under Chapter 6.95 of the Chdror
Dia Health k Safety Crile,Sections 25505,25533 and 25534.1 understand the if me building
does not cuncndy have A Lanae,mar it is my responsibil'vy m olum,the nee npanwr the
regairmentswhiehmeslMsm,ltionIfifCnf.cureredicnfaerpanmy. ,� ';Signature ofApplicant Date
/ l l --� ' L''
ow rrrauthoriraaagEnl Dale' All roof coverings to be Class "B" or better
� � X03
(I; - CITY OF CUPERTINO( J
CUPEt�TINO PERMIT APPLICATION FORM o //,7
APN # , 5� . 0 I Date: 10 , 1 (b . 6A--
Building
`Building Address: Mailing Address (if different from building address):
66q'h v o� VA
Owner's Name: NN6 Phone #:
Contractor: License #:
(1�VAV rof-PMT
Contact: Phone: Cupertino Business License#:
Fax:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description: t-O �x� � � toygP — ")0�1 51-L/6 4 �>
Residential ❑ �L �� l Commercial ❑ MrJIPA MISS .)Nk
Sq.Ft. Floor Area: $/Sq.Ft.:
1011,
Cost of Project: Occupancy Gro
r-
Type of Construction: Please check ilis box if the ject is a
second-story adai r
Pro'ect Size: Standard ❑
L;;;; Ma or ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI 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
BELE 1000 Elec 60 V <= 10 A
C 0 00 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
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PROPERTY LINE
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,—(N) DECOMPOSED C y011D B I i to i i o i 644 Topaz Street
I I I GRANITE AND I I I x I I I x l I Redwood city, CA 94061
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(APPROVED ON 9/24/04) N ------------- _--- I
H SCOPE OF WORK: NEW PATIO COVER I --------
PARCEL NO: 35918019 2 PLAN ON OWNERS:
CL TRACK: 717/LOT 43
CL ZONING: R-1 I — , „ COPPER DRIP 3 1p" OOFING FELT Stephen Ling &April Heunta
a LOT SIZE: 78'X 125 Scale: 1/4" — 1 -0 FLASHING OVER 1/2" CDX PLYWD 10645 Felton Way
-:. � � �.�3! , : , Cupertino,CA 95014
CONSTRUCTION:
ORSES TION: TYPEV 7_6 r- , ;�.; 4 __ tel (408)973-8639
OCCUPANCY: R-3, SINGLE FAMILY 20'-7" p
NOTE:ALL WORK SHALL BE IN I N
ACCORDANCE WITH THE 2001 UBC, UMC'V
UPC AS AMMENDED BY THE STATE OF C
CALIFORNIA
AND THE CITY OF
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SEEA2.0FOR FRAMING PATIO COVER
EXISTING & PROPOSED SITE PLAN Z
Scale: 1/16" = 1'-0" 4 NORTH & SOUTH ELEV '
Scale: 1/4" = V-0"
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644 Topaz Str et
'y y V • Redwood City, CA 94061
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tel&I!= 650.306.7842
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Q�3 RENEWAL
1� DATE
a �x �� TF OF cp,
1 OWNERS:
Stephen Ling &April eurg
.(� X0 10645 Felton Way
Cupertino, CA 95014
tel:(408)973-8639
AS 2 5-P�`( CS7x p�(wcap
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FAAMiNG
PLAN
CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACTOR INFORMATION:
95. .Y. :.:.Z ':4
nuaowc ADDRESS: LEVAN FORRI STT DESIGN PERMIT Ng ZI100117
0645 FELTON WY
OWNER'S NAME: PERMIT ISSUE DATE
STEPHEN LING & APRIL HEVNG 34S S 19TH ST 10/18/2004
NE: SANITARY NO. CONTROL NO.
(408) 297-8538
ARCHITECr/ENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECII
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
x •(- 1 ion 7 affirm that 1 am licensed under provislona or Chapter 9lmmmca.(commencing Job Description
aZw
With llforcn 7(dXpecDiviaion3of the Business and Pndesxinm COU,,antl myliccnsc is
mmnrmaana,rre,t. REVISION--.IN HOUSE USE ONLY
License ClasxLic.N
n' — CantracWT NO NEW PERMIT/ORIG. 40410034
Fp Da
ARCHITECTS DECLARATION
Yya Y a I understand my plans shall W used as public records
JyU
3 G y Licenud Professional
OWNER-BUILDER DECLARATION
,,a E 1 hereby affirm that I am exempt from Ne Contractor's License Law for the
e° following reason.(Section 7W 15,Business and Professions Code:Any city or county
K m which anquires a permit Or construct,alter.Improve,demolish.or mpair any structure
ami
prior it)itsissuance.also requires the applicant foreach Permit to file a signed statement
that he is licensed pursuant o the provisions of the Contractors License Law(Chapter 9 Sq. Ft. Floor Area Valuation 0
mom ramming with Section 7q%)of Division 3 or the B usmcas and professions Courter
'a Nat he is esemP(therefrom and she basis for the alleged exemption.Any violation of
Section 7071.5 by any applicant for a Permitsubjmu the applicant to a civil Penalty of Ali Number Occupancy Type
not more man five hundred dollars(S5B0J' 3S918019 . 00
P Y YP
D I,as Owner of the property.or my employees with wages as their sole compensation.
will do the work,and the structure is not intended OroRemd for sale(Sec.70,14.Business
and Professions Code:The contactors License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
Own employees,provided mat such improvements arc not intended or offered for sale.it,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or Or prove fur purpose of
LD as owner of the property.am exclusively contacting with licensed contranms t^ ��
com met the project(Sec.7(94,Business and Itrofessions Code:)The Contractor's Li
cense Law uses not apply to an owner of properly who Wilds or improves thereon,and
who contracts for such projects with a eontnaeT(s)licensed pursuant o the Contractor's
License Law.
1 am a emp( der Sec. .B&P C for this reason
Dt
WORKER' OMPENSATION DECLAHATI
1 may affirm Inde penalty of perjury one of th/e f�T'II ing ticdaretiens:
I hawandwillmaimeinaCenifeme of Cnnacros etlS if-'nsum for Worker's Cumpem
ation.as provided far by Section 37M of the labor Code,for the perfomance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 or the labor ewe,for the performance of the work for which Nis permit is issued.
My Worker's Compensation Insuanee Cartier and Policy number am:
Canter: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not becompleted if tW Permit is for one hundred dollars(SRgB
or leas)
I ecrofy tha to the serfmmonee of the work far which this P,rmit is ism d.I shall not
employ any p rson in any manner s^u in become subjecuo the Workeri Compensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation previsions Or the Li Code,you toes(
.Jz forthwith Comply with such provisions or this Permit Shall W deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
I hereby affirm that there its construction lending agency for the Performance of
D: 7 the work fur which this permit is issued(Sec.7097,Civ.C.)
fa7 Q Lenders Name
°v
Leader's Address
�z
U O 1 eerily that I have rind this roUlicafca and sum mat he above information is
coat.I agree to comply with all city and county ordinances and sate laws relating(o
Q U building Conswction.and hereby Sorrento,representatives Of this city to enter upon the
r D.1 above-mentioned property for inspccona purposes
(We)agree na Cove,iademni fy and keep harmless the City of Cupertino against
F ,,,, liabilities,judgments,costs and its penacs which may in any way Scenic against said City
U Z in mount)ence Of the granting of his Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINTIssued by: Date
SOURCERE LATION � '�ro'
Re-roofs
\ S' naW of ApplieanVCrrt Noe Date
HAZA OUS MATERIALS DISCLOSURE Type of Roof
Will the aPPlicom Lir future building Occupant store or I mdic hazardous material
as dcGncd by the CupeninO Municipal,Code.Chapter 9.12.and the Health and Safe,
Code,SectionYes ss3z(z)'! All roofs shall be inspected prior to an roofing material being❑Yen Na P P Y g g installed.
Will thea secant or future beading«ecu t use a If a roof is installed without first obtaining an inspection, I agree to remove
zap b p^^ equipment or devices which g
U
naamnaa_air Contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Jialrier
D Yes No
1 have mad the havmdnus materials mquimmenm umkr Chapter 695 of me Califo>
nia licalth&Sarcry Cadc.Station,255115.25533 and 155]4.I untkamnd distills,building
dow not currently haw a rental mat it is my res nil hilily W notify the t,cm,e l of the
requirements which ran SbXe nnrtni a&ioificamofOccupancy ' Signature of Applicant Date
Ow rnnamnri,<d roe \� �,W All roof coverings to be Class "B" or better