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05090160 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTORINFORM, QN AJi•`)�.z- f .c.L(4 m4XN�g.rv" [V- ��3_�la�'6?'( BUILDING ADDRESS: JOHN KINNEY PERMIT NO.05 O 90160 23050 VIA ESPLONDOR if 40 OWNER'S NAME: PERMIT ISSUE DATE AilkJOHN KINNEY 23050 VIA ESPL 2005 ONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: G PER BLDG BEIIACINIIT INFO MECH o4;o o owe LICENSED CONRACOR'S DECLARATION V j O C I hereby affirm Har 1 am Incurred under provisions of Chapter 9(commencing Job Description nzlm with Section7")ofDivision3ofdeeuaind.ssandProfessionsCode,andmylicenseis V•, ffl tea License icenseenm GAS LINE TO FIRE PLACE t'r Vy'l�� y� form Clays, Lie.N E;1 Due—Convinced, F IJ` ARCHITECTS DECLARATION W U 1 undcmanJ my plans shall W used as public records 00 6e LKCId professional OO �r groS OWNER-BUILDER DECLARATION r� 4 F 1 hereby affirm that I am exempt form the Comroctrrs License law for the p o following mason.(Section IID 1.5,Businnts and Proessiuns Code:Any city or county /�yqj m which mquires a permit to construct,aleq improve,demolish,or repair any ssrucmm /tfYn3s� 18 0 0 prior to iuismancc,a9omquims the applicant forsuchpermittoflcasigncdrutcmcm < Our heislicensed poran,totheprovisionsoftheContractoriLicense Law Sq. Ft. Floor Area aldation m y (commencing with sudden000 d 7 )of Division 3 of the Business and Professions Code)or e g$— that M is exempt therefrom and the basis for the alleged caemption.Any violation of Section 7031.5 by any applicant for a permit subjects Ne applicant m a civil penalty of *014 nod mom Nan five hundred dollars(55003, r Occupancy Type 0 Laowddrofurd property,ormycmploym with wagesa theirmle cempenaation, will do the work,and Ne awcture u nor intended oro@red(orale(Sec.7o44,Busirea and Predications Code:The Conmcurs Licenz law does nor apply N an owner of Required Inspections property who buildsorimproves demon,and whodxs such work himselfor through his own employers.provided that such improvements are not intended orofrded for we.If, however,the building or improvement is sold within odd year of completion,the twom. builder will have the burden of proving Nur he did not Wild or improve for purpose of ark.). ❑1,as owner of the property,am exclusively contracting with licensed contractors N construct the project(See.7044,Business and pmfossions Code)The ConOacer's Li- come law does not apply m an owner of property who Wilds or improves thereon.and who contracts for such pre'l,ces witha ,m eror(i)hearead pursuant to the Cmmacmr'a License Law. 01am em oder 5e B A,PP C too,this reason Owrur P. �DatM1'— WORKERS COMPENSATION DECLARATION) �- 1 hereby affirm under pera ty of perjury one of the following decluatioos: I have and will mainuin a Certificate of Consent a self-insure for WorkersComper- ation,as Fournier]for by Section 3700 of the labor Code.for rue perfomun¢of the work for which this Fermi,is issued. ' 0 1 have and will maintain Workers Compensation loneurantt,m required by Section 3700 of the later Code,for de peRermance of the wok for which Nis permit is iemed. My Wmkers Co.pcommot Imunmee ceroid,and Policy number am: Cartier. Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Tbir second decd wt W menputsd if the permit i,Around hundred dollars(SIM) or leas.) I droopy that in Ne pe,to once of IW work fe ch Nis Fe his Word,I shall not employ any'person in an pmt anpf�ingS.m LE2�tt�bjco�tkcrs'Crmpcnsation laws of Califo ton n aP•Ls/M—l'/• r or Applicant �R� `�— NOTICETOAP 1 :If.aRermokohg,bia Cerifimof Exemption.youshould bttome subject u orkcr'a Compcnation pmvisiom o c lahm Codd.you mute .J O foMwith comply with such provision or this permit shall be doomed revoked. z '-' CONSTRUCTION LEADING AGENCY F r I hembyBms Net Nem its connlending agency per the performance of a 7 the work for which N (See is permit u issued(Sec.3097.Co.C.) A Isnd Dcrs z lander,Add Addrea U Q I cuAly Nat I havr read this applicadon and,ue that the above mfmmation Is i,, F comm I agree to comply with all city and county ministers and state laws totaling to C U building constructed.and hereby authorim mpresenutives of Nis city to enter upon the �•'til aWve-mentioned property for inspection purposes FG (We)agree to save,indemnify and keep harmless to City of Cupcnino against CA liabilities,judgments,costs add expenses which may in my way sande against said City Uz Aconsequence of the granting Of Nu permit. APPLICANT DERSTA'NDJ$AND WILL COMPLY WITH ALL NON-POINT Issued b (h SOURCE G ATltyls l l y Date -1 Re-roofs Stgnawr f m"TIoccurAZAracmr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Ned applicant or forum building occupan,store or handle hazardous material as defided by the Cupertino Municipal Code.Chapter 9.12.and Ihe Health and Safety "likodc.