04030180 CITY OF CUPERTINO
BUILDING DIVISIONPER MIT CONTRAkUR �(SRMATfU1�ja
BU ILDING ADDRESS: PERMIT NO.
04030180 '
r OWNER'SNAME: PERMIT ISSUE DATE
ONE: SANITARY "19OL NO.
ARCHITEC YENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O O
+�o p LICENSED CONTRACTOR'S DECLARATION _ Job Descrlptl0llOEM
u 1 hereby M.the,1 am licensed under provisions of Chopsr 9(commencing
a� with section 7(lllo)afDividon Sof due Dust.and Profcssiont Code,and my license ie
men f.....d areae'' REPLACE WATER MAINES
Z Z„ License Clash Lic.N
�^ Dere Contmcror (r6f'tY 11 2004
-
ARCHITECTS DECLARATION
i I urderss til my plana shall he used As public records dy '
;off LicensedPrefcaionel BUILDING
OWNER-BUILDER DECLARATION
I 1 hcrchy affirm that I not exempt from the Conrado/s License Law for the
0following rcmon.(Section 7031.5,Business and Professium Cade:Any city Or county
22 Which requires a Permit to enmdacl,eller.improve,demolish.or repair any someone
prior to its issuance.also requires tom applicant forsuch Permit o file a signed statement
?< that he is licensed pursuant m the provisionsef the Commeturi License LAW,(Chapter 9 Sq.Ft.Floor Area Valuate n
f (commencing with Section 7000)of Division 3 of NC Businesaand Professions Code)or
.. that he is emmpt themfmm and the basis for the alleged exemption.Any violation of
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil Penalty of 3pJI$`{llp�erp 0 Occupancy Type
not moa than five hundred dollars($500).
❑1,m owner of the property,army employees with suggests their sole compensation,
will do the work and Ore structure is main ended or offered forsale(Sec.7044,Business
And Profession.Coda:The Contracmr's License Law does not apply m nn owner of Required Inspections
property w ho builds or impress thereon,end who doea each work himsel f or through his
ownemployees,provided thotsuch improvements are not intended or Offered for sale.IL
however,the building or improvement is sold within one year of completion,the Owner.
builder will have the burden of proving that Ice did not build or improve for purpose of
ale.).
❑1,u Owner of the property,am exclusively contracting with licensed contractors to
..uvea the project(See.7044,Business and Professions Cade:)The C.M actm'a Li-
came Law dors not apply in an owner of property who Wilds or improve thereon,And,
who contracts for such projects with a cortin clor(s)licensed pursuant to rhe Con racoofs
License law.
❑lamexem sad Sec. ,B&P C for this reason
ow r ADW g '
R'S COMPENSATION DECLA t(/31' 014
I hemby affirm under penalty Of perjury one of the following declarations:
I have and will maintain a CartiOalo of Consent in self-imue for WorkersCamper.
ation,a presided for by Section 3700 of the Laixr Coda,far the performance of dm
work for which this permit is issued.
❑I have and will maintain Workees Compensation Insurance,As required by Section
3700 of the labor Cade.for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ths section need not W camphoed if the Permit is for one hundred dollars(SIM)
Or Iesa)
1 certify that in the performance of the work for which this Permit is issued,I shall not
employ any person in any mancrso a in become subject to the Workcri Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.If.Moo,making this Certificate of Exemption,you should
become subject to to Worker's Compensation provisions of IW tabor Code,you must
.J O foMwith comply with such previsions or this permil shall be deemed revoked.
zCONSTRUCTION LENDING AGENCY
[—t (hereby a@rm that users is a construction lending agency for Ne Performance of
a> the wurk for which this permit is issued(Sec.3(197,Co.C.)
