06070210 CITY OF CUPERTINO '"' �' '' "� -
BUILDINCDIVISION PERMIT CON, TR"AGTOR�II�F!?aRMAZTON
BLILDING ADDRESS: THOMAS MAIER & ELIZABETH INo'06070210
10889 BARRANCA DR
OWNER'S NAME: PERMrr IS5UEDATE
THOMAS MAIER & ELIZABETH HIPNDL 006
NE: SANrTARY NO. CONMZOL NO.
ARCHRER/ENCINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�Op LICENSED CONTRACTOR'S DECLARATION Job Description
1 berthann.(has I.li,,- d coder Pea.=.:.._.of Ch-P, 9(mmmeoebp
R1� and
wid Srcdm 7000)of Divubn 3af,he Budnea nod Prafca,itw Code.arld mylimme at
n full f. enat MODIFYING/RELOCATE EXISTING WATER LINE
z Dome Clea IJc.I
ARCHRECTS DECLARATIONPme
oduvaoJ
Ivmy pWuadmit be med apablk rtcamJs
myU
.ij Lkvaed Profmwbul
OWNER-BUILDER DECLARATION
if I hereby aflino that 11.ucmpt Bum Ne CeNnnofa Lkommi lata f«the
:O9 falbwlnrmi . emniim'/ml.7,BusixasaodP .&MIL Code.Any cky armory
's Tion. which mgolro.permit m ccasnmcl aBa.hnpva,demulls4 u rtfuir r/artaaurt $500
3I; prim m is Lium..alto nalim—Weapplkam r«such permit to 0k.signed wtuarde (
< don be;tl mod paraa(to the,PmQd0ea of de CWMW',Boma UW(CbaPw9 Sq. Ft.Floor Area Valuation
FCS (c meneing With Smlm 7000)9Division J of We Buonev and Prarmlua Code)or
5 3
that he la uanPl thmod.and Ibe baud,for tle al4{e l uempti.My vlWWun of
Serio TO 1.5 by My apdiaol for a permit mbjeem rite aPption((o.cell pnathy aOccupancy Type
got come date font luodud dela,(5500).
❑ do,tbo
ref de, roam mynaimon ea wuhwagoaide,(am. .Bminm.
ndd°,hewan,code aNrnveh°m,nleodrmeal Law d"eied ILAWY.to monmra Required Inspections
and PmofodaN cone:Tlr CoauamM1 IJame Law Oau m(appy n av,weer a( - eq Pe
manem wye ddb,«Impaaae inop andwW mt abwarm himself,Wray bat
awncm,duess,Winj.ddwaWimprnemmtsart intieto a PlimdWark U.
boWerr da bol the«deaf of a.z add Within nae uev of m,rowfor de nose a
builder wW alae ds WNm of prminC dot r db comm dub a hoPare far paps,a!
��
I.u aW,c of dr pmpaty.w_"..A ely conuame,wIW lia..-a sa,uaws to ��
cm a Lao old or wt (See to ane Budnea sad Pmfoddam Cade:)The Caamaneofs LF B
can law dao m(apply b n mmc a(pmpu(y who W i p«Im W the Wnean.and /j®/p
whocann v rIX ouch psYcds wNh]Can,racfau(1)Ikewd pcwaN u de Cnm,maa2a
Ll Tato.
Itun
pan rpt u,alm see ,BkPefu Wu rtum
w,aer oar _ .o b V lay0y✓ 7Q06
oR COty.f P.
raorcua+ rtg Uigl9�jp
IhrrtbyaQum mderpctWy or perjury,orator thc foWawiog drel dmm
oN
Ilion andtont rend by S CeNBoa of Cmwntw an-barthe Wakdio Geopen- /a
sadmf r Providedt1m Tar hr Sudan 5T00 of Ne Lab«code.for de pnfarmanm¢M Ne
wat f«whkh tha term.c IatN.
1 baw:and will mainuin W nes co mpemadan ImmmCc,n mlu med by saabn .
M)of da Lala Code,for de paformarce a!de wok f«whkh that pnmu u I-"
My Workef.Cmlpe ealw Iaanna artier mod Policy numb«art:
Cartier Polley No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSAnON INSURANCE
trbie salon ner,"be o«opla it u We pclmb is famehmdeddn0m(3100)
«kora)
I cmify Wm In do pe t o rnamet of the work for Whirl Nis proal(Is lim-, I"I not
employ any penin In my glamor aa�ecame ambjrtt to de WIXkms•CIXnpmwim .
lawn or CzlirM .Dole
-o
NOTICETO APPLICANT:a.afar mW Gems { ¢of Eacmpdm,you b
dxame sabj«a,o One Wodi Compcaadoa proMdau of the lab«Code,yoe mus
.J O fwbmtb comply with meb Prvvldon,a Nu permit Wall W doomed omw
z� CONSIRUCnONLENDING AGENCY
f 4 Ibonb,.M..da Hereuacvnsrnim,lendin{.Rncy for de perfumanm of .
fY> de wort for wMeh Unit permit a issued(Sec.5091•Civ.C.)
