04120060 JER'S
OF CUPERTINO -
LDlrvc Division PERMIT' CONTRACTbR INI ORMATION
'i�w-0NTfd ...F'('�xa°0 F0R
ADDRESS: - - - - - - - - -- - ' PERMIT NOO 4120060
NAME: - PERMIT lSi5UE DATEENDELL & SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: „ - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Loo LICENSED CONTRACTOR'S DECLARATION - . Job Description '- -
y G 1 humby affirm But 1 am li¢w.d under provisions of Chapter 9(commencing - - _
U with Section TOCK of DivisionJof se Business and Pru(essiunx Code.and my license is _
of inBtBmrceandeffecL LAUNDRY. RM" (WASHER .-& DRYER) -- ' -
gj Z Lima.Class IJc.X
Date Canuacmr -
qq'J' ARCHITECTS DECLARATION
Ny a-a 1 understand my plans shall he used as public¢weds _--
JyU
u0 Licensed Profcazional
.�<5 O. I..na rn"to DECLARATION
� I hereby affirm Net 1 . exempt tram Ne Consns Co c:Any rlaw for the - - - -
O O following muan.(Section](n LS.Business and Profestiuns Calc:Any city or county
K m which requires a permit to ten.,,arm,.improve,demoikh.Or repair any,anctuen 2nn -- -
_zy prior to is issuance.alw reaches the applicant(orsuch permit to BIC a signed statement '-
Y�Gthat heislicensed pursuant othe previsions ofthe Connectors License Low(Chapter 9 SCI.Ft. Floor Area a, ValUatlOn
'.5 (commencing with Section 7")of Division 3 of Oc B usinevs and Professions Code)or tl/J !,All R
$ Ban he u exempt therefrom and the basis for dm alleged exemption.My violation of / /I
Section 7031.5 by airy applicant for a permit subjects the applicant co a civil penalty Of _ 3 2601MI2 prO OI,ice 1 Occupancy Type
not mom than ave hundred dollars(5500). l
❑I,uowner of the propmy,or my employees wide wegesaz their salt compensation, I ,
and do Newous andthe he Concanols Licase, does
e(Sec.oMn,Bulinus
and Professions Code:The Conuanofa and
Law dors not apply lf an owner is — -= aired Ins CllO��� '
.a enywho builds provided
Oavas it improve who ammo chworkh offeorthmugh his OC
howemployers,p building
or improvement
improvements whin not car ofdaroaemd for Owner- (\�S/fGp - d -
Wilde,LNrbvethgumc.ommenruan did rune yeas ofcompletion.to,purpose
owner-
builds will have the Wrdcn of proving Nat k did nm Wild as improve for purpos of �6
sate.). - _ y/r�`/,I1,/' .
❑I,as owner of Ne progeny,am uClusivdy contracting with licensed comnctors m V
construct Ne pmjca(Sec.7064.Business and Professions Code:)The Contractors Li-
¢me law does not apply in an owner of property who Wilds or improves charter,and. -
whocontractsforsuchpmjecmwithacomracmKs)licensed pursuant m Ne Cantracloes - _ -----•- - - �
License Law.
D i em cauerito under Sec. B g:P C for Nis reason — -
t Q/TL
cv/ WORKER'S COMPENSATION ECLAR a9iQ`I
I hereby aRren under penalty of perjury one of tha following declarations: '
I hsm and will mnta
aiin a Cardfrcam of Consent toself-insum for Worker'sComprn-
saton,u provided for by Section 37M of the labor Code,for the performance of the
.work for which this permit is issued.
1 have and will maintain Workci Compensation u s Compertion Iuuco, enquired by Section .. -
3700ofthcUWrCme.forthcpdormar cofthew Wwhichthupemtitisiazued.
My Workers Compensation Insurance Cartier and Policy number are: `-
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Th6 section need na W camplC¢d if the pcohn is foronc hundred dollar(SIM)
or Ica.)
I umry that in the performance of the work for which this permit Is issued,1 shall not _
employ any person in any manner an az to become subject to me Workers'Compcnsauon - .. .. .- --.-
Laws ofCalifornia.Date
Applicant - -
NOTICE TO APPLICANT:If,after making this CmiBcam of Esemptirn,you should
become subject to the Worker's Compensation previsions of the labor Code,you most
.J O forthwith comply with such provisions ar this permit shall W deemed revoked.
Z N CONSTRUCTION LENDING AGENCY
�-w�-- Ibembya?rm that then is a eatstructinn hmOngapency l'm the perfurmanauf
the work for which Nis permit is issued(Sec.3099,Civ.C.)
W�� lenders Name
_
=z lender's Meme,
V 0 I ttNry Nat 1 have mad this application sum Nat the above information is N
F" building 1 agree to comply with all city and county
oNiva¢
nf and sum laws relining
0 a
C.I building Cumecd iun.atd hereby amhoponforescnmcivcs of this city mcnmrupon the
r W ahovc(We)
ogre progeny for inspectionnifa purposes
(Wc)agme to save,indemnify and kith harmless the City rat Cupertino against
h liabilities,judgments,Of
Stas and Of his rs which may in any way settee against sort City
V z A SonsequNIT of DEStanRST N of this permit
r-� APPLICANT UNDERSTANDS AND WILL qOMP Y WITH ALL NON-POINT Issued by: Date
SOURCE GULA S -- -
Re-roofs
Sig lumof Applicam/Comraccor �/ Dale
1 wiBu appBa�lorRDOR�idingo upaMATERIALS�mre�h�alrn,amttam. w Type ofRoof
az defined by the Cupertino Municipal Code.Chapter 9.12.and thc Health and Safety
c.Section 255320)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes u
Will the applicant or fume building amupam um eyuipmmt rr devises which If a roof is installed without first obtaining an inspection,I agree to remove
emit havardnus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Diarist? `
Dyes WNu
I hats mad the hmasdous mamrial4 mquimmcnts underCWp er 6.95 of Ibe Califon
ria HmIO tit Safety Code,Sectium 25X15,25533 and 2 536.1 undersand that if the Wilding
does not currently have a tenant that it is my resptn bibly to notify the a:cupant of the
mqui¢me awhic . usi ,akpdgrt 'm atraCmirmamofampancy. Signature of Applicant Date
ow tar amhori'rcd antro Dar All roof coverings to be Class"B"or better
CITY OF CUPERTINO
WJILDING DIVISION PERMIT C0N,TRACTa0R INFuORMATION x.
BUILDING ADDRESS: """'04120060
ERMIT N004120060
OWNER'S NAME: PERM9155UEDATE
WENDELL & PAMELA
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
coo LICENSED CONTRACT'OR'S DECLARATION Job Description
I hominy rem
y affirm 1 am licensed under provisions of Chapter 9(commencing
zu wso ith Section]IXk))of Division J of the Business and Professions Code,and my license is
% mmB ad effect.
LicevcCludesClan Lic.p LAUNDRY RM (WASHER & DRYER)
Dam Condxmr
J
a ARCHI muoECLARATION —!7
1 undcrsunJ on,plain shell he used as public mentis
Oyu
30t; Licensed Pm2uinnal
g
OWNER-BUR-DER DECLARATION
I hereby affm that 1 1. exempt tram the Comore,Coo License Law for the
o O following mason.(Scctian]th L5,Businns and Pmfcsxiam Codc:Any city or county ..
K$ which mquims a .it m conmosel,.lar,improve,demnum.or repair any a becmu
sat prior..its issuance.also mquims the applicant for such permit m file a signed statement
'££ < that heislicensed pursuant tothe provisions Ofthe ConuacmriLicense Law(Chapter 9 Sq.FI. FIoorArea Valuation
p C (commencing wi th Section 7")or Division J of the Business and Professions Cmd,)or
Nexemption.
st. .. at he is exempt therefrom and the basis far the alleged mption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of 32XP5UC ffficr00 Occupancy Type
not mom than five hundred doll..(5500). .
I,ses owner of me peOpeny,of my employees with wages as their sale comp,mation,
will do the work,and the structure is not intended or offered for sale(Sec.7044.Business
and Professions Cade:The Cnnmetios License Law docs not apply to an owner of Required Inspections
properly who builds or improves mcreon,and who does such work himself or through his
ownemployms,provided rem such improvements arc not intended or offered formic.If,
however.lie huildingor improvement is Said within one year ofcompletion,Neowner,
builder will have the burden of pmving Or.,he did nm build m improve for purpose of
me.).
0 1,as owner of the propin,,am exclusively contracting with licenud contractors to
consuact the project(Sec.7044.Business and Professions Code:)The Conuaclnr's Li- ..
cense law does not apply to an owner of properly who builds or improves demon,and
who contracts for such projects with o con ractor(s)licensed pursuant o me Contracmr's
License law.
0 1 sma tonerkpaunder(SSeec.f� .B k P C for this reats_on
ncr a >
WOORKER'S RK S
COMPENSATION ECLAR
L
1 hereby arfim under penalty of perjury one or the following dedoretions:
I h.vc and will maintain a Ccrlificou of Comunt to elf-insure for Wa keri Compen-
sation,u provided for by Smuen 37M of the labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation insurance,as required by Section
3700 of the labor Code,for the performance of the work for which this permit is issued. - -----
My Worker's Compensation Insurance carrier and Policy number are:
Camey: Policy No.:
CERTIFICATE OF EXEIAMON FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not becomplcted Bohm permit is for one hundred dollars(SIM)
or less.)
I certify mal in the performance of the work for which this permit is isood,l shall nor
employ any person in any mannerso as to became object o the WodcrsCompensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Cenifcam of Exemption.you should
become subject to me Worker's Compensation provisions of the labor Codc,you most
�Q forthwith comply with such provisions m this Permit be deemed revoked.
z CONSTRUCTION LENDING AGENCY
'r. I hereby affirm that there is a Construction lending agency lot me performance of
a the work for which this permit is issued(Sec.30971,Co.C.) -
!+] A Isndces Name
ar. Isndc sAgomtss /
U 0 1 Certify that I have read this aPPlicodim and sou that me above indentation is
V.0 U correct.1 agree ct comply with all city and county ordinances and sum laws relating e
V show-mentioned
rationed propentl forebyaureonpurposscmotivcs of mix City mcnmr upon me
W shave-(We)V gree 1. averty far inspcnion purposes.
has
(•-' D. (Wc)agmeto cove,indemnifyand hich hay in an the City of against against
y IiaConsequenc judgments.me .and of his expenses which may in any way accrvc against mid City
V z AcPLICAN Consequence afore graining or his per mit.
^ APPLICANT UNDERSTANDS AND WILL OMP LY WITH ALL NON-POINT ISSUed by: Date (C wllel
SOURCE R GULAT O S.
I f eN-- Re-roofs
Sig lure of ApiocasYContramm I Dau
1 Will doappliHwzoRDOrtSMari,OCCPo.1m.ohandllehanecl.smaurial Type of Roof .
as defined by the Cupertino Municipal Code.Chipmr 9,12.and the Health and Safety
Calc,Section 25532RO1 tt-�ll All roofs shall be inspected prior to any roofing material being installed.
❑Yea /e],Na
Will mea applicant or far..buildingn«a t sae e t er devices whim If a roof is installed without first obtaining an inspection,I agree to remove
pp pan Area
n
emit hanrdnus air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
Disuin?
❑Yes *Nu
I hove mad the ha a films mamri ils requirements under Ch.pur 6.45 or the Califor-
nia Hcalm X Sarcty Code,Sectors Z!5505,25533 and 2534.1 undcrsund mot if the building
does not currently have a tenant,mat it is OtHreorm nilny on nod ty the ncup.,of thc
requiremcros which musy�� or ntnvanaofa'Ccreficate of Occupancy. Signature of Applicant Date
--�f�ISPJ ��� All roof coverings to be Class„B"or better
Ow or authorized agent I Dine
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.
