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06010109 CITY OF CUPERTINO ln+a' r 'nwa ssn.xs '^ �+ BUILDING DIVISION PERMIT "CONTReSCTORINF�RIVIATION. t f BUILDING ADDRESS: PATRICK HAMILL F"MITNo06O1O109 10300 MORETTI DR OWNER'S NAME: PERMIT ISSUE DATE Alk PATRICK HAMILL 10300 MORETTI DR 01/20/2006 NE: SANITARY NO. CONTROL NO. ARCHITEC AINGINEER: BUILDING PERMIT INFO BLDG ELECT tu I� PLUM MECH LS t� ED iso LICENSED CONTRACTORS on&,$DECLARATION Job Description.,,, Y b 1 Wmby)(firm that I am licensed under and Pr ions of Chapter 9(commencing withilfoSection 7IXp)of Divielon 3af the Business sed Profesunns Code.and mylicensc is Xs n� Infailneat. REPLACE WINDOW IN LIV. RM (R�jty Contamor �$? Liccnu Class LM,X IN Deto ARCHI'TECT'S DECLARATION I un a named my plans shell W used as public records () r )sed LkenaedProfewonal "' / 2006 g OW NER-BUILDER DECLARATION 4 I hereby affirm that I am exempt from the Ca onotor's License Law for IW 0,0411pp p o following mason.(section 71313,Business and Profesdons Code:Any city or county which requires a permit In construct.alter.Improve,demnlish,or rtpur any structure d - _�Sn prim to its issuance.afw requires the applicator for such permit in file a signed statement Fg G that he b licensed pursuant the previsions of the Con=wr's License,Law(Chapter 9 Sq.Ft. Floor Area alU tib Y�$ (commencing with Section 7000)of Divielon 3 of the Business and Profession Code)or .. that h e h exempt therefrom and the bub for die alleged exemption.Any violad'on of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty or XPA t 0 0 Occupancy Type not mom than five hundred dollars(5500). ❑1,u awns of(he pmpeny,m my employee with wges u their ale emnperaadon, will da the work,and the structure bnm intended mediums forsale(sm.7044,Business Required Inspections sed PmfealaN Code:The Conmecmh Li2ue law does nut apply b an owner of q p property who builds ar improves the mon.and who dons such wrt himself or through his Own employees,provided that such improvements art not Intended creamed(orale,If, however,the building or Improvement is sold within one year of compledon,the owner builder will hive the burden of proving that he did not Wild or Improve for purpose of sale.). (]dies Owner of the property am exclusively contracting with licensed conoamo u to construct the pmjca(Sec.7044,Business and Professions Code:)The Contractor's Li- came law does net apply to an owner of property-who Wilda of improv,desmon,and, who contracts for such projects;with aconusetor(s)licensed pursuant to the Conta,oes License Law. ❑I am exempt under Sec // B k P C for this recon wnm QYYr e/. tYTe ihm Dmr_14 _70 d WORKER'S COMPENSATION DECLARATION I hereby sifirm under penally of perjury aro of the fallowing decorations: I ham and will maintain•Cenl0cauaf Cmumm m selGimurt for Wmkcri Compcm tion,u provided for by Section 3700 of the Labor Code.Ire the performance of the wrk for which Nis permit is maxed. ❑I haw and will mumaln Worker's Compensation I...u ncq.imd by genion 3700 of the labor Cade.for the performmce of the work for which this permit is leaned. My Worker's Compensated Insurance carrier and Policy number art: Cartier. Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (ITh section need not becompmed if the permit Is forgo hundred dollars($1001 or less.) 1 cattily that In the performance of the work for which Nis permit b issued,l"I rmt employ any person in my nerve oto bemuses jecltotllC Workeri Compensation Laws of Caliromia.Dae Applicant NOTICE TO APPLICANT:IL after making this Certificate or Exemption,you should become subject to the worker's Compensation provisions or the Lather Cade.you must O Q raMwith comply with such provisions or this Permit W deemed revoked. .Z.e 51 CONSTRUCTION LENDING AGENCY [rte thereby affirm that them laaconstmctinn lending gency for the performance or use work fur which Nis permit Is issued(Sec.3097,Civ.C.) Q Lender's Name , =z Lende'.Addmss U O 1 certify that I have rad this application and state that to move information Is it,!' m lml.I ages to comply with all city and county ordinances and rota law misting to OSV` buildingcanswction.andherebyauthouuepresentativesofthiscitytocnmruponlM [f7 above-mcmiamed property for lmpeNon purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against ry faq liabilities,judgments,casts and expeuea which may in any way accrue against said City t.> in consequence of the gaming of this permit. - APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date / (J—D C SOUR 2jlEGjJLAT1ONS.� � � y ow Re-roofs Snpnuurt df AppinaHAZARDO V Dau HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the a CuKri ar future Wilding aampuat9re m MIWk h Balt anmaterial u defined by the Cupertino Municipal Code.Chapter 9.1],and the Health and Safety Cma.Seedanz553z(n7 ��. All roofs shall be inspected prior to any roofing material being installed. ❑yea Will Ne applicant or future building=upon,use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove It haardous air contaminants as donned by the Bay Area Air Quality Management all new materials for Inspection. iaaict7 ❑Yes G(TFo I have mW the huirdeaa matedah rMiememr underCNpur 6.95of the Califer- nhH,IthBSumyCede,Secuans25SO5,23533and2553d.imuser and gwirlhe Wilding does not currently havea anal.Net it h mY reaponsibilitY to ratify the aecuPut n(the mfimv�wnie mustmem aadaarcc a nuBesspoeapanry. Signature of Applicant Date owner ar a amass agent YCG.a Ua4 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 UPEkTINO Building Department JOB ADDRESS: PERMIT# Q Q O It23oUMv✓eff-i D✓�t%e p� � OWNER'S NAME: Pa i c k It a m , l l PHONE # 7 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: �� ( Za igrla' a Date Please check applicable subcontractors and tomo Tete 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 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 be eformed 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- Dat 1� DG Job Address: 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 OCITYF 100300(o��arae CUPERTINO 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 ownerbuilder 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 perfornung 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. do not carry out these obligations,and these risks are There may be f mancial risks for you if you 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,en'oneously implying that the property owner is providing his or her own labor and material personally. Buddmg 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 Pftad an Recycled Paper RECEI�.rF� JAN .2 0 20.06 Sq ,f L i iia q roam �R r�lk,le e� i w i.7�ow 1030Ofylove CITY OF CUPERTINO -CITY OF PERMIT APPLICATION FORM G `' ° U ` CUPEkTINO N# 3 7.r fir. Date: �i uilding Address: / Mailing Address (if different from building address): l0 3 ou Mure�, Dr ��e Owner's Name: Phone#: �C6 q v 'FA �c�c 1�Qm � ( ( 7 Contractor: License#: Gwn Contact:PQ 'c'< H m ` I I Phone:4�6 `/ID Cupertino Business License#: a Fax. 7 Building Permit Info:_ Bldg [ Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential C2,- ( UCR0ne4)fK" iNLiNn 9 12°OCommercial ❑ Sq.Ft. Floor Area: q.Ft.: Cost of Proiect: i /rN Occupancy CXoup: Type of Construction: Vv_/ Please check this box if the project is a second-story addition: El Aj�roject Size: Standard ❑ Large ❑ Major ❑ uant ity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL 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<= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINYESTIGA Investigation fee BUILDING 1 of 3 S� CITY OF CUPERTINO cuPE 0 PERMIT APPLICATION FORM QuantityFee 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 BOVERTRAE Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum . PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture 1 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 Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK 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 PLUNGING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm 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 BREAE[NHOOD 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 2 of 3 0TY CITY OF CUPERTINO CUPEIZTINO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, 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 hispection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERAI Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERNEITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERAUTFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plambing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING 3of3