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02070104 (4) CITY OF CUPERTINO BUILDING DIVISION PERMIT -CONTRAGTORiEWORMATIOM,i BUILDING ADDRESS: PERMITN . 7514 FALLENLEAF LA BROOKE RAHN 82070104 W TWSNAME BROOKE RAHN APPLICAnl1O / Df72002 t - PHONE: SANIIARYNO/. 1 / CONTROL No. e x zARCHITECf/ENGINEER: {u 00 BUILDING PERMIT INFO <U�i BLDG ELECT PLUMB MECH y i LICENSED CONTRACTOR'S DECLARATION Job Description I hemby affirm that l am licensed ander p isions of Chapter 9(commencing KITCHEN REMODEL P res with Scnion]ODD)of Division3 ofthe Business a5O Professions Code.and my license m Z j is in ful fort and ellen. c g/ 0 a Licenu s Lion a sts(((vvv"' 3 _1- a ARCHITECTS DEC TION O I undersmnd my plans shall be used as p lie records dc,ce Licensed Professional oLL OWNER-BUILDERDECLARATION =' 1 hereby (Scan that 11. exempt(sate me Convenor's a Any c Law for the t z a following reason.permit gat IDnstruBusiness dnaProfessionsveldeli Code:Any city or county $25000 go G which rets ig a e,alsom give,aper,improve,demolish, file rcpaigany svurtm, requires a3°�-° pnor toisaiuuance,al-ionot0;pheaplons O for such Charmrm,I License Law(ogur uhaptert _ _ (commencing with Wrsuint tome pro,ofDilomof the the Busters Leen a Law(Chapter9 - �-�'��--'-""`""' -' (rommencing witp•Sersiw]Og0)of Division3 of Nc Business and Prgfesaions Code) r%3il•C�2oEI�1b�r.AT'@a,.', ; Valuation os that he is exEmpi mcie(rom and the basis for Ne alleged exemption.Any violation of Section 70316 byany epplieam far.Permit subj"Ne applicom m a civil pcmlry .roof is.than five hundred dancers(55M), 10 14PN 1 ➢3biDAT I ON Occupancy Type ❑I.sa owner oflh.property,or my employees with wage,as their tele compensation. 102 - PIERS will-do the"worC and em shoetbre'fs not intendedorofferedfdr-ole(See:7044,' Bulinus"mid Pmfeasions Code:The Convenor's License Law does not apply su.n - Required Inspections owner of property employees, builds or improves Neeson,dna whomen eon such work himself 104 - REBAR o Wad for his own employers.provided that such vementrmems art not one y ear or r -:e0e.edforule." nowrvciethiWdvetcarimenOfprovngoldhemi°oneWeldor - 105 -- " ANCHOR BOLTS .... ... . . .... domrrovo fm me ownrnbuildcr will neve the burden of proving ten he did not build or improve dor padpo:ear:ale.). 106 - SEWER & WATER _ .owner h. .. . .... _.._. ont 202- '- UNDERFLOOR PLUMBING- ❑1,u owner of the property,am exclusively contracting him licensed convenors to � answet th<proven(Sec.]oa4,Baainna dna Pmressiona eoe<:)Tate Commanota 203 - UNDERFLOOR MECHANICAL',,`.. .. License Low does not apply loan owner of proprvy who builds or improves thereon, .and.who.con°aerk for.such pmjeru with a commcmr(s)licev a pumaam.to the -. .. 2 O4. .— UNDERFLOOR FRAME- .. " .0 tremors License Law _ -. .....__._.... ' lam Pt der I4 P C for this..on 205 - UNDERFLOORS INSULATION Dave' 301 - ROUGH PLUMBING R'S COMPENSAW DECLARATION I"-`f_ 302 - TUB & OR SHOWER I hereby M.order penalty of perjury am oft he following Aerlamaom: 303 - ROUGH MECHANICAL } 0 1 have and'win maintain a comilcate or consent m self-insure for Workers 3 04 - ROUGH ELECTRICAL / Ccmpena.tian,-n provided for by Section 3700 or he Labor Code. for the 305 — FRAME _ = performance.(the work for which this Permit is issued ❑l have and willm'alabor WOAer i Compcitvikm lnsaroven.as required ble Section 306 - HOLDOWNS 37M of the UWr Code.for the performance of that work for which Nis parrop is 3 07 — INSULATION issued.My Worker's Compensation Insurance carrier and Policy number arc: 308. -. SHEETROCK_ . Cam `• l ••Policy No.:" .. cERT1P1cnnDN of ExEMPnoN FROM.WORI(ER8' 309-* l-, EX'TER'IOR LATH . COMPENISATIONINSURANCE" "'•.' ` 1 310...