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051201006 CITY OF CUPERTINO BUILDING DIVISION PERMIT, „� RAI='rC1T�NMATIO�,, BUILDING ADDRESS: JOHN WINCN PERMITNO-05120100 OWNER'S NAME: PERMR ISSUE DATE JOHN WINCN P.O.BOX 631 12/16/2005 NE: SANITARY NO. CONTROL NO. PAW 2 ARCHITECT/ENGINEER: BUILDING PERMIT INFO PW MB MECH �BLonEIFCT 0 0 0 LICENSED CONTRACTOR'S DECLARATION I hereby afBun that 1 am licensed under provisions of Chapter 9 (commencing �/ IIOnlSCr IO ]ae p with Section 7010) ofDivWan 3 of the Business and Professions Cotle.and my license is at roll and erceal GAS LINE (INTE 2 T9FL LAUNDRY) License eCtClw Lie. A Dale Gar, DECLARATION ARCHRECsS DECLARATION 1 undermnJ my puus Mall W used ss Public records // Licensed Professional OWNER -BUILDER DECLARATION 1 hcroby affirm that 1 am exempt from the Commences License Law for the 1 following maven. (Section 7031.5. Business and PIDICEalrn' Code: My city or county which requima • permit m construct. after, improve, demolish, ar repair any urns mm $100 Prior at it, Issuance, 2150 mquirea the applicant for such permit to Ble a signed summent that he is licensed proceed to the provisions of the Cardamom's weave Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Sacdon 7000) of Division 3 of the Business and Profwln a Code) or Nn he B eampt therefrom and the basis for the alleged excmpdon. My vialmon of F Occupancy Type Semon 7031.5 by airy applicants for a permit wb)ecu the applicant te a civil penalty of not more thin live hundred dollar. (SSW). 0 I, as www of Ne properly, army employed wOh walnut astheirsole compenadon, Required Inspections willda thewarl,.amidesuuerurets notinenhhumu@redfmalo1Sec.7014, Bud. and Profession' Cade: The Conlrxroes License ss law donet apply m an ass. of q p properly who builds or improves mereon, end who Oaf sue h work himself or through his own employed, provided that such Improvement, are notinended maRerml fm sale. If. however, the building or Improvement is mid within aro Sear of ompledon. the owner. builder will have the burden of proving that M slid not build or improve for purpose of tile.). 0 1, as owner of the propeny, am ealusively contraaing with licansed contractors; in construct the project (Sec. 7044, Business and Profession' Code:) The Cormscter's Li - come law does not apply in an owner of propeny.who Wilda or improves Ihemon, and. who canuacu far such projects with acom acutr() licensed pmwant in the Contractors License law. ❑lam caempt eSec. . B k P C for this reason Owner Dau WORKEWS COMPENSATION DECLARATION I y affirm under penury of perjury are of the following declarations I haw and will mainssin a CemOate of Convent m elf -insure forwarkehcompem- astion, as provided for by Section 37M of the labor Code. fm the performance of the work for which this permit is Issued. 0 1 ban and will maintain Worker's Compensation lusuonm, As required by Section 37W of the labor Code, fm she performance of the work for which this permit is bound. - My Warkees Compeaation Issuance carrier and Policy number am: Carrier. Policy No.: , CERTIFICATE OF FXEM PITON FROM WORKERS' COMPENSATION INSURANCE (Thu action reed not bo completed If the permit Is foram, hundred dollars ($id)) or las) 1 unify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manncr50ss mbccomc subject lotMWorkcn'Coope ' n Laws of Califomis t Applicant NOTICE TO ASP NT. IL after making this CediOca s of Exemption, you Mould become aubJm Worke's Compensation provisions of the labor Codc, you mute forthwith compl ith such provision' or this permit Abel be decreed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that Nem, is a consuaedrn lending qem y for the permrmanm of the work for which this permit is Issued (Sec. 3097, Civ. C.) Lmre es Nurse , Landela Address I Carl that 1 have mad this application And sou Nat the above information is contact. I agree m comply with all city and county remittances and sue Ire misting in Wilding construction, and hereby au mal repmantatiws of this city m enter upon the almve-mentioned properly for ImNedon purposes. (We) agree to an, indemnify and keep harmless the City of Cupertino against iimilidut. Judgment,, cops and espouses which may in any way acme against cold city n consequence of the granting of this permit. APPLICANT DERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date URCER L ON Re -roofs Type of Roof mmure pplm. nuamr Data HA7dfM MATERIALS DISCLOSURE III the applicant or fumed Wilding occupant atom m handle hanamous material Asdef d by 0e Capsular, Municipal Code. Chapter 9.17. and the Health and Safety ;isuicl? d , Section 255320)? All roofs shall be inspected to any roofing material being installed. 0Ya ON. prior If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future Wilding aecupant =equipment m devices which II havamttus air contaminants a defined by the Bay Area Air Quality ManaSCIaM all new materials for inspection. 0Yut ON. I have mW the basements maurialsmquimmems under Chapur6.95 ofthe Califor. nia Health&SafmyCodc.Swd=25505.25533 and 25531.1 understand! dutifthe Wilding dues not currently he anal N It Is my rcapousihllity m notify We occupant of N requimmcmawhic m mkt issuanecof a Certill. arOcwpamy. Signature of Applicant Date All roof coverings to be Class "B" or better owrer or mtla ed. ant p .r. . CITY OF UPERTINO JOB ADDRESS: Community Development 10300 Torre Avenue Cupertino'CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department PERMIT # ZS C'/ OWNER'S NAME: . ', ", el,4AIC Al I PHONE # '5V 772 n 94�� C GENERAL CONTRATOR FAX # I am not using any subcontractors: 1APLl Signature Date Please check applicable subcontractors and complete the following information 41 Owner/ Contractor Signature Date 0 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting 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 41 Owner/ Contractor Signature Date 0 OWNER -BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform A. \/I 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— .armed 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). Property Owner's Signature: Date: Job Ad dress: L G%C Permit # �ODSn /. , Any changes to the information provided on this form shall be submitted to the City of Cupertino Build DegartmenL Dear Property Owner. City of Cupertino Building Department 10300 Torre Avenue, An application for a budding permit has been subnutted in Your name listing yourself as the budder of the property improvements specified For your protection you should be aware that as owner4uilder 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 unmedsate 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 employe=. 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 Inteaial 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 budding 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 95614. please complete and return the enclosed owner-by,ilder 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 return ed. Very truly yours, Building Department : _ - City of Cupertino ti Prtraetl w Ree) a Paper - - �CITY OF CUPERTINO CITY OF CUPERTINO 0S,/ zal c REPIPE/SEWERS/MAIN SERVICE PERMIT APPLICATION FORM APN # 5 r7 T t0 BUILDING Date/GSC Building Address: /L%/ /✓�/� PPERMITFEE Owner's Name:``AA r'I PLUMBING BPREPIPE Phone #: 2 5� a�� Contractor: Phone: Pbl . Fixture License #: l Main Water Service PLUMBING BPSEWER Contact: Phone: BPSEWAGE Cupertino Business License #: rpt • 16zaS a 8Ll Building' Permit Info: Business License BUILDING Bldg ❑ Elect ❑ Plumb Ar Job Description: Residential `x Commercial ❑ ��� Cost of Project: C E Qty. if Annlicable Fee ID Fee Descrintion 7?)r4 ` Fee Groun BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Pi in S stem Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPFIXTURE Pbl . Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING is