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09030133 . . . 7777777777=1 77777777. CITY OF CUPERTINO BUILDING DIVISION PERMITMo ._Mom BUILDING ADDRESS: PERMIT NO. 20800 VALLEY GREEN DR #500 TBD — OWNER'S NAME: PERMIT ISSUE DATE HO A CONTROL NO. ABUILDING PERMIT INFO RCHITECf/ENGiNEER: BLDG ELECT PLUMB MECH U O C LICENSED CONTRACTOR'S DECLARATION Job Description m I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Professions Code.and my license is n in full force and effect. INSTALL WASHER/DRYER UNITS IN APTS—INCLUDES D v2 Z License Class Lic•N r ±t,o Date Contractor E/M/P S-SEE PERMIT #09030198 FOR PLAN CK ARCHITECTS DECLARATION �d< I understand my plans shall be used as public records COMMENT 3. '°" (DOUBLE FEES) U.y Licensed Professional G< OWNER-BUILDER DECLARATION } I hereby art,,.that I am exempt from the Contractors License Law for the Ofollowing reason.(Section 7031.5,Business and Professions Code:Any city or county y which requires a permit to construct.alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation Xh (commencing with Section 7000)of Division 3 of thc Business and Professions Code)or 8100 y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). 32609040 .500 ❑1,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 Required Inspections and Professions Cade:The Contractors License Law dors not apply to an owner of q P property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, 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 I,as owner of the property,am exclusively contracting with licensed contractors to wnstnct the project(Sec.7044,Business and Professions Code:)The Contractors Li- ccuse Law does not apply to an owner of property who builds or improves aeteon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law. ❑[am eexxemmp�t under/Set: B&P C or th' reason Owner Date 5 ' WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: C3 I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation insurance carrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section recd not be completed if the permit is for anc hundred dollars($100) or less) I certify that in the performance of the 'k which this permit is issued.I shall not employ any person in any manncrg sa�dtt�a6b,,bbeec mCy.3csy7�ect to the Workers'Compcnsalion Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Cade,you must 0 forthwith comply with such provisions or this permit shall be deemed revoked. Z" CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of pi the work for which this permit is issued(Sec.3097.Civ.C.) a0 Lenders Name ]Z Lenders Address V Q 1 certify that I have read this application and state that the above information is LL►" correct I agree to comply with all city and county ordinances and state laws relating to Vbuilding rnnstruction,and hereby authorize representatives of this city to enter upon the W above-mcntioncd property for inspection purposes LL (We)agree to save,indemnify and keep harmless the City of Cupertino against to liabilities,judgments,costs and expenses which may in any way accrue against said City U`L in consequence of the granting of this permit. Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NPN-POINT Issued by: • (X. Cl S -AP UR REGU TI` ONS. \.J��^ � �� Re-roofs Signature of Applicant/Contractor '11 Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will toe applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Cade,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Ycs �lo If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? L Yes (yyrto 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&SafetyCodc,Sections 25505,25533 and 25534.1 understand sat if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the re uircments which m be met art issuance of a Certifeae of occ panty.! Signature Of Applicant Date TrIC.�da� ��/ O� All roof coverings to be Class'``or better Owner or authorized agent nit, A :: :: a see 3:"sa`>_x;s .. . CITY OF CUPERTINO .>,.�.:.. ;H :. BUILDING DIVISION PER ',. .. ".���i2.�...`.'m�rx.� ?>, BUILDING ADDRESS: PERMIT NO. 20800 VALLEY - OWNER'S NAME. J ) PERMIT ISSUE DATE JQ L/ 2009 PHON : A CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o c LICENSED CONTRACTOR'S DECLARAnON Job Description E= I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z rvj, with Section 701111)of Division 3 of the Business and Professions Code,and my license is °`oH in mu fora anderfed. INSTALL WASHER/DRYER UNITS IN APTS-INCLUDES ?24 License Class LIC.x ;F Q Date Contractor E/M/Pi S-SEE PERMIT #09030198 FOR PLAN CK HITECrs DECLARATION- 15-4 ARC 1 understand my plans shall be used as public records COMMENTS. e m I•- Licensed Professional (DOUBLE FEES) < OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the -CHofollowing reason.