08070083 (2) •
CITY OF CUPERTINO % *,Av.,•i' xlca<^ •. At ' -
•
BUILDING DIVIE ON PERMIT C,ONTR°ACTOR II�FII'.ORNTATIQ
f u� - : sh.e '„rere -0,4,- T^(x w,m, -z.wso=#!tib
Bmt171NCaAAPRESS;
WOLFE RD RAYMOND KOT PERMIT NO.
08070083
OWNERS
tNAME: NPERMIT ISSUE DATE'
RAYMOND KOT 10887 N WOLFE RD 07/14/2008
•NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB • MECH
0 0 C C
u 00 0C'' wLICENSED CONTRACTOR'S DECLARATION
a§ I hereby affirm rm duo I am licensed under provisions of Chapter 9(commencing Job Description
4c' ith Sea ction7(00)of Division 3 of the Business and Professions Code.and mylieense is CHNG TILES, REPAINTING, PATCH SOME HOLES
721% in full forand effect
j•rn2 License Class Lic.a .
qqqq Date Contractor
f 1 understand my ARCHITECTS DECLARATION
plans •
shall be wed as public records
6
10
k G Licensed Professional
3 OWNER-BUILDER DECLARATION
<E I hereby affirm that I am exempt from the Contractor's License Law for the
p o following mason.(Section 7031.5,Business and Professions Code:Any city or county
3 ff which requires a permit to coneduct alter.improve,demolish.or repair any structure
'C
prior tosLL issuance
Sq.
sego tines lireapplicantiko (ef such permit to file a cense aw(Cbaptned statement
< that be is licensed pumant to the provisions of the Contractor's license Law(Chapter 9 Sq.Ft.Floor Area Valuation
X - (commencing with Section 70101)of Division 3 of the Businessand Processions Cade)or $2000
t 72 that he is exempt therefrom and the basis for the alleged exemption Any Weldon of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Occupancy Type
not more than Eve hundred dollars(S500). 3 1 6 0 5 0 5 3 .MN Number
0 I.as owner of the property,or my employees with wages as their sole compensation.
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business
and Professions Cade The Contractor's License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employees,provided dist such improvements are not intended or offered for sale IL •
however,the building or improvement Is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.). •
Aa •
i.as owner o ••••ely.am exclusively contracting with licensed contractors to
• eject(Sec.•044.Business and Professions Code:)The Contractor's IA.
cense does not apply Is owner of. •• ny who builds or Improves thereon,and.
who • tracts for such proje with a con .. )licensed pursuant to the Contractor's
Lice Law.
O Iam exempla •. - �,�� : &PCffoo Btu 7;8
Owner „31 din LIbi r Da. � /
0' ?'iT•J. O,DECLARATI•.N
I hereby affirm u.. r persalt of perjury one of the following declarations:
S I have and will maintain aCertifi of Consent to self-insure for Wod¢YsCompem
Afton,as provided for by Section 37.'of the Labor Code,for the performance of the
work for which this permit is issued.
ID I have and will maintain Worker's Compensation Insurance,as required by Section
3701 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 are:
Cartier Policy No.:
CERTIa- PILON FROM WORKERS'
COMPENSA •N INSURANCE
•
(Thu -•ton need not be completed' the penult is throne hundred dollars(5100) '
or less) .
I cenifv that in the perform.... of the .•rk for w ich this permit Is issued,I shall not
employ any person in any manbecome• •jecl to the Workers'Co,pe..don
Laws of California.Date W1:f``1- ��
Applicant &i\\NITa aeszi ih,
NOTICE TO APPL.1 " :'7MTW'i' I.f!',.is¢ate of Esc 0', o should
become subject to the Worker's • w'on provisr ns of the • C•• you must •
0 Z forthwith comply with such provid-ns or permit shall be deemed revoked.
Z.-• CONSTRUCTION LENDING AGENCY
y
H I herwhichmthat there is a consSecinn lending agency for de performance of
I5:> the work for which this permit u issued(Sec.3097.Civ.C.)
II]6 Lender's Name
=Z Lender's Address •
tJ 0 1 certify Nat I have read this application and sate that the above information is
LL- correct I agree to comply with all city and county ordinances and sale laws relating to
0 . . . . on.. 'on.and hereby authorise represenativ s of this city to enter upon the •
• -mentio • . .. ny for inspection purposes.
y n
(We)agree •ave.indemnify and kap harmless the City of Cupertino against i
r I liabilities,judgments. esti and expenses which may in any way accrue against said City WilligI
tJ z 'n consequence of granting of, is permit —7
APPLICANT U • 'STANDS ND WILL COMPLY WITH ALL NON-POINT Issued by: re II knot f Date / �G�"
SOURCE n.. U .TV S. '�
a. �1 �I� 7 a • Re-roofs OF
Signal=o�•h.lSPl�i, :•P,�� A Dao
H .ARDOUS M ' ' AIS DISC 'SURE Type of Roof
Will the applicant• future bui.. g occupant store or handle hazardous material .
as defined by the Cupeni •Municipal Code.Capmer 9.12,and the Health and Safety
Code en 55324)7 '� No
LL
0 Yu A All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining inspection, g an I agree to remove
Will the applicant or future building occupant use equipment or devices which
mit hart s air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
DYes o u
I ve read the ardzau materials requirements und:rChapner 6.95 of the Califor'
nix Health. Safety Sections .505.25533 and 25534.1 undersand Wilhite building •
does note only t tenant his my repo ' " dry the occupant or the
•
mgalmments ( �, t• to' nka •
cettir¢t 3 ' ' - Signature of Applicant Date
Owner or mho .ed igen / '❑�,e tl . All roof coverings to be Class r%¢"or better
CITY OF CUPERTINO
. 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN • 31605053 .AMI
DATE ISSUED • 07/14/2008
RECEIPT # • BS000005453
REFERENCE ID # . . . : 08070083
SITE ADDRESS • 10887 N WOLFE RD
SUBDIVISION
CITY • CUPERTINO
IMPACT AREA
OWNER • RAYMOND KOT
ADDRESS • 10887 N WOLFE RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM • RAYMOND KOT
CONTRACTOR LIC # *OWNER*
COMPANY • RAYMOND KOT
ADDRESS • 10887 N WOLFE RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
1BSEISMICO VALUATION 2, 000 . 00 0 . 63 0 . 00 0 . 63 0 . 00
1STPLNCK HOURS 1 . 00 122 . 00 0 . 00 122 . 00 0 . 00
1SUPINSFEE HOURS 1 . 00 122 . 00 0 . 00 122 . 00 0 . 00
TOTAL PERMIT : 244 . 63 0 . 00 244 . 63 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
CREDIT CARD 244 . 63 VISA
TOTAL RECEIPT : 244. 63
•
01o7c00e3
pa- CITY OF CUPERTINO
• CUPEONO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # i 0 Date:
3/(P OE 3 • ° 0 7//3 /oe
Building Address:
/0P37 N. 6volFr Road, CU/)e/frAO. CA
Mailing Address (if different from building address):
Owner's Name; Phone#:
Raymond Ka' 1115 -Frei- P2
Contractor: Phone:
Owner k klet_ Fax:
Contractor License#:
Cupertino Business License#:
Contact: Phone:
• Fax:
Residential ❑ Commercial
Job Description: •
cian9e Ties , Reps 40, PaFch Some holes
•
Building Permit Info:
Bldg ( Elect 0 Plumb 0 Mech ❑
Type of Construction (Usage Class): Occupancy Type:
I-A, 1-B ❑ IUIIUV-A ❑ IUIII B, IV-HT, V-B Ca e • 13
Valuation: Square ootage:
Project Size: Express 174—Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
to the application or if applicable, include in plan set& the sheet index.
• Points Achieved:
For help, contact Build it Green at www.builditureen.org (29
Revised [7 %/
'" CITY OF CUPERTINO
TY of
CUPERTINO GENERAL BUILDING •
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1BBOILERI For the installation or relocation of ea M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw)
1BBOILER2 # Installation /relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
1 BBOILER3 Installation/relocation of ea M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
1BBOILER4 Installation/relocation of ea M •
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1BBOILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
1ELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour)
1PLMBINSP Other Plumbing& Gas Inspections P
(per hour) •
1MEETING1HR Application Meeting B
_ CITY OF CUPERTINO
�TM°F GENERAL BUILDING APPLICATION
CUPEICTINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
1ACOUSFDW SFDWL/Duplex New B
1ACOUSRESAD SFDWL/Duplex-Addition/Alteration B
1ACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
I CHIMNEY Chimney B
1 CHIMNEYR Chimney Repair B
• FENCES
1 FENCE>6FT Non-masonry, over 6 ft in height B
1FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
•
1FIREPLMAS Fireplace Masonry B
1FIREPLFAB Fireplace Pre-Fabricated/Metal B
1FLAGPOL>20 Flag pole(over 20 ft in height) B
1MODUSTRU Modular Structures B
FOUNDATIONS
1FOUNDREP Foundation Repair B
IP ILECAST Pile Foundation Cast in place concrete B
• 1PILEDRIV Pile Foundation Driven (steel,pre- B
stressed concrete)
3 of 5
., i CITY OF CUPERTINO
CITY IF GENERAL BUILDING APPLICATION
CUPEkTINO
FEE SCHEDULE •
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY)
IRETSTN Standard (up to 50 ft) B
IRETSP310 Special Design, 3-10' high (up to 50 `) B
1RETSPIO Special Design, over 10' high (up to B
• 50')
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft)
IRETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft)
SHED-(EACH) Shed Over 120 sq ft B •
SIDING
1SIDEST/BK Siding, Stone & Brick Veneer B
(interior/exterior)
1SIDEOTHER Siding all other B
SKYLIGHTS
1SKYL<10 SF Skylight less than 10 sf B
1SKYL>10SF Skylight greater than 10 sf or B
structural
ISTAIRS Stairs-first flight/ea addt'l B •
STORAGE RACKS
1SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B
1SRACKS>8 Storage Racks over 8' high (up to 100 B
st) •
4of5
; - CITY OF CUPERTINO
�'�°° GENERAL BUILDING APPLICATION
cuIRTINO
•
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows)
1WINMEWSTR New Window-structural shear B
wall/masonry(includes plan ck fee)
1EPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit Fee P
•
1ELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P
• / 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
I when not over counter) hourly-stand alone
1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
• ITRAVDOC Travel & Documentation B
1BUSLIC Business License B
\':rST .30 Sip , iv&/la0 51-1-2.8
Green Building Plan Check
Index of Green Building Points/Categories
• A. Category Example of an Index or Table of Green Plan Sheet or Page Points
Building Points Categories that must be
shown and referenced on the Project
Plans See below
B. Site 9. Install H E Irrigation, (details/spec)' L-1 2 points
11. Permeable Paving, (Note) L-1 2 points _
C. Foundation 1. Use 15 % Flyash Concrete,(note) S-1 5 points
D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2 2 points
5. Use Truss with heels, (detail) 5-2 2 points
6. B. OSB Sheathing,(detail) S-2 2 points
E. Ext. Finish 1. Composite Decking, (Note/Spec.) A-3 2 points
4. B. Fiber Cement Siding, (Note/Spec.)_ A-4 2 points
F. Plumbing 1. Insulate all H.W. pipes, (Note/Spec.) p-i 2 points
5. Tankless W.H., (Note/Spec.) A-2 2 points
11. A 2500 Gal.Tank, (Note/Spec) L-1 10 points
G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 4 points
H. Appliances 1. Energy Star Dishwasher, (Note/Spec.) A-3 1 point
3. Energy Star Refrigerator, (Note/Spec.) A-3 1 point _
P. Other 1. List Green Features on Plans A-1 1 point
z'4 ,, 'x: i ..: . TOTAL POINTS 40 points
•
•
Plan Review Process Work Book Page-12-Revised 3/25/08
Green Points Rating System for Remodeling Projects
Due to the diversity of remodeling project types,assigning a'total points'value to a project to be considered environmentally friendly is •
not feasible. However,25 measures have been highlighted to signify that every effort should be made to incorporate them into your
projects. These items have been chosen based upon their impact on the environment and the health of the home in coordination with
ease of implementation and relative low cost. These measures can be used as a starting point for'greening°your project.
INPUT Resources Energy IAO/Health
A.Site
1,Recycle Job Site Constriction 3 Demolition Waste
65%=1 point;75%= 2 points;80%=4 points up to 4 Resource pts 0
2.Salvage Reusable Building Materials. 4 Resource pts y=yes 0
3.Remodel for Mixed Use,Adaptive Reuse,and
Historic Preservation 4 Resource pts .y=yes 0
4.Protect Native Soil 2 Resource pts y=yes 0
5.Minimize Disruption of Existing Plants&Trees 1 Resource pt y=yes 0
6.Implement Construction Site Stormwater Practices 2 Resource pts y=yes 0
7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0
.8.Design Resource-Efficient Landscapes and Gardens 4 Resource pts y=yes 0
9.Reuse Materials/Use Recycled Content Materials
for Landscape Areas 2 Resource pts y=yes 0
10.Install High-Efficiency Irrigation Systems 2 Resource pts y=yes 0
11.Provide for On-Site Water Catchment/Retention 2 Resource pts y=yes 0
0 0 0
B.Foundation
1.Incorporate Recycled Flyash in Concrete
25%Recycled Flyash=2 points;Add 1 point for every 10% • .
increase of flyash,up to 5 points up to 5 Resource pts 0
2.Use Recycled Content Aggregate 2 Resource pts y=yes- 0
3.Insulate Foundation/Slab before backfill • 3 Energy pts y=yes- 0
0 0 0
C.Structural Frame
1.Substitute Solid Sawn Lumber with Engineered Lumber ' 3 Resource pts y=yes 0
2.Use FSC Certified Wood for framing •
(For every 10%of FSC lumber used=2 points,up to 10) up to 10 Resource pts. 0
. . 3.Use Wood I-Joists for Floors and Ceilings 2 Resource pts y=yes 0
4.Use Web Floor Trusses 2 Resource pts y=yes 0
5.Design Energy Heels on Trusses 6'or more 2 Energy pts y=yes 0
6.Use Finger-Jointed Studs for Vertical Applications 2 Resource pts y=yes 0
7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes 0
8.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0
9.Use Structural Insulated Panels(SIPS)
•
a.Floors 3 Energy pts y=yes 0
b.Wall 3 Energy pts y=yes 0
c.Roof 3 Energy pts y=yes 0
10.Apply Advanced Framing Techniques 4 Resource pts y=yes 0
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes 0
12.Use OSB
a.Subfloors • 1 Resource pt y=yes 0
b.Sheathing 1 Resource pt y=yes 0 •
o o 0
•
•
INPUT Resources Energy IAOIHealth
.Windows
1.Install Energy-Efficient Windows •
• a.Double-Paned 1 Energy pt y=yes 0
b.Low-Emissivity(Low-E) • 2 Energy pis y=yes 0
•
c.Low,Conductivity Frames 2 Energy pts y=yes 0
2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 0 •
0 0 0
J.Heating Ventilation and Air Conditioning
1.Use Duct Mastic on All Duct Joints 2 Energy pts y=yes 0
2.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0
3.Vent Range Hood to the Outside 1 IAO/Health pt y=yes 0
4.Clean all Ducts Before Occupancy 2 IAOMealth pts y=yes 0
5.Install Solar Attic Fan2 Energy pts y=yes 0
6.Install Attic Ventilation Systems 1 Energy pt y=yes 0
7.Install Whole House Fan 4 Energy pts y=yes 0
8.Install Sealed Combustion Units
a.Furnaces - 3 IAO/Health pts y=yes 0
b.Water Heaters 3 IAO/Health pts y=yes 0
9.Replace Wall-Mounted Electric and Gas Heaters with
Through-the-Wall Heat Pumps 3 Energy pts y=yes 0
10.Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y=yes 0
11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yes 0
12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Fumace 2 Energy pts y=yes 0
13.Retrofit Wood Buming Fireplaces
• a.Install EPA certified wood stoves/inserts 1 IAO/Health pt y=yes 0
b. InstalVReplace Dampers 1 Energy pt y=yes 0
c.Install Airtight Doors 1 Energy pt y=yes 0
14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0
15.Install High Efficiency Filter 4 lAO/Health pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAO/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3IA6Mealth pts y=yes 0
o 0 0
K.Renewable Energy end Roofing
1.Pre-Plumb for Solar Water Heating • 4 Energy pts y=yes 0
2.Install Solar Water Heating System 10 Energy pts y=yes 0
3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes • 0
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=18 points) Up to 18 Energy pts 0 •
6.Select Safe and Durable Roofing Materials 1 Resource pt y=yes 0
7.Install Radiant Barrier 3 Energy pts y=yes 0
o 0 0
L Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy pts y=yes 0
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts . y=yes 0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0
• 0 0 0
•
74 3/0.E'
• Quickly Café Ike lac-e (ties
10887 N. Wolfe Road, Cupertino, CA 1 `
a� Y 4%\.p /Wet;tic)
Restroom
• Kitchen
T JUS 4 470/9
40 Deep
Preparation Area
•
[F1
Seatting/Waiting Area do
(Replace New Tiles) C I�
19.5' Wide
Total Store Size= 780 square feet
/ / 33 /3 . 7z/ Chany'es in level , Abrupt Change( 11
leve ( al°9 any cc'cressIhle ro4e shoot r►oF eviceecl /2 incltO
• ( i2.7mm ) , wheel cirannes /'l (fuel do occur, f-hey shat/ be
beveled w'Th 4 slope ho 9re4te1 Matt one vert ver?`cttl
to 2 un }-1-s- horrzot/ f/ (Sopercerf) , ercepf ,a-f level chaM9es
not eiCeebth Y4 iaci C6nvm ) May he verfir4
Community Development
10300 Tone Avenue
Cupertino CA 95014
•
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
•UPERJINO
Building Department
All Cupertino building permits must meet certain conditions related to maintaining
environmental quality and public peace and safety. The two most common
conditions are described below.
STORM WATER POLLUTION CONTROL •
State law requires that Cupertino, 12 other Silicon Valley cities, Santa Clara County and
the Santa Clara Valley Water District control stormwater pollution. Educating local
residents and businesses and enforcing stormwater pollution control laws are key parts
of the City's compliance efforts.
• Stormwater pollution prevention: It's up to us
In northern Santa Clara Valley, storm drains flow directly to local creeks and San
Francisco Bay, with no treatment. Stormwater pollution is a serious problem for wildlife .
dependent on our waterways, for people living near streams and baylands, and for the
local water supply. Common sources of stormwater pollution include:
• Dripped oil, fuel, and antifreeze from vehicles and heavy equipment;
• Construction debris, including dirt, concrete and paint; •
• • Landscaping runoff containing pesticides or weed killers; and
• Any material dumped or spilled into streets or storm drains
The property owner and the contractor share ultimate responsibility for activities
occurring at a construction site and will be held responsible for any environmental
damage caused by subcontractors or employees. •
For more information on construction-related stormwater requirements, see the .
Stormwater Quality Regulations section of the City of Cupertino web site at:
http://www.cupertino.orq/city government/departments and offices/
environmental services
COMMUNITY NOISE CONTROL
The basic noise control requirements for construction sites are as follows:
• Typical construction work hours are: .
- Weekdays - 7 a.m. to 8 p.m.
- Weekends - 9 a.m. to 6 p.m.
• Construction other than street construction is prohibited on holidays.
• Residential daytime noise levels from complaint site - 60 dBA
• Nonresidential daytime noise levels from complaint site - 65 dBA
For more information on noise control, please see Chapter 10.48 of the Cupertino
Municipal Code, which can be accessed at http:/lwww.amlegal.com/cuoertino cal
• •
Greg Casteel
Building Official
OWNER-BUILDER VERIFICATION
• 1. (Check one) I or my immediate family (parent, spouse or child)will perform:
A. K 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 f perjury th the abo e is true and correct. I have read and understand the
Owner-Builder Information (rev•rseside).
7/Property Owner's Scignatur 111V• �,, \.,, Date: UQ
.r
Job Address: I 0 0 R7 1e WDt Ec oad atrertri 0, Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
• Department.
CITY OF • City of Cupertino Building Department+
C U P E T I N O 10300 Torre Avenue
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
Printed on Recycled Paper
Quickly Cafۥ Pe lace <<I eS
10887 N. Wolfe Road, Cupertino, CA
cd- Yak / Wartic)
/� reo 11
Restroom
t �
Kitchen
•
..
40 Deep
Preparation Area
1
m
cocoO
• • n
Seatting/Waiting Area
(Replace New Tiles)
19.5' Wide • 'JUL 14 MS
Total Store Size= 780 square feet
1133 l3 , 7 Q • Chanles %n /eve/ , A hcapt cartes rn
level alone any cCcessihlk roafe Sha(( nor evicecc 56 i�IC�t�
• Ci2. 7mm ) , • wheel ehlaii9es irl (fuel do occur, f-hey shall be
het/elect with 4 slope no greater Metal one unit verf/caf
to Z Un !tc hor,zonfal (5o percent) , ercepf- level chances
not etceechh %4 66nrm ) may be verfirct.
Community Development
At 10300 Torre Avenue
Cupertino CA 95014
w .
i'
Rte\ J Telephone(408)777-3228
CITY OF Fax(408)777-3333
•UPERTINO
Building Department
JOB ADDRESS: /o &7 N Wolfe Road arrn'no PERMIT ,2 a0�
OWNER'S NAME: a m Y 1/15
GENERAL CONTRACTOR: FAX PHONE # 5!U� &`O� �00
I am not using any subcontractors: 74 3 /4
3
Signature Date
Please check applicable subcontractors and complete th e 'lowing 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
ck
Tile
ntractor Sigr/$ture Date