08100038 CITY OF CUPERTIN_O
BUILDING DIVISION PERMIT VEONTRACT Olt'INFOMON,
FERMI I NO.
Bu1L0.1HctM%'7kOFIELD DR TBD — TO BE DETERMINED 08100038
OWNER'S NAME: PERMIT ISSUE DATE
NEWMAN MARJORIE R AND WILLIAM 10/07/2008
NE: SANITARY NO. CONTROL NO.
ARCHMCffENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
X00 LICENSED CONTRACTOR'S DECLARATION lob Description
fim w
C wr 1 hereby afthat 1 limn under ProviS oto of Chalem 9(mamearm ng P
Ztlyo th5ectim7IXg))ofDivuion3ofdreBusiressandProfesi Cwsa.a mylianau SVC UPGRD TO 200AMP W/SUBPNL IN GRG &INSTL 4
ani ucfc^IsfmOa'le�nelrect. Ix.g DEDCTD 20AMP SNGL PHSEE 120V CRCTS, (1 LNDRY, 2 IN
2� Dam ARCHrr6CrSDDECLARATION KTCH.2 N06 30AMP DRYR PLG IN LNDRY (ALL CRCTS FED
W6
I undnsund my plans shall be used u public records
a.
s Guls
t7 Licd Professional
3 OWNER-BUILDER DECLARATION
1 herby aRrm Net 1 am exempt from to Contractor's License Law for the
Q O following reser..(Salon 7031.5,Business and Professions Cade:Any city or county
� which squire a permit to consWct,slur.improve.demolW,err repair any nmctum
:Z t, print b its issuance.akn mstims BC applicant for such Permit w file a signed c admeml
E `e thYM6licensedpur>vantmrocpmaeavnrthe canaamrsu�nsl.w(Chxpmr9 Sq.FL Floor Area $5800 Valuation
x a (commencing wits Section 7000)of Division Sof the Business and Professions Cods)or
f 5 F that he is exempt therefrom and the basis for the alleged asmptim.My violadan of
Section 7031.5 by any applicant for a permit objects the applicants o a civil penalty ofNumber Occupancy
not mart Nur few hundred dollars(5300} 3 5 910 0 01 . Parc Y Type
I,as owner orde property,army emPloyem with wages"debsk mmpewdm,
wiOdo Ne work and Neswctus6mlinumhdaanerws(mask(Sa.7M0,Busirm Required Inspections
Yid PNfaSLON Code'The Comsectole IJRM1A:U.daCl MI apply to N Pxner of `I P
property wM beildamiroproves thceon.and who doessuchwart himself ,Omagh hit
own employcel,provided that such improvements ore notinunded mortared rorsala 11
however,a e building or impoommaml Is sold within one year of completion,the owmr-
builder will have the Wreer of proving Nat he did rot kdld m improve for purpose of
mak.
1,u owner of the propen,am exclusively canoasting wits Raved comranon b
cont act the project(Sec.7040.Bviness AM Pmlessians Cade:)The Comuames Li-
cove Law does not apply As an owner of property who Wildt or Improves themon.and.
who contracts for such projects with a conYstor(U licensed pmsuan,to Nc Comacene.
License law.
lamemomnmadryder See & .B&PcfeaNumasen
owner (.� // �.Cs/1��Date 10114
WORKER'S SATION DECLARATION
I barely M.under penalty,or perjury ora of the following declarxtiav:
I haw and w01 maintain•CeniOos of Covent at self-insure far Wortdscompen-
radon.An provided fm by Section 3700 of the labor Cade.fm lac performance of the
wart far which Nu Permit 6 issued.
❑I have and will maintain Woftes Compensation Ivunve,as required by Section
3700af Ne Labor CMB.for the performance of Ne wort for which this permit is issued, '
My Worker's Compsrrwime huuruue camera and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EKEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(N6 sedan Iews not he compleud If du permit Is income hundred dollars(SIM)
Or Irma)
1 c odfy land in Ne performsoce of the work far which this Farrell is issued 1"I NO
employ any Person in my me b mhjeclto BYWortus'Compewdm
Laws of t ifog -Da e
Nal"ICAppuet APPLICANT.
NOnCE TO APPLICANT:IL after Compensation
this Lesions or of E Labor
od you sham
become subject y id Wohcr's Compensation orTIL ons of end labor Cade.you muu
0 fanhwith camplY wits such pmvitiov a Nu permit shall be dcemnd mrotcd.
'Z ^ CONSTRUCTION LENDING AGENCY
F+� Ihembyarfim that Nem is.coatorada lendingagemcy far the perfmm..1'
Ci the wart For which Nu permit Is issued(Sec.309'(,Civ.C.) '
Q lender's Name
z lenders Andress
UC) 1 earthy that I have news this applicuim madman:that lac above iNomutim 6
w E mated I age tecomply wits all oily and county mdindNrrRa aisle laws rekdng b
C) �Vbuilding conswctian,Wherebymman=repmxnuliwsaftsueity tocnmrupon Ne
W alneve-mentioned pmNny run inspection purposes
(We)agree b save.indemnify and kap hamless the City of Cupertino against
liabilities,judgments,cons and existence;which may in any way acme against said City
U,z I.mracqucnce of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date IQ—1
SOURI REGULA Is
10/-71,9 d' Re-roofs
Signatures ApplicamUComlractor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WH the appBont or No.building accupam slam Or handle hazardous material .
aa defined by the Control.Municipal Code.Chapw 9.11,and dee Health and Safety !�
Code.rosy.25532(,)r C Ely. Na All roofs shall be inspected prior to any roofing material being installed.
Will Ne applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardnv air cmtsmimants An defined by tha Bay Area Air Warily Management all new materials for inspection.
amm"
❑Yo No
1 have mad the harardow matana6 requimmcnts under Chapter 6.95 of the Califor.
as HcoIN&Safely Code,Sectiones 25%5.25533 and!25534.1 undemtsmd Nu if 0m building
does an,currently have a meant.than It 6 my mrpartumbly to Mary N4 occmNt of the
requirements which note, 1priarb issaarcc afa Certifeam ar occupYey. Signature of Applicant Date
�; ' "` ��ef' , /0/7Zy All roof coverings to be Class'W or better
Owner or antomeasdagent Data
CITY OF CUPERTINO
• 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35910001 . 00
DATE ISSUED. . . . . . . : 10/07/2008
RECEIPT # . . . . . . . . . : BS000006292
REFERENCE ID # . . . : 08100038
SITE ADDRESS . . . . . : 20738 SCOFIELD DR
SUBDIVISION . . . . . . . -
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : NEWMAN MARJORIE R AND WILLIAM
ADDRESS . . . . . . . . . . : 20738 SCOFIELD DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2962
RECEIVED FROM . . . . : CYNTHIA PALACIO
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 5, 800 . 00 0 . 60 0 . 00 0 . 60 0 . 00
1BUSLIC FLAT RATE 1 . 00 110 . 00 0 . 00 110 . 00 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1ERT<200 UNITS 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1PRWHEATR UNITS 1 . 00 24 . 48 0 . 00 24 . 48 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
- -- ------- ------- ----------
TOTAL PERMIT 257 . 45 0 . 00 257 . 45 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
--------------- --------------------
CREDIT CARD 257 . 45 VISA
---------------
TOTAL RECEIPT 257 . 45
.s�"- s � -��.� ,ss.. t .q,a t ars- 4 "'�y$e;" a -,3 .' }-�,.; Jt Ey t 7 r"`. [r"� y ''+•a 'b +�-.
�� g RESIDENTIAL $ROJECTdCOVER SHEETr�° x r '
41
Assessor's Parcel Number: 0
Name of owner. 't--(i n
Project address. �iy--7 38 G{ b-,- I "�
Contact person. K(. S &Ars rr Phone. S1 1 7 7 a u-g�
Fax.
Net square footage of lot. /Nr
Existine Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
46e there at least two 10 foot by 20 foot clear spaces inside the garage?
