12030028 CITY OIC CUITR•I'INO BUILD11\'C I'I:RiMIT
BUILDING AIIDRESS. 10424 VISTA DR COFI'RACR)It:OU Cli IN 1.131:AND SUSAN PE1011'['NO: 12030028
'ISUN,NIHI RUS
OWNER'S NAME: OU CHIN LEE AND SUSAN ISUN MEI TRUS 10424 VISTA DR DATE ISSUED:03/06/2012
OWNl.It'S PHONE: 4083981089 CUPERTINO,C\ 95014 PIIO,NE FO:
❑ LICENSISD CON'TRACTOR'S DECLARATION r r r
BUILDINC I'ISIL\1I"f INFO: BLDG ELECT PLUMB
License Class Lic.# Ir r r
I\ ECIi RI?SIUIi N'I'L1L CO,\h\I ICRCIA I.
Contractor Date
I hereby affirm that l au licensed under the provisions of Chapter 9 JOB DESCItI PTION: REMOVE PLYWOOD STORAGE ARBA IN GARAGE,CODF
(connuencing i%ith Section 7000)of Division 3 of the Business S Professions ENFORCEMENT CASK.
Code and that me license is in full force and effect.
I herehy affirm under penalty of perjury one of the follo%%ing Oro declarations:
I have laid will maintain a ecnificute of consent to sell'-insure for Worker's
Compensation,as provided for by Section 3700 ot'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 Sq. Pt Fluor Arca: Valuation:$100
Section 3700 ofthe Labor Code,for the performance of the work for which this
permit is issued,
AI'N Number.31633130.00 Occupaney'I'ype:
APPLICANT CEltlIFICAIION
I eerily that I have read this application laid state that the above information is
correct. I agree to comply with all city and county Ordinances and stale laws relating)
IO building construction•and hereby authorize representatives of this city to enter I'I':-Rl�'II I EXPIRES II' �VOIZK IS NOTSTARTED
I:U
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities.judgments. WITHIN 180 DAYS OI` PERMIT ISSUANCE OR
costs,and expenses which may accrueagains[said City inconsequence
0d'the 180 Di 1rS I'IZO�'1 -I CALLED INSPECTION.
grunting of this permit. Additionally,the applicant understands and will comply V',"(f J
with all non-point source regulations per the Cupertino Municipal Code.Section ��/,/ ,!)
9.18. Issued 1)v: — �Y Date:
Si-mature Date 3
LI OW;\'ER-BUILDER DECLARATION RE:R(IOFS:
All roofs shall be inspected prior to any reading material being installed. Ifo uof is
I hereby affirm Thal 1 am exempt from thLaw for Contractor's License Lafor ane of installed without first obtaining an inspection,I agree to remove all net,nunteri:ds for
the following Oro reasons: inspection.
I,as owner of the property,or my employees with wages as their sole compensation,
will do tine work,and the structure is not intended or offered for sale(See.7044. Signature of Applica nC Dane:
Business S Professions Code)
1,as owner oflhe property,am exclusively contracting with licensed contractors to
construct the project(Sce.70-1.1,Business R Professions Code). ALL ROOF COVERINGS TO HE CLASS"A"OR BETITIt
I hereby affirm under penalty of perjury'one of the follon'ing three
declarations: IL\%ARDOIIS MATERIALS I\I S DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California 11calth&Safely Code.Sections 255115.25533,and 25534. 1 ,ill maintain
performance ofthe work for which this pcnnit is issued. compliance with the Cupertino Municipal Code.Chapter 9.R:Oud Tho Health S
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code.Section 25532(a)should 1 store or handle hazardous nuterial.
Section 3700 of the labor Code,for the performance of the work for which this Addtronally,should I use equipment or devices which emit h morclous air
omit is issued. contanninants:u defined by the Bay Aren Air OnalitY.\IanaL'vmeni District I.,ill
F maintain compliance with the Cuperlinu %lunicipal Code,Chapter 9.12 and the
I certify that in lire performance of the work for ,[rich this permit is issued,I shall Health&Safety Code.Sections 25505,2553J.and 2.5534.
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 exennption,I O%vner nr;yn mriz •„Lent:
become subject to the Worker's Compensation provisions of the Labor Code,Inose /T�—p�lO+1�! Dille:. �n h
forthwith comply with such provisions or this permit shall be deemed revoked.
CONS 1,14 11-1'10\ I.EIN:D TNG AG ENC['
A PPL I CAN'T CERTIFICATION I hereby affirm that[here is a construction lending agency lin the per imnance of%cork's
I certify that I have read this application and state that the above information is for%which this pcnnit is issued(Sec.3097•Civ C.)
correct.1 agree to comply with all city and county ordinances and state laws relating Lender's Name
to building consauction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(%1'c)agree to save Lender's Address
indemnify and keep hamdess the City of Cupenino against liabilities.judgments,
casts,and expenses,which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCI lI T EM"S 1)EICLA RATI ON
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature02=, Datc 3 ��L
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
Im ADDRESS: 10424 vista dr. DATE: 03/06/2012 REVIEWED Bl': larry s
APN: 3 1301BP#: oZ03UO:Pe3r 'VALUATION: $100
•PERRIIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair
PRIMARY SFD or Duplex PENTAMATION
USE: PERMIT TYPE:
WORKremove plywood storage area in garage, code enforcement case
SCOPE
Aleeh, P6n7 Check Wood). Plan Chat* Elea Plan Check
.41ean. Permit bee., Phmeb.Permh Fee: Elam Permir Fee:
of/m•Alecla.fnsµ Other Plumb torp. other Elea lisp.
