08070121 CITY OF CUPERTINO �a��da,,ddT� ",&C
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BUILDING DIVISION PEl\1Y11T kCORACTQRTN ®RMA"CTQN
BUTWING ADDRESS: PERMIT NO.
21.577 VILLA MARIA CT TINA WOO - 08070121
OWNER'S NAME: PERMIT ISSUEDATE
TIiMA WOO 21577 07/17/2008
HE SANITARY NO. CONTROL NO,
ARCHITECOFNGINEER: BUILDING PERMR INFO
BLDG ELECT PLUMB MECH
200 LICENSED CONTRACTORS DECLARATION O O O
1 botchy ddb.Nal I w licenrca under pmwicoons of reaper 9(smmmeming Job Description
_ viNSred.,70("ofDivWon3ofthe,Essences andprofessions;Code.And!mylkenau RE—RF RMV WDSHKS& APPLY ASPHLT SHNGLS 4X8 1/2"
aasdin full Force aad effec.
i'n? Luenm Class L3c.0 PLYWD SHEETNG CLS A 17SQ
ARCHITECTSECTI-SDECLARATION
a-u IuMenund my pWushad!the used aspublic records
ash Licensed Professional -
5 OWNER-BUILDER DECLARATION
iE I hereby aRnn Not I em exempt from the Conuactws License Law for Ile
0 O following reason(asitias 7031.5,Business;and Professions;Code:Any city w county
2
$ which requires a Permit m cunsuvct.alas,improve,demaltsh.or tepaif any swarm
_i< prior 0 its issuance.coxa requires Ne Applicant for such Permit o file a signed su¢mem
y+5
££ that he is licensed pumunttothe pm.iamueoftheConwcmrtLaw Sq.Ft. Floor Area Valuation
@ (commencing with Section 7000)of Division 3 of dm Business and Prafauiom Code)or $4500
Q`t.- Net he is exempt therefrom and the basis for Ne alleged exemption.Any violation of
Secdon 7031.5 by any applicant for a permit subjects the applicant k a civil penalty of Number Occas
nmmmeNlive 35623059 . Occupancy Type
0I,uowneroftheproperty,mmyemployedwi0wgdudmGsokca M.don,
will do the work,and the structure is not intended m.hared fwoak(Sec.7W.Becomes
and Prolamines codm
e:The Conumma
r,License Lew does t apply m an owner of Required Inspections
Property,who Wilds wimproW thertu,and wb^doessuch wrkhimeelfar through his
aw^employ .proAadthas Bmhimpmwmetsart mminuMdwoRemd fwsale If.
however,Ne Wilding or improveroant L sold within arc year of comPkdon,Inconstant.
Wittier
cowmr-
Wilder will haw the Wrderr of proving that Ise did ant Mtild w impmw in,propose of
,,Zu�lJJe.l.
.u owner of the Property am exclusively counseling with BemmL contractors m
tom muss the N^j^st(Sec.70414.Business Aad Professions Code)The Camracturs U.
wine Law does not apply to an owner of pmpwy what Wilda or imPmwa dCRwl.Nd,
who commas for such projects with a camncmr(s)licensed pmsu,An the Canracmrs
Isees law.
D l am exempt under Sts. ,B h P C for this;ream^
0. Dare
WORKERS COMPENSAnON DECLARATION
1 hereby,fano under penalty of perjury Was of the following declarations,
1 have and will msinuin•Certi9cam a Garment to self-ims.for WorkersComport-
sedan u provided fox by Section 3700 of Ne Lather Code,[w Ne performance of the
fxr which this Permit is issued.
1 have and will maintain Wormi'.Compensation Iowan¢,as required by Season
of NeLi me.f dwmaneaftha wort for which this permilu issued.
