14040004CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10146 ALPINE DR
CONTRACTOR: AVRAM MEYERS AND
PERMIT NO: 14040004
GALE MEYERS
OWNER'S NAME: AVRAM MEYERS AND GALE MEYERS
2397 ROMANO CIR
DATE ISSUED: 04/01/2014
OWNER'S PHONE: 4155156644
PLEASANTON, CA 94566
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL F]
* *UNIT 1 ONLY ** UPDATE/UPGRADE ALL ELECTRICAL
License Class Lic. #
INCLUDING: RELOCATE & REPLACE (E) UNIT 1 PANEL
FROM COMMON LAUNDRY AREA TO INSIDE HALLWAY,
Contractor Date
37 (N)
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.
Sq. Ft Floor Area:
Valuation: $4000
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 32615105 00
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
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
WITHIN 180 D -AE-PEIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We) agree to save
180 D OM LAS LED INSPECTI N.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
against said City in consequence of the
/
costs, and expenses which may accrue
Issued by: Date:
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,
RE- ROOFS:
Signature Date
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.
OWNER- BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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)
, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self - insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cuperti Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sect' s 550 , 2 3, a 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: 1 Date: l `
permit is issued.
/]
ertify 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
CONSTRUCTION LENDING AGENCY
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
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C )
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regula ns per the Cupertino Municipal Code, Section
Licensed Professional
9 18.
I Date L ' l
Signature
GENERAL PERMIT APPLICATION �
A� CEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 ` O
(408) 777 -3228 • FAX (408) 777 -3333 • buildin -g a.cupertino.org MISC\\"�,`
11 A, Qf =T T AATF:OTTc
UrL,urviDUVV
PROJECT ADDRESS /� %/ �t / ` ��1 r� %
Y
APN #
OWNER NAME PHONE /lj`i
E MAIIaI%l(/�J (a'a`^'�
STREET ADDRESS / /
CITY, STATE, ZIP 4
7-/ je FAX
' `
CONTACT NAME J
J
PHONE
E -MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER OWNER- BUIIDER ❑OWNER AGENT ❑CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX MULI- FAMILY
TPROJECTINWILDLAND ❑
PROJECT IN ❑ YES
[t]O
IS THE BLDG AN ❑,., YEAS
EICHLER HOME? L7'rvtl
BUII.DING: ❑ COMMERCIAL -
URBAN INTERFACE AREA NO
FLOOD ZONE
DESCRIPTION OF WORK CZ- 4e c- / C A Z- �
Jf
-3 7
c� 5
'RE'CBICrED
TOTAL VALUATION: O�
By my signature below, I certify to each of the following: I e property owner or authorized
ent to act on the operty owner's b have read this
application and the information I have provided is correct. Kayle read th escription of Work and verify it is accurate. I a mply with all applicable local
ordinances and state laws relating to build onsPetio . thori epresentatives of Cupertino to enter the above -� nti fji d property for inspection purposes.
Signature of Applicant/Agent:
Date: `7
SUPPLEMENTAL 'ftF07ttION REQUIRED
_ toFcE usE oiL�.
NEW— FI-01.
� �sT.AND�AI2D
MEPMiscApp_2011.doc revised 06121111
4"
CITY OF CUPERTINO
1 1PIPIWi. F.CTTMATnR — RITII.DING DIVISION
[&IADDRESS: 10146 ALPINE DR UNIT 1
DATE: 04101/2014
REVIEWED BY: MELISSA
APN: 32615105
BP #:
EVALUATION: 1$4,000
*PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
p
PENTAMATION 1 REAP2
USE:
$47
PERMIT TYPE:
WORK
I * *UNIT 1 ONLY ** UPDATEMPGRADE ALL ELECTRICAL INCLUDING: RELOCATE & REPLACE E
SCOPE
UNIT 1 PANEL FROM COMMON LAUNDRY AREA TO INSIDE HALLWAY, 37 (N) OUTLETS, 26 (N) p
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Services
1ERT <200
150
Amps
$47
Recep /Switch /Outlets
1BREMRECEP
,Salppl. 11rsj) d'ce
63
#
$262
Fixtures, Lighting
1BREMFIxT
PME Permit Fee:
54
#
$328
Administrative Fee: 1ADMIN
$44.00
Work Without Permit? 0 Yes E) No
$0.00
TOTALS:
_
$637.00
Strong Motion Fee: 1BSEISMICR
Plan (.'heck
iF1e,, 1A Permit Fee,'-
1,kc {i. Cosu. 1 c:
1117 a;b. Plum Ch(;, <4,
Plumb. llcrmil Fee:
(:her Plumb bash.
