05120123 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �a CONTRACTOR INFORMATION .-
BUILDING ADDRESS: SARAH AND ANDY FEIT PEaMRND.05120123
MNER'S NAME: PERMIT ISSUE DATE
SARAH AND ANDY FEIT 21 2005
NE: SANITARY NO. CONTROL N0,
ARCHITECDENGINEEK: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u o o LICENSED CONTRACTOR'S DECLARATION
u 1 hereby affirm but I am liwmcd under o Prof ss of Chapter 9(rommense is Job Description
W with Swoon lPMgec Divisian3of Nc Business and Professions Cade.and my license is
n'14 in muronxameerrwt INSTALLING GAS FIREPLACE INSERT INTO PRE-EXISTI
uwmm Cloy Lion
Dale Con MASONRY FIREPLACE, ADDING SWITCH & OUTLET
Z�Z DELL ARCHITECTS DECLARATION
C 1 undersand my plans shall k used as public record /$1p((J��s❑�
k o Licensed Professional
OWNER-BUILDER DECLARATION
COO hereby affirm That 11. exempt from the Cessions o e:Any c law for the
COO following won.(Swtion TinMi Business and improve.
durum Cafe:Any city or county
it m which myvims a permit m cnnswcL ester.improve,Ocmniksh.m repair any structure
z y
He,m its issuelmc,also requires the applicant for such permit to file a signed comment
E€< that be is licensed pursuant to the provisions of Ne Contractors License Lew(Chapter 9 Sq.Ft. Floor Area/
ry1 aluati$14000
y (commencing with Section 1000)ofDivision 3 of the Business and Professions Code)or
y $ Nat he u Otc
exempt refrom and Ne basis for silo alleged exemption.Any violation of �0
Section 7031.5 by arty applicant for a permit subjects the applicant m a civil penalty of APN Number Occupancy Type
On mare son five hundred dollam($5W). �
❑I,as owner of the pm36211005 . 00
perty,m my employees with wage as their sole compensation. f s'a flT1
will do the work,and the stmnurt is not inrcroud or o@rind for side(Sec.1064,Business aHar '1%and Professions Cads:The Contractor's Liatus law don not apply m in"me of Required Inspecti.on,•�
property who builds orimproves thcmon,andwho doesswbwork himself orth ough his
own employees,provided Net such improvement$are wtimended oro@red forsak.If.
huxamw e,the building or improvement is sold within enc year of completion,the owner-
builder will have Ne burden of proving that he did not Wild or improve for purpom of
Vtile..
1,es awrmr of the property,am exclusively contracting with licensed contractors to
rtswm Ne project(See.1014.Business end Professions Cotler)The Comtracmrs U.
eetue law dors not apply to an owner of propeny.who Wilds or improves thenen,and
who concocts for such projects with a conuacmr(s)limned pursuant or the Contractors
License law.
❑l am\ef1�te/mdfar un Se
rt ,B&P C foe this won
Owr�yI Dale
3334440 KERS COMPEL SA N DECLARATION
I hereby affirm under penally of perjury arm of the following declarations:
1 ham and will maintain a Cenificam of Consent to self-inion,for WorkcrsComfort.
utian,as Provided for by Section 3100 of the Isbor Code.fm the perform.of Nes
work for which this permit is issued.
❑1 have and will maintain Workers Compensate.Imran¢,as rego ni d by Section
Worth.tabor Code,for the performance of the,work for which this permit is issued.
My Workers Compenulon Insunnts eamer and Polity number am:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ina section recd Out be wmplcted If the permil is for.h rmill dollars(SIM)
or leu.)
I cenify One,in the performance of the work for which this Permit is issued,I shall not
employ any person in any; sur um to theWorCompensationCompetion
laws of Cali a. ecsubjnt
Applicant 4
NOTICE
PPI ICA If.after magia"siCerfiricate of Exemption,you should
kcome subject m Nes Workers Compensation previsions of the labor Cock,you most
0.Z forthwith comply with such previsimes or this permiuhall W summed mvrked.
'Z'O CONSTRUCTION LENDING AGENCY
E-+ l hemby affirm that Nem is a construction lending agewy for the performance of
W✓ thc work to,which this panni)Is iaued(Sec.3091,Civ.C.)
1 Q Lenders Name
Z lender's Addreu
U 0 1 Mnify Nat 1 have read this application and sum that Nes a Wve information is
I2.P Cortese[.I agree to comply with all city and county ordinances and Marc laws elating to
0 U Wilding construction,and hereby summon hemesenmives of this city to color upon Nes
shove-mentioned property for inspection purposes.
(Wes)agree to arc,indemnify and keep husnlew the City of Cupertino against
V Z liabilities,judgmcros,costs and expcums which may in any wayacnue against said City
in consequence of the grassing of this permit.
n-- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOU C^RE `-� .Q� Date Z' Z ^O�
"A a0
l4/-/` ,?-I A-ae 0� Re-roofs
Swore ofApphmrVConmmtm Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding oaup intsione or hurdle harardon material
u defined by the Cupenino Municipal Code.Chapter 9.12.and the Health and Safety
Cade,Section 25532(a)?
❑Yat e—N. All roofs shall be inspected prior to any roofing material being installed.
Will thea Beam or future Wilding Occupant use If a roof is installed without first obtaining an inspection,I agree to remove
pp g P .Air Qu or devices which g P
it horardnms air conaminans az defined by the Bay Ana Air Quality Management all new materials for inspection.
trio?
❑Yat No
1 have mad Ne hanrdous materials requirements under Chapter 6.95 orate Califor.
ria Health&Safety Code.Sectiow 255(15.25533 and 25534.1 undco and that if Ne Wilding
does not currently hoc a avant.that it IS my reapomibility,m notify IW occupant of the
ne 'motto hies must met on a cofactrufrnmofOccu tr. Signature of Applicant Date
l 0 S
w.ororaONotimilage., Date All roof coverings to be Class"B"or better
az Community Development
j' 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADDR SS: PERMIT #
JJVJ 6, 4L ./e G, ,erkivo 1 05' 10z01A3
OWNER'S NAME: cf Ya(n F PHONE # Qa 8
GENERAL CONTRACTOR: O w Vj ,r 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
Owner/Contractor gn tore Date
UWNtK 15U1LUMC , VCKir1l Al1V1V
1. (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 _7-- All of the work
B. A portion of the work (complete section below)
Contractor Address/City, Phone # State License # Type of work to
be ertvtuacd
13 P
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.
PersorVFLrm 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(r,Ie�versee side).
Property Owner's
pSignatur�/W�-�5��I �/pLm rye Date: U
Job Address: l 6 �0� �4 Vl i 1E Uf . l_ I SIJ C�l�1 lro Permit# V �rl2 el 2�
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
City of Cupertino Building Department .
CITY OF 10300 Torre Avenue
CUPERTINO Phoma f�1777.3
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 bo 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 obligatis
on , and these risks are
especially serious with respect to workers' compensation ins ran e
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,ff you wish,the US.Small Business Administration). For more specific information about your
obligations under slate 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 aIlowe 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 hes own labor and material
personally. Building permits are not required to be signed by Property owners unless they are performing
their own work personally.
may be obtained by contacting the Contractors State License
Information about licensed contractors
Board in your comm urdty or at 1020 N Street,Sacramento,California 95614.
the enclosed owner builder verification form so that we can confirm that
Please complete and return
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
Punted m pecyded Paper
ca CITY OF CUPERTINO
CUP TYOF O PERMIT APPLICATION FORM
N4 3iva_ i�— oO5 Date: a l iJeCi
Buildin Address: �p Mailing Address (if different from building address):
y0 ✓�kS�lIt� Cf VU 4-iv-0 I CA- 050JI
Owna
�85
Owner's Name: Phone#: 3 ?�.t 3
1/
Contractor: 'TB b
License#:
Contact- Phone: 40$ a63 g� 1.3 Cupertino Business License#:
SQ/1�Q.4 F -+-e - Fax:
Building Pemvt Info: jvtS fcel�ikg gas f'✓eplo{e ince+( iNb �✓e e� sf,ug
VKQScMrJ ,�i✓eo(&o , (xAe ltig Sw FCi- 4 0µf le+-
Bldg ❑ Elect Plumb 01 Mech L/
Job Descripti?o
Residential LJ Commercial ❑
Sq.Ft. Floor Area: q.Ft.:
Cost of Proiect: 0 p Occupancy GrouD:
Type of Construction: Please check this box if the project is a
l/�// second-storyaddition: ❑
a. roject Size: Standard Od Large ❑ Major ❑
Quanti Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILER1 Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 1 OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 11\1 to 1-.75 M Btu MECHANICAL
BBOILERS Boiler> 1.75MBtu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/OffConnn/Quasi BUILDING
BCONSTA) BQ Con. Tax for B Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax -Resi/"Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENTERGYADD Energy Add MW—ti BUILDING
BINVESTIGA Investigation fee BUILDING
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aCITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEIZTINO
uanti Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUMCylE New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUMaV New Comm Plumb PLUMBING
BOVERTIAf Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE 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
BPSENVER I Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo 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
BREMACOVBR A/C Unit > 10,000 cfm MECHANICAL
BRENLAIRHAN A/C Units <= 10,000 cfm 1`/fECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways. ELECTRICAL
BRENIFIXT Lighting Fixtures ELECTRICAL
BREI\ff URN Relocation of Furnace MECHANICAL
BREMFURNOV ReloFurnace> IOKbtu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BRE1\11NIE100D Installation of Hood MECHANICAL
BRENMSC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BRENffOLE Pol=Healing
Fixture ELECTRICAL
BREMPONVER PoweDevice/Apparatus aratus ELECTRICAL
BREMRECEPT Rc tOutlets ELECTRICAL
BREMRELOCA ReHood MECHANICAL
BREMREPALT Reeating MECHANICAL
PP Remp liance ELECTRICAL
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CITY 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
BR_EMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISAIICOM Seismic Commercial BUILDING
BSEISAIICRE Seismic Fee Res BUILDING
BSPECIAL S ecialInspection BUILDING
BSW7h4 Swimming Pool BUILDING
BTEA11P Temporary Power ELECTRICAL
BTEAIPPERA4 —Temporary Bldg Permit BUILDING
BTEMPSVCS Te mp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERAIITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERA11TFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/ Multi-Fam I PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING '
ZADDCHG Address Change BUILDING !
. s
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