08050153 CITY OF'CUPERTINOJ ,=.fs ' ^>
BUILDING DIVISION PERAIIT .�CONTT,9 .0-T ORINF'0UWVQN
PERMIT NO.
Bullnjn§ TTES�HIL LN TBD TO BE DETERMINED 08050153
OWNER'S NAME: PsENm ISSUE DATE
LT.
CHANG & MEICHUAN SONG 05/20/2008
ONE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
w
00 LICENSED CONTRACTOR'S DECLARATION
72 m I hereby afRrm Wt 1 am licomes umkr pmHsiona or Chapter 9(commencing Job Description
_ withSrsdon7MMBafDividon3ofNcDemocvvbPmfcesiomCode.Wmyliecmis RE—RF PLYWD 1X 1 1/2 FLT PAPR 30LB CLS A ASPHLT
in a� ue1orr wurm. La.0 SHNGLS 15SQ. DOUBLE FEES DUE TO WKG WITHOUT
p Dom ARCHITECTS DECLARATION PERMIT.
3W< i undcrsunJ my pane"I be used u public mcoM
JyU
k O t; Ul.d Rufess mutt
3 OWNER-BUILDER DECLARATION
e E 1 hcrcby.firm Nn I am nempt form Ne Canuacmh License Law for Oe
OO following reason.(Section 71131.5,Business and Professions Cade:Any city or county
3 a g which member a Permit to cnnarom,alfa,improve,demolish.m repair any atmnure
prior to its issuance,also requires the applicant far such Permit to file a signed automem
££ Nat he is licensed pursuant m Me provisions of de Contractor's Lae.Law(Chapter 9 Sq.Ft.Floor Area $8000
WValuation
�$ (commencing with sion the Section 7000)of 3 of Bell.end Professions Cpdm e)Nat he is exempt Merefrom and the basis for the alleged esempdon.Any violation of
Semon 7031.5 by any applimen for a Permit subjrcu me applicant to a civil penalty OfNumber
ml mom than five hmesmlla
d ders(SSoO). 37540048AlbT Occupancy P Y Type
0 1,as;owns of die property,or my employe.with wag.u Neirsole compensadon,
will W Me wmb,and the shumum 4 not NQnded err allemd fm Yk(Sec.7061,Business
Nd Pmfe{LmY Code:The ConVYmr3 LiaAm Law do s nal apply m N.W Required Inspections
property who Wlldsorimproses umrma.med whodo nnuchwork Menselfmthrough his
awn employers,provided that such improvements am nm intended oroRcmd!reams B,
kwwnvcr,to building or Wprovensot a fool within arc year of cmoVkuor.me owner,
Milder will Tuve Me ander of proving Nn an did wt build or improve for immune of
kJ.
I.u owns of de property,am nclusively carousing with o.."'-d conoanma m
construct nate pmjm(Sec.7004,Business and Professions,Code)no Commmees Li-
cense law does not apply to an owner of property who Wilda or anprow themen.and.
.1M contract fm such projeeu with aconou bra)Earned pursuam to Ne Commm es
License law.
0 larecrumpsunder See ,B&PCfathismasm
Itor Ons �/ Dat.
WORKER'S CO ENSAnON DECLARATION
I herby affirm under penalty of pedeny ren of do following declarader c
01Neeend WIIf.b, •CeN 37M.(Consenttosel .fI far Wfd..offt
wean,r provided(Pe mi Section 3700 of the labor Code.(m me peAarmancs of the
wort far which mid Permit is issued.
0 1 have and WII mainuin WorhYs Compensation Innaranm,u required by section
3700 Mme labor code.for me perfomarm of me work I.which ma permit a lamed
My Workefs Compensation Insummes carrier end Policy number am:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
IThomaim nod othce epkted tithe permit a(armoh utd cddehar($100)
or leu)
I cenif-v mot in the perform.M me work for which this Permit is armed.I Nati ret -
employ any person inanymamerrou =W �,d a(e
b�'e 1 to de Wmkss'Coopcnsrion -
Laws of Calif.rpi�.j�u�te �—I n
AppBcant��LJcL t /
NOTICE o Me Wo T:es&ActCom making m' uufiese M Exemption,you shaeet
becomesubject
comply with
it Worhero CompensationprovisionsTea of the mWr Code,you muse
., ,�[ forthwith comP1Y with sash provisions m this permit shall h dartos mated.
zrO CONSTRUCTION LENDING AGENCY
F+•+ I hereby afro ren mem is a construction kndinj agency for do iseformano of
a me work for which this permit is issues(sec.309'1.Civ.C)
dLonde,Name
Z) z Lessees Address
U O 1 ce nary that I have ter this application aM sam uses me above afo natiur is
U
. ^. Ostrom.1 apo to Men
comply with all city and county ontes and sum laws mating to
0 rl'J building comuuctum.and hereby aumori.Mpromneed.of ma city be tout upon me �5
r ISI above-mentioned property t fan is peeuon pummel V"'w�'J liJt✓
t--t 0. (We)gree to...indemnify and top harmless the City of Cupertino against
Z incoises.genceO MecaauandOf Map which may in any wyurneagainalsaid City
f,z A APPLICANT
of me panting of this Permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT' Issued by: Date
50 CE REGULATI NS. / ZU^G
—w— °a Re-roofs
ignasum a(AppliuHAZARDOU Dae
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant en!mute Wal Co 0ecapant avec alnd M haadmu material
u de0nes by the25 Cupenico Municipal Cao.Chapter 9.13.and th Health and SMcq
ode,Otian sss3xg7 1.� All roofs shall be inspected prior to any roofing material being installed.
Y. Ue Na
WIII the applicant or.futum building o e.paret mac equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hvardoes air camamirtsnts n defined by me Bay Ams Mr Quality Managcmant
District? all new materials for inspection.
/
Cy. No
1 hate mal the hvudau materials requirements underChaperti.95 of the Califer.
ria Health A,SMmy Cadc,Sce mu 25505,25533 and 25534.l understand mat ifine Wilding
does of curtendY have•muni ter it a my maponsibility to Muff de occopent of me
rcquircnents �nmmhm.priormirtmn<eMacettiacarofommarcy. SignatureofApplicant Date
All roof coverings to be Class'n"or better
Owns anmoNsa,gem Dam' g
CITY OF CUPERTINO
S2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37540048 . 00
DATE ISSUED. . . . . . . : 05/20/2008
RECEIPT # . . . . . . . . . : BS000004833
REFERENCE ID # . . . : 08050153 ,
SITE ADDRESS . . . . . : 19241 PHIL LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : IRENE CHANG & MEICHUAN SONG
ADDRESS . . . . . . . . . . : 19241 PHIL LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : IRENE CHANG
CONTRACTOR . . . . . . . : TBD .- TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS
CITY/STATE/ZIP . . . .
TELEPHONE . . . . . . . . :
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BA
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 8, 000 . 00 0 . 80 0 . 00 0 . 80 0 . 00
1REROOFRES SQ FEET 15 . 00 390 . 00 0 . 00 390 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 390 . 80 0 . 00 390 . 80 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 390. 80 DISCOVER
---------------
TOTAL
-------------
TOTAL RECEIPT 390 . 80
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
0S/0.t> v��3
Sta
CITYOF CUPERTINO
REROOF
*CUPERTINO PERMIT APPLICATION
APN # Date:
� 75Yoc) `��� DO -Zo - Zao
Building Address: l 24 I C/l Pr I PO C 0 /
Owner's Name: Phone #:
�r2h2 Chgr\ 4 � '� 391 - 7o2
Contractor: Phone #:
Fax #:
Cupertino Business License #: -T D Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
A Asphalt Shingles X Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
o Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings o Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: R p� W o o
I �
�— qo6 f i nj I . poky 30 of
Cto-c-5 A — 4-5phAAL
Residential 14 Commercial El
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the there are any restrictions: ❑
application or if applicable, include in plan
set & the sheet index.