Q Lender's Name
z Lender's Addeas
U Q I certify that 1 have reed this application end sura that the and.Informations
(L Hcorrect.I agree to comply with all city and county collimates and sok laws relating to -
DUbuilding convection,and hereby authorize represematives of this city to color upon dm
W about-mentioned property for inspection purposes.
gy (We)agree to save,indemnify and keep harmless the City of Cupertino against
rn Iiabilitiu,judgmens.cass and expenses which may to any way accrue against said City
t.)Z in consequence ofthe granting of this pormit. f]
APPLICANTUND RSTANDS AND WILL COMPLY WITH ALL NON-POINIT Issued by: &A Date
S URCE UL G 0"1
Re-roofs C7 j
ignawm Ammeter Dam
HAZARDOUS MATERIALS DISCLOS Type of Roof
Will the applicant or future building occuparnstere or handle haaydaaa material
As defined by the Cupertino Municipal Cade,Chapter 9.12,ad the Hcallh and Safety
Code,Section 35532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Ym �No
Will No applicant or future building occupant use equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit h..dom air a nlami...tam dconod by the Be,Arca Air Quality Management all new materials for Inspection.
District?
❑Yesu
I have mad the harardotmmarerials requirements underChapsr6.95 of the Califon
nia Hcalth&SafetyCode,Section;25505,25533 a125534.1 un@rsrand thetiflhe Wilding
des not c Ily ve n mnan4 than it N my respomihiliry m nodl'y the occuPar of Ino
equiemcs hi t melprioreissuaccofeCcrtificamOfQcupacy ,SignatureofApplicant Date
X4,Or n sat Dmi-e O All roof coverings to be Class"B"or better
i
Community Development
10300 Torre Avenue
-! Cupertino CA 95014
Telephone(408) 777-3228
CITY F Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDRES : j0570 S'Mp -C-9 AVE PERMIT # o 0 3d Qf�
OWNER'S N 11RL)N KRirHIvAN PHONIC 40e 777' 92-3.5
GENERAL CONTRACTOR- n n _ FAX #
I am not.using any subcontractors:4 i 1�7 L-- \ -?//0014
Signature Date
Please check applicable subcontractors and 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
Plumbingf1KL 71r�m/9�
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
3111 9o
Own r fVr Signature Date
CITY OF CUPERTINO b ��3 °/,?D
OREPIPE/SEWERS/MAIN SERVICE
CUPERTINO PERMIT APPLICATION FORM
APN# 17ss `J�.,,�+ 6 QC Date: 3/ 18 D�
Building Address: 10970
0970 S70 k- A vC
C(,S
Owner's Name: Phone#:
ACM KR lfRIYW 40k 777 9235
Contractor: CARL T}fomA-S Phone: License#:
Contact: ^^ Phone: Cupertino Business License#:
HN H-t�! �O S 718 S 852.
Building Permit Info:
Bldg Elect ❑ IC I
Job Description: W v-6y mae i yl Seer yl CR /�
Residential Commercial ❑ > /
Cost of Project:
•
Qty. if
ApplioMeN, Fee ID Fee Description Fee Group
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPERMFEE Bldg. Permit Fees BUILDING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: (0 5 7 0 S rokev AVG PERMIT # 04 D3 0 1 gZ)
OWNER'S NAME: AKUtj klelrl �91V PHONE # -7 8235
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: 7 0
ignature Date
Please check applicable subcontractors and 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
ITi
eet Rock
lee
51-7 0 -
Owner/dontractor Signature Date
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent,spouse or child) will perform
A. 4,11
=„ 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
vc cia�aaaacu
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 AddresgCity 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 (rev seQjde).f� r
Property Owner's Signa`t J e: �v ��Pte: 51-1 0`f
Job Address/:/ 10`310 S?oKfis Ave CuK-P'1,ND, eA PPermit# 014 ()3 015'0
C/ q'01t,
Any changes to the information provided on this form shall be submitted to theCity of Cupertino Build
Devartment.