Af Jc/nip. Feer Plwnb.harp.Fee: F,irr./ny. Fee
NOTE: This estimate does not include fees due to other Deparmtews(i.e. Planning.Public Works. Fire,Sauitary Sewer District.School
District,etc.). These ees are bayed on die rrelininarl'is ornmtion available and are on/r an estimate. Contact the De t oraddri'I info,
FEE ITEMS (Fee Resolution 11-053 E0: 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 Select a Mise Bldg/Structure
Suppl. PC Fee: Q Reg. 0 OT 0.0 has $0.00 or Element of a Building
PNIE Plan Check: $0.00
Permit Fee: Hourly Only? t)Yes 0 No $0.00
SuppI. Insp. Fee-.0 Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
nru'tntclinn Ina:
Administrative Fee: Q
Work Without Permit? O Yes 0 No $0.00 G
Advanced Planning Fee: $0.00 1 hours Inspections G
7}•amel Docamentatrina Fees- $130.00 ISTINSP Inspection, Hourly O
Strong Motion Fee: IBSEISAIICR $0.50 = hrs Admin./Clerical Fee
Bldg Stds Commission Fee: IECESC $1.00 $41.00 IADAIIN
SUBTOTALS: $1.50 $171.00 TOTAL FEE: $172.50
Revised: 1/19/2012
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&Jxeril�o CA Ci se f4
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12FCE � I
MAR 0 5 2012
BY: "® {
1 '
610'
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION-CUPERTINO
APPROVED `
This set of plans and specifications MUST be kept at the
job site duringilsfr0'tis119�1t1;unlawful to make any
�—
therefrom,without approval from the Building Unlclah
SHANOT
The stamping of this plan and apeciFl alions of the v ola on
be held to permit or to be an app
of any provisi ns of any City rdinence Or State Law, I O 1 • ,
DA 31, a, OFFICE C 16 PY.
PERM
19'4"
STORMWATER POLLUTION CONTROL AND NOISE CONTROL
G COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O.,BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE -CUPERTINO, CA 95014-3255 ,
(408) 777-3228 • FAX(408)777-3333 •buildinc(&cuoenino.orc FACE COPY
GENERAL INFORiNIATION
All construction work must meet certain conditions related to maintaining environmental quality and public
health and safety. This policy described the two mostcommon inquiries regarding construction: Stormwater
Pollution Control and Noise Control.
STORININVATER POLLUTION CUN TROL
State law requires that.the City of Cupertino, along with 12 other Silicon Valley cities, Santa Clara County and
the Santa Clara Valley `Vater District control siormwater pollution. Educating local residents and businesses
and enforcing stormwater pollution control laws are key pars of the City's compliance efforts.
Stormwater pollution prevention: It's up to us!
In northern Santa Clara Valley, storm drains flow directly to local creeks and into the San Francisco Bay
without going through a water filtering/treatment process. Stormwater pollution is a serious problem for
wildlife dependent on our waterways, for people living near streams and baylands, and for the local water
supply. Common sources of stormwater pollution include;
• Dripped oil, fuel, and antifreeze from vehicles and heavy equipment;
• Construction debris, including dirt, concrete and paint;
• Landscaping runoff containing pesticides or weed killers; and
• Any material dumped or spilled into streets or storm drains.
The property owner and the rQptractor share ultimate responsibility for activities occurring at a construction site
and wi e e&s-6�bh�'e f�r99any environmental damage caused by subcontractors or employees. For more
inform on on constructipn-related stormwater requirements, see the Stormwater Quality Regulations section
'
of the City ofiy{b'�tpetntin6l+,I
�ebsite at: htru://w�vw.cuoertino.orJindex.asos?Daae=487
CONLY� OL
Construction,noiserisrlimitedgm DEPARTMENT
• Residenh016' noise'Tev Mirom complaint site—60 dBA
• Non-resident3al)d'a imerEDse levels from complaint site— 65 dBA
This set of plans and specifications MUST be kept at the
Day-ti me,,,hoursarecdefinedies beingi betweenithe Bowing hours:
• Weekdays°I `ObarnRo-r8'.O0pUito deviate
•the. elk ��ou'9':OOrama4om6 pemuilding Official.
The stamping of this plan and specifications SHALL NOT
Cousirlktiti O dthertt€tar?i sft&rCFIF6 tue{t06 Fea{!ernthan 750 feet of a residential area, is prohibited on
holