06120072 CITY OF CUPERTINO az :ne �+^r
'BVILDI 40 DIVISION PERMIT CON'TRACTOR.INFO,RMATIO
BUILDING ADDRESS: PERMIT N0. 06120072
918 FERNGRO
OWNER'S NAME: PERMIT UGUEDATE
PATRICK GANNAN
E:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO'
BLDG ELECT PLUMB MECH
o p LICENSED CONTRACTOR'S DECLARATION
to FjI Wish,affirm that 1 am licevod umler provisions of Chapmr 9(commencing Job Description
with Section]000 of Division 3 of the Business and Piafesiuv e u Cade.and my Ikens
Z,,
in fun farce andeffml REPLACING 4 RECEPTACLES GFI AT GARAGE
License Class Lic.0
iF0 Dam Contractor
ARCHITECTS DECLARATION
i < I understand my plans shall W taxed as public necords
IyU
in Liceved Pmkssi.Ml
C5 oat I am exempt fr DECLARATION
C I IKKNy aiTim on 1 am exempt s an the Contractor's Co License taw for ec
p O following massa. each i Pomor Business and improve.
de o i Calc:Any city or county
m which requires a permit m enwnmt,alcor,improrm,demolish,or repair any structure
. $250
ay prior or its issuance,also mquims the applicant for such permit to Ne a signed statement
< thetheislicensed P.....uothe prevision ofthe ConuxmrsLicense Law(Chapte,9 Sq. Ft. Floor Area Valuation
Imo$ (commencing with Section 70DB of Division 3 of the,Business and Professions Code)or
_ that he u exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by Cory applicant for a permit subjects the applicmt to a civil penalty of JAW 10h,43tv, u U Occupancy Type
not mole Nan five hundred dollars(SSW).
❑Lasownerk.um pmpcacrm is employeewithwagevthe(sale Business cam do thework.Codec he ComunatinmMeam ofwdoes not apply
as ia,ower of Required Inspections
cosi Professions Code:The ConuavoYs red who law does not apply lf an owner is q p
propert,man em who builds provided improve th mil¢and who ar ehat intw ded oroelf ar through Ito
own employva,ding ori amt such improvements are not intended mond for ownu- -
huilder..the buildingorimprovement is sold within one year of improve for
the ownv-
builaer will have the Wrdrn of proving eat he did not build or improve Icor puryose of
sok.).
1.asowner the propenY•sA exclusively conuaning with IicensN mnuxtors m
cis sewn the j n(Sec.7064.Busmen and Profcsuov Code:)The Comtxtals Li.
Cove Law tlae os spplY an owner of property who builds or improves dilatation.and.
whaeontmN such pno eN wits a eanVY=D.�
Can t"
Licenm law.
❑lam excm t under r cis an
Owner
CO1 SATI=N DECLARATION
O1 hereb affirm under ty of perjury ane of the following dvlarations:
f have and will maintain a Certifier¢of Consent wself-inure for Warke/s Compere.
nation,as provided for by section 37W of the Labor Code,for the performsnCo of um
work for which this permit is issued.
❑1 hart and will maintain Worleces Compcvadon Insurance,as required by Semon
37W of the Labor Code.for the performance of the work for which this permit is mued.
My WarkeYs Compenution Laurance canis and Policy number am:
Cartier: Policy No,
CER11RCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thuseetianceed W crospkmd iflW permit is forms,hundred Wit.(SIW)
or less)
1 certify that in the perform co of c work for which this Permit u issued.I shall not _
employ any person in my'an rs as in becomes ject in Wog rkers Cqm on
lawsCalifamia Dat ��
Applicant
NOTICE TO APPLICAN :1. s r king s Ccnt tam of Exemption,you should
become subject m the Worker's Co nen'n provisions of the labor Code,ymi muss
Oforthwith comply with sucA paovi60 r u permit shall be aremca rcwkcd.
'Z'm CONSTRUCTION LENDING AGENCY
Em I-+ I hercbyich thi WtdmmuacovSit . lending agency the Performance of
a
the work for which this permit is issued(Sec.W.Civ.CJ
6W. Q Im.
s Na
� z LxiskecndeYS Address
U C) I certify thn 1 have read this application and num that the aW w iorton tion u
D. carina 1 agree m comply with all city and county ordinances and sum laws Misting to
OJ building conswction.and hereby autharire representative of this city to enter upon the
ahovcmcmiun,d P ny for inxpeaks purpoms.
F0. (Wc)agrte o enc,indemnify and trop harmlev the City of Crpcnino against
rn liabilitie.piki mtt4 a se and expemanwhich may in the coy of C gainst Nrtinsaig City
()z in eonuequvme of N granting of this permit.
^ APPLICANT U RSTANO A WILL COMPLY WITH LL NON-POINT Issued by: Dale
SOURCE REGU ON .
Re-roofs
SigneduscofApPlittiXonknoW Date,
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will useapplicam or future building ocupantsmrc or handl,word,is material
as delmid by tae Cupertino Municipal Code.Chapter 9.13,and the Herlth and Safety
Code.pre,25532(a)?, _ETITo All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupam use equipment or dcviccs which If a roof is installed without first obtaining an inspection,l agree to remove
.mit henadnus air numimnu v d'r,.d by the Bay Arta Air Quality Management all new materials for inspection.
Duvict? �
Ely. j N.
I ove hvvdwk bmquimmenuunder Chapmr6.95o(Oc CalifopriaHcahh&s Code, u .35533m,125534.1undersmndmanifthe Wilding
doe not cram y ba a nu y asibility m sou'ale ore panto the
rcquimmcru k s ' r nfact oft 0q.TaT ry, Signature of Applicant Date
Ownermaue Sndagcnt ,m All roof coverings to be Class "B"or better
CITY OF CUPERTINO
On 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 37538029 . 00
DATE ISSUED. . . . . . . : 12/15/2006
RECEIPT # . . . . . . . . . : 37057
REFERENCE ID # . . . : 06120072
SITE ADDRESS . . . . . : 918 FERNGROVE DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : PATRICK GANNAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : PATRICK GANNON
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
qEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- -- - -- ----- ---------- --- ------- -------- - - ----------
BREMRECEPT NO. OUTLETS 4 . 00 4 . 80 0 . 00 4 . 80 0 . 00
BSEISMICRE VALUATION 950 . 00 0 . 50 0 . 00 0 . 50 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 43 . 67 0 . 00 43 . 67 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 43 . 67 VISA
TOTAL RECEIPT 43 . 67
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
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. A portion of the work
C. _ None of the work
If B or C is checked, complete 2 or 3 below.
' I
2. A state licensed contractor will be hired to do:
� I
A. _ All of the work
B. A portion of the work (complete section below)
I
Contractor Address/City. Phone # State License # Type of r work to
L, _ -L.._...i
I I i
• 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.
I I I I
Person/Firm Address/City Phone Number Type of work to be
performed
I '
I I i
.....................................................................................................................................................................................
I declare under penalty of perj that the above is true and correct. I have read and understand the
Owner-Builder Information (revtrs side).
l a�i
PropertylOwnei i
s Signature: Date:
Job Address: Permit#
I � I
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
I I
I I I
r:'
City of Cupertino Building Department
CITY_OF 10300 Torre Avenu*
C 1 I D E[?T 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 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 compensatioro
contdbrrtions.
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 contractorsmay 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.
Vary truly yours,
Building Department, •
City of Cupertino
Printed on Recycled Paper
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Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
i0 CITY OF Fax(408) 777-3333
�UPE(�TINO
Building De artment
JOB ADDRESS _ PERMIT # 6 /Z
VO 7Z
OWNER'S NAME: PHONE # Y— �
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
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
ler/
4ontr
•
d
ignature Date
SNISCITY OF CUPERTINO Q�Q 12 2
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Ad
APN # UDate:
Building Address: /� Mailing Address (if different from building address):
J �l
Owner's e j Phone#:
a- 4a -q-.& &S
Contractor: License#:
c
Contact: Phone: Cupertino Business License#:
Fax:
Building Permit Info:
04
Bldg ❑ Elect 0 Plumb ❑ Mech ❑
Job Description:
Residential 0 Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: Occupancy Group:
�� du
Type of Construction: Please check th s box if the project is a
second-story addition: ❑
roject Size: Standard B Large ❑ Ma'or ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERl Boiler<= 100,000 Btu MECHANICAL
BB0ILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to IM Btu MECHANICAL
BBOILER4 Boiler> 1 M 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
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ag;, CITY OF CUPERTINO
dry-°F PERMIT APPLICATION FORINT
CUPEP\TINO
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. 1„eP ,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
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo 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 PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platfonn Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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1- CITY OF CUPERTINO
PERMIT APPLICATION FORM
CUPEkTINO
AAkQuantity Fee ID Fee Description Fee Grou
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 BUILDING
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 oot ELECTRICAL
tl EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanical sq. foot MECHANICAL
MPERMITFEE Mech Permit Issuance =BUILDING
PPERMITFEE PlumbingPermit Issue
PPLBG Plumbing Fees foot
PLLONGRNGC PlanningLR Comme/Multi-Fam
PLLONGRNGR PlanningLon Range Residential
ZADDCHG Address Change
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