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04040160
,CITY OF CUPEW11NO a i, `w In, '- w. BUILDING DIVISION PERMIT ,COIVTRACTQR INFORMATJON ; BUILDINGADDRESS: - GLENN L GABBARD PERMIT No 04040160 190 LOCKWOOD DR W NRR'S NAME: - PERMIT ISSUE DATE GLENN L GABBARD --..Q4/26/2004 NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECTPLUMB MF.CH 0 0 0 0 u o o LICENSED CONTRACTOR'S DECLARATION- u❑ 1 hereby affirm that 1 am licensed under provisions of Chapter 9 Poommenctng Job Description �W with Section]LYRt)ufDivixion3 ofthe Business and Professions Codc,and my license is �Q�® in full force and effect. ELECT PANEL UPGRADE 200 AM Nf� ED glz License Class Ltc.N ^y DO,,_Contractor F ARCHITECTS DECLARATION MAY l0 2004 UI understand my plans shall he used as public records ;oG Licensed Professional S OWNER-BUILDER DECLARATION BUILDING I 1 hereby affirm that 1 am exemP,from te hCommune's License Law for the O O following reason.(Section 7031.5,Business and Professions Code:Any city Or county YK m which requires a permit In construct,alter,improve,diminish,or repair any structure yZi prior to its issuance,alsumquires the applicant forsuch permit refile a signed statamem 81300 pxa that it.is licensed pursuant 1.the provisions of the Connotation's License Law(Chapter 9 Sq. Ft.Floor Area Valuation y I-� (commencing with Section 7")of Division 3 of the Business and Professions Code)or ' y that he is exempt domfrom and the basis for the alleged exemption.Any vintmloa of Section 7031.5 by any applicant for a Permit subjects me applicant to a civil Penalty of 34251+a"eer00 a Occupancy not more than rive hundred dollars($500). P Y Type ❑1,az owner or the property,or my employees with wages az their sole compensation, will do me work,and me structure is not intended or offered for sale(Sec.70 ,Business and Professions Codc:The Contractor's License Taw tices not apply to an owner of Required Inspections Property who builds or improves thereon.and who dues such work himself or through his - own employees,provided that such improvements me nut intended or offered far sale.If, however,me building or improvement is sold within one year of completion,the owner. builder will have the burden of proving that he did not build or improve for purpose of ale.). I,as owner of the property,am exclusively contracting with licensed contractors to o slmet the project(Sec.00x4,Business and Professions Code)The Convector's Li- cense Law docs not apply to an owner M property who builds or improves demon,and who contracts far such projects with a contraction-B)licensed pursuant to the Contractor's Lice se Law. ❑1 em exempt under Sec. B&P C for this reason tJI/J45'2L1s le Wrier WORKERS O1S OM NS�AT� I hereby affirm under Penalty of perjury one of the following declarations: have and will maintain a Certificate of Consent to self-insure for Worker's Comped ran,as provided for by Section 37W of me Labor Code,for the Performance or the work for which this Permit is issued. 0 1 have and will maintain Worker's Compensation Insurance,as required by Section 37W cribs Labor Code,for the performance of she work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number am: Carrier: Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section need not be complcted tribe T rmit is foronc hundred dnllam(SIfN)I r Ina.) 1 certify 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 the WorkersCompensation Laws of California.Dam Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must .J O forthwith comply with such provisions or this Permit shall he deemed revoked. „zt h CONSTRUCTION LENDING AGENCY Ethereby affirm mat mere is a construction lending agency for the performance of > the work fur which this permit is issued(Sec,3097,Civ,C.) W� ❑ Lender's Name D ,z Lender's Address U Q 1 cenify mat 1 have read this application and sure that due above information is ry H Coreel.1 agree to comply with all city and county ordinances and state laws relating to �U building construction,and hereby authorise representatives of this city to enter upon the �+a above-mentioned paireny for inspection purposes. (We)agree to save,indemnify and keep harmless the City Of Cupertino against rN Iiabilides,judgnunls.costs and expenses which may In any way seems against said City UZ in consequence of the granting of this permit. '—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date i Fr-1yo, GULAT10Mr7N Re-roofs papplicaCDamHAMATERIALS DISCLOSURE Type of Roof /e applicanuilding occupant r 9.1 nr handle Health a mamdalNe Cupertipel,Cude,Chapter 9.1 E,antl me Health anJ Safety xss3z(anAll roofs shall be ins ected rlor to an roofin material beim P P � Y g g installed. e applicanbuilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove s air contadefined by the Bay Area Air Quality Management all new materials for inspection. 1hwcreadthehaearduusmamrialsmquimmentsunder Chapter6 atifineCalifon- iiaHcalm55dctyCode,Sccdons]5X15,25533 anJ 25 hit 1. mofmdmotifinebuilding Jces not currently have agyteeenrrayyn��t��,ppm t it lisyyeemssy respo bilis m nndfy the rccupant of me rcyvimmcn �/p/rte/ trance of err eataofocomourry. Signature of Applicant Date Owner ser authorimJ agent Dam All roof coverings to be Class "B"or better I Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 Cl OF 91PEkTINO Building De artment JOB ADDRESS: PERMIT # C/0416/6 D l�w oo D O OWNER'S NAME: ,� — �- / A PHONE # o $-72.s= o z S GENERAL CONTRACTOR: D VAJ&. FAX# I am not using any subcontractors: . I G se Signature Date Please check applicable subcontractors and complete the followin information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting �P g Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental 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. 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 ✓c ua✓auacu 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 of perjury that the above is true and correct. I have read and understand the Owner-Builder Information (reverse side). � /J Property Owner's Signature: C!y "��/l Date: job Address: I b l / D L e L le,O BOD D Permit# Oq 4 q O l6o 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 Avenu Phone: (408)777-322 CU PEf�TINO 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. -Builder verification form so that we can confirm that Please complete and return the enclosed owner you are aware of-these matters. The building permit willnot be issued until the verification is returned. . Very truly yours, Building Department, City of Cupertino Printed on Recycled Paper CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM " ° CUPEkTINO APN# -3' q 2— � � Z Date: Building Address: CKO Mail* dress (if different from building address): v c Lockwoa D n AdO . 7 5 v—o s' O is Name: Phone#: Contractor, License #: �1v Contact: Phone: Cupertino Business License#: Fax: Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: ( 0 1 Zd.n w Residential ,F—L G A ffJkCommercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: C3 © kDX Cost of Project: Occupancy Group: 300 ,0 Type of Construction: Please check this box if the project 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 <= IOOOA 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 I of3 -t / / '7 37. . CITY OF CUPERTINO cuP TY0 PERMIT APPLICATION FORM Quantityft Fee ID Fee Description Fee Group or 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 Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste hiterceptor 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 BPSPRENK 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 cfrn MECHANICAL BREMAIlZHAN A/C Units <= 10,000 cfln MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace 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/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 BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips, Maz uee ELECTRICAL 2 of 3 CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group 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 Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of