05090063CITY OF CUPERTINO
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INFORMA.T QN
.
BUILDING DIVISION PERMIT
,CCI,NTRACTQR
BUILDING ADDRESS:
WINDERMAN STAN/EVA SPERTE
"" "°05090063
OWNER'S NAME:
PERMIT ISSUE DATE
005
1IF;
SANITARY NO. CONTROL NO.
ARCHITECrIENOINEER:
BUILDING PERMIT INFO
BLDGPLUMB MECHO
O
3LICENSED CONTRACTOR'S DECLARATION
Job Description
I haneby rt@m that 1 un licensed audit provision of Chapter 9 (mmmcnert,
with Smile. 7O sB) of Divislan 3 of the Rumeam and Professbm Cafe, and my he-- is
in full fame and afrem
License Class Lle. {
REMODEL KITCHEN/ADD . PARTITION WALL
DateConeactor
ARCHITECTS DECLARATION
I understand my plans Nall M used As public o ca ds
Licensed Professional
3 OWNER -BUILDER DECLARATION
I hereby .Ren n 1 em accept from the Demi.. ao1 License Law for Um
0 (Section 70313,Butiaas and Code: Mycity county
reaso o
i
daiali
improve, notice.
which requires t m .:pair ed We ant$10881
which myuiroe a permit re eine, the alter, impmw, do Such permit
�^ prior m,licensem,tluantto rp theapplf Contrormiuof0ca, Law atalement
9
Sq. Ft. Floor Area
Valuation
< of
that he lalicansedpurwentrothcproviaioenfdcConlrumrYLkenxlaw(Chapter
(commencing with Sectmm 7000) of Division 3 of Use Business and Profaatinm Code)or
$ dust he is cumpt themfmm and the bash for the alleged emaciation. My Nolnlan of
J APM W515per 0
Occupancy Type
Section 7031.5 by Any apple=, for a permlt subjects the applicant to • civil penalty of
Out mart than eve hundred doll.. (SSW).
❑ L a ower of the proper(, army employes with magna u dcirsole eompewUon,
Required Inspections
q
will dothewark. and the for.u(Sly
hemmlaecesImdedaawd 0 An,Bavrcv
and oro Cade The
lfoltotal his�0'JN/J�
duan, Luise law des tet hirer lf am owner is
daarimpmvesthermprovedwhO
,.w„
property who ve,
propenyloycan Are not oro for
thnaehimprowmwusam not iawnd
owever.oYes,ping
• n/7✓
omplamed
owner-
or improvement owe r-
hawser, Ne bveAm{ar4mld within of mprove
�s
0
,build for
builder M0 have the burden of proving des he did nm build Or Improv fa purpeae of
> ,t.!'
❑ 1, as owner of the proper(, exclusively connecting with licensed m
mmenmr,
a ProfessionCade:) The Conuanas.
Business had ro
anseua the project , B
'
rty who Wi red
cense law dura ma appty b an owner of proper( who builds or lmprowa demon,
apply in an
.
or's
whoanuss fonebp with weuxmRH licemed pwswntmtheCauanofa
Licence law.
q
lore exam rand a. .a"PCfor�my�n
❑ p
aM (('
Owner Dhm
WORKER'S OMPENSATIONDECLARATION
Jimreby a(nnn under penalty of perjury nue of Ne fallowing declarations:
1 ham and will maintain aCe lJOamofCansent m wlf-insum fmworkeesCompen-
on. u provided fm' by Secdon JIM of the Labor Code, for the perfurmanae of the
want for which this permit is Issued.
❑ 1 hive and will maintain Worker's Compensation Insurance, As required by Section
3710 of the labor Code. for the performance or the work for which this permit is Issued.
