08060124 CITY OF CUPERTINO
BUILDING DMISION PERMIT
PERMIT NO.
Bu1LDIgG.ADWtE$S; PORTAL AVE JEFF &.DENISE OLIVER 08060124
OWNER'S NAME: LV PERMIT ISSUE DATE
JEFF & DENISE OLIVER 10270 N PORTAL AVE 06/17/2008
ONE: SANITARY NO. CONTROL NO.
ARCHnECT/ENGtNEER:
BUILDING PERMIT INFO
'BLDG ELER PLUMB MECH
uaio LICENSED CONTRACTORS DECLARATION Ib Description
1 Wrathy.frim that I am lictvmd under proOL:SCTIp
vision,of Chapmr 9(commencing
with Section 7M)of Division 3 of dm Businces and ProM Professions Code.amy license u PERMIT TO RE—OPN #04080003 (ELCT PNL UPGRD) &
^ as n full from and dreg
jg? License Class Us.0 #02110138 (BTHRM RMDL)WHICH REQUIRE FINAL
^=c Dam ARCHtTECTSDECLARATION INSPECTIONS & THIS PERMIT ONLY FOR FEES
1 understand my plans shall be used as public rtrod,
I.0
Licensed Proportional
OWNER-BUILDER DECLARATION
f I hereby china Oat I am exempt from the Conuacer's License Law for tw
C O followingmoon.(Section 703 1.5,Business and Profession Code:Any city of county
UK which raquires a permit to comment.dmf.improve,demolish,Or rep.if my stmctme
prim nues isauaoro,also requ.m,Os appli..i fm such permit to Rmsigned statement
p than he is liensed pursuant to Ne provisions of the Comment's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
y�s (commencing with Secdon 7000)of Division 3.1'the Business and Pnefiesms Coda)or $12000
`< Nu he is exempt therefrom and de buts fm the alleged exemption.My violation of
Section 7031_5 by arty applicant fm a permit subjcu de applicant m a civil penalty orNumber Occupancy Type
.at comm Nan Run handled dollars(s50)). 3162 9 0 O 1 . P Y YP
❑1,u awmr of Ne pmmny,m my wpRrycs with wgn u thea Bole rompcnsatian.
will Professions
and the he Contranot Nmnded Lawdomasala(See.706/,Businw
Nd enywho Code:The L'anV neon. ndwhis IiW dma or apply lf an rownuough of Required Inspections
property Ww wiproy ki mpmvesch improvements
andwho dma,uclt World ar.11lraf Waugh his
however,
thscildingr iNs,tveentis id within
not earofomoBertd forsake.lB,
builder,will
building or improvement is sell within one year of completion,Ne owe of
soil.).will haw the burden of proving Nu k did wt wild m impose for purpose o!
1,u own,of the property.m exclusinell contrasting with lienal romncon s W
ron,rm,t the project(Sec.7014.Business and Pmfesdons Code:)The Conmctoh U. .
cense law does not apply to an I.of property who builds or improv.demon,and.
Who conmcu fmrtuch projects withamaern enf.)Imensed passamr to the Contractor,
License law.
D1met exempt u erW ,B&P//Cfmthi.....
Dace (0
I
OMPENSATION DECLARATION
e y t undo enahy of perjuryne aor the following helaraRone
Ih< will maintain aCutifia¢of Comentmxlf-iuumfmWoduYfCompen-
sntion, provided for by Saction 37011 of the Labor Cade.far the performance of the
work far which Nis parent is issued
D t Mnt and will maintain Winters Compensation Immanc,u required by Section
3700 of0c labor Code,for the perfanmanec or Ne wvnk for which Nis permit is brand. '
My Wcolmes Compenum.Laurance artier and Palms numb.art:
Canine Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
MosseNon need Out be completed truss pewit is(moot hundred dollen($100)
or Ines)
1 canary that in Ne perramsance of Ne work far which this permit is issued.I anal not
employ my perm.in any ma rerse b aro 'e t e Wmkus'Compensxdon
Laws of Califomi d
AppII
NOTICE TO ANT:1 making this Certificate of Exemption,you should
became au I C SWd, a Compensation provision,of the Labor Code.you most
.,,z foMwith ca ly with such provisions IT Ni,permit shall be deemed revoked.
z O CONSTRUCTION LENDING AGENCY
.y., 1barm AMM Nu dart i,a construction lending a
Y S genry fm the perfunnuae of
G' On doh for which Our permit u iumd(Sm.709'x,CO,CJ
4 L<ndul Name
7 z Isndeh Address .
U Q 1 roNfy that 1 have read this application and sum Nu the above information is ..
LL t"' correct.I agree m comply with all city and county oNiwmes and seem ,re
laws; to
0th) building ansumahm.and heleb,.uthod.teprtasnaroves of duncilY mcntmupon tie
W above-mentioned property for inspection purposes
Cil (We)agree N cent,indemnify and hick hay in m Ne City of Cupertino id City
UfA inmisu,JWgmenu,emuandapsubustrom Of On Z=fiDg Of isremiichmayinanyw+Yaccsseag,lnslsaidGq �+
'�^ t.
APPLLIICCANT UN ERSTANDS AtWWILL COMPLY WITH ALL NON-POINT Issued by: Date C""/-7iv
SOURCE S.
1 11 Re-roofs
Si a ran o fur Dam
H US MATmuISDISCLOSU E Type Of Roof
to tie applicant m future building ccupmnstore m h,Mm anc eden,nanoid
ned by ua Cupenine Municipal Code.Chapter 9.12,and tie Health and Safety
Code.Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
DT. AN.
Will Ne applicant or future wading acceptant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Mhmadnns air==memo u derined by the Bay Ams,Air Quality Management all new materials for inspection.
It
bn P
DYen �No
I have mal Ne hvvdeas nemriala requirements under Chapter 6.95 of da Csiifm-
m.HcalNhSafety Cad,Savau nV3D5.25533 and 25534.1 undoccu dNat if Ne building
dean not frendy haw a screen eClt u my responsibility m mtify the occupant of the
requirements i b am .a of.C.dra.mofa upuay. Signature of Applicant Date
Odn or tl xd em Dem'
All roof coverings to be Class'na'or better
CITY OF CUPERTINO
• 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 31629001 . 00
DATE ISSUED. . . . . . . : 06/17/2008
RECEIPT # . . . . . . . . . : BS000005142
REFERENCE ID # . . . : 08060124
SITE ADDRESS . . . . . : 10270 N PORTAL AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : OLIVER JOHN L AND JOYCE L
ADDRESS 10270 N PORTAL AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JEFFREY L OLIVER
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : OLIVER JOHN L AND JOYCE L
ADDRESS . . . . . . . . . . : 102701N PORTAL AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
IBSEISMICR VALUATION 12, 000 . 00 1 . 20 0 . 00 1 . 20 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40. 79 0 . 00
1MPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 .79 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 .79 0 . 00 40 . 79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
TOTAL PERMIT
164 .36 0 . 00 164 . 36 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 164 .36 VISA
---------------
TOTAL RECEIPT 164 . 36
•
o�v� oi�2y
SIM CITY OF CUPERTINO
CIT• CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN# 2/
(4 '? 00 v v Date:
Building Address:
/02-11-0 ,U. IPDX -t.. 49i J✓ -;- J, ten` -. 99- 1
Mailing Address (if different from building address):
Owne!!f e: D S£ Z4Phone#: S
Contractor: f Phone:
C7lN,�AfzfL/3�r��L
Fax:
Contractor License#:
Cupertino Business License#:
Contact: Phone:
• Residential Commercial Fax:
Job Description: �l�ttk �loo� �, L)k0& �.'a�p�
FIrjAL 5;ee-e-7O+JS N� Arft-E. 9r-� j, RfcO
Building Permit Info:
Bldg Elect Fr- Plumb El--' Mech EIL'
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ IUIIIJV-A ❑ IVIII B, IV-HT, V-B Qom- i-l- --3
Valuation:/ZD"Dv Square Footage:
Project Size: Express Q—Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
Points Achieved: to the application or if applicable, include in plan set& the sheet index.
•
For help, contact Build it Green at wwww.builditgreen.or �—
Revised 6/16/08
CITY OF CUPERTINO
CUPERTiNO GENERAL BUILDING
PERMIT APPLICATION FORM •
Quantity/Sf Fee ID Fee Description Fee' Permit Type
Group 1GENRES or
I GENCOM
1BTEMPPER Temporary Building Permit (good for B
30 days
1BBOILERI For the installation or relocation of ea M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw)
1BBOILER2 Installation/relocation of ea M
boiler/compressor over 3 horsepower
to &incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
IBBOILER3 Installation/relocation of ea M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to •
& incl 1,000,000 Btu/h
1BBOILER4 Installation/relocation of ea M
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1BBOILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
IELECINSP Other Electrical Inspections (per hour) E
IMECHINSP Other Mechanical Inspections (per M
hour)
1PLMBINSP Other Plumbing & Gas Inspections P •
(per hour
1MEETINGIHR Application Meeting B
(rv& CITY OF CUPERTINO
clwoF GENERAL BUILDING APPLICATION
CUPEI�TINO
• FEESCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group IGENRES or
I GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW SFDWL/Duplex New B
IACOUSRESAD SFDWL/Duplex-Addition/Alteration B
IACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1 CHIMNEY Chimney B
1CHIMNEYR Chimney Repair B
FENCES
1 FENCE>6FT Non-masonry, over 6 ft in height B
1FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
1FIREPLMAS Fireplace Masonry B
1FIREPLFAB Fireplace Pre-Fa)ricated/Metal B
1FLAGPOL>20 Flag pole (over 20 ft in height) B
1MODUSTRU Modular Structures B
FOUNDATIONS
1170UNDREP Foundation Repair B
1PILECAST Pile Foundation Cast in place concrete B