Phinib, hrAp. F`ee:
NOTE: This estimate does not include fees due to other Departments (i.e. Ptammng, ruouc works, rrre, aamrary ,3ewer "isrrec, 13cuuor
n..- :. Tt f r. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11 -.053 Eff. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan C:'hecl,: F!C:
5lijq)l, PC" Fee
PME Plan Check:
$0.00
,Salppl. 11rsj) d'ce
PME Unit Fee:
$637.00
PME Permit Fee:
$47.00
Con,stvw lion Tax: -F-T
Administrative Fee: 1ADMIN
$44.00
Work Without Permit? 0 Yes E) No
$0.00
r1(1V( PCe t1 Planning Fees:
Travel Documentation Fee: 1TRAVDOC
$47.00
Strong Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
$ 776 50
$0.00 L FEE:
776.50
Revised: 01/15/2014
M
CUPERTINO
OWNER- BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255
(408) 777 -3228 - FAX (408) 777 -3333 - buildino(a )cuoertino.org
Dear Properly 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:
SITE ADDRESS /9
I APN �s��^ lfJ� BP #
` v
KI
0WER NAM E J �l r ,
OWNER ADDRESS: �•�
DESCRIPTION OF WORK:
If Z_ 1/, G /
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 veri l this information.)
� . I 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.
4 in� . I 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.
�pr3. I understand as an "Owner- Builder" I am the responsible party of record on the permit. I understand that I may
otect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
�
name instead of my own.
y
C•�l A. I understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
Qk5. I. 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.
0A. 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.
6e&. I 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.
&. I 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.
0i4;7ie]B1dIde7Fo7771 2010.doc revised 04114110
E
r• fyl : I understand I may obtain more information regarding my obligations as an "employer" from the Internal
` Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments,
and the California Division of Indus`Jial Accidents. I also understand I may contact the California Contractors' State
License Board (CSLB) at 1 -B00- 321 -CSLB (2752) or %1% w.cslb.ca.gov for more information about licensed
contractors.
0. I am aware of and consent to an Owner - Builder building permit applied for in my name, and understand that l
am the party legally and financially responsible for proposed construction activity at the site address listed above.
4&11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, i vdill abide
by all applicable laws and requirements that govern Owner- Builders as well as employers.
&12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If
you contract with someone who does not have a license, the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed
Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while working on your property, you may be held liable for damages. If
you obtain a permit as Owner - Builder and wish to hire Contractors, you will be responsible for verifying whether or not
those Contractors are properly licensed and the status of their workers' compensation insurance coverage.
CONSTRUCTION LENDINIGAGENCY
(DIRECTIONS: Please complete the following construction lending agency information.)
I hereby a7rm that there is a construction lending agency for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name:
Lender Address:
Before a building permit can be issued, this form must be completed and signed by the property owner and
returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license,
form notarization, or other verffication acceptable to the city�may be required to be presented when the per�nit is issued
to verify the orooerty owner's signature. /i, / /% / /
Property Owner's Signature: / 2�', Date: 4-fC1 l
- - -------------------------------------------------------------------------------------------------------------------------------------------
(NOTE: The following Authorization Form is required to be completed by the property owner only when designating an
agent of the property owner to apply for a construction permit for the Owner - Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNERS BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an
Owner- Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy. Note: A copy of the property owner's driver's license, corm notarization, or other
verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's
signature.
Property Owner's Signature:
Date:
0v,77erBuilde7Fonn 2010.doc revised 04114110
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014 -3255
Telephone: 408 - 777 -3228
C U P E RT I N O Fax: 408- 777 -3333
CONTRACTOR / SUBCONTRACTOR. LIST
JOB ADDRESS:
PERMIT # . l . Z O 6>6
OWNER'S NAME: Z411 ,�1,�' �fQ
PHONE # - 4 2 = ._.; 6C K<Z
GENERAL CONTRACTOR:
BUSINESS LICENSE #
ADDRESS:
CITY /ZIPCODE: .
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
P
4. Owner / Contrad6r Signature
lee // �
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
P, LC e-- 7 i4 1 C
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
P
4. Owner / Contrad6r Signature
lee // �
Date
- . /,v� P
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LEGEND
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the Building Official_
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PLE..-iiviiT No.
sPc-Cifications SHAI I tue
Of the vio:
ation
49i5llcs or State Law.
6