City of Cupertino Building Department
CITY OF 10300 Torre Avenue
CO P E I N O Phone: (408)777-3228
IJrL�1
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 i
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 ff 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
CITY OF CUPERTINO
BUILDING DIVISIONPER MIT CONTRAkUR �(SRMATfU1�ja
BU ILDING ADDRESS: PERMIT NO.
04030180 '
r OWNER'SNAME: PERMIT ISSUE DATE
ONE: SANITARY "19OL NO.
ARCHITEC YENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O O
+�o p LICENSED CONTRACTOR'S DECLARATION _ Job Descrlptl0llOEM
u 1 hereby M.the,1 am licensed under provisions of Chopsr 9(commencing
a� with section 7(lllo)afDividon Sof due Dust.and Profcssiont Code,and my license ie
men f.....d areae'' REPLACE WATER MAINES
Z Z„ License Clash Lic.N
�^ Dere Contmcror (r6f'tY 11 2004
-
ARCHITECTS DECLARATION
i I urderss til my plana shall he used As public records dy '
;off LicensedPrefcaionel BUILDING
OWNER-BUILDER DECLARATION
I 1 hcrchy affirm that I not exempt from the Conrado/s License Law for the
0following rcmon.(Section 7031.5,Business and Professium Cade:Any city Or county
22 Which requires a Permit to enmdacl,eller.improve,demolish.or repair any someone
prior to its issuance.also requires tom applicant forsuch Permit o file a signed statement
?< that he is licensed pursuant m the provisionsef the Commeturi License LAW,(Chapter 9 Sq.Ft.Floor Area Valuate n
f (commencing with Section 7000)of Division 3 of NC Businesaand Professions Code)or
.. that he is emmpt themfmm and the basis for the alleged exemption.Any violation of
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil Penalty of 3pJI$`{llp�erp 0 Occupancy Type
not moa than five hundred dollars($500).
❑1,m owner of the property,army employees with suggests their sole compensation,
will do the work and Ore structure is main ended or offered forsale(Sec.7044,Business
And Profession.Coda:The Contracmr's License Law does not apply m nn owner of Required Inspections
property w ho builds or impress thereon,end who doea each work himsel f or through his
ownemployees,provided thotsuch improvements are not intended or Offered for sale.IL
however,the building or improvement is sold within one year of completion,the Owner.
builder will have the burden of proving that Ice did not build or improve for purpose of
ale.).
❑1,u Owner of the property,am exclusively contracting with licensed contractors to
..uvea the project(See.7044,Business and Professions Cade:)The C.M actm'a Li-
came Law dors not apply in an owner of property who Wilds or improve thereon,And,
who contracts for such projects with a cortin clor(s)licensed pursuant to rhe Con racoofs
License law.
❑lamexem sad Sec. ,B&P C for this reason
ow r ADW g '
R'S COMPENSATION DECLA t(/31' 014
I hemby affirm under penalty Of perjury one of the following declarations:
I have and will maintain a CartiOalo of Consent in self-imue for WorkersCamper.
ation,a presided for by Section 3700 of the Laixr Coda,far the performance of dm
work for which this permit is issued.
❑I have and will maintain Workees Compensation Insurance,As required by Section
3700 of the labor Cade.for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ths section need not W camphoed if the Permit is for one hundred dollars(SIM)
Or Iesa)
1 certify that in the performance of the work for which this Permit is issued,I shall not
employ any person in any mancrso a in become subject to the Workcri Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.If.Moo,making this Certificate of Exemption,you should
become subject to to Worker's Compensation provisions of IW tabor Code,you must
.J O foMwith comply with such previsions or this permil shall be deemed revoked.
zCONSTRUCTION LENDING AGENCY
[—t (hereby a@rm that users is a construction lending agency for Ne Performance of
a> the wurk for which this permit is issued(Sec.3(197,Co.C.)