$CCLet 25532(a)7 All roofs shall be inspected prior to an roofing material beim ❑Yes p p - y g being installed. Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove tit hominis,air common ants a defined by the Bay Area Air Quality Management all new materials for inspection. isuia, OYcr QKu 1 have read the h ddhem s maerialsrequitomcnu underCWp rr6.95 of the Caliper. noHralth&Safety Cede,Sections 25505.25533 and 25534.1 undemund Nat Rod Wilding does not cumendy have a mora that it 4 my reapontibility In notify the acupam of Oc tequircmcnas whkhm hereat ori uanaefacemreaerfoceeprrcy. Signature of Applicant Date Owner or author rot D, All roof coverings to be Class "B"or better .w.. Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 , CITY Of Fax(408)777-3333 UPEkTINO Building Department JOB ADDRESS: PERMIT# Z3015z) V,CS — Lexdok.. 6 ,, LI, ak*go DS D fd160 OWNER'S NAME: t,u rlt PHONE # 65-0- 968-72y GENERAL CONTRACTOR: FAX # I am not using any subcontractors: � �'{ �� '3 O 5— Signature Signature Date Please check applicable subcontractors and complete the following information 60 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 �47 C^ a er/Contractor Signature Date OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent,spouse or child) will perform A V 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 . ✓c cu vaca�cu 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). Property Owner's Signature: LF ( Date: Job Address: 2 / C— V Permit# Any chanties to a ormation provided on this form shall be submitted to the City of Cupertino Build DeRartment. its City of Cupertino Building Departmen CITY OF 10300 Torre Avenu C U PE IST I NO phone: (408)777-322 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.subjed 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 spedfic information about your obligations under federal law,contact the Internal Revenue Service (and,if you wish,the U.S.Small Business Administration). For more spedfic 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 • r CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM Q CUPEfI;TINO Date: JAPN# 3� 2 Building Address: Mailing Ad�'r ess (if different from building address): 2 3O 5o V 1 ES LQ.c,c��t-t C°ct -t cam; .--)O Ca Va&,* 96 Owner's Name: Jo -Pt� Phone #: e Contractor: t zow-c)q A,` �O�i° License#: Contact: Phone: Cupertino Business License#: Fax: Building Permit Info: Bldg ❑ Elect ❑ Plumb Mech ❑ Job Description: / C2 � Residential Z05T44L 0.s I-IAJe 7-0 �r.2 /��oinmercial ❑ Sq.Ft. Floor Area: q.Ft.: i Cost of Project: / Occupancy Group: Type of Construction: l Please check this box if the project is a second-story addition: ❑ ro'ect Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3. Boiler>500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M 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 EElec600V<= IOOOA ELECTRICALBELEC1001 600V> IOOOA ELECTRICALBELEC200 Evcs 600V <= 200A ELECTRICALBENERGY Ener BUILDINGRGYADD r Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 3133 lof3 20 0 , / 50- CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm,Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum . PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING MIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BRENiAIRHAN A/C Units<= 10,000 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFDXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREWMAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc A aratus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 umCITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Lonz Range Residential PLANNING ZADDCHG Address Change BUILDING • 3of3