05090191 ° CITY OF CUPERTINO
BUILDING DIVISION PERMIT x4C0NTRACT0R INFORMATION
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ADDRESS: A MARTY ZIMMERMAN PERMIT NO.05090191
10165 MC LAREN PL
OW NER'S NAME: PERMIT ISSUE DATE
MARTY ZIMMERMAN 09/28/2005
NE: SANITARY NO. CONTROL NO,
ARCHITEC IENGiNEER: BUILDING PERMIT INFO
BQ ELEC7 PLUMB MECH
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LICENSED C09MAMWS DECLARATION Job Description
1 hereby affirm that 1 am Hemscd under provisions of Chapter 9(commencing
with Section TOM)of Division 3 ofthc Business and Professiun Code,and my Items,is
m� 1.mRfeuxand eEaa CONNCECT OUTSIDE A/C COIL &
!!g'z ueanmclw Lk.M FINALIZE A/C
Dam Contractor
ARCHITECTS DECLARATION
1 understand my plans shall W used as public records
it U
=t� Leered Professional
g OWNER-BUILDER DECLARATION
4I q 1 hereby onmm that 1 am exempt from the Convacmrs LiLaw for the
I O fallowing msson.(Section.7031.5,Business and Profession Code:Any Any C city Of coumy
$2 which requires a Permit to construct.since improve demaibh,or repair soy structure
y prior m its issuance,elan requires the applicant for such permiOo file signed stammer
_
< the he is licensed pursuant to the provisions of the Conuco
au's laccmse Law(Chapter 9 Sq.Ft.Floor Are Xjua aOOO
expo (commencing with Stenon 7000)of Division 3 of the BusineuaM Profcasian Code)or
3$ 1Mt he Is exempt th refram and the bub for the alleged cumpnon.My violation of
Secdon 7031.3 by any applicant for a permit Subjects the applicant An a civil penalty of APN Number Occupancy Type
not mom than Ove hundred dollars($500). 31621050 . 00
I,as owner of the property,OR my employees with wages ss their sole compengidon, -
willdethe work.and the smuaum bcotimmoded reoffered fmsale(Sec.7001.Busmen Required Inspections
and Profession de CoThe Contractors Liamer ee Law does ami apply m an ownof q P
property who builds o i mproves themon,atm who davuch work himself ar through his
.we employees,provided that such Improvements arc not Intended Or offered ferule.If.
however,the building or improvement Is sold within one year of compledan,the owner.
builder will have the OuNen of proving that he did not Wild or Improve for purpose of
=to L
�1.u awnr of the property am exclusively communing with licensed contnaon in
trammel the pmkct(Sec.7094,Business and Profusion Cade:)The Contractor's Li.
cane Law duo not apply to an owner of property who builds or improves thereon,and
who contracts for such pmjccu with a conumoor(s)licensed pursuant to the Contractors
License U.
❑lam ea pundr .B&PCf Nis non
Owner Data q OS
WOR LARD ION
I hereby AM under t o duty one of the following declossamu:
I haus and will maims aNficom of Consent to self-Insumfor Worker'.Compen-
a...u provided for by Section 3700 of the labor Code,fo the performance of the
1CA3-1y
rk for which this Permit is based.
1 have and will maintain Worker`!Compensation Inaurane,as required by Section
00 of dm Labor Code,for ththe e performance of work for which this Formal is Issued.
Wouce,Compensation Insurance carrier and Policynumber art:
rier. Poli)Na.:
CERTIFICATE OF E%EM MON FROM WORKERS'
COMPENSATION INSURANCE
(Tbb seed..dead malsocamplemd if the Permit IS foroubundned dollen(SIM)
or less)
1 amity that in the Mr...of the work far which this Permit b issued.I shall not
mnPloyany perem in any manners,ssm o mctt 'tett tis Warton Cnmpasation
laws of Calif Orem ,
APPlicmt
NGfICE IO P I ng tldr2enE of of Exemption,you should
become auhJtet m the s,4 C pe ado.p--I...of the Lahnr Crede.You man
OZ fotawith comply withsac tot rhes permit shall de domed revoked.
z CONSTRUCTION LENDING AGENCY
(ti14 1hemby0T.m dist them lea construction lending agency for the performance of
a.> Ne work for which this permit is issued(Sec.3097,Civ.C.)