Q Lender's Name
z Lender's Addeas
U Q I certify that 1 have reed this application end sura that the and.Informations
(L Hcorrect.I agree to comply with all city and county collimates and sok laws relating to -
DUbuilding convection,and hereby authorize represematives of this city to color upon dm
W about-mentioned property for inspection purposes.
gy (We)agree to save,indemnify and keep harmless the City of Cupertino against
rn Iiabilitiu,judgmens.cass and expenses which may to any way accrue against said City
t.)Z in consequence ofthe granting of this pormit. f]
APPLICANTUND RSTANDS AND WILL COMPLY WITH ALL NON-POINIT Issued by: &A Date
S URCE UL G 0"1
Re-roofs C7 j
ignawm Ammeter Dam
HAZARDOUS MATERIALS DISCLOS Type of Roof
Will the applicant or future building occuparnstere or handle haaydaaa material
As defined by the Cupertino Municipal Cade,Chapter 9.12,ad the Hcallh and Safety
Code,Section 35532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Ym �No
Will No applicant or future building occupant use equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit h..dom air a nlami...tam dconod by the Be,Arca Air Quality Management all new materials for Inspection.
District?
❑Yesu
I have mad the harardotmmarerials requirements underChapsr6.95 of the Califon
nia Hcalth&SafetyCode,Section;25505,25533 a125534.1 un@rsrand thetiflhe Wilding
des not c Ily ve n mnan4 than it N my respomihiliry m nodl'y the occuPar of Ino
equiemcs hi t melprioreissuaccofeCcrtificamOfQcupacy ,SignatureofApplicant Date
X4,Or n sat Dmi-e O All roof coverings to be Class"B"or better
i
Community Development
10300 Torre Avenue
-! Cupertino CA 95014
Telephone(408) 777-3228
CITY F Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDRES : j0570 S'Mp -C-9 AVE PERMIT # o 0 3d Qf�
OWNER'S N 11RL)N KRirHIvAN PHONIC 40e 777' 92-3.5
GENERAL CONTRACTOR- n n _ FAX #
I am not.using any subcontractors:4 i 1�7 L-- \ -?//0014
Signature Date
Please check applicable subcontractors and 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
Plumbingf1KL 71r�m/9�
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
3111 9o
Own r fVr Signature Date
CITY OF CUPERTINO b ��3 °/,?D
OREPIPE/SEWERS/MAIN SERVICE
CUPERTINO PERMIT APPLICATION FORM
APN# 17ss `J�.,,�+ 6 QC Date: 3/ 18 D�
Building Address: 10970
0970 S70 k- A vC
C(,S
Owner's Name: Phone#:
ACM KR lfRIYW 40k 777 9235
Contractor: CARL T}fomA-S Phone: License#:
Contact: ^^ Phone: Cupertino Business License#:
HN H-t�! �O S 718 S 852.
Building Permit Info:
Bldg Elect ❑ IC I
Job Description: W v-6y mae i yl Seer yl CR /�
Residential Commercial ❑ > /
Cost of Project:
•
Qty. if
ApplioMeN, Fee ID Fee Description Fee Group
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPERMFEE Bldg. Permit Fees BUILDING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: (0 5 7 0 S rokev AVG PERMIT # 04 D3 0 1 gZ)
OWNER'S NAME: AKUtj klelrl �91V PHONE # -7 8235
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: 7 0
ignature Date
Please check applicable subcontractors and 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
ITi
eet Rock
lee
51-7 0 -
Owner/dontractor Signature Date
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent,spouse or child) will perform
A. 4,11
=„ 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
vc cia�aaaacu
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 AddresgCity 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 (rev seQjde).f� r
Property Owner's Signa`t J e: �v ��Pte: 51-1 0`f
Job Address/:/ 10`310 S?oKfis Ave CuK-P'1,ND, eA PPermit# 014 ()3 015'0
C/ q'01t,
Any changes to the information provided on this form shall be submitted to theCity of Cupertino Build
Devartment.
City of Cupertino Building Department
CITY OF 10300 Torre Avenue
CO P E I N O Phone: (408)777-3228
IJrL�1
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 i
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 ff 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