Valuation:
800 0 ,
• I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
/Signature
CITY OF. CUPERTINO
n REROOF
CITY OCUPEII;TINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
IREROOFRES Re-roof Residential B 1SFDWLR00F
�S 5[Lvat2/
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
IBSEISMICRE Seismic Residential B
1BUSLIC Business License B
•
Community Development Department
Building Division
City of Cupertino
• _ 10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City,the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
• 5. If plywood is installed,a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: IY P 112 C bM n O /
(57
Job Site Address: 1 T2 ,611 9S-o l
Roofing Company Name:
Applicant's Signature: S`—ZO—7.409
Greg Casteel
Building Official
Revised 11/2/04
Green Building Plan Check
Index of Green Building Points/Categories
A. Category Example of an Index or Table of Green Plan Sheet or Page Points
Building Points Categories that must be
shown and referenced on the Project
Plans See below
B. Site 9. Install H.E. Irrigation,y(details/spec)' L-1 72points
11. Permeable Paving, Note L-1
C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1
D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2
5. Use Truss with heels, (detail) S-2
6. B. OSB Sheathing, detail S-2
E. Ext. Finish 1. Composite Decking, (Note/Spec.) A-3 2 points
4. B. Fiber Cement Siding, (Note/Spec. A-4 2 points
F. Plumbing 1. Insulate all H.W. pipes, (Note/Spec.) P-1 2 points
5. Tankless W.H., (Note/Spec.) A-2 2 points
11. A 2500 Gal. Tank, (Note/Spec L-1 10 points
G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 4 points
H. Appliances 1. Energy Star Dishwasher, (Note/Spec.) A-3 1 point
3. Energy Star Refrigerator, (Note/Spec. A-3 1 oint
P. Other 1. List Green Features on Plans A-1 1 point
MMOMIMM TOTAL POINTS 40 points
Ph A t"1
Mari® tool i
rL
Plan Review Process Work Book Page-12-Revised 3/25/08
Green Points Rating System for Remodeling Projects
Due to the diversity of remodeling project types,assigning a'total points'value to a project to be considered environmentally friendly is
not feasible. However,25 measures have been highlighted to signify that every effort should be made to incorporate them into your
projects. These items have been chosen based upon their impact on the environment and the health of the home in coordination with
ease of implementation and relative low cost. These measures can be used as a starting point for'greening'your project.
Site
1.Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;B0%=4 points - up to 4 Resource pts 0
i2.Salvage Reusable Building Materials 4 Resource pts y=yes 0
3.Remodel for Mixed Use,Adaptive Reuse,and
Historic Preservation 4 Resource pts y=yes 0
4.Protect Native Soil 2 Resource pts y=yes 0
5.Minimize Disruption of Existing Plants&Trees 1 Resource pt y=yes 0
6.Implement Construction Site Stormwaler Practices 2 Resource pts y=yes 0
7.Protect Water Quality with Landscape Design _ 2 Resource pts y=yes 0
6.Design Resource-Efficient Landscapes and Gardens �� 4 Resource pts y=yes 0
9.Reuse Materials/Use Recycled Content Materials
for Landscape Areas 2 Resource pts y=yes , 0
10.Install High-Efficiency Irrigation Systems 2 Resource pts y=yes 0
11.Provide for On-Site Water Catchment/Retention 2 Resource pts y=yes p
1 1 1
B.Foundation
1.Incorporate Recycled Flyash in Concrete
• 25%Recycled Flyash=2 points;Add 1 point for every 10%,
increase of flyash,up to 5 points up to 5 Resource pts 0
2.Use Recycled Content Aggregate 2 Resource pts y=yes 0
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes 0
C.Structural Frame
1 1 1
1.Substitute Solid Sawn Lumber with Engineered Lumber , 3 Resource pts y=yes 0
2.Use FSC Certified Wood for framing
(For every 10%of FSC lumber used=2 points,up to 10) up to 10 Resource pts. 0
