03110005 CITY OF CUPEWFINO "0'�'`" 3 y;;��f' "s ,.x` •* ''r
BUILDING DIVISION PERMIT , CONTRACTOR INFORMATION
BUILDING ADDRESS: JOSEPH & ELIZ EPPEL PERMIT NO133110005
20874 GARDEN C-ATF DR
OWNER'S NAME: 20874 GARDEN GATE DR PERMR ISSUE DATE
AM JOSEPH & ELIZ EPPEL
11/03 /2003
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
aC 0
?Op LICENSED CONTRACTOR'S DECLARATION
mF I ion 7 affirm that 1 em licensed under and
Professions,
of C odes. 9(commencing Jo(D )ltQOp ssss �sv ®®
'try with scnion7IX10)of Division]of the Business and hofcuiuns Code.and myliccnm is ®®®YUJp�0 P`A'Olm�wtiim�a
±�„ in mummeanacrccc'' REPLACE WALL HEATER 3 0 O TU
)q? License Class Lie.X r
��n Dam Contractor NOV 5 2�W
ARCHITECTS DECLARATION
u1 understand my plans shall M used as public records ■O1y
Loy Licensed Pmfcssionel BUIL®INM
OWNER-BUILDER DECLARATION
a I 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
00 following niton.(Section 7131.5.Business and Pmfics.;bm Code:Any city tar county
<m which Mother•permit to construct,alter,improve,demolish,or repair any structure 4 0 0
�zy pnorm its issuance.alsu tcquires the applicantforsuch permit to Glc a signedmmemcn,
;r o that he is licensed pursuant it)the pmvisiosu of the Contractor's License law(Chaper 9 Sq. Ft. Floor Area Valuation
2t— (commencing with Section 7DW)ofDivision 3oftheBusiness and Professions Code)ser 32630053 . 00
Nu at he exempt Other..Other..and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant fee.permit subjects the applicant to a civil penally of APN ve Number O
not mom Than fin hundred dollars(i3007. Occupancy pane y Type
❑ L as owner of the property,or my employers with wages as their sole compensation,
will do the woh,and the ssrucmrt is not intended of offered for sale(Sec.7044,Business
and Professions Code:The Convector's License Law dors not apply to an owner of Required Inspections
propeny who builds or improves thereon.and who does such work himself or through his
own employes,provided not such improvements are not located or offered for sale,if.
however.the building or impmvemem is sold within one year of completion,the owner.
builder will haw the burden of proving that ha did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting wit licensed contractors to
construct ore pmjcn(Sec.70W,Business and Professions Col The Contractors Li-
cense Law docs not apply to an owner of propcny who Wilds or improves thereon,and
who contracts for such projects with a convactor(s)licensed pursuant o the Contractors
License Law,
❑Ism ex funder Sec. ,B&PCL thrsoamm
Ow c ate d^ 0
WOR ER'S COMPE IS ION DEC ION
IIt ya(im.under penalty of perjury one aft allowing declarations:
1 haw and will maintain a CcNfimm of Consenuo ulf-iwum for Wofker'sComNn-
Union,u provided for by Section 3700 of the labor Code,for the performance of the
work for which this permit is issued.
❑1 haw and will maintain Workers Compensation Insurance.as"uimd by Section
37M of the labor Cade,for the performance of the work for which this Fermi,is issued.
My Worker's Compensation Luutrnee cartfm and Policy number am-
Cannot: Policy No.: _
CERTIFICATE OF EKEMPnON FROM WORKERS'
COMPENSATION INSURANCE
(Thu section raced oat be camplacd if tie Icrmit is for one,hundred dollars(SIM)
tar less.)
1 cmnifY that in,he performance of Ne work for which this permit is issued,1 spall not
employ any permn in any manner an an m become subjecpo the WorkersComFemation
Laws of California.Dare
Applicant
NOTICE TO APPLICANT:If,after making this Cenifieare of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,you must
�O forthwith comply with such provisions at this arrant shall bnonfoononfood.e deemed nonfood.
�'r✓3 CONSTRUC7nON LENDING AGENCY
1 hembY affirm that them is a comtructiom lending agency for the performance of
L� the work for which this permit is issued(Sec.3897,Co,C.)
Q Lenders Name
Z Lenders Address
;J Q 1 certify that I haw read this application and sutc that the above information is
yf" cavocL l agree m comply with all city and county ordinances and sate laws relaung to
�U building construction,and hereby amhorim representatives of this city to enter upon the
W ahovcties juuned property for inspection inopwhich ms
C. (We)agree to saw,indemnify and kncp hornless the City of Cupcnino against
h in Consequence
of ts.the coarsen of this csmit. may inany way accrue against mid City i
,J z APFN qucncc of UNDERSTANDS
of thisPermit.WILL
AP CANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINT Issued by: Date V 7
50 R GUL TIONi.S� A
G �C/ ��0" o Re-roofs
Si arc of pplicaVUContra or p
HAZARDOUS MATERIALS DISCLOSURE ate Type of Roof
Will the applicant or future building occupant store or handle haiarduus material
u de0ncd by the Cupenin0 Municipal Code,Chapter 9.12,and the Health and Safcty
odc.5ccuon 23532(a)?
'0 Yet AN. All roofs shall be inspected prior to any roofing material being instal ed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
i,hazardnus air contaminants as defined by the Day Area Air Quality Management all new materials for inspection.
Istria? u
❑yes
Ihaveread Ochanrdtmsmmcriau"uimmcnuunt rChaptcr6.95oHhe Glifor.
Via Health&Safety Code,Secuom 25505,25533 and 25534.1 untie
that if the building
r dose no,her
remly haw a¢neat,Nat it is my responsibility to no the upam of the
'quirt a lwhimmuat curet 'aroiaaa oracert;6ca or p c^. gnatureofApplicant Date
/I0 6
am, authofircdagent I D c All roof coverings to be Class "B" or better
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 RFCEIVEn i//
If B or C is checked,complete 2 or 3 oFVO
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 side). s
Property Owner's Signatae: G /�h Da
Job Address, C QR C a&b . Permit# 7
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
City of Cupertino Building Department
CITY OF 10300 Torre Avenin
C U P E R T I N O, Phone: (408)777-322
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 compensation•
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
fS5 CITY OF CUPERTINOCITY OF PERMIT APPLICATION FORM
CUPERTINO
IN APN # 2, Z,75 � �� Date: `/ O.3 D 3
Build i Agdldrress: /'' jar Mailing Address (if different from building address):
Owner's Name: _ Phone#:
Jos epa Eel 2, q6oF- 3C1f9
Contractor: Cry ^ A fl � License#:
Contact: Phone: Cupertino Business icense#:
Fax: /✓
Building Permit Info:
Bl ❑ Elect ❑ lumb M ❑
Jo Description: ,} r3
Residential Z 6C11.e Q fc¢ W i Commerct ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: Occupancy Group:
Type of Construction: Please check this b ooject is a
second-story addition: ❑
—Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
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
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
z3 62 /
Iof3 /L / 7 / (� �
( - CITY OF CUPERTINO
1
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Adilk
Quantity Fee ID Fee Description Fee Group
lip BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI Multifamily Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res 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
Vir 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 HeaterNent 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> 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 Devi ce/Ap aratus ELECTRICAL
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(C CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BREMRECEPT Repill, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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 foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
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