My Worker's Compmuadon Whan we carrier and Policy number am:
Carter; Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mals acetic sued mat be completed If the permit is for We hundred down (SIM)
or less)
1 cenify, Nat In the per Aman of thc work for which this permit is issued, I shall not
employenypersoni ymaner o to rem, thicet1 rico.' m on
4ws Of Catifomi
ant
NOT: IL after making Nis Ceninate O FLab rtio should
NOTICE TO PLhe
dyou
Wori provisions m Oi Ne Tabor CMA, you mail
become su en m the WOrkeM1 visions
i
? foMwith eomplY with such pmvlelnm a Nie permit shall Ce damW rewked. ,
is
y CONSTRUCf10N LENDING AGENCY
I Mxhy alllem that them is a comtm th m linden{ ageey fm dtc perfammce of
y the work for which this permit Is used (Sec, 3097, Civ. C.)
Lender's Name
.
Lattice, Address
1 ceNfy that I haw read this application and Aute Nn the Above Information is
correct. 1 agree to comply with all city and county ordinances and sum lave relating m
building eonsuuctlon, and hereby interim mpmsematiwa of this city m enter upon the
abovemendoned pmpany for inspection purposes.
(We) agree to saw. indemnify and kap Iwmless the City Of Cupertino agalmt
yLj IlabllWes,judgmenus.eom, and expenses which may in any way accrue against aid City
In consequence of the gran tof this pemrit.
APPLICANT UNDER ANDS AND WILL COMPLY WITH ALL NON -POINT
/J �•_O r'
Issued by: Date 7
SOURCE REGULATI S. n
7
Re -roofs
Type of Roof
Signature of App' anUContra Dam
HAZARDOUS MATERIALS DISCLOSURE
Will applicant or fume Wilding oaupmtnore or handle ha.rdom material
As dented by the Cupenie Municipal Code, Chaplet 9.12, and die Health and Safety
Calc, Section 25532(a)7
All roofs shall be inspected to any roofing material being installed.
❑Yes T`O
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or building occupant use equipment or devices which
It havarmus air containment a dcrined by the Bay Asea Air Quality Management
all new materials for inspection.
tnrict9 ��y///
[:3 Yes J Nu
I have mad the ha eadmn materials requirements under chapter 6.95 of the Caller.
ncaa25505.25533u25530.lundcWAnd Uwlfdc buildingYa4dr
tdoNmently --c.at l. my responsibility m notify do occupant of the
mqul.mcnuw must be atpdorm' uamoraCertificateoroccu a
Signature of Applicant Date
�/
All roof coverings to be Class "Bt' or better
Owner oradmriredagem D,
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CITY OF CUPERTINO
4 R 'S *s //--r +'+�sg�k �r7�}'�p``kw '�
BUILDING DIVISION P]-1'
WINDERMAN STAN/EVA 7PIRTE
BUILDING ADDRESS:
M11No05090063
OWNER'S NAME:
FERMIT ISSUE DATE
5
NE:
SANITARY NO. CONTROL NO.
ARCH17ECTIENGINEER:
BUILDING PERMIT INFO
-
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby anion Nn I w licensed under provisions of Chapter 9 (commencing
p
with Section 70BBof Division 3W she Business and poor ..I m Code, and my license is
In fall fora andeflox.
REMODEL KITCHEN/ADD PARTITION WALL
License Class; Lk.0
.
Dam Chmawwr
ARCHRECrS DECLARATION
I understand my plans shall he used as public records
Luenmd Plareaalaw
OWNER-BUILDER DECLARATION
1 hereby •Mm that I sm exempt from she Contramar, License Law for cite
following reason. (Section 7031.5. Business and Profeason, Cade: Any city or county
which requirns a permit to canusucL Wer. improve, demolish. or repair my strucmm
$10881
prior an its IYuanR.•ka requires; the applicant fm each pRmfl at ilk a signed moment
Ft. Floor Area
Valuation
Net he is licensed pursuant to the provide. of the Contractor's Umme, law(Chapter 9
Sq.