My Worker, moss o 1 name carder And Policy number ere:
Cartier. Policy No.:
CERIN TE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(I7de modest need not he cwaPlemd lithe pWmll Is phone hundred dollars($10)
w lest)
I unify,Nat in the performance of the work for which this Permit is based.I shall not
employ any person in any manmren As m become subject to the Warken'Compewation
Taws of California.Dau
Applicant
NOTICE TO APPUCANT.If,After making this Certificate of Exemption,you should
become subject m the Workers Compensation provisions of Ne Labor Cod,you mar
,z forthwith comply with such provision or this permit shall k deemed ummlmd.
Z OCONSTRUCTION LENDING AGENCY
F I kmby dliw NU Nemo a construction lending ademT for the Performance of
C> the work for which this Permit Is issued(see.3097,Civ.C.)
aq Leaders Nano
U O 1 mti(y Nat 1 Wve read Nis application W sou Nas 0c abuse iodomutiu u
IL !'�. eallut 1 agrlY m CamPly w'rN all City aM Cmnty wdiMMcf Lb.ttale law rtkdng m
O`r.'1' Wildingconsweriu,erldkubyauNmmmpm Udveofthi,eilywm=umnthe
W above-mens ams property for inspechrn Puryama t—[�]t\��}�—(�/ /
C (Wc)agreem sew,iudcmdfy Add keep hawkss wCityofe .im aid City
z usmet
com e,judgrmnts,con,mld expe�awhtch may in any wyacmm agum said Cry
U Z inconsequcoe a[Ne Bunting of Nu pewia
'—' APPLIC UNDERSf�{oS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date i
souReuunoys /
�� r /�Y"" Re-roofs
SrdfiRunQpVAppbdHAZARDOUS MATERIALS DISCLOSURE o.te Type of Roof
MSB the epplicam w future Wilding oeupant come,or handle hanallou materiel
u deBmdd by the CupmNo Municipal Code.Chapter 9.13.and tic Health and Safety
Code.seaaou 25532(.)T
❑Ye All roofs shall be inspected prior to any roofing material being installed.
No
I'LWill Ne applicant or future Wilding occupant use equipment w devices which If,a roof is installed without first obtaining an inspection,I agree to remove
L air cuurrirunts u defined by the Bay Area Air Quality Management all new materials for inspection.
isuiclT JV
DYe ryNo
1 have mad the hasakuus matedal,requimmomat under Chaper6.95ofNe Califen-
nutlike ASe[mYCcds,Sommor 25505.25533 old 25534.1 umkvmantl NRif Ne Wilding
doe not cum ave•un Nal It u my mxpo sibility m mdfy Ne occupant of the
require h' mtube et 'arwissuanccafaCcNfiduaf�spm Signature of Applicant Date
?t '��u
Own onoarbadegeDaucoverings to assAll f in be Class m ' roof cover4r or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35623059 . 00
DATE ISSUED. . . . .. . : 07/17/2008
RECEIPT # . . . . . . . . . : BS000005495
REFERENCE ID # . . 08070121
SITE ADDRESS . . . . . : 21577 VILLA MARIA CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : TINA WOO
ADDRESS . . . . . . . . . . : 21577
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4800
RECEIVED FROM . . . . : RAYMOND WOO
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : TINA WOO
ADDRESS 21577
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4800
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
IBSEISMICR VALUATION 4, 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1REROOFRES SQ FEET 17 . 00 221. 00 0 . 00 221 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 221 . 50 0 . 00 221 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 221 . 50 VISA
---------------
TOTAL RECEIPT 221. 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
a07 olozl
CITY OF CUPERTINO
REROOF
•CUPEIZTINO PERMIT APPLICATION
APN # Date:
256,-), 3,0!5q, oU qu-( Zoog
Building Address:
/LtsC) �1 �11�t1� MR�IP� Ct
Owner's Name: Phone #:
Af,Tm - Woo k* -1_<Ss - 2�
Contractor: Phone #:
0-W `tia-r- �> 1t_ Fax #:
Cupertino Business Lic nse #: Contractor License-#: .