Is privacy protection planting required for the project? I�N
On what floor(s) is work being.done? �� �
4.r dP to a P.4k
Brief description of work. Sfe/vx,-t cue 41 I IS-o 42:- 2 P "S
A"J 1 (3 C, Grp c � (�Na „�. r'ti c ja+r& d"t4C 7• mss( c ra � fs
Code editions: 2008 CBC (Y -N)2008 CFC <(Y N)2008 CMC (Y-N)
2008 CPC (,_-N)2008.NEQ:ia Q N)
IN ALMaD.41"'CE tJITN THE CfiY 0
CSI BMNO (ODES AND OgDIPANCE,
Effective 1/1/08 DATF,��(�
be kept on ti" atlons QiUS, f
lawful mei s. itis un
on samea al with u �, � � or alteration �1v(llr�Ulr� COPY
the building b,p,,, mssion fron
The Stamping of iks p n r�.tino.
3HALL NOT behold t specification
Ipproval of the violctidnpof snor to be ai
• t anv city Ob nnnrFnr �mta I flProvision•
OCT o 72001
Plan Review Process Work Book Page-B-Revised 1/1/08 -
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. _<P_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
/-R s ro PI{cR- 644_ Dver& >� o
510 k Yc�r
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 sidle),
Property Owner's Signature: �1r 7 it �� i L�✓Y /— Date:
Job Address: 7 3 SGo �/ u irs+ 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 A I 10300 Torre Avenue
C U r(�C kT I I�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 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
Community Development
10300 Torre Avenue
y - Cupertino CA 95014
` Telephone(408)777-3228
CITY OF Fax(408)777-3333
4UPERTINO
Building De artment
JOB ADDRESS: 0-7 38 Sc-oPj` PERMIT #
C (F 0002
OWNER'S NAME: en PHONE #
GENERAL CONTRACTOR /t/1 FAX #
I am not using any subcontractors: �44.0 xglcl `�•� 10/7/a
Signature Date
Please check applicable subcontractors and complete the followinginformation:
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
A:2�11 /24. a kuH ��
OwOd
ner/Contractor Signature Date
oSI o ou3�
OF CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING o�
PERMIT APPLICATION FORM
APN # Date:
o�� q / i�c�c.� l • o u I b � 08
Building Address: a o-t 3 8 S co �� Gwluc -kwo Ctq
Mailing Address (if different from building address):
Owner's Name: d- C�r,a &J n ati Phone#: 5-! 0 _ 4-7 2-
..Contractor:
Contractor: Phone:
(_ Y Fax:
Contractor License #: CIO - 7 31'3
Cupertino Business License#:
Contact: 01, Ckf Phone: — -7 -Y2--2-1
Kr-i S c�.r�r-erg �.-c-• °^trocfsr 5 t O - S` t 7- 7 f/ a
• Fax:
Residential Commercial / l
Job Description(0 �* �I
S ;x s� .1-1.0 V C� rc-t-4-r
30 1 yew -
Two
CGREJZ�c Ctfc. S a `2Q V2`Building Permit Info:
Bldg E9- Elect 0-` Plumb a- Mech 0--
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B
Valuation: �5600 Square Footage:
Project Size: Express 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.builditgteen.org
Oct ( t
�"'t r-" dh— e ` � PP Revised 7/01/08
PA"-R-
c_cu�./
Put
CITY OF CUPERTINO
CITY OF
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1 BBOILERI 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)
1 BBOILER2 Installation /relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
I 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
1 BBOILER4 Installation/relocation of ea M •
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorpiio'ri"sys over 1•,000,000 Btu/h to '
& incl 1,750,000 Btu/h
1 BBOILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h "
1 BAPPLOTH For ca 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.
J
IELECINSP Other Electrical Inspections (per hour) E
1 MECHINSP Other Mechanical Inspections (per M
hour)
1PLMBINSP Other Plumbing & Gas Inspections P
(per hour)
1MEETINGIHR Application Meeting B •