3.Use Wood I-Joists for Floors and Ceilings 2 Resource pts y=yes 0
4.Use Web Floor Trusses 2 Resource pts y=yes 0
5.Design Energy Heels on Trusses 6'or more 2 Energy pts y=yes 0
6.Use Finger-Jointed Studs for Vertical Applications 2 Resource pts y=yes 0
7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes 0
B.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yas 0
9.Use Structural Insulated Panels(SI Ps)
a.Floors 3 Ener
b.Wall 9y pts y=yes p
3 Energy pts y=yas 0
c. Roof 3 Energy pts y=yes 0
10.Apply Advanced Framing Techniques 4 Resource pts y=yes p
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes 0
iTUse0SB --�— '—
a.Subfloors ---- 1 Resource pt y=yes 0
b.Sheathing 1 Resource pt y=yes 0
1 1 1
.Extenor Frms
11.Use SustaiINPUT ReFmTces Energy 1ADIHeafth
nable Decking Mater a s -
a.Recycled content 3 Resource pts y--yes 0
i b.FSC Certified Wood 3 Resource pts y--yes 0
2.Use Treated Wood That Does Not Contain Chromiun/Arsenic i 1 IAO/Health pt y--yes 0
3.Install House Wrap under Siding E 1 IAO/Health pt y=yes 0
4.Use Fiber-Cement,SSiding Materials '^^ 1 Resource pt y=yes 0
1 1 1
E.Plumbing
Install Water Heater Jacket �� 1 Energy pt y=yes 0
2.Insulate Hot and Cold Water Pipes 2 Energy pts Y--yes 0
3.Retrofit all Faucets and Showerheadsw th F'ow Reducers
a.Faucets(1 point each,up to 2 points) Up to 2 Resource pts. 0
b.Showerheads(1 point each,up to 2 points) Up to 2 Resource pts. 0
4.Replace Toilest with Ultra-Low Flush Toilets
(1 point each,up to 3 points) Up to 3 Resource pts. 0
5.Install Chlorine Filter on Showerhead 1 IAO/Health pt y=yes 0
6.Convert Gas to Tankiess Water Heater 4 Energy pts y=yes 0
7.Install Water Filtration Units at Faucets
(2 points each,up to 4 points) Up to 41AO/Health pts. 0
B.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
r•.tiecmcar 1 1
1.Install Compact Fluorescent Light Bulbs(CFLs)
(6 bulbs=2 points,10 bulbs=3 points,12 bulbs=4 points) Up to 4 Energy pts. 0 •
2.Install IC-AT Recessed Fixtures with CFLs(1 point each,up to
5 points) Up to 5 Energy pts. 0
3.Install Lighting Controls(1 point per fixture,up to 4 points) Up to 4 Energy pts. 0
4.Install High Efficiency Ceiling Fans with CFLs
(1 point each,up to 4 points) Up to 4 Energy pts. 0
1 1 1
G.Appliances
1.Install Energy Star Dishwasher T 1 Energy pt y=yes 0
2.Install Washing Machine with Water and Energy
Conservation Features 1 Energy pt y=yes 0
3.Install Energy Star Refrigerator 1 Energy pt y=yes 0
4.Install Built-In Recycling Center 3 Resource pts y=yes 0
H.Insulation
1.Upgrade Insulation to Exceed Title 24 Requirements
a.Walls 2 Energy pts y=yes 0
b.Ceilings 2 Energy pts y=yes 0
2.Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0
3.InstalLRecycled-Content,Fitier6lass Insulation witli i
No Added Formaldehyde 31A0/Health pts y=yes 0
4,Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes 0
5.Use Cellulose Insulation
a.Walls 4 Resource pts y--yes 0 •
b.Ceilings 4 Resource pts y=yes 0
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
D.uaiiings 4 Resource pts y=yes 0
I. in ows
1.Install Energy-Efficient Windows
i a.Double-Paned I 1 Energy pt yeses 0
It.Low-Emissivity(Low-E) 2 Energy pts Y--yes 0
c.Low.Conductivity Frames _ i 2 Energy pts y=yes 0
2.lnnta l Low Heal Transmission azing 1 Energy pt y=yes 0
1 1 1
J.Heating Ventilation and Air Conditioning
r_Use Dud Mastic on All Duct Joints 711AQ/Health
pts y-yas D
2.Install Ductwork within Conditioned Space pts y=yes 0
3.Vent Range Hood to the Outside pt y yes 0
4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 0
5.Install Solar Attic Fan 2 Energy pts y=yes 0
6.Install Attic Ventilation Systems 1 Energy pt Y--yes 0
7.Install Whole House Fan 4 Energy pts Y--yes 0
B.Install Sealed Combustion Units
a.Furnaces 3 IAQ/Health pts y=yes 0