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles &"sphalt Shingles
XWood Shakes ❑ Wood Shakes
41 ❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
E( To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
Residential Commercial
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation:
4so0 ,o.o
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 6/16/08
Zino CITY OF CUPERTINO
REROOF
CUPR,TINO FEE SCHEDULE .
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1RER00FRES Re-roof Residential B 1SFDWLR00F
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
• Telephone: (408)777-3228
Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed,a plywood nail inspection is required.
• 6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled
IMPORTANT:
1. Flat roofs must have a minimum of 1/4" per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will compl with the above stated policy on re-roofing.
Homeowner's Name: G
Job Site Address: LV79 U)7LIA ► kA
Roofing Company Name: �(
Applicant's Signature: -� Date: ` j
• Greg Casteel
Building Official
Revised 11/2/04
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
Plans See below
B. Site 9. Install H.E. Irrigation, (details/spec)' L-1 2 points
11. Perrneabfe Pavin , Note L-1 2 oints
C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 5 points
D. Structural 3. Uses Wood Waist, (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.) A3 2 points
4. B. Fiber Cement Siding, (Note/Spec. A-4. 2 ofnts
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/S ec 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. Energ Star Refrigerator, (Note/Spec. A-3 1 oint
P. Other 1. List Green Features on Plans A-1 1 paint
TOTAL POINTS 40 points
•
Plan Review Process Work Book Page-12-Revised 3/25/Og
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.
114PUT Resources Energy IAQ;Healih
A.Site
1.Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;60%=4 points I up to 4 Resource pts 0
2.Salvage Reusable Buildng 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
LDesigr n Resource-Efficient Landscapes and Gardens 4 Resource pts y=yes 0
9.Reuse MaterialsfUse 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
B.foundation
1.Incorporate Recycled Flyash in 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=yes 0
i t 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=yas 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
B.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.(Nall 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
a.Subfloors 1 Resource pt y=yes 0
• i b.Sheathing 1 Resource pt y=yes 0
1 1 1
INPUT ResDurces Energy AQ?HE311h
D.Fxten r rrms
1.Use Sustainable Decking Materials .
a.Recycled content 3.Resource pts y=yes 0
b.FSC Certified Wood 3 Resource pis Y--yes 0
2.Use Treated Wood That Does Not Contain Chromium/Arsenic ` 1 IAQ/Health of y--yes 0
3.Install House Wrap under Siding {I 1 IAOMealth pt y=yes 0
4.Use Fiber-Cement Siding Materials ) 1 Resource pt yryes 0
E.Plumbing
1.Install Water Heater Jacket 1 Energy or yryes 0
2.Insulate Hot and Cold Water Plpas 2 Energy pts y=yes 0
3.Retrofit all Faucets and Showerheads with F11—ow Reducers
a.Faucets(1 point each,up to 2 points) Up to 2 Resource pts. 0
b.Showerheads(1 point each,up to 2 points) Up to 2 Resource pts. 0
4.Replace Toilest with URra-Low Flush Toilets
(1 point each,up to 3 points) Up to 3 Resource pts. 0
5.Install Chlorine Filter on Showerhead 1 IAQ/Health pt y--yes 0
6.Convert Gas to Tankless Water Heater 4 Energy pts y=yes 0
7.Install Water Filtration Units at Faucets
(2 points each,up to 4 points) Up to 4 IAQ/Health pts. D
B.Install On-Demand Hot Water Circulation Pump 4 Resource pis y=yes 0
1 1 !
r.riecmcar
F1.Install Compact Fluorescent Light Bulbs(CFLs)
(6 bulbs=2 points,10 bulbs_-3 points,12 bulbs=4 points)—1 Up to 4 Energy pts. 0 •
2.Install IC-AT Recessed Fodures with CFLs(1 point each,up to
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.1 0
1 1 t
G.Appliances
�1.Install Energy Star Dishwasher V 1 Energy pt y=yes 0
2.Install Washing Machine with Water and Energy
!Conservation Features 1 Energy pt y=yes 0
3.Install Energy Star Refrigerator 1 Energy pt y=yes 0
4,Install Built-In Recycling Center I 3 Resource pts y=yes 0
H.Insulation
1.Upgrade Insulation to Exceed Title 24 Requirements
a.Walls 2 Energy pts y=yes 0
J.Ceilings 2 Energy pts y=yes 0
2.Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0
f Install Recycled-Content,Fiberglass Insulation with
No Added Formaldehyde __ _, 31AO/Health pts y=yes 0
4.Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes 0
5.Use Cellulose Insulation
a.Walls 4 Resource pts y=yes 0 .
J.Ceilings 4 Resource pts y=yes 0
6.Alternative Insulation Products(Option,spray-foam)
a.Walls 4 Resource pts y=yes 0
n.Ue rings 4 Resource pts y=yes 0
1
- 1.win ows
INPUT ReSDUTCDS Energy ]AUMEalth
• 1.Install EEnergy-Efficient Windows �,
a.Double-Paned 1 Energy pt y--yes D
b.Low-Emissivity(Low-E) 2 Energy pis 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 t
J.Heating Ventilation and Air Conditioning
1r.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 D
4.Clean all Ducts Before Occupancy 2 AO/Heath pts y=yes 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 D
B.Install Sealed Combustion Units
a.Furnaces 3 IAQ/Hea th pts y--yes 0
b.Water Heaters 3 IAQ/Health pts y=yas 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=yzs 0
12,Install 9D%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y--yes 0
• 13.Retrofit Wood Burning Fireplaces
a.Install EPA certified wood stovesfinserts 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 D
14,Install Zoned,Hydronic Radiant Heating 3 Energy pis Y--yes 0
15.Install High Efficiency Filter 41AQ/Health 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 1
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 pis y=yes 0
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2A kw=12 points,3.6 kw=1 B points) _ Up to 1 B Energy pts 0
'6Selec
I t Safe and Durable Roofing Materials - V _ 1 Resource pt y=yes 0
7.Install Radiant Barrier 3 Energy pis y=yes p
1 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 0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pis y=yes 0
• 1 1 1
M.Indoor Air Quality and Finishes
G.lJse LowMo VOC Pant 1 IAQ/Health pts y=yes 0 •
2.Use Low VOC,Water-Based Wood Finishes J 2lAQ/Health pts y=yes 0
F3-.Useiow%No VOC Adhesives A� 3 IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes D
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Hea1th pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes D
Seal all Exposed Particleboard or MDF _J 41AQJHealth pts y--yes D
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yas 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring B Resource pts y--yes D
Use Rapidly Renewable Flooring Matedals _ . 4 Resource pts y=yzs 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAO/Health pts y--yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
Total Points 1 1401 130 57 •
Total Points Pro'ect R 1 01 01 0
G:daiarpmgslgmenbuldinoguideiineshemodelersrgmenpoimsfinal21204prolaWed.xls
•
08o-70/,�
OWNER-BUILDER VERIFICATION
• 1. (Check one) I or my immediate family (parent, spouse or child) will perform:
A. D 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 Information (revers side).
Property Owner's Signature: Date: V
Job Address: '1697 VILLA VACA CT.. Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
• Department.
A
City of Cupertino Building Departmene
CITY OF 10300 Torre Avenue
C U P S kT'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 maybe 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,,e. ♦ Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
lCUPEkTINO
Building Department
JOB ADDRESS: ?- STgr1 Vlt-LA KJAJL�A CT. PERMIT # �� (0-7
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OWNER'S NAME: lql\� PHONE # 4% - 255 — 7-311I
GENERAL CONTRACTOR: uy FAX #
I am not using any subcontractors:
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 n r� y
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Owner/Contractor Signature Date