(commencing with Section 7MM of Division 3 of Bre Business and Professlans Code) or
that he is stamps Ihe¢from and the bast far the alleged eamsption My violatfon of
r
Occupancy Type
Section 7031.5 by arty •pigia•at Box perms subjects, the applicant an a civil pe-try of
not mom than Bw hundred dollars (S500).
awnuk. ad army mploycas ode,
wages u theb wk7044.
as F
fired Inspections
ampmy,
ore fmat a (See 70M, Basion
will do she wontC d tiro not kteMedara B
cased
and Professions Code: 7ba Conumtora Licease Law darn nos apply an an ower a(a
1. com u
property who builds arlmpmws theman, and whodouuch work himselfar through h4
own employers, provided thatmch improvement am net Intended maResed fm We If,
however. the building or improvement is mid within one yetr of completion, the mvor-
Witter, will haw the burden of proving got he did et build m Improve far purpose of
AIOt/ �� r
Int
as
ii
Lt00"is.).)•
0 I, a ower of the property, •m exclusively cootsaering with licensed ermactms to
am Tans Cade:) The Covacter. U.
project (Secapply
came
g�
to in weerBusiof wh
cense law dam not apply m an owner of property who sedd, or Imprensa Norton, and
Law property
NN
�U' L®
who eonuem fm such projects wise a eantrmtoRU Ilcenssd punuam m Oso Contnemra
Lken,e law. /
See Bd
LLEkkd9 D MM
Olamexemptu PCfmr' n
Owner 27e)kt
WORKERS MPENSA710NDECLARATIDN
I beieby eMaw under penalty of perjury am of the folbwing declantions:
hsw and will mW
•inn • Cm10rsm of Consent mmif-insurt fm WorkersCampers-
an. as provided far by Section 3700 of the Labor Code. for the esce W perfaursthe
work far which this permit is issued.
0 I low and will maintain Waders Compensation Immnna, as required by Section
3700of the laborCode, far the pmform•ms of lM wast formich this permit Is issued.
My Worker• Compensation Iomnmx carrier and Policy number are:
.
Cardec Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tbl• mcdm need not be completed If the permit Is forone hundred dollsraGI00)
or less.)
1 unify, that in the performance of the wad for which this Permit It issued, I dull am
employ any person i ymeanerww mbccmmc bjet to Ne Warkeri mteo,a0on
�f
laws of califom a r /- /^
Applimtu �Ti If /7 1 -3
NOTICE TOAPPLICANT•. If,%ftmr making this Cenilfcau of Exemption, you should
became, rZ to the Worker's Compensation provision, of the Leber Code, you most
foMwith comply with such provisions m this permit shall be do mad revoked.
CONSTRUCTION LENDING AGENCY
1 herohy •Firm can Nen 4 a muccum firm lending agency far the performance of
The wad for which was permit Is issued (Sec. 3097, Civ. C.)
'
Landers Nurse
,
-
Lenders Address
1 certify ms I haw rad Ws application and mm thu the show mformNe t
emract. 1 agree to comply with all city and county ordiwxes and Nle law rehtht m
building construction, and hereby authorize representatives or this city m mmr upon she
shove-mantiorsrd property for Impaction purposes.
(We) agree to nw, indemnify and keep h•rmlen the City, of Cupertino against
liabilities. judgment. cnst and expensm which may in my my • a e si uns sand city
A PLIC11nceofineg Yof Nispermit
APPLICANT UNDER ANDS AND WILL COMPLY WITH ALL NON-POINT
/J��O
Issued by: Date e'
SOURCE REGULA71 S.
Re-roofsf' .??�
Type Of Roof
51gnatum of Appals' a Ontrset Data / HAZARDOUS MATERIALS DISCLOSURE
Will Uf applicml R future bulldog a cupas rime orhmdk hmNous commial
as defined by the Cupertino Municipal Code. Chapter 9.13, and the Health and Safety
Code, Sewers 25532(e)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yeeo
If a roof is installed without fust obtaining an inspection, I agree to remove
Wit] the applicant or future building occupant use equipment or devices which
harmicu aI, contaminant u defined by the Bay Arca Air Quality Management
all new materials for inspection.
Met? \ /
0Yca GSNo
I hew read the wounduusmmdals requirement under Chapmr6.95 tribe Caliran
ilk1ial"SJGyCpM, S cd.25505,25533w25S34.1uMcnunddmifft building
dura ameancndy awamwt WtIttmymtpomihllhYmnWfy Oeamupantofte
ca
requirements mus W met pilar In usmcofacenificateof o7
Signature of Applicant Date
All roof coverings to be Class "B" or better
--=
0wner or utnaszeda ant Date
004ER-BUILDER VERIFICAT4WN
1. (Check one) I or my immediate family (parent, spouse or child) will perform
• A. i< 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.
Z 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 perioamed
• 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/F=
Address/City
Phone Number Type of work to be
formed
zv d
o � ��-94z
R.Ele
Bias
o
I declare under penalty of perjury that the above is true and correct I have read and understand the
Owner -Builder Information (reverse sifie).
Property Owner's Signature:
Job Address:
Department
0
Date: 2/ o
CL)/0e&/UQ Ca Permit #
City of Cupertino Building Department
a0f 10300 Torre Avenu�
CUPERTINO,°ne: `'3
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 compensatiore
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
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CUPEkTINO
0 CITY OF CUPERTINO
PERMIT APPLICATION FORM
"S,�""�3.
APN #-�44o e f/
b
Date:
Byilding Addres : Mailing Adds/ss (if different from building address):
/ 91;Z50 0 0 N 6.4 9S0/ �
Owner's Name:
c-Y�s -Nd�ti1
Phone #:
�oB as3 -go/
111111 dlµµ
License #:
Contact: Phone:
Fax:
Cupertino Business License#:
Building Permit Info: 1 )�
.Bldg�d Elect LI/Plumber !Mecch ❑
Job Description:
Residential Commercial ❑
Sq.Ft. Floor Area:
q.Ft.: f 8
Cost of Project:
Occupancy Group:
Type of Cons ct' n:
`/
Please check this box if the project is a
second -story addition: ❑
ro'ect Size: Standard Laze ❑ Major ❑
BBOILER5
Quantity Fee ID
Fee Description
Fee Group
BAPPLOTHER
Other Appliances
MECHANICAL
BBOILERI
Boiler <= 100,000 Btu
MECHANICAL
BBOILER2
Boiler > 100K to 500K Btu
MECHANICAL
BBOILER3.
Boiler > 500K to 1M Btu
MECHANICAL
BBOILER4
Boiler> IM to 1.75 M Btu
MECHANICAL
BBOILER5
Boiler > 1.75M Btu
MECHANICAL
BCONSTAX
Construction Tax
BUILDING
BCONSTAX
Ind/Off/Comm/Quasi
BUILDING
BCONSTAXBQ
Con. Tax for BQ Zone
BUILDING
BCONSTAXH
Hotel and Motel
BUILDING
BCONSTAXR
Constax — Resi/Mobile
BUILDING
BELEC1000
Elec 600V <= IOOOA
ELECTRICAL
BELEC1001
Elec 600V > 1000A
ELECTRICAL
BELEC200
Elec Svcs 600V <= 200A
ELECTRICAL
BENERGY
Energy
BUILDING
BENERGYADD
Energy Add Multi
BUILDING
BINVESTIGA
Investigation fee
BUILDING
u
X31 of 3 1133
1"6F. 72---
31
•
•
Assessor's Parcel Number: 3 7 4r0 — 6 S- 6
Name of owner.
,/
Project address.. I 935a �l ASO N il1��
Contact person. &hied Phone. W bol zl — 0;2
Fax.
Net square footage of lot.
Existin
Square footage: First floor:
Second floor:
Garage:
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces inside the garage?
Is privacy protection planting required for the project? N
On what floor(s) is work being done?
Proposed
VA
N
Code editions: 2001 CBC (Y - N)2001 CFC (Y - N)2b01 CMC (Y- N)
2001 CPC (Y - N)2001 NEC (Y - N)
Effective I1/1/02zY1'� 1
Plan Review Process Work Book Page -8-Revised 4/28/04
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