05080204 CITY OF CUPERTINO o- s •« �>n '' ynrr 'I' '�' ,�..L
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BUILDING DIVISION PERMIT CONTRACTOWINFORMATION, '
BUILDING ADDRESS: SAM SETO PERMIT NO()5080204
19515 GREENWOOD CT # 1
OWNER'S NAME: PERMIT ISSUE DATE
ldhk SAM SETO 08/23/2005
14 NE: SANITARY NO. CONTROL NO.
ARCHM-CUENGINEER: BUILDING PERMIT INFO
RLDG ELECT PLUMB MECH
0 0 0 0
u00 LICENSED CONTRACTOR'S DECLARATION ": -t/f
C 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description";S I
f�
lbw with Scene.70Bo).(Division 3 altar Busincssand ProfessionsCodc.and my licerueus 171 Y , .
^`o�', i.btBmmeande(fcn. REPLACE CIRCUIT BRAKER '�
y>a? License Class Lie.x "'r;
p DareContractor -ra
ARCHITECT'S DECLARATION HtJil
De,< 1 undersunJ my plans shall be used u public records
aU
G Lieetlsed Professional - {�
S OWNER-BUILDER DECLARATION 'f B
fY
<I I hereby affirm Nal 1 am exempt from the Contractor's License Lew for the
p O following mason.(Section 7(D L5,Business and Prefess'om Conk:Any city or county gl4 [.�
v m ff which.,.i.a permit w ennmruct.altos,improve,demolish,or¢pair any sIMcmm
oa1 Gq pgBp,A 2 0 0
prior to its issuance.also mquiuea the applicant for such permit to file a signed statement
that he is licensed pursuant to the provision of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
acf-0 (ommuter.,with Scene.10(0)of Division 3 of the Bunnmi,nd Prefesuou Cole)or
y that he u exempt thcrefmm and the hands;for the a11egW exemption.Any violation of
Section 7831.5 by any applicant for a permit subjects the applicant to a civil penalty of 0Y OCCU
not mom thanaraC five hundred dollars(SSW). Occupancy Type
1% 1,uownerofthepmptny,ormyemployeeswishwag.utheirsolecompcnuuon,
Will do the work and the structure is not intended or offered for sale(Sec.1014,Business
and Professions Code:The Contractor's License Law dors nut apply m an owner of Required Inspections
pmperty who Wilds or improves them.n,and who doessuch work himself orthmugh his
own employes.provided that such improvements am not imcirded uroRnedi for sal.,If.
however,due building of improvement is said within one Year of enmplcuon.the owner.
builder will have the burden of proving that he did not Wild or improve for purpose of
sal'.).
❑h as owner of the property,am exclusively contracting wish licensed contractors in
construct the project(Sec]Ord,Business and Professions Code:)The C.Maxo rte.Li- .
comm law dots not apply to an owner of property who Wilds or improves Ramon,and
who eontmets for such projects with a eontraetoKs)licensed pursuant to tW 9ontractors
License law.
O l am exempt under Sec }}�� ,B&P C for thus reason
Owner —15:��L Date T Of
WORKER'S COMPENSATION DECLARATION
1 hemby aRrm under penalty of perjury ane of due following declarations:
I have and will maintain a Certificate of Comtism,to self-inseam for Worker's Cont
cation,as provided far by Section 3700 of the Later Code.for the performance of the,
work for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance,as mquimd by Secuun
3700.17 the later Code,for Ne performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Carrier'. Policy No.: _
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Thus sectio.need not be completed ifthe permit is foronc Wndred dollars(5100)
of less.)
1 certify that in the performance of the work for which this permit is issued.l shall not
employ any person in any manner sotarsu be'.Te mbjecuo tM Wenceui Compensation
Laws of California.Dam r Z?To t'
Applicant
NOTICE TO APPLICANT:IL after making This Cci ifcate of Exemption,you should
become subject Re the Worker's Compensation provisions of the UWr GM',you mus
.J O forNwith comply with such pmvisiems or this permit shall W deemed rooked.
'z y CONSTRUCTION LENDING AGENCY
(--� I hereby alRrnt that Rare is a cortmclinn lcmdin,.,,MrY for the peif...of
C' IW work for which this permit is issued(Sec.3W7,Civ.C.)
{gl Under's Name
a• lender's Address
� z
U Q 1 ceNfy that 1 have read this application and sure that the above information is
f-' cones.l agree to comply wit all city and county ordinances and state laws relating in
p U building convection,and hereby auNorite representatives;oftris city to enter upon me
l(7 ahove-mentioned property for iupcclion purposes
4, (We)agree to taw,indemnify and keep harmless the City of Cupertino against
mFr V1 liabilities,judgments,costs and expenses which may in any way accrue against said City
U in consequence of the mmi.,of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
/�m Re-roofs ?X
Signature or Applican wf Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle huard.us matenal
u defined by the,Cupenin.Municipal Code.Chapter 9.11,and the Health and Safety
Code. yes )2(N.No
15533(a)?
DAll roofs shall be inspected prior to any roofing material being installed.
yes
Will the applicant or future building=upon(use equipment or dt•ices which If a roof is installed without first obtaining an inspection,I agree to remove
it hvardous air contaminants m defined by the Bay Area Air Quality Management all new materials for inspection. '
District?
Dyes 9J u
T
Ihave man the de,Socnusmaterialsmquimme 55under Chapter that ofthe Wilding
nus act cur SaRentlyhaw 3 about that
it MY r and 15534.1 undersand a Occupfft Wilding
Joca 11.1 currently bow•tenant Nat it is my rtsperihilitY w notify the acupanl of the
requimments which must/tW ctctpdorwimumncon CcmFicawofaQZ��1uppaney. ,Signature of Applicant Date
Owner or amhoriecd agent I
'- i `-` `9` ^ All roof coverings to be Class"B"or better
�Dv c
Community Development
e 10300 Torre Avenue
-✓' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
1g,5l 5 G12c 1 Warm CaiQr I C Lf-01?6rzoK
OWNER'S NAME: 9---r PHONE # 4 06 -2 3�
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: 03'
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
Omamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
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. ZG 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.
Person/Firm Address/City Phone Number Type of work to be
_performed
iii A AQ�`I D Z3 I R€P FlGc C(&LAr SW6
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side).
Property Owner's Signature: -� Date: Sf z 3�0�
job Address: l S! S 6�-67J D CA� Da'06- Permit# od--M -o
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department. '
City of Cupertino Building DeA777-7322
' I
CITY OF 10300 Torr
C V P E Q T'N O Phone: (408)
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 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
F CITY OF CUPERTINO 6 a
CUP
CITY
YOO PERMIT APPLICATION FORM D S 8 2
APN# 3 �-.� Date: Z
I
Building Address: Mailing Address (if different from building address):
�9S lS 62zeitwo b 6DVer*1 GVPcaxriiio , �S o l¢
Owner's Name: S Phone #:
Art SETo
Contractor: License#:
�WNe-.2 BV lroarz
Contact: Phone: Cupertino Business License#:
Fax:
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Job Description:
Residential ®- MPLace C12Gni fga�s�cam- Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: &2 d0 oa Occupancy Group:
Type of Construction: Please check this box if the project is a
AWL second-story addition: ❑
Project Size: Standard ®• Large ❑ Ma or ❑
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 IM 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 <= IOOOA ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Flee Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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73 ' 7
, Ant CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
' CUPEkTINO
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
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 Repie Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
AdOlk BP.TRAP 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 din MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFDXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Fumace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREN MISC Mise Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform 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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CITY OF CUPERTINO
C rr OF PERMIT APPLICATION FORM
CUPERTINO /
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Sips, 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 Insection 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 Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
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