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06120093 (2) CITY OF CUPEATIN0 2 iM-+x'y ter^ • ,7 Edi 7 ' BUILDING DIVISIONPER MIT CONTRA.C-TORINFORMQTIO,N BUILDING ADDRESS: PERMI OWNER'S NAME: rva?g ROM EACCHETTI LARRY C AND MARY L 12/18/2006 NE: SANII NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description w 1 Immby affirm Out I am Iicencd ion of under,loorbChm ap n,9(comening �iwith SOction]0f10)afDivision3afthc Businessand Profession Code.andmyliccnos SERVICE UPGRADE 200 AMPS in full fame and effect. ZLicense Class L'c,as - O Dam Conuscor tJs ARCHITECTS DECLARATION ¢< 1 understand my plans shall bo used u public¢cords °pry Licensed Pmfcssional g OWNER-BUILDER DECLARATION to I hereby affirm Thal I am exempt from the Conuanur's License law for the o O following moan.(Section]031.5,Business and Profession Code:Any city or county Q which requires a Permit to construct,alter,improve,demolish.or repair any swcture prior to its issuance.ales mquires the applicant for such permit to file Satires!statement that he is licensed pursuant o the provision of Om Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation :x tFG mark(commencingwitt 7000)of Division of al Business and ProfessionsiCoot)or 300 5$ Out bo u exempt therefrom and the Eases for de vllegcd esempdan.Any violation of Section 7031.5 by any applicant for a permit Subjects the applicant to a civil penalty of Number O not mom than fiva hundred&It.(S500). 35932003 . Occupancy P Y TYPe ❑I.u owner of the property,Or my employees with wages as their tele collimated... will do the west,and the nnsctum s not intended or offered farsam(Sec.'/fN4.Buri. .rid Professiaa Code:The Canes eS Lune Law dao Cal apply In an awnr of Required Inspections property,who buildsorimpruvn thereon,and whodoessuch work himself or through his t wnemployres,pmnided that web impraemens am not intended oroRered forsale ll, advent.the building or improvement is old within on year of complation.the owner- builder will bane the Eurden of proving that he did not Wild or improye for purpose of calej. �pf(1 1.of Owner of the pmpmny,am exclusively conditioning with licensed mndactars w ):ontmct the pmjca(Sec.]tk4.Business and Profession Code:)The Contncrots U C.taw docs not apply to an owner of property who Wilds w improves demon.site. who conuacis for such projects with a cornomtoNs)licensed pursuant to the Con insors License taw, /rja+ao ❑ lam plunder Sec 8P Z Owner � - r Dal O WORK r S COMPENSATION DECLARATION I hereby aRrm us der penalty of perjury one of the fallowing declarations: 1 have ono will maintain a Cwnf37M of Concur r Code.for fn Wortm ante of me ration,r phich du for by Section 3]00 of the tabor Code,for the Performance of the wort for which Nis permit is issnd. ❑1 have aril will maintain Workers Compessation I....ss menited by Scion 3700 of the labor Code,for the performance of the wwk for which this Permit is issued. My Workers Compensation Wurane,Cartier and Policy number Sm Canter: Policy No.: _ CEIMFICATE OF EXEMPDON FROM WORKERS' COMPENSATION INSURANCE (TTs section need not W completed Buie Permit Is foranc hundred dollars(SIM) ,if leu) e certify that ig Ore performance of tW won for which this permit s issued,1 shall rat employ any pf rain any man s =Subject, ft WorkersCompensation Uwa of Cy f ApPlican NOTICE TO APPLTCA .If,aAc,making this Certificate of Eum,thm.you samaid become wjcn bo tW N hers Compensation povisions of the labor Codc,you most O foMwUlt comply with such provision Or this permit shall he deemed mvokcd. Z�y CONSTRUCTION LENDING AGENCY (-n I hereby affirm that them is a convection lending agency for the perfurnimcc of a the wurk for which i s permit is issued(Sec.3091,Civ.C.) a A Lenders Namc M z Lenders Address U O 1 coldly that I have mad Nis application end sum that the above information IS; iL correct.1 agree to comply with all city and county oNinanees and Stam laws mating to QJ building c.neuueli.n.md bcmby authwimmpracmarincs.f this city,.enter ulmodc ahovomenuuned property for inspection partners, H LL (WC)agree to Save,tadcmn fy and keep harmless the City of Cupwhno against h IiabiliticS.judgmenu.coss and empcnses which may in anyway see=against said City C)Z in c acne Of the grantin6 of this permit. AP ICA UNDERSf NDS AND WILL O�Ll,NON. Issued by: Date T�EOUNDE p� ','(y fU 1�/(G� r �� Re-roofs Signawm afA1mamUCOmracror 'Date HAZARDOUS MATERIALS DISCLOSURE Type Of Roof Will de applicant or future building occupant Stam or handle hoOmmus material as de0nd by the Captain!..Municipal Cade.Chapter 9.13,and the Health and Safety coJc.9ccdon 25532(a)T ❑Yes No All roofs shall be inspected prior to any roofing material being installed. 41 � Will the a liean,.rfuture eaildin ..,Sol ria If a roof is installed without first obtainingan inspection,I agree to remove PP g P Area Ail eu w JM..S which P� emit District' es air cnuminanu u JcfncO by the Bay Arta Air Quality Managcmcnt all new materials for inspection. Disui<R OYea No I have reel the Wrarduus aerials requirements under o- Chaper6.95 afthc Cdifo a Ithh Salcty Codes S.d 25505.25533ar 2553d.lunJcrsundt iftic building d Ot curmndy nave a enaryr.'thet it s my reaponihili,y m notily dm oaupowf Ne ywhichmnlb etm. wiaC. < .Cero TEC 'r. Signature of Applicant Date owner car a.tnari da tent D,te All roof coverings to be Class"T or better CITY OF CUPERTINO • 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35932003 . 00 DATE ISSUED. . . . . . . : 12/16/2006 RECEIPT # . . . . . . . . . : BS000000016 REFERENCE ID # . . . : 06120093 SITE ADDRESS . . . . . : 7417 ROLLINGDELL DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : BACCHETTI LARRY C AND MARY L ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : SANTA CLARA CA, 95051-5842 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : BACCHETTI LARRY C AND MARY L ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : SANTA CLARA CA, 95051-5842 TELEPHONE . . . . . . . . : • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL --------- -------- --------- ---------- ------—-- ---------- --—------ BELEC200 METERS 1 . 00 29.43 0 . 00 29.43 0. 00 BSEISMICRE VALUATION 300 . 00 0 . 50 0 . 00 0 . 50, 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 .37 0 .00 38 .37 0 . 00 TOTAL PERMIT 68 . 30 0 . 00 68 . 30 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 66 .30 5163 --------------- TOTAL RECEIPT 68 . 30 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ----- ------ ------------ --------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 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. ' I 2. A state licensed contractor will be hired to do: I A. _ All of the work B. _ A portion of the work (complete section below) I Contractor Address/City Phone # State License # Type of work to ✓c -uauauccu I I I i • 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. I I I I Person/Firm Address/City Phone Number Type of work to be performed I I I I I I ..................................................................................................................................I................................................... I i I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information (r verse side). Property lOwnrer s Signature: Date: job Address: Permit# Any changes to the information provided on this form shall be submitted to the Cit o�pertino Build • Department. I I I I I City of Cupertino Building Department CIT'_OF 10300 Torre Avenu* C 1 11]E kT 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 vourself 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 Printed on Fecyded Paper Community Development 10300 Torre Avenue r1 Cupertino CA 95014 ~ Telephone(408) 777-3228 CITY OF Fax(408)777-3333 46UPEkTINO Building Department JOB ADDR S: PERMIT # OWNER'S NAME: PHONE GENERAL CONTRACT FAX # I am not using any subcontractors: 61 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 er/Contractor Signature Date ((,-a�o CITY OF CUPERTINO CiWbF - PERMIT APPLICATION FORM CUPEkTINO N # C ?n Date: 7 Buildin Address: Maung Address 'f differen from buildi g addres ): 'All M O er's Na Ph on #: D'f a�7 as 3 Contract License#: 'tPiil Contact: Phone: Cupertino Business License#: Fax: Building Permit Info: �GPC/1QGtt / Q /} gyp . Bldg ❑ Elect / Plumb ❑ Y Mech ❑ Job Description: Residential 0 Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: D0 . Cost of Project: ° Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ Oroject Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 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 <= 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 1 of E � CITY OF CUPERTINO Cfrti OF PERMIT APPLICATION FORM ' CUPEkTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New.Comm Plumb 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 Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen TraR 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 BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMNIMAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREEMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 CITY OF CUPERTINO Sz- c1W`oF PERMIT APPLICATION FORM CUPERTINO Quanti 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 BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming 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 Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING • 3 of 3