11030073CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10991 NORTHSKY SQ I CONTRACTOR: ROY BENJAMIN PERMIT NO: 11030073
OWNER'S NAME: ROY BENJAMIN 110991 NORTHSKY SQ I DATE ISSUED: 03/15/2011 1
OWNER'S PHONE: 4088599802
u LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor
Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, 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 provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature.
Date
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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 & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code). 463
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, 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 provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Vis, and expenses which may accrue against said City in consequence of the
sting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Y
CUPERTINO, CA 95014
PHONE NO:
r f— F
BUILDING PERMIT INFO: BLDG ELECT PLUMB
r r r—
MECH RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: ADD 2 SKYLIGHTS TO ROOFTOP
Sq. Ft Floor Area: I Valuation: $1616
APN Number: 31640005.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAY SAF PERMIT ISSUANCE OR
180 DA OM LAST CALLED INSPE TO
.
Issued by: Date:0 /�
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should 1 use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sectio s 25505, 25533, and 25534.
OwAter or authorized agent: � Date: 41V11
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
OWNER -BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 '
(408) 777-3228 • FAX (408) 777-3333 • building(a—�cupertino.org
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at: 1 10 3Cl'i�-Nq3
SITE ADDRESSAPN BP#
16 ? 9/ N c,- MS> <y �S' atPak-) MIC)
O NER NAME I ^ OWNER ADDRESS.
DESCRIPTION OF WORK:
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner- We
will not issue a building permit until you have read, initialed your understanding of each provi §i d, and
returned this form to us at our official address indicated. An agent of the owner cannot e e notice unless
you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS: Please read and initial each statement below to signify you understand or verify thi his 'n
ion.)
Y
1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material
personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my
insurance coverage for injuries to workers on my property.
P6 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contractor to assume this responsibility.
P&3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may
protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
name instead of my own.
4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
�5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be
considered an "employer" under state and federal law.
R6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and
federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
�6_7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is performed under contract with a licensed general building Contractor.
�J 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction
defects in the workmanship or materials.
OwnerBuilderForm 2010.doc remised 04114/10
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(abcupertino.org
MEP
MISC
L jPLUMBING LJ MECHANICAL LJELECTRICAL InMISCELLANEUUS
PROJECT ADDRESS
APN #
OWNER NAME6-F/U , v7 jA,
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E-MAIL
STITREoET ADDRESSr]/
CITY, STATE, ZIP c� �"'3^ /
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FAX
APP�,ICANT� NAME / Y ,
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E-MAIL
STREET ADDRESS
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FAX
OWNER OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPw4ANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS q j Y
A '
COMPANY NAME
E-MAIL
AX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
•
IC
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF
PROJECT IN WILDLAND
STRUCTURE: Residential ❑ Commercial
URBAN INTERFACE AREA ❑ Yes ❑ NO p FLOOD ZONE ❑ Yes ❑ No
I TOTAL VALUATION: I RECEIVED BY: I
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: �Cu� Date:
SUPPLEMENTAL INFORMATION REQUIRED = ,OMCE use ONLY
MEPMiscApp_2011.doc revised 03/02/11
CUPERTINO
March 1, 2011
BUILDING PERMIT / APPLICATION EXPIRATION LETTER
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(&-cupertino.org
ROY BENJAMIN
10991 NORTHSKY SQ
CUPERTINO CA, 95014
SUBJECT: BUILDING PERMIT / APPLICATION EXPIRATION LETTER
Site Address: 10991 NORTHSKY SQ"'°
Permit Number: 10070110
Permit Expiration Date: 1/24/2011
FOR EXPIRED PERMIT APPLICATIONS: According to our records, a building pe>1a�ee�iKf�een
issued for your permit application (noted above). Since an extension was either not requested or not
granted, your construction permit application has expired.
The permit application is null and void and you have 10 business days pick up your plans and documents
or they will be recycled. The permit application will be voided in our Permit Tracking System and all
documents pertaining to the permit application will be recycled.
FOR EXPIRED BUILDING PERMITS: Your Building Permit (noted above) has expired. Please
contact our office within 10 business days to let us know you plan to re -activate the permit. Discretionary
Planning Approvals are also subject to expiration. Please refer to the Planning Department to
determine if a new planning review process is required A code enforcement case will result if a
construction site is left abandoned and unsafe. Please review your following options to re -activate your
building permit:
Construction has been suspended or abandoned less than one year. A request in writing to extend
your building permit may be submitted provided no changes have been made or will be made in the
original plans and specification for such work. Valid reasons shall be cited for the delays on your
construction schedule with a justifiable cause demonstrated to the Building Official. The extension, if
granted, will be for a period of not more than 180 days. A $39 processing fee plus one-half the current
permit fees will be due upon submittal of the request. An extension will NOT be granted if any codes or
any other pertinent laws or ordinances have changed subsequent to the date of application.