W� Lender's Name
Z lander!Adams,
U0 1 certify Nn I have read this applicadon and sun that the above information Is
Iy coned 1 agree m comply with all city and county arinsnaw and sum tam mlaung to
C building construction,and hereby authorize mpnsenutives of this city to enter upon the
FI) above-mentioned property for Inspection purpML
gL (We)agree to give,indemnify and keep barrimas the City of Cupertino against
,..r rn liabilities,judgments,costs and expenses which may in any way accrue against sAid City
U Zin consequence of the granting of this permit.
APPLICA UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC UNDE N5. _
Re-roofs
Signmure 5f ppl can Dam
AZA S M TERIALS DISCLOSURE Type of Roof
Will Ne cep liar or futu 11 ng asurml amt o handle hundou mamrid
ss mooed by Um C u i code.Chapter 9.17,and dm Health and Safety
a 1c.Section 25333()? ����tttg'''' All roofs shall be inspected prior to any roofing material being installed.
❑You
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
it hmurdous air eontaninnu u defined by the Bay Aro Air Quality Management all new materials for inspection.
tonal
❑Yrs RIO
1 he.read the humdra s ream ulsmquimmen s underCWpmrd.95 of the Califon -
meHeol @Safety Code,Section 25505.25533 and 25334.I understand thetlfthe building
dace n rrealy he a mnenr,Wt It b my resporibillly to nodl'y Nc as pmt of the
reqs uwhich nbcmnpdortoIssuanceoraCodfrwcofDec m Signature of Applicant Date
ow.a,.r am nadxaa a \Dow All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
' Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: toy (Y1 t LAm" PERMIT#
Cu CL(Z's,N0 0 0 $°-01( D/
OWNER'SNAME: T&A-,Rvy PHONE # 4o$-irm-4Sq
GENERAL CONTRACTOR: Sr-- t-f FAX # t l0 8
I am not using any subcontractors: '2-8 o E
i e Date
Please check applicable subcontractors and comp e e e following information:
CA MA
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Ah 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
-- 92sos
e Co tractor Signature Date
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent,spouse or child) will perform
A. _x 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/Fu-m 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 (r rse side).
Property Owner's Signature: Date: c5
Job Address: o S M <L p+� Cv QK�V ro Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
City of Cupertino Building Department
aCIOF 10300 Torre Avenu
CU PERTINO '° ` X408'�_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 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 US.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
CITY OF CUPERTINO
FURNACE/AC C)
CUPERTINOO PERMIT APPLICATION FORM
APN# 3 k �, a ` 050 Date:
q -2 g-05
Building Address: 1 oltoS JV\ c L Ctk l'C e-Tiao cf,h F15014
Owner's Name: �\AARTy Phone#: y aF - -7,z-7-gi4y
Contractor: s� C F License#:
Contact: tNI497 y 1 v"vv%e*_ ACupertino Business License#:
Building Permit Info:
Bldg ❑ Elect IM Plumb ® Mech I�
Job Description: CoNr-3EcT ou'Ss,of A Q, Co ,L
Residential �5 Commercial ❑
For Residential Installations:
Attic ❑ 151 floor ❑ 2"d floor❑
Adhere to min set back requirement
For Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Plannin A royal Re uired ❑
Cost of Project: o0o Type of Construction: Occupancy group:
Strapped ❑ On Platform ❑ Bonded ❑ Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BREMFURN Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfin MECHANICAL
BREMAIRHAN A/C Units<= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
/ BSEISMICRE Seismic Fee Res BUILDING
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE - .—Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING