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08040188CITY OF CUPERTINO n„° s- '° fiI �y�e,�Y '=B7`wING DIVISION PEIMT �7!+•�r}:�s-��a�,,a.i:I/.;�* �*y� �'�v�,.{` �e ggr gTQRIaj QRMt�. V BUILDING ADDRESS: PERMIT NO. 7716 SQUIREHILL CT TBD — TO BE DETERMINED 08040188 OWNER'S NAME: FERMIT ISSUE DATE SHEEHY PATRICK E AND PAUAHI M 04/25/2008 NE: SANITARY NO, CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO KITCHEN REMODEL .0O PLUMBMECH LICENSED CONTRACTOR'S DECLARATION lb Description o thereby truer ern 1 licensed under provisions of Chapter 9 (commencing 1 hm with Section 700) ofDi2L.3 of W Business and Professions Code, ad my license Is in full torte and effect Llcame Class Lk. S Da¢ Cuntmmer ARCHMICrS DECLARATION 1 underelaml my pica still W used an public records Licensed Prof easional OWNU-BUILDER DECLARATION I berehy allim that 1 an attempt from the Canuemoes License law for Ne following mann. (Section 703 1.5, Business sed Professions Coda: Any city m county Which requires a permit m conmuct alter, improve, demoish, or repair any amount prior to is int enee. also requires the ipplicam forach permit On filea signed statement that he is licensed pumanuo Ne provisions of the Consomme, License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) OfDivision 7 of the Business ad protectionist Coda) or that he Is camps themfmm sed the hos for the alleged exempd.. Any violNan of APN Number Occupancy Type Section 7071.5 by my applicants for a permit subjects the applicant on a civil penalty of es mom tem live hundred dollars (S500). ❑I, uawner of use mopvty,ormy employes with wageaude'vule compewdon, Required Inspections b rap evils cam and Pmfesdom Cade: The Contracmfs License Law doesf a[ Apply property who builds or impmaea thereon, end who doessuch work himaeH or through his awn mployvas, provided that such impmsemmts an not intended proffered formle. If, however Ne building or impro tsoldwithinernyeralmmpstion.doowner- builder NE bow the burden of moving Nat he did rot Wim or improve for purpose of Luower of ass 04•.met..adsronuusins with I)caed nsmme. b watmct the Project (SiSec. property. Brains and Propulsions Code:) The Conmcmr'a m asLaw does nos apply to an owner of property who builds or improves ft.. and , whecs far avch projeN withacavamW(Olicnmdpununtmthe ContrnohCleaner Law. Law. �TAR 1psDaa PC orthls Ownv Data �f SA14 WORKER'S COMPENSATIOND LARATION I hereby Mm under penalty of perjury man art following declvWotte have uM will maintain a Cemfum, of Confect m self.l. for WorteYs Cmmpen- Winn, a provided for by Semlan 7700 of the Labor Code, for the permmaes of the were for which this Permit Is issued. , ❑ I have ad will maintain Worker's Compensation lonarmoe, u required by SoNon ' 77W of the labor Code. for the pcolomace ofthe work for which this permit is Wood. ' My Workers Compensation buts. cmc and Policy number se: Cartier. Polley No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE - (This scakmsued a,on completed lithe permit IsTetuanhundred doll s(SIM) or Ica.) T certify thrt In the performance, of me work s for which this Permit Wood. l shall am employ Nypeart.pAy mmmso ra m become subjecl/g.U)sW pcnsavdw Lave of Callfomi.a.an•— _�L.//1 LLD AppUcant NOTICE TO AP UCANP. If, afar making thsWfican of Exemption, you should become subject to the WokcYs Campea-dan pro bion of me labor Code, you muss forthwith comply with such artwom s or Jul, permitsmall W deemed..ad. CONSTRUCTION LENDING AGENCY I hereby of rmthv term is. comuucdm coding.Voc, for the perform. of the work for which that Permit is issued (See. 7(191, Civ. C.) ' Undoes Nares, , larder's Address 1 cutify that 1 have read this application end sum that the above Informadan is ' romct I agree to comply wire all city ad county Ordinances and assn seas resting an Wilding bvnurection, and hereby utharim mpmsatWvu of this city Or enter upon the above-mendamd mop ry for inspection purposes. (We) agree m am, indemnify std seep harmless the City of Cupertino agmum liabilities, judgments, ems ad expenses which may In my way amuse aalest aid City in cunsegarne of the grating of this permit APPLICA LNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT soURC r olgi /n, Issued by: Date ,Z illi 3t�'�u(u I / /� �r� Signau err ApplicanoCenuamar '- Yme HAZARDOUS MATERIA ISCLOSURE Re -roofs / Type of Roof Will the.pplleator forum Wilding Occupant seem orltandle hmandoes material at defined by Un Cupertino Municipal Code. Chapter 9.13, ad the Health ad Safety Code. Boston 25572(a)7 All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove wn the.ppfinnt art more ddlamg acuwm ac egaipmat m daales whmb hrrardnva air carmormas u defined by the By Arms Air Quality Management all new materials for inspection. trim? `\ ,� OYcs IAN. Ihie real the eme dens materials requirements under Chaper 6.97 of the Catifs.- bitHu.1"SaretyCole sections 25M. 25577 ad 25$74. l uMemend theft de Wilding des rotcurrentlycuntly an. .seems. tett is s my mmcandwllty m ratify the combat, of the mgnimmou, hucvaml Wmel rteiva f.ceni(kacarCe- Signet re of Applicant Date All roof coverings to be Class "or better owner D�' or at isdagent ® 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36223032.00 DATE ISSUED.......: 04/25/2008 RECEIPT #.........: BS000004591 REFERENCE ID # ...: 08040188 SITE ADDRESS .....: 7716 SQUIREHILL CT SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: SylviaM COPY # : 1 OWNER ............: SHEEHY PATRICK E AND PAUAHI M ADDRESS ..........: 7716 SQUIREHILL CT CITY/STATE/ZIP ...: CUPERTINO, CA 95014-5017 RECEIVED FROM ....: PATRICK SHEEHY 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 DAL ---------- ------------- 1BSEISMICR VALUATION -- -- 21,000.00 ---------- 2.10 ---------- 0.00 ---------- 2.10 ---------- 0.00 1REMRESKIT SQ FEET 98.00 429.00 0.00 429.00 0.00 1STPLNCK HOURS 1.00 122.00 0.00 122.00 0.00 TOTAL PERMIT ----- 553.10 -- - - -- -- 0.00 ---- - - - - - - 553.10 ---------- 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 553.10 --------------- 553.10 REFERENCE NUMBER -------------------- VISA �3a CUPEkTINO CITY OF CUPERTINO ADDITION/REMODEL PERMIT APPLICATION FORM �)P() 46 APN # Date: 4Jz Y o Building Address: - -7i / 6 CT7Ca ew Mailing Address (if different Wm building a dress): Owner's Name: Phone # : ¢ Z Contractor: Phone #: Fax #: Contractor License #: Cu pertino Business License #: Contact: -a Phone #: Fax #: Building Permit Info: Bldg. 4e--' Elect. Plumb. Mech. fEi" Hillside ❑ ob Description: Addition (adding sq footage): What is being remodeled? 1<1tC1e,\ _ Remodel Includes Re -Roof: Yes ❑ No If yes list number of squares Remodel Includes Structural: Yes ❑ No Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen 04`l•5� Bath Other Type of Construction (Usage Class): Occupancy Type: 1 FR, I IFR ❑ 11, 111, V -IHR ❑ 11, 111, IV V -N (2 Valuation:Please check this box if the project is a I Cj0 —second -story addition ❑ Green Building Check list must be completed and ttached to the plans. Green Building Points Achieved: *For Office Use Only*** Over -the -Counter ❑ ,*�' 4` ` ' CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft GARAGES 1R3SFDADD OR 1R3SFDREM 1GARDTW<=1K Wood Frame up to B 1,000 SF 1GARDTM<=1K Masonry up to 1,000 SF B BCONSTAXR Construction Tax Res (new detached garage) PATIO'S OPEN 1R3SFDADD OR 1R3SFDREM 1PATIOWOOD Wood Frame up to 300 B SF 1PATIOMETAL Metal Frame up to 300 B SF 1PATIOOTHER Other Frame up to 300 SF B PATIO'S CLOSED 1R3SFDADD OR MSFDREM 1PATIOENCLW Enclosed Wood up to 300 B SF 1PATIOENCLM Enclosed Metal up to 300 B SF 1PATIOENCLO Other Enclosed Patio up B to 300 SF 1COVPORCH Porch Covered -Each B (Each) 1REROOFRES Residential Re -roof Each B 100 SF REMODELS 1R3SFDREM 1REMRESKIT Kitchen Remodel up to 300 SF B (Deduct "$"for ea plan check 1REMRESBAT Bath Remodel up to 300 B 96 SF 1REMREOTH Other Remodel up to 300 B « SF . REMODEL PLNCK /ISTPLNCK (1-3 for Standard Plan Check B NOT FOR OVER THE remodel) I I COUNTER PLAN CKS. 3 of 3 CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Sci Ft Fee ID Fee Description Fee Group Permit Type WINDOW/SLIDING 1R3SFDREM GLASS DOOR 1 WINREP Replacement windows ea 8 windows B IWINNEWNSTR New Window (non- structural B 1WINMEWSTR New Window (Structural Shear Wall/Masonry) B 1 WINBAYSTR Bay Window (Structural) B SKYLIGHTS 1R3SFDREM 1SKYL<10 SF Skylight less than 10 sf B 1 SKYL>10SF Skylight greater than 10 sf or structural B ISTAIRS Stairs -first flight/ea addt'l B IEPERMITFEE Electrical Permit Fee E IMPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit Fee P IELCPLNCK Stand Alone Electric Pln Ck hourl E 1MECPLNCK Stand Alone Mechanical Pln Ck hour] M 1PLMPLNCK Stand Alone Plumbing Pln Ck hourl P 1BSEISMICRE Seismic Residential B 1TRAVDOC Travel & Documentation B 1BUSLIC Business License B 4 of 3 I] • 0 • 0 0 oVE° oh. �N PEE N� C$ S P%N ORDtN NCS GNPER� �-6 DPSE g\GNEs t of -'as o at a\t t5 se oroattecatifCon. jDevak �a et"I� kkm\ permsswo. l \aWt�:lstimrthou„t., olt of ,, pec�6chtPpOac. 91" sa\ he aoemL `s�;Nsp`�etby 'HP" at of the , •nc�ce •�Eav 0 Q C > 7 lL 3 O O -q-•O. .p(o U i ��✓ `' 10pg wm o •r � v � �QQ J �r L) d � i CITy Of OUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 Building Department All Cupertino building permits must meet certain conditions related to maintaining environmental quality and public peace and safety. The two most common conditions are described below. STORMWATER POLLUTION CONTROL State law requires that Cupertino, 12 other Silicon Valley cities, Santa Clara County and the Santa Clara Valley Water District control stormwater pollution. Educating local residents and businesses and enforcing stormwater pollution control laws are key parts of the City's compliance efforts. Stormwater pollution prevention: It's up to us In northern Santa Clara Valley, storm drains flow directly to local creeks and San Francisco Bay, with no treatment. Stormwater pollution is a serious problem for wildlife dependent on our waterways, for people living near streams and baylands, and for the local water supply. Common sources of stormwater pollution include: • Dripped oil, fuel, and antifreeze from vehicles and heavy equipment; Construction debris, including dirt, concrete and paint; • Landscaping runoff containing pesticides or weed killers; and ® • Any material dumped or spilled into streets or storm drains The property owner and the contractor share ultimate responsibility for activities' occurring at a construction site and will be held responsible for any environmental damage caused by subcontractors or employees. For more information on construction -related stormwater requirements, see the Stormwater Quality Regulations section of the City of Cupertino web site at: http://www.cui)ertino.org/city government/departments and offices/ environmental services COMMUNITY NOISE CONTROL The basic noise control requirements for construction sites are as follows: • Typical construction work hours are: - Weekdays - 7 a.m. to 8 p.m. - Weekends - 9 a.m. to 6 p.m. • Construction other than street construction is prohibited on holidays. • Residential daytime noise levels from complaint site - 60 dBA Nonresidential daytime noise levels from complaint site - 65 dBA For more information on noise control, please see Chapter 10.48 of the Cupertino Municipal Code, which can be accessed at http://www.amlegal.com/cui)ertino ca/ ®' Greg Casteel Building Official , v n e S � G - � G y r P rri N N O r c 0 E. O , i� • 0 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. ,1. Recycle Job Site Construction & 0�-molition Waste 65%=1 point; 75%= 2 points; 80%=4 points i2. Salvage Reusable Building Materials 3. Remodel for Mixed Use, Adaptive Reuse, and Historic Preservation 4, Protect Native Soil 5. Minimize Disruption of Existing Plants & Trees 6. Implement Construction Site Stormwater Practices 7. Protect Water Quality with Landscape Design je. Design Resource.Efficient Landscapes—and Gardens 9. Reuse Matedals/Use Recycled Content Matedals for Landscape Areas 10. Install High -Efficiency Irrigation