0 lsndv's Nave
= Z I^Mlrs Addma
U0 f muf,duo l haw:road Wu appli ab awe da de mow information u
LL Fes' carrot I agrte to comply with all city anal crony atom i and sae tarn relating to
OU buildi,cooeuuedon,aod hertbyaudariertpmswatites of this City to my upon do
W alwuc-mendu d rroFn>for im,don purine`
(We,)agree to ave.indemnify and kap harmless the City d Cupenion agdNl
F" ra/1liabilities,judgoi cess mlalupon,,which m.,in my,ny sax agaWst said City
U Z in cmu
agnm of de time.,of olds Permit-
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date f
sou gtsVD4Ns.
XD D, --1 _31-06 Re-roofs
Signrum4
R WS MA DISCLOSURE w� Type of Roof
Will deappllam«retort Watom,oxvrw(acreahandle ha -m.aerial
a deflesd by We Cupmim Municipal Cade.Cbmper 9.12 and de HedW and Sofa,
Code,Sccden 2555244. All roofs shall be inspected prior to any roofing material being installed.
❑Ya
If a roof IS installed without first obtaining an inspection,I agree t0 remove
W01 de aprilcant«tutu¢Wilding occupam ata equipment a dcfm which
emit Waumoa dr conwcirwes a defined by We Bay Art.Ab Qmolly Mauagement all new materials for inspection.
Diark,9
D Yea L_l ova
1 home sad the hvardou,maerl.ls rtgviemoems undo Chaluer495 of de Calif«-
mmiaHWdh Safay Cad,.Stationer 15505.25577 and 21534.I md:rmnd uha(n do Wilding
dna not currently hoe a tow.ala it IS my re>pormWHY to norify the omopam or do
nta whkh mus be met Fri.,to iaua«e ora catiraae or onmP.-Y. Signature of Applicant Date
�—31"n la' All roof coverings to be Class B"or better
Owns orqm Date'
f Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
6UPERTINO
Building De artment
JOB ADDRESS: �OS, 1 L6rrC+ ,CR PERR 06 0 7d2(C
OWNER'S NAME: PHONE # J ?65
GENERAL CONTRACTOR- I FAX #
I am not using any subcontractors: ���,,`{��(��a11� —1 31 -0 le
Signature Date
Please check applicable subcontractors and complete the followin 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
Sheet Rock
Tile
• `7 -3( -o b
Owner/Contra or Signature Date
OWNER-BUILDER VERIFICATION
1. (Check one) I or• mm
y immediate family (parent,spouse or child) will perform:
A. ✓myAll 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
ba
' 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 side).
Property Owner's Signature: IE2r ` Date: 1 —_1 1 �o
u
Job Address: l D g S L fO A LAn b✓ Permit#
AU changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
•
v
City of Cupertino Building Department
CITY OF 10300 Torre Avenue.
C U P E IST I N O 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 vourself from possible liability if that person applies for the proper pemlft 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 compensatior�
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 Admir i ation). 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 retumed.
Very truly yours,
Building Department, .
City of Cupertino
Printed on Recycled Peyer
CITY OF CUPERTINO
!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # : 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32601009 . 00
DATE ISSUED. . . . . . . : 07/31/2006
RECEIPT # . . . . . . . . . : 35444
REFERENCE ID # . . . : 06070210
SITE ADDRESS . . . . . : 10889 BARRANCA DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : THOMAS MAIER & ELIZABETH HENDL
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : ELIZABETH HENDLEY
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : THOMAS MAIER & ELIZABETH HENDL
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . .
TELEPHONE .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- - - - - - - - - - - - - ---------- -- - - ------ -- -- ---------- ----------
BPWSVCS WATER SERVICE 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---- ------ ---- ----- ----- ---
TOTAL PERMIT 47 . 37 0 . 00 47 . 37 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
--------------- -- - - - -- -------- -------- -
CHECK 47 . 37 2686
------------
TOTAL RECEIPT 47 . 37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB & OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
Was CITY OF CUPERTINO a0000-, 0
REPIPE/SEWERS/MAIN SERVICE
SCUPERTINO PERMIT APPLICATION FORM
APN # J6�01 J ()V- I I
Date: .-,_31-0 b
Building Address:
' l08$�l �ivrp�n CA �Y
Owner's Name: . Phone#:1/6
r 6
Contractor: o y�� Wr 'c)jPhone: License#:
r
Contact: Phone: Cupertino Business License#:
0�vv?e,y-
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description:
Residential Commercial ❑
Cost of project:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Piping System Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPFDXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
f