(Section 70315,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure which Z y prior to its issuance,also requires the applicant for such permit to file a signed statement that he is lianscd pursuant to Ute provisions of the Conuacmrs License Law(Chapter 9 Sq.Ft.Floor Area Valuation tx-O (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 70315 by any applicant for a permit subjects We applicant to a civil penalty of APN Number Occupancy Type not mote than five hundred dollars(S500). ® 32609040.500 ❑I,as owner of the property,or my employees with wages as their sok compensation, will do the work and the structure is not intended or offered for sale(Sec.7044:Business Required Inspections and Professions Code:The Contractor's Licwtm law daes`not apply to an owner Of 9 P property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements am-not ingndod oroQered forsale.If. however,the building or improvement is sold within one year of completim the owner- builder will have the burden of proving that he did not build or improve for purpose of sal . as owner of the property.am exclusively contracting with licensed contractors to construct the pmject(Sec.7044,Business and Professions Cede:)The Comtractues Li- curse Law docs not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractees. License Law. ❑I am exempt under ung der-(Sec. - n ,B&P C ter mason Own. 1 ►Vt WV4n� I�V ' Date �J V WORKER'S COMPENSATION Dtx-r eRsTION I hereby affirm under penalty of perjury one of the following declarations ❑1 have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Workers Compensation lasunnce,as required by Section 3700 of the Labor Code.for the performance of the work for which d&permit is issued. My Workers Compensation Insurance carrier and Policy number am: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc hundred dollars($100) or less) I certify that in the performance of the ork f which this permit is issued.I shall not employ any person in anymannersy,a Vq ccdmastrmectwtheworkers'Compensation Laws of Date JJ [� Applicant California.Y NOTICE TO APPLICANT:If,after mating this Cerifict a of Exemption,you should become subject to the Workers Compensation pmvisions.of the Labor Cade:you must 0 O forthwith comply with such provisions or this permit shall be deemed revoked. z CONSTRUCTION LENDING iAGENCY 1 hereby affirm that there is a consuuction lending agency for die performance of tYi> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lenders Namo r7 ZLenders Address . U 0 I certify that I have read this application and state that the above information is itr►-" corccL I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the a above-mendoned pmperty for inspection purposes. . (We)agree to saw,indemnify and keep harmless dee City of Cupertino against r�r liabilities,judgments,costs and expenses which may in any way accrue against said City V 2 in consequence of the granting of this permit r-h APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N-POINT Issued by: Date SMUR T10NS. 6 Q _ -�J�-�- , Re-roofs Signature of Applicant/Contractor Wale I HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or futum building occupant store or handl hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety cnil,Scdion 25532(a)? �r All roofs shall be inspected prior to any roofing material being installed. ❑Yec gyrro If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building oceupantnscequipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? - ❑Yes Imo 1 haw read the hazardous materials requirements under Chapter6.95 of the Califor- nia Health&Safety Code Sections 25505,25533 and 25534.1 umdouand thKif the building does not currently have a tenant,that it is my responsibility to notify the occupant of the uiremcnts which m t be met err issuance of a Ccrificaate of pec Signature of Applicant Date re �C �' �'�" I All roof coverings to be Class'J� or better Owner or authorized agent tD te CTYOF CITY OF CUPERTINO CUPEkTINO GENERAL. BUILDING PERMIT APPLICATION FORM APN# Date: 2L- 0 C(- o L/o a o6 Building Address• �y / 'Zo b Mailing Address (if different fr m building address): Owner's Name: R 12 -S Phone#: HOA: (Exterior work only) ,Yes U No 14 o oze:�o If yes, provide letter from HOA Contractor: T Phone: � � Fax: . Contractor License#: T� Cupertino Business License#: Contact: Phone: Fax: L108-- '773- �d2S Residential Commercial ❑ Job Description: t tt Sjc �0 13.1 1 `t Building Permit Info: Bldg 'Z Elect &r' Plumb Woe' Mech L� Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B [f —2- Valuation: /00, 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 et& the sheet index. Points Achieved: For help, contact Build it Green at www.buildilgreeg.org Revised 02/05/09 j 's -��,- CITY OF CUPERTINO CIN°fGENERAL BUILDING APPLICATION CUPERTINO 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) 1 WINMEWSTR New Window-structural shear B wall/masonry(includes plan ck fee) 1EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1 MECPLNCK 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 when not over counter) hourly-stand alone 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES IBSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1TRAVDOC Travel &Documentation B 1 BUSLIC Business License B �� (�V 1�F-P l,Pt,= 5 of 5 _a City of Cupertino Building Department CITY OF 10300 Torre Avenue C 1 I P E R T I NO 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 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. -).Z 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 - „� .ow3 3%S Witt R. N 634 M2 a8Cc, sf� 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 V 3026 g3( S39 Baso P Wu,,., , eA Donola, 4%X - a $3� (,, 8 Bann`�o ..................................................................................................................................................................................... I declare-.tender penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information (reverse side). Property Owner's Signature: Date: Job Address: 5 00 t=- vlO, 64 Permit# Apy changes to the.information provided on this form shall be submitted to the Qjy of Cupertino Build Department.