Systems 11. Provide for On -Site Water Catchment / Retention up to 4 Resource 4 Resource pts y= 1. Incorporate Recycled Flyash in Concrete 25% Recycled Flyash =2 points; Add 1 point for every 10% 1-7 increase of flyash, up to 5 points up to 5 Resource pts 0 2. Use Rec cled Content A re ate Y 99 9 2 Resource pts y=yes 03.Insulate Foundation/Slab before backfill 3 Enerav ots v=ves C. Structural Frame F1. Substitute Solid Sawn Lumber with Engineered Lumber—�i 2. Use FSC Certified Wood for iraming J (For every 10% of FSC lumber used = 2 points, up to 10) 3. Use Wood I -Joists for Floors and Ceilings 4. Use Web Floor Trusses 5. Design Energy Heels on Trusses 6' or more 6. Use Finger -Jointed Studs for Vertical Applications 7. Use Engineered Studs for Vertical Applications 8. Use Recycled Content Steel Studs for Interior Framing 9. Use Structural Insulated Panels (SIPS) a. Floors b. Wall c. Roof 10. Apply Advanced Framing Techniques 11. Use Reclaimed Lumber for Non Structural Applications 12. Use OSB — — — — a. Subfloors b. Sheathing 3 Resource pts up to 10 Resource 2 Resource pts y: 2 Resource pts y: 2 Energy pts y: 2 Resource pts y: 2 Resource pts y: 2 Resource pts y: 3 Energy pts y=yes 3 Energy pts y=yes 3 Energy pts y=yes 4 Resource pts y=yes 3 Resource pts y=yes 1 Resource pt 1 Resource pt 1. Use Sustainable Decking Materials a. Recycled content 3 Resource pts y=yes0 2 Energy pts y=yes 3. Retrofit all Faucets and Showerheads with Flow Reducers Up to 4 Energy pts. 0 a. Faucets (1 point each, up to 2 points) b. FSC Certified Wood 3 Resource pts yryes 0 Up to 4 Energy pts. 0 (1 point each, up to 3 points) Up to 3 Resource pts. 2, Use Treated Wood That Does Not Contain Chromium/Arsenic 1 IAO/Health pt y=yes 4 Energy pts Y --yes 7. Install Water. Filtration Units at Faucets D (2 points each, up to 4 points) 3. Install House Wrap under Siding 1 IAO/Health pt y --yes 0 4. Use Fiber -Cement Siding Materials 1 Resource pt y=yes 0 E. Plumbing 1. Install Water Heater Jacket 1 Energy pt Y --yes; 2. Insulate Hot and Cold Water Pipes 2 Energy pts y=yes 3. Retrofit all Faucets and Showerheads with Flow Reducers Up to 4 Energy pts. 0 a. Faucets (1 point each, up to 2 points) Up to 2 Resource pts. b. Showerheads (1 point each, up to 2 points) Up to 2 Resource pts. 4. Replace Toilest with Ultra -Low Flush Toilets Up to 4 Energy pts. 0 (1 point each, up to 3 points) Up to 3 Resource pts. 5. Install Chlorine Filter on Showerhead 1 IAO/Health pt y=yes 6. Convert Gas to Tankless Water Heater 4 Energy pts Y --yes 7. Install Water. Filtration Units at Faucets (2 points each, up to 4 points) Up to 4 IAO/Health pts. B. Install On -Demand Hot Water Circulation Pump 4 Resource pts y=yes P-. wacmcar 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 0 0 0 0 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 G. Appliances 1. Install Energy Star Dishwasher 1 Energy pt yryes 2. Install Washing Machine with Water and Energy Conservation Features 1 Energy pt y=yes 3.Install Energy Star Refrigerator 1 Energy pt yryes 4. Install Built -In Recycling Center 3 Resource pts y --yes H. Insulation 1. Upgrade Insulation to Exceed Title 24 Requirements a. Walls 2 Energy pts y=yes b. Ceilings 2 Energy pts y=yes 2. Install Floor Insulation over Crawl Space 4 Energy pts y=yes 3. Install Recycled -Content, Fiberglass Insulation with No Added Formaldehyde 3 IAO/Health pts y=yes 4. Use Advanced Infiltration Reduction Practices 2 Energy pis y=yes 5. Use Cellulose Insulation a. Walls 4 Resource pts y --yes b. Ceilings 4 Resource pts y=yes 6. Alternative Insulation Products (Cotton, spray -foam) a. Walls 4 Resource pts y=yes o. L;enings 4 Resource pts y --yes 0 0 0 0 0 0 0 0 0 0 0 0 0 r :1.Inst01Energy-Efficiant Windows 2 Energy pts • a. Doubie-Paned 1 Energy pt b. Low -Emissivity (Low -E) 2 Energy pts 1 c. Low. Conductivity Frames '2. 2 Energy pts Install Low Heat Transmission Glazing 1 Energy pt J. Heating Ventilation and Air Conditioning 2 Energy pts y=yes 1. Use Duct Mastic W-Adl Duft Joints _ 2 Energy pts y=yes 2. Install Ductwork within Conditioned Space 3 Energy pts y=yes 3. Vent Range Hood to the Outside 1 IAQ/Health pt y=yes 4. Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 5. Install Solar Attic Fan 2 Energy pts y=yes 6. Install Attic Ventilation Systems 1 Energy pt y=yes 7. Install Whole House Fan 4 Energy pts y=yes 8. Install Sealed Combustion Units 3 IAQ/Health ots v=ves a. Furnaces 31AQ/Health pts y=yes b. Water Heaters 3 IAQ/Health pts y=yes 9. Replace Wall -Mounted Electric and Gas Heaters with Through -the -Wall Heat Pumps 3 Energy pts y=yes 10. Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y=yes 11. Install AC with Non -HCFC Refrigerants 2 Resource pts y --yes 12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace 2 Energy pts y=yes 13. Retrofit Wood Burning Fireplaces 10 Energy pts y= • a. Install EPA certified wood stoveslnserts 1 IAQ/Health pt y=yes b. install/Replace Dampers 1 Energy pt y=yes c. Install Airtight Doors 1 Energy pt y=yes 14. Install Zoned, Hydronic Radiant Heating 3 Energy pts y=yes 15. Install High Efficiency Filter 41AQ/Health pts y=yes 16. Install Heat Recovery Ventilation Unit (HRV) 5 IAO/Health pts y=yes 17. Install Separate Garage Exhaust Fan 3 IAQ/Health ots v=ves 0 K. Renewable Energy and Roofing 1. Pre -Plumb for Solar Water Heating 4 Energy pts y= 2. Install Solar Water Heating System 10 Energy pts y= 3. Pre -Wire for Future Photovoltaic (PV) Installation 4 Energy pts y= 4. Install Photovoltaic (PV) System (1.2 kw = 6 points, 2.4 kw = 12 points, 3.6 kw =16 points) Up to 16 Energy i------------ ------- -- i6. Select Sate and Durable Roofing Materials _ ' 1 Resource of y=', _ 7. Install Radiant Barrier 3 Enerav ots v= L. Natural Heating and Cooling 1. Incorporate Passive Solar Heating 5 Energy pts y=yes 2. Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes 3. Plant Deciduous Trees on the West and South Sides 3 Enerov ots v=ves 1. Use Low/No-VOC Paint 2. Use Low VOC. Water -Based Wood Finishes 3. Use Low/No VOC Adhesives 4. Use Salvaged Materials for Interior Finishes 5. Use Engineered Sheet Goods with no added Urea Formaldehyde 6. Use Exterior Grade Plywood for Interior Uses 7. Seal all Exposed Particleboard or MDF B. Use FSC Certified Materials for Interior Finish 9. Use Finger -Jointed or Recycled -Content Trim 10. Install Whole House Vacuum System N. Flooring 1. Select FSC Certified Wood Flooring 2. Use Rapidly Renewable Flooring Materials 3. Use Recycled Content Ceramic Tiles 4. Install Natural Linoleum in Place of Vinyl 5. Use Exposed Concrete as Finished Floor 6. Install Recycled Content Carpet with Low VOCs Total Points MaMaE e: Total Points Project Received: 1 IAQ/Health pts y --yes 0 21AQ/Health pts y --yes 0 31AQ/Health pts y=yes 0 3 Resource pts y=yasH 0 1 1 61AQ/Health pts 1 IAQ/Health pts 41AQ/Health pts 4 Resource pts 1 Resource pts 3 IAO/Health pts 8 Resource pts 4 Resource pts 4 Resource pts 5 IAQ/Health pts 4 Resource pts 4 Resource pts GUatarprog-Jgrembull6ingguidelinedremodeleNgmenpdntsrimiI1204prdeded.xls 0 r 1 OWNER -BUILDER VERIFICATION (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 T 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 erformed I declare under penalty of perjury that the above is true and correct. Owner -Builder Information (reverse side). Property Owner's Signature: Job Address: i ? > >' — C I have read and understand the Date: Permit # Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. 0 j City of Cupertino Building Department CITY OF 10300 Torre Avenue• C U 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 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 e Printed on Recycled Paper • • o u Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Buildine Department JOB ADDRESS: PERMIT # ©�p1f.0( t 4 LR2S3 6 ' OWNER'S NAME: PHONE #QsjwoA GENERAL CONTRACTOR p FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and cmmplPtP the following inFnr nf4 1 - Owner/ Contractor Signature Date 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