-....,INTERIOR. LATH_. — .... -- ..: (.:..: -... •' tTni;:dio��reanorberainple;ealrmepermirararon<wneredaon.rs 311 SCRATCH COAT (3100)or leu.) ., , ,. , . ': `i«nify set in dm perfoem;nre of date"A res:which this permit is iasuea,] ... ...._ ...ROOF .NAIL hr0 her empl y Any p {oo c t berg a sub en to Na Weekeri 501 - FINAL ELECTR-I CAL"ENERGY CAampr 1 t IW f s D `m /7 Z - w 502 FINAL PLUMBING ENERGY NOII�f To La ANT if art maksgMsCemBoteorExempuom.yggsAomd 503 - FINAL MECHANICAL�ENERGY z beWSers b uo the Warkeu Co pc'sahon pros estate of the Labor Code,you must OO ten."g,mplywithsuchpreviadnaormaPermitshahbedeomedrevo_ked. 504_ - FINAL BUILDING ENERG`,;'. •CONSTRUCTION LE1NDWOAGENCY - 5.05 - FINAL ELECTRICAL- ;4 > l hereby affirm Nru ghem'is a Eonswaic n leadin' n for(he . g,C.) p °"°" 506 - GAS TEST rr of the wok for hap dol permit rs issued(sec:309],pv.C) ,'.r'.G Iaguie fAa 507 - FINAL PLUMBING 40d sAddass _ .. .._. .... ... GOo Z 508 - FINAL MECHANICAL" Q r I certify mat I have rtad Nis application end state than the above information is W r f+ coffee,.I egma to comply w;m all usy'gia cowry ordinances aM sum laws rthGng 509 - FINAL GRADE O'U mWildingconnrvciiomaMheabyaumorivaprcmnuuve,o ddacirymemrupv° 510 - FINAL PLANNING r�'xkd the above-mentioned! for inspection purposes.. a; (We)eg tosave,mdemNfy Id keep habNnineCity ofCupeunoaliment 514 - FINAL PUBLIC WORKS h 'iabilitin,judents,others and e-xpemes which may in any way accrve agairw said U.� Ciry•in consegtome fthe ting is pcdm4..' _„ APPUCMT"N STAN 5 q. COMPLY WItH ALL NON-POMIT soviicERF, p"s: ...'.... . . ......: n �1 2 Issued by: Date rco �:HtlAZnRDoIIS MATERIA DISCLOSURE ' Re-roofs -' Ne appltceoi or forme W)ding oawpant sone bag herardoes ntume Type of Roof as d f by dm Cupeni o M pal Code Clash.9 12 and th Health and Safety - - - - Code:Section 25532(e)7 . .. ❑Ye, NO All roofs sball be inspected prior.to any roofing material being installed. Wdttheapplmamo roma W let goerap.nt ,drop pmemord.wces which If a roof is installed without first obtaining an inspection,I agree tokemove emu hewaous av eontamsvann n defined ny the Bay Arc.Air Qu jiiy Management Disdict?. ,, y . . _ .P"°. all no -p m[sourceregulations. _ . tan .. . . comply. 1 . . . ❑ye, all new materials for inspection. Applicant unders ds and willwith t .' . . .. n o' . '1'hNi.ead'mc luzirdous'm.creak requiainenu under Chapter 6.95 of and Celifomfa He '&Sefay Cad echdns 25505,25533 and 25534.1 undrrsreM that if ily Etiildijyyppp un urdcvs) Crete Vasitis my respomibilirymhosify Ne °CCP tt lg'som prior w usuaoes of a Cron,It or w Om Signature of Applicant _ Date ' Or e m z d agcn - . . '"i Date,,,, _ All roof coverings to be Class,"B" or better ' AVER-BUILDER VERIFICA*N 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. _ 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 (reverse si Property Owner's Signature: Date: 2I'-716Z job Address: 72 7 /—i4Ler [Le F L,4 t J 2 Permit# 0-07010 Any changes to the information Provided on this form shall be submitted to the City of Cupertino Build Department. • City of Cupertino Building Departrrc CITY OF 10300 Torre Aver C O P E IST 1 N 0 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 compeusatic 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 gay SKETCHADDENDUM File No. 3017 ' losrywerlCliant KAHN ' -P+oyartyAadrou 7514 FALLENIFAF LANE .-. aey CUP ERTINO N=ty SANM CL"ARA state CA v ce 95014 A[")ERIIKAC EOUIFIRST"N�R'IC,AGE 'nemarn �l✓/� ,O F /�es,dei fA 16 (,.'�.. [-' : �Ijl JUL 1 7 2002 v MASTER BEDROOM 10.5 PA I l i l�� . FP UU U U UU L= u "DINING HALF - MASTER BATH ROOM BATH .:ic` BEDROON -:LIVING ROOM - 43 "• LAUNDRY 27.5 HALL BATH KITCHEN NOCK FAMILY ROOM n ENTRY _. ! L y/ . �,• BEDROOM ,BEDROOM 3.5 GU. 2v FP th APPROVED 29 IN ACCORDANCE WITH THE CITY Ofi CUPERTINO D NO RDI NCES .t' DA MAIN L1V1 G REA• 23 GARAGE 23 SIGNED k This set;of,pian, d specifications MUS7 be kept.tiri'the:job at all times and it is un '1 lawful to make any changes or alMrationS on same without ,writtenpetmissicn from ' the building Dept., City of C'1p^thin. The stamping of this plan rr :•r,,"r'CationS zo SHALL NOT be bed to pe t., ; '.r ;: r;; an tpproval of the wolatiin of of ony Citv O.d;nanra or LIVING AREA' '�`: """"""««`a'"^`•H „»,�,��,,,� . .10.5 x 16 168 - 24 x69 = 1656 " 3.5 x 24 = 84 8.5 x 29 a 246.5 ' Subtotat' 2154.5 SF - r iY 00 P U , F1 ,fn JUL 17 2002 Li . .a 57 48' 31 `e e 3A3 W18421 fI' 0 o W2142R WMSC271Pw (D i it =.:7 q -e382E _�. DISH..24" . S 6°` ;' BD18 ; " ,AIT' .. L----------._ I FYY ' .. 92 • � . .; ., .its . . . PP12 490R RE36" F;IC ;' B18R. .';I, �. . . 3 618E OC332400D U WR3624: ' ' ' f '; iii ".1:'. ',• p`i:� ,. «' W2 2R CRHF3624 rJr W21 2L, A6'PRO d J~i- IN'ACCORDANCE:•tllTH '(HE uu . _ CtIP NO ^,ODES ��'•c)INANCL . DATA s SISREU. u cf This set of pl7 .1p . specifications 'MUS) d`' be kepton the 10'lat.all times and it is un lawful 1P melee,any chenges or alterations on samor iyithout written permission from the huitdlne Dept-, Clty of Cupe-hno. The stem%•ng of this pan nd specifcations SHALL NO be hd d i'1 pe mit ar t re an ippiT3l of the vv latom of any pr. •r i�nr Aa Ahnensle,p b alae deslyugons .' . )wan are sublea to vedlwdon on THE This it an original design end must 7100A2FA kyle:rtuz4rarm Design:oni0102 )n , . " Iob sbe and aayasbnen o)Ipb HOME DEPOT net be released er gepled unless Data :07,15102 m1010oru. - apWhsble fad bas been paid or Job BROOKEAKELLT RAHN a=' :order placed,' 7514 FALLENLEAP LANE Designer CUPERTINO CA ANTONIA T r • 1 JUL 17 2002 . 164 — t 12 . X Zy r� TV ' • 84 9®6 11 El 52 45 APP6a6Ut61Et IN ACCORDANCE WITH THE CRY ul CUPERTI _ pand ND .RDINANCES DATE CTt. SI;PIED 1 This sa of planspecifications MUST . t be ttert on ttrc job at all times and it is un lawful to mala any ctanges or alterations on Famewitnnm written nermission from 6i. i wlding Capt., Ciry' a: ;upertino. Ti, stamping ^i t6,q clac and specifications • S .'ALL f'!!- 1 'u ,rrrrit ar to be an a : •,"c ., r ,u,., qi 3ny provision- All dimensions 8 size des verification This Is an original design and must Scale:maximum g no. given are subject to verificaFlon on H' TME not be released or copied unless w I( consite ditions. adjustment to Flt Job' 0"E DEPOT applicable fee has been paid or job 8510 FALLENLEAF LANE ANTONIA order placed. CUPERTINO CA WaIUC Line# 1 I • (g - CITY OF CUPERTINO Z 7 0` CUPo 1 kT F O PERMIT APPLICATION FORM APN# Date: 3592 1 OZ Building Address: 11 � S`I ' � f-a��e � L-e-gF L AtJv Owner's Name: /� Phone#: ' 1J" Roo Ke- RA 14,J yf78-Zs-s"-076�t Contractor: License#: �L r Contact: Phone#: Applicant/Contractor: Fax #: 3QooKc QR�..I 6ot—�:3 - y ' G�i'4'D m uildermit Info: lect Bldg Plumb Mech ob cription: I Residential: 1 — Commercial: Sq.Ft. Floor Area: $/Sq.Ft.: Architec.UEngineer: Valuation: ypeofConstruction: I / Occupancy u Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances 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 <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA — Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BNEWMULTI New Multi-family Res ELECTRICAL BNUCOMME New Comm Electric . ELECTRICAL BNUCOMMM. New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING � qrJ �— lof3 9( c? - q2-