1PILEDRIV Pile Foundation Driven (steel, pre- B
stressed concrete)
3 ors
p- CITY OF CUPERTINO
CIT IF GENERAL BUILDING APPLICATION
CUPEI�TINO
FEE SCHEDULE •
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
7OR MASONRY)
1RETSTN Standard (up to 50 ft) B
1RETSP310 Special Design, 3-10' high (up to 50 `) B
IRETSP10 Special Design, over 10' high (up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft)
1RETCRB> Gravity/Crib Wall over 10' high (up to B
50 fl
SIDING
1SIDEST/BK Siding, Stone &Brick Veneer B
(interior/exterior) •
1SIDEOTHER Siding all other B
SKYLIGHTS
1 SKYL<10 SF Skylight less than 10 sf B
1 SKYL>10SF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B
1 SRACKS>8 Storage Racks over 8' high (up to 100 B
st
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
•
4of5
CITY OF CUPERTINO
CITY OF GENERAL BUILDING APPLICATION
CUPERTINO
• FEESCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
1 WINREP Replacement windows/sliding glass B
door ea 8 windows)
1 WINMEWSTR New Window-structural shear B
wall/masonry includes plan ck fee
/ IEPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
IPPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alone Electric Pln Ck (hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
/ 1TRAVDOC Travel &Documentation B
1BUSLIC Business License B
•
5 of 5
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
ONAOMNMM Plans See below
N.
B. Site 9. Install H.E. Irrigation, (details/spec)' L-1 2 points
11. Permeable Paving, Note L-1 2 points
C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 5 points
D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2 2 points
5. Use Truss with heels, (detail) S-2 2 points
6. B. OSB Sheathing, detail S-2 2 points
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.) A3 1 point
3. Energy Star Refrigerator, Not /S ec. A-3 1 oint
I P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS1 40 points
•
•
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.
INPUT Resources Energy JAWHealth
A.Site
1.Radycle Job Site Construction&Demolition.Waste, .'.`
65%=1 point;75%= 2 points;110% 4 points up to 4 Resource pts 0
2.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 Stormwater 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 0
1 1 1
B.Foundation
1.Incorporate Recycled Flyashin 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=yesF; 0
1 1 1
C.Structural Frame
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
6.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0
9.Use Structural Insulated Panels(SIPS)
a.Floors 3 Energy pts y=yes 0
b.Wall 3 Energy pts y=yes 0
c.Roof 3 Energy pts y=yes 0
10.Apply Advanced Framing Techniques 4 Resource pts y=yes 0
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y--yes 0
12.Use OSB
a.Subfloors 1 Resource pt y=yes 0
b.Sheathing 1 Resource pt y=yes 0 •
1 1 1
INPUT Resources Energy IAQ[Heaith
I.Windows
1.Install Energy-Efficient Windows
a.Double-Paned 1 Energy pt Y--yes 0
b.Low-Emissivity(Low-E) . 2 Energy pts Y--yes 0
c.Low.Conductivity Frames 2 Energy pts y=yes 0
2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 0
1 1 1
J.Heating Ventilation and Air Conditioning
1.Use Duct Mastic on All Duct Joints 2 Energy pts y=yes 0
2.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0
3.Vent Range Hood to the Outside 1 IAQ/Health pt y=yes 0
4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 7
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
8.Install Sealed Combustion Units
a.Furnaces 31AQ/Health pts y=yes 0
b.Water Heaters 3IAQ/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 Buming Fireplaces
• a.Install EPA certified wood stovesrnserts 1 IAQ/Health pt y=yes 0
b. Install/Replace Dampers 1 Energy pt 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 41A0/Heallh pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes p
1 1 I
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=18 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 Of
I 1 1
L.Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy pts y=yes 0
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts , y=yes p
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0
1 1 1
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 IISignature:
rmation (reverse side).
Property Owner's Date: 9-k 0
Job Address: Z l` s/ Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
•�4 Department.
CITY OF City of Cupertino Building Departmenle
10300 Torre Avenue
CUPS TIN 0 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 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.
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
�4 r Community Development
/ )J 10300 Torre Avenue
W Cupertino CA 95014
Telephone(408)777-3228
,40
CITY OF Fax(408)777-3333
g�UPERJINO
Building De artment
JOB ADDRESS: PERMIT #
OWNER'S NAME: 71keor7- /7i a PHONE #
GENERAL CONTRACTOR: " owl FAX #
I am not using any subcontractors: ---�
gna a Date
Please check applicable subcontractors complete 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
0
r actor Signature Da(e