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03070233 (2) CITY OF CUPERTINO zbxs BUILDING DIVISION PERMIT �CONTRAC�TOR INFORMATION -* BUILDING ADDRESS: KARAM & SAMIA GERGES PCRMITNO03070233 0';7r JUDY AVE, t• OWNER'S NAME: 10376 JUDY AVE PERMIT ISSUE DATE KARAM & SAMIA GE 2003 HE SANITARY NO, CONTROL NO. ARCHITECT/ENGINEER: BUILDING PE MIT INFO BLDG . ELE PLUMB MECid 100 LICENSED CONTRACTOR'S DECLARATION O O O �w❑ I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing lob Description <W with Section 1000)of Division 3 of NC Business and Professions Code.and my license is inf,llnote and effect UPGRADE MTER 200AMP ��. a Date ClassC.mr ' ID fd3 As sbaLl use DECLARATION SEP 5 20M 'r 1 understand my plans shall W used as public records W tau l;; Licensed Pmfcssianel 5 OWNER-BUILDER DECLARATION �� 0 0 I hcmtay,(firm thin 11. exempt from the Contractor's Code:Any c Law for the G ❑O folInwwhich mgrcasnn.(ermian]TonstrBusinessand mprve.demolish.or Any city or County V m which requires a permit to ennstrvn,alter.improve.Jemnikh.nr repair any awmum statement 8250 -Zprior.)its issuance.also requires she applicant(orsuch permit to tire a signed ttm that he is licensedpursuanothepmvisions(IftheComcmr'sLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation e t-C (commencing with Section 700))of Division 3 of the Business and Professions Code)or that he u exempt thcrtrom and the basis for the alleged exemption.Any violation of 37510005 . 00 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number nos mem than rom hundred d011ars(SSW). - -- - Occupancy Type ❑1,az owner of Nu prat ser my employees with wages as their sol.compensation, will do the work,and the smeum is not intended or offered for sale(Sec.7041,Business — .nd Pofeseions Cade:The Contractor's License Law does not apply I.an owner of 5 01 - FINAL n�NERGY progeny who builds or improves thereon,and who docs such work himself or through his ntun employees.provided that such Improvements are not intended or offered for sale.B, SOS - FINAL ELECTRICAL ow ver,the building or improvement is said within one year of completion.the owner- builder will have the burden of proving ws le did not build or improve for purpose of aslcJ. 1�as ne4w r of d,propcny,am exclusively contracting with licensed contactors to w t she project(Sec.7041,Business and Professions Code:)The Cmdracmr's Li- cense Law docs not apply to an owner of property who Wilds or improves themon,and. who contracts for such projects with a eontracor(s)licensed pursuant to the Contractor] License law. []lam ese p der See ,B&PCfarthisreaun OwDam WORKER COMPENSATION DECLARATION 1 hereby amnn under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to aeff boom for WorketsCmnpco- aIi.n,as provided for by Section 3700 of the tabor Code.for Ne perfortnaner of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as required by Section 37W of the Labor Code.for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number art: Cartier: Policy No.; _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE les:)(This ru is auction ed not W completed if the Permit is for one hundred dollars(e PIX) nr I certify that in the performance of Om work for which this permit is issued.1 shall not employ any person in any manner an as to become subject to the workers Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:If,after making this Ccnircate of Exemption,you should become subject to the Worker's Compensation provisions of the labor Code,you most 70 forthwith comply with such provisions Or this Permit&hall W deemed revoked. Z N CONSTRUCTION LENDING AGENCY 1 hereby affirm that Vert is a construction lending agency for the Performance of Yv the work(or which this permit is issued PSCC.3097.Civ.C.) 31 Q I,end.h Name 3. Lcndera Address Z) Z J Q 1 certify that I have read this application and sate that Ne above information is corrin 1 agree to comply with all city and county aNinumcs and state laws ml it I . Z)U building COnsuumion,and hereby authorirz representatives of this city to toner upon dm (e1 ahovea , d propertyam, (or itepenses purprwhich may gy (We)agree to ave,indemnify and torp harmleas the City of Cupenino against i,lZ Comm not.costs expenses which they in any way accoc against said City J Z graining of this permit. " RSTANDS AND WILL COMPLY WITH ALL NON.POINT Issued by: Date 7 ��O 3 S. Re-roofs VCom men" Date AZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant sore or handle butartlous material as defined by the Cupenino Municipal,Code.Chapter 9.13.and she Health and Safety Odc.Scnion 25532(1)1 ❑res pN. All roofs shall be inspected prior to any roofing material being installed. Will the aPPbexnt or future building..pan( Or devices which If a roof is installed without first obtaining an inspection,I agree to remove is haraNnus air connminaC3 as dcfin.d by the Bay Arta Air Quality Management all new materials for inspection. is, ❑Yes ❑NO I have read the hunolous materials requirements under Chapter 6.95of the Califor- Ith&Salt Codc.sratium 25505, by due Che p'l liter i(tM Wilding d ham a tenant Nal it u my responsibility o notify the m:cupant of Be q eh noredissuanceofaCenlficateofa;pmmy. Signature of Applicant Dale �3 �o 't iaedag.nt Date All roof coverings to be Class "B"or better OWNER-BUILDER VERIFICATION i� 1. (Check one) I or my ' / ediate 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 KLi✓'Gt GeV- c rre_P1a:-,q_Pq &t& ;c . 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 erformed . ..................................................................................................................................................................................... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information (rever side). Property Owner's Signature: Date: //?1 /0 3 Job Address: 1 0 3 7 6 permit# Any changes to the informationyrovided on this form shall be submitted to the City of Cupertino Build Department. City of Cupertino Building Department ' I CITY OF 10300 Torre Avenu C V P E Q I 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 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 Pnnted on Recycled Paper SON41- CITY OF CUPERTINO o3 -07 -:-, 233 A 7 3 3 CITY OF PERMIT APPLICATION FORM CUPEkTINO N -7OD Q Date: ( Building Address: Mailing Address (if different from building address): 103-76 '_v AVS Owner's Name: Phone#: Contractor: V License #: OW� vv- Contact: Phone: Cupertino Business License#: Fax: Building Permit Info: iC� o A, , Bldg ❑ Ele ❑ Plumb ❑ Mech ❑ Job Description: Residential ❑ Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: oZ SCS Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ uanti Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING 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 BBOILERS 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 Elec 600V <_ I OOOA 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 226 1 of v3, 2� V CITY OF CUPERTINO CITY°F PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BOVERTIME 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 Repipe 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 HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/A aratus ELECTRICAL 2 of 3 aI CITY OF CUPERTINO CITY of PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Sips, Marquee ELECTRICAL BREMTHEATR Theatrical Li ting 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 Swinuning 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chan e BUILDING 3 of 3