Loading...
05110017 (2) BUICITY OF CUPERTINO zF:.&' x 'C*� *^ °' 2� ''-_ — I BUILDING DIVISION PERMIT xCONTI2AC�xTQRII�tt�'UILM T LDING ADDRESS: JUDY LIN PERMrrN0.05110017 OWNER'S NAME: PERMIT ISSUE DATE JUDY LIN NE: SANITARY NO. CONTROL NO. ARCHrrER/ENGINEER: - BUILDING PERMIT INFO 'BLDG ELECT PLUMB MECH jop LICENSED CONTRACTOWS DECLARATION Ib Description l I bmeby affirm slut 1 am licensed under pmvieiw of CMpW 9(comma eOCSCrip mit with section Fore,ofDivWon 3 of t e Busineaad Profeaioes[ode.ad my license is � = i«�ma�crteer g TEMP POWER POLE ' eO Dan Contractor ARCHITECTS DECUBATION G a O 1 snd mY Pua Nati be usetl u public oacorda yG� Liceuad Profesf(r�/ 5 OWNER-BUILDER DECLARATION Coo homy.diem 6.1 1 am exempt from he Commutes License Law for de /1//1U p o following rcuon.(Scotian 7001.5.Business and Pmfevdnm Code:Any city at county ''// /0 Coo � which requires a permit b construct,slim,Improve.demolish,or Occur my wumum 2nn, $700Path - i y Prior b i4 inuance.atw requios dee appinant for such permit b Rb a signed statement(commencing Nat W is Headed pursuant to the provisions of the Constant's License Law(Chapter 9 Sq.Ft. Floor Area Valuation 8 (commencing with Sedan 70W)of Divisian7of the Business and Professinu Cade)or !vY ( that he It exempt dumfmm and the but,for de alleged esemp don.My violation of Secdm 7031.5 by any applicant for a permit abkcu the applicant In•dril Penally of MaTF-0 0 1 cy Type ant more dun nve boatload dollars($500). ❑I.u owner of de Property.or my employes with wages as their cob compauchm. will do the week.and the summa u ret needed or-Road for salu(San.7044.Budrcss Required Ins eCt10DS and Ptore aids Code:The Comment License law dos sea n et apply b a owof q p . property who builds or irepows ttomma,and who des such workhimself or though his use employes,provided that such impvvemerhu ammtinleded mo0ened(orals.a, however.the building or improvement Is mid within are you of eempletme.the ownm- builder w01 haw dire burden of proving that le did Out Wild or Improve for purpose of ale.). Q 1,a Owner M time prepeny,am exclusively contracting with licensed contractors b cauwct the project(Sac.7044.Business and PofasdOes Code:)The Cmeramte's Li- ceame raw dams not apply b an awner of pmpenywhO Wilds or improves theman.ad, who comment for such project,with a eonuactor(s)licensed pursuant to the Cantractor$ License raw. ❑IsmeacopidderSee .BEP f?1dds— Oweer /.Tin Dam . DS 0 KEIT OM SArcutvv CI,ARAnON 1 bmeby ahem under penalty of pcomy arc of de followdna Md••^Out lluw cod wild fart inedniOab of Couem COO. for Wooer's Comperme 730 m,ss provided for by Sedan 77011 of the lade Code,for the pe,fomane of the rt for which ear permit is issued. 1 haw and will mainWn Worker$CompensWon Insurance,u required by Seim0 of the labor Code,for the performance of Ne work fm which this Permit u iamd Worker's Compenation issuance carrier ad Policy number aro: rrier. Paltry Na.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This session reed Out he completed lithe Permit Is farm hundmddo0ara(S 1007 or bas) I certify tut In the Performance or the woo fm which this Permit is issued I slWl nm employ any Peron In coy marc,so as ne Income abject to de Wormnif Compeaatim I.Of Gldfomis Data - Appliant - r .� i%= N(MCE MAPPUCANT: C r mrtina dW alncate of cmp'on.You dW-W bemem subject b the WOhar's Compensation provisions of dhc Labe Coda.you mus wJ Qforthwithfowith comply with such Provisions visions this permit 0101 Wit deemd rewhad. •Zmy CONSTRUCTION LENDING AGENCY [r I hereby 4111em that Nem W a construction lending agency for the performanco of the work for which this Permit is issued(Sec.3097.Civ.C.) W�Q Lender's Name =2 Lander's Address U Q I certify that I haw mad this appEwim ad sub des the above information 6 {i•!". comm I agree n comply with all city tY acounty pNlnarua and laws mining lrelating in0 SV^ Wilding construction.cod hereby authorize mPmscouim ofthu city mentor upon dec Lid ahove-mentioned property,for inspection purposes (We)agree to ave,indemnify and hep hamba the Cly of Cupertino against i., CA liabildsia.ldgmenu.cosuandupeesowhichmayi anyraycarneagimaN❑ty &M V Z in comuequtnce of the grummg of this Permit. ., APPLICANT UNDERSTANDS AND WILL COMPLY W ALL NON-POINT ;wued by: Date �• souRCE REcul AnaNs.p l� �lCl Re-roofs �f� a Signature of ApplicwdCmuader Dau HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will W applicant or future building scup etxinre or handle hazardous material u denned by the Cupeethm Municipal Code.Chapter 9.12•and the Health and Safety ode.Secdan vssx(a)7 w ❑Yea All roofs shall be inspected prior to any roofing material being installed. l'TT Mu WIII the epplinnl or furore Wilding mcupanl use cyulpmmt or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit huvardaa air co merit u u Rod by than Bay Ama Air Quality Management all new materials for inspection. Dissict7 13 Ya 1 have mal the hnaNauoatesi W mg msmi muuhutrChtPIm693ofdmCalifm- nt,Heal"Safmycode.Secsmsx55W.25577adu5361umknuduu0ue build'uhg des WE Y haw a i nam•that it u my responsibility n otify drt axupent of the requirenawienmaxi rmW aracwfk.np/r°�" Signature of Applicant Date /,�yq'�/��yt y/�� `�7y`OS All roof coverings to be Class"B"or better Owner or authono sego Dau' Community Development 10300 Torre Avenue aClOF Cupertino CA 95014 Telephone(408) 777-3228 Fax(408)777-3333 #UPEkTINO Building Department JOB ADDRESS:(Vn.Z ' J okgn S�� ^� PERMIT�(�O OWNER'S NAME: I 5 ` l/ PHONE # L4rj -Z C> Z0 GENERAL CONTRACTOR FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 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 Signature Date OWNER-BUILDER VERIFICATION 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 —71 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/Pirm Address/City Phone Number Type of work to be erformed ..................................................................................................................................................................................... I declare under penalty of perjury that the above is true and correct I have read and understand the Owner-Builder Information(reverse side)).. / J Property Owner's Signature: //�l/� lyGl�1 1y/ l/1 Date: Z Job Address: L� l Z )oi1 An ' 'eo ��= Permit# AU changes to the information vrovided on this form shall be submitted to the City of Cupertino Build Department. City of Cupertino Building Department *ITYOF 10300 Torre Avenu CUPERTINO Phoma `,M'-7"3 Dear Property Owner. An application for a budding permit has been submitted m 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 Budding 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 compensatio is contributions. . There may be financial risks for you ff 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 US. 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 perfonxiing their own work personally. Information`about licensed contractors may be obtained by contacting the Contractors en State Licse 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 an Recyded Paper CITY OF CUPERTINO TEMP POWER 1 ,00 17 *CUPERTINO PERMIT APPLICATION FORM APN# -7�n 73�� Db Date: ' / 03 a S Building Address: Owner's Name: U I ✓/ I V Pho e 0 Z�Z Z b Contractor: Phone: License #: Contact: Phone: Cupertino Business License#: Building Permit Info: Elect ❑ Job Description: — levv Residential Commercial ❑ l Cost of Project: I7 ©D � Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL / EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING 3 137 ov 47