b.Water Heaters 31AO/Health pts y=yes 0
9.Replace Wall-Mounted Electric and Gas Heaters with
Through-the-Wall Heat Pumps 3 Energy pts y=yes 0
10.Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y=yes 0
11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yes 0
12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts Y--yes 0
13.Retrofit Wood Burning Fireplaces
• a.Install EPA certified wood stovesrnserts 1 IAO/Health pt y=yes 0
b. Install/Replace Dampers 1 Energy of y=yes 0
c.Install Airtight Doors 1 Energy pt y=yes 0
14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0
15.Install High Efficiency Filter 4 IAQ/Health pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 51AQ/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes 0
1 1 1
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes 0
2.Install Solar Water Heating System 10 Energy pts y=yes 0
3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts Y--yes 0
4. Install Photovoltaic(PV)System
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=16 points) Up to 16 Energy pts 0
'6:Select Safe and Durable Roofing Materials— '� 1 Resource pt y=yes 0
7.Install Radiant Barrier 3 Energy pts y=yes D
1 1 1
L.Natural Heating and Cooling . .
1.Incorporate Passive Solar Heating 5 Energy pts y=yes D
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts . y=yes 0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0
• 1 1 1
M.Indoor Air Qua ity and inlshes
(1.Use Low/No-VOC Paint�- �' _ - _1 1 IAQ/Health pts y=yes 0
2.Use Low ITM Water-Based Wood Fnishes 2 IAO/Health pts y=yes 0
13:Use LowMo VOC Adhesives _ _ 3 IAO/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes D
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes 0
B.Use Exterior Grade Plywood for Interior Uses_ 1 IAQ/Health pts y=yes 0
7 Seal all Exposed Particleboard or OF 4 IAQ/Health is es
L— ----- — P Y=Y 0
8.Use FSC Certified Mate als for Interior Finish 4 Resource pts y--yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yesD
r.Use Rapidly Renewable fl nng Materials 4 Resource pts y=yes D
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
1 1 !
Total Points Available: 1 1401 130 57 •
Total Points Project Received: V 01 0 0
G:daiarprogsrgmenbuildnoguidelinestremodelerslgreenpointsf nal2.1204prolected.xls
•
Community Development
e 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPEI,TINO
Building De artment
JOB ADDRESS: 2 4 , _
1 PERMIT #���� O ��
OWNER'S NAME: Z 1 P C a n PHONE # 4-08 — ; 21 --7072
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
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
• 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
S 1 Zo— 0
Owner/Contractor tgnature 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 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
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). / p /�
/ Property Owner's Signature: pV�Za ��— '—D Date: —2R—08
Job Address: L 24 �h i4 ti Cvkr " 60 i 1Alh/� Permit#Q,O i n 1 S3
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
• Department.
CITY OF City of Cupertino Building Departmeno
10300 Torre Avenue
CO P E IST I N O Phone: (408)777-3228
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 govemment 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 aware of these matters. The budding permit will not be issued until the verification is returned.
Very truly yours,
Building Department, •
City,of Cupertino
Printed on Recycled Paper
Community Development
' I 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
IJUPEkTINO
Building Department
JOB ADDRESS: PERMIT#
Lct .4 1 Ek I Gii Krtih o GA 95-o r . 0805 o rs 3
OWNER'S NAME: PHONE # 40 3 z
GENERAL CONTRACTOR: /7 FAX#
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation:
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