Construction has been suspended or abandoned more than one year or codes have changed
subsequent to the date of application. A request in writing to renew your building permit may be
submitted. A $39 processing fee, $126/hour exploratory inspection fee and full plan review and permit
fees will be due upon submittal of the plans for the project. For projects that require plan review, six (6)
new sets of plans designed to meet current code are required to be resubmitted for review. An exploratory
inspection will be required to determine if any part of the existing construction can maintain vested rights
with Building Codes standards in effect at the time the original building permit was issued.
Sincerely,
Sylvia Mendez
Senior Office Assistant
City of Cupertino
sylviamncupertino.org
Expiration Letter. doc revised 12/06/10
CUPERTINO
March 1, 2011
BUILDING PERMIT/ APPLICATION EXPIRATION LETTER
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building@cupertino.org
ROY BENJAMIN
10991 NORTHSKY SQ
CUPERTINO CA, 95014
�0 91 -
s
P QJ i' -
SUBJECT: BUILDING PERMIT / APPLICATION EXPIRATION LETTER
Site Address: 10991 NORTHSKY SQ
Permit Number: 10070110
Permit Expiration Date: 1/24/2011
FOR EXPIRED PERMIT APPLICATIONS: According to our records, a building permit has not been
issued for your permit application (noted above). Since an extension was either not requested or not
granted, your construction permit application has expired.
The permit application is null and void and you have 10 business days pick up your plans and documents
or they will be recycled. The permit application will be voided in our Permit Tracking System and all
documents pertaining to the permit application will be recycled.
FOR EXPIRED BUILDING PERMITS: Your Building Permit (noted above) has expired. Please
contact our office within 10 business days to let us know you plan to re -activate the permit. Discretionary
Planning Approvals are also subject to expiration. Please refer to the Planning Department to
determine if a new planning review process is required A code enforcement case will result if a
construction site is left abandoned and unsafe. Please review your following options to re -activate your
building permit:
Construction has been suspended or abandoned less than one year. A request in writing to extend
your building permit may be submitted provided no changes have been made or will be made in the
original plans and specification for such work. Valid reasons shall be cited for the delays on your
construction schedule with a justifiable cause demonstrated to the Building Official. The extension, if
granted, will be for a period of not more than 180 days. A $39 processing fee plus one-half the current
permit fees will be due upon submittal of the request. An extension will NOT be granted if any codes or
any other pertinent laws or ordinances have changed subsequent to the date of application.
Construction has been suspended or abandoned more than one year or codes have changed
subsequent to the date of application. A request in writing to renew your building permit may be
submitted. A $39 processing fee, $126/hour exploratory inspection fee and full plan review and permit
fees will be due upon submittal of the plans for the project. For projects that require plan review, six (6)
new sets of plans designed to meet current code are required to be resubmitted for review. An exploratory
inspection will be required to determine if any part of the existing construction can maintain vested rights
with Building Codes standards in effect at the time the original building permit was issued.
Sincerely,
Sylvia Mendez
Senior Office Assistant
City of Cupertino
sylviam@cupertino.org
Expiration Letter. doc revised 12/06/10
lw-Go --Ak,
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a
PLAN VIEW
10991 Northiky Square
Cupertino, Ca. 95014
2X8 24"O.C.
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�ONORTHPOINT HOMEOWNERS ASSOCIATION
10880 NORTHPOINT WAY
CUPERTINO, CA 95014
(408) 996-3734
Roy and Simona Benjamin
10991 Northsky Square
Cupertino, CA 95014
Re: Skylight approval
Dear Mr. and Mrs. Benjamin,
NPHOA.ORG
November 30, 2007
This is to inform you that your request for skylight installation dated October 16, 2007
has been approved by the Board of Directors.
Please note all installation requirements and responsibilities on the Architectural
Review application, a copy is attached for your information.
Also, I would like to remind you that on Monday, December 3, 2007 the fence repair
people will be doing the needed repairs on your fence.
Thank you,
Linda Starnes
On Site Manager
MAR 15 2011
PML MANAGAGEMENT, 655 Mariners Island Blvd. Suite 301, San Mateo, CA 94404 (650) 349-9113
CUPERTINO
OWNER -BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 05014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinana cuoertino.org
r
Dear Property Owner(s): t
An application for a building permit has been submitted in your name listing yourself as the buirproperty
improvements specified at: 1o�
SITE ADDRESS APN B #
OWNER NAME OWNER ADDR ss
/�d ' cf C'.G(' l illO
DESCRIPTION OF WORK:
n L_cQ
S
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We
will not issue a building permit until you have read, initialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.)
A1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material
personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my
insurance coverage for injuries to workers on my property.
* 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contractor to assume this responsibility.
&L3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may
protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
name instead of my own.
4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
t5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be
considered an "employer' under state and federal law.
�6. I understand if I am considered an "employer" under state and federal law, I must register with the state and
federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
�6_7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is performed under contract with a licensed general building Contractor.
6 J 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction
defects in the workmanship or materials.
OwnerBuilderFortn2010.doc revised 04/14110