03080049 CITY OF CUPEW11NO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION a,
BUILDING ADDRESS: JANICE & FRED BOITANO PERMIT N003080049
14q7 T.TTTT)V PT,
_ OWNER'S NAME: PERMIT ISSUE DATE
JANICE & FRED BOITANO QS /12 /2003
ONE: SANITARY NO. CONTROL NO.
ARCHITECP/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
iOp LICENSED CONTRACTOR'S DECLARATION
II hereby from Thal l am licensed under provisions of Chapter 9(commencing Job Description
With Section 7").(Division 3 of Ne➢usinco and Professions Code.and my license is p� �p ,y�
i ? in full farce and effect. REPIPE tl—�tlVb*�.B Errech
License Class Lic.N
s F Date Contractor
ARCHITEM DECLARATION
i I undcrssand my plans shall M used as public records AUG 2 6 2003
ayU
u.t7, Licensed Professional
3 OWNER-BUILDER DECLARATION
I I hereby affirm that 1 am exempt from the Committees License Law for the BUILDINGp o following reason.(Section 703 1.5,Business and Professions Code:Any city or county
<2 fila which requires a permit m construct,alter,improve,demolish,or repair any atrumure
'!`< prior its issuance,also requires the applicant for such permit ro tilt a signed statement
that he is lice pard punuml to One provisions of the ConVactuea License Law(Charter 9 Sq. F[.Floor Area Valuation
JF2 (commencing with Scotian?0(G)ofDivision 3orthe 9usimoand ProfcazinmCode)or 35624003 . 00
Nat he is exempt thdmfrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mor.Nan five hundred dollars(550))
0-1,as owner of the pmpeny,in my employees with wage as their sole rompensation,
will do the work,end meswttnm is not intended oronered potash,(Sec.7W,Business 3 01 —
and Professions Code:The Contractor's License Law does not apply town owner of 502 - F I NAL eC RY RGY
Property who builds or improves thereon,and who doeasuch work himself or through his
.we empleyeds,provided that such improvements..at intended.,offrmd for sale.If. 507 — FINAL PLUMBING
however,the building or improvement is sold within one year of completion,the mmor-
builder will have the burden of proving that he did not build or improm fur purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed convectors to
consumes the project(Sec.7044,Business and Professions Code:)T he Conuactari Li.
cense law does not apply to in Owner of progeny who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant o the Contractors
Liccnm La
❑ tem sae tunde'sm. ...� B&P C for this moon
caner �D.O '/3-0
WORKER' COMPENSATIONO ATIDN
may affirm under penalty of perjury one of the following decimations:
I bass and will maintain a Cenificale of Consent to self-insum for Worker's Compere.
rtion,as provided for by Section 37W of the Labor Code,for the performance of the
work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
3?W of the Labor Code,for thd performance of Be work for which this permit is issued.
My Workces Compensation Insurance terrier and Policy number am:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rrbistactima need nos be completed if tn<permit is format hundred dollars(glop
,it less.)
1 certify that in the performance oLthe work foyyhiah��riI permit is issued.I shall net
employ any person' mannermazle Mcaindsubie[t to 0m�arke` vms—t ?
LLwlaf Getfoml - // /t.
Applicant AX
NOTICE;WtPL1 :If,site,making this CitmE uc of Exemption,you should
bosom.s to t orkeri Compensation provisions of the Labor Code,you most
,JO forthwith comply r such provisions of this Permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
[-� .�., I hereby affirm Nm there is a contraction lending agency for performance of
D4
> the work for which skis pemdl is heard(Ser.DA/.Civ,e.)
W Lender's Name
z Lender's Add..
U Q 1 certify that 1 have read this application and sum that the about inforn lion is
1y F correct.I agree to comply with all city and county OWinan S ad sum laws relating to
�U building eonstranion,and hereby amhariaarepresentative of this city to entar upon the
1.4 C above-mentioned property for inspection purposes.
(~ (We)agree to save,indemnify and keep harmless the City of Cupertino against
h liabilities,judgments,costs and expenses which may in any way accord against mid City
U in consequence of the laboadg of this permit. /
;isuict?
LI NT UNDERSTAN ND ILL MPLY WITH ALL NON-POINT Issued by: Date
RC REGULATIONS. �� e-roofs
r of Applicam/Con mor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
ill the apr ice"(ser future building occupant Bore or handle hazardous material
reed by the Cupertino Municipal Code,Chapter 9.12,and the Heath and Safety
.Section 25532(e)? All roofs shall be inspected prior to any roofing material being installed.
❑Yds NuWill the applicant. fnturd building occupant use equipment ordcvic.s which If a roof is installed without first obtaining an inspection, I agree to remove
hazardous air contaminants o do5ned by the Bay Arca Air Quality Matugcmcnt all new materials for inspection.
C)yes No
I haw mad the have hmaarhds requirements under Chmser 6.95 of the Califor
n th&Safety Code.Secuvo2s) 25533on125534.1undersandthmtifdm building
d no currently ham o Lon y respomihility m notify Ih occupant of the
quirt cntswhrehmus ct miss ,,.fisc catcof(keypmcy Signature of Applicant Date
m oat aathmriaad agent U /DaOic 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
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
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
erformed
.....................................................................................................................................................................................
I declare under penalty ofp that the above is true and correct. I have read and understand the
Owner-Builder Information,{rederse sideG
Property Owner's Su ..ture: ate: 0 '0 -11)3
i s� D�
Permit# 2=;Job Address:
Any chanties to the information provided on this form shall be submitted to the City of Cupertino Build
\� Degartment.
j
City of Cupertino Building Department
CITY OF 10300 Torre Avenu�
C U P E IST I N O Phone: (408)TT7-322
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 vrotect 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 awareof these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department,
City of Cupertino
Printed on Aecyded Paper
1
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE o3 "
7
• CUPEI�TINO PERMIT APPLICATION FORM
X APN# 3��/ cs� � Date:
Building Address
-jLi ROS
Owner's Name: Phone
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Contractor: Phone: �License#:
s
Contact: rPhone: Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description:
eOPO>CR -
Residential 0Commercial ❑
Cost of Project: �0a
Qty. if
Applicable Fee ID Fee Description Fee Group
PPERMTI'FEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPERMFEE Bldg. Permit Fees BUILDING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
?� BUSLIC Business License BUILDING
- aa? Y
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