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
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/Firm Address/City . Phone Number Type of work to be
erformed
.......................................................:.............................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information ( everse side). L I 'J
Property Owner's Signature: Date: T
Job Address: S �l Permit# n` H
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
r
City of Cupertino Building Departm
' I CITY OF 10300 Torre Avenu
CUP E QT I N O Phone: (408)777-3
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 vrotect vourself from possible liability if that person applies for the proper permit in his or her name.
f 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 compensatioll
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
Pnnted an Recycled Paper
�r
g
L
s
n A0
�i16
c'; KIN
2-4
rl APPROVED
tN AC ORDAN WITH TN CTTY 06
CUP ND;' RDINANCF�
SATE7 /
SIGNE
Thi c s and specifications M�S:
�l be kept on the job at all times and it is un >
lawful to nake any changes or alteraNm d
J r'
on same ithout written permission frons
buildit g Dept., City of Cupertino. II J J
iThe stam ng of this plan and specrficatidw a S 5
SHALL Nor be held to permit or to be lar, '
p royal o the violation of any provrsn,ns M -i- ti- ,
Mh Orrtmance or trate I aw $ p 5
Vo Vo
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I M
® �r
Dryer vent letter Page 1 of )
Wendell Stephens
From: Christopher Flood [cflood@communitymanagement.com]
Sent: Friday, December 03, 2004 2:33 PM
To: WBStephens@comcast.net; 'Jon Kessler'
Subject: RE: Dryer vent letter
This should suffice:
The Board of Directors has approved your request to install a dryer vent through the roof of
your unit. This approval is given with the understanding that you will be responsible for all
repair and maintenance of this vent and for any damage that may occur as a result of it's
installation.
If you should have any questions, please let me know.
Christopher Flood
Community Management Service, Inc.
1935 Dry Creek Road, Suite 203 ,
Campbell, 95008-3631 Sin(408) 559-19797 k,7 [�j
® (650) 961-2630
-----Original Message-----
From: Wendell Stephens [mailto:WBStephens@comcast.net]
Sent: Friday, December 03, 2004 12:56 PM
To: Chris Flood; ]on Kessler
Subject: Dryer vent letter
Chris & Jon,
Thank you for approving the installation of a dryer vent in my roof at 21055 Freedom as
indicated in the November newsletter. However, I apparently need a letter from the
HOA to get a permit. I took the minutes with me and that was not acceptable to the
city. Could you please provid�eQa letter stating I can p t the dryer vent in? Thanks
Wendell
Wendell Stephens /
21055 Freedom Drive
® ' Cupertino, CA 95014
(408) 996-8964 (H)'
12/3/04
' (E2- CITY OF CUPERTINO
® CUPEI�TFINO PERMIT APPLICATION FORM
APN # 32 / S,3 02 Date:
Building Address: .2-4 O SS m Mailing Address (i ;diff r nt frobuilding address):
Ownertse_,_ Phone#q5 / �A—
Contractor: os License #:
Contact Phone: cl�,ggl Cupertino Business License#:
Fax:
Building Permit Info:
Bldg ( Elect ❑ P umb ❑ Mech ❑
Job Description: �C . r
Residential ❑ / U Commercial ❑
Sq.Ft. Floor Area: S� $/Sq.Ft.:
Cost of Project: Occupancy Group:
/300
ype of Constructio Please check this box if the project is a
second-story addition: ❑
Project Size: Standard ❑ Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> IOOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> IM 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 <= IOOOA ELECTRICAL
BELEC1001 Flee 600V > IOOOA ELECTRICAL
BELEC200 Elee Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of3
S�
CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEI�TINO
Quantity Fee ID 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
f' BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pblg 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 Pipe 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
BREMFLXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Fumace > I OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rept], Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
2 of 3
1
t CITY OF CUPERTINO
CITYOF PERMIT APPLICATION FORM
CUPEkTiNO
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR 'Theatrical Lighting Fix ELECTRICAL
BRFAIVENFAN 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 Insl5ection 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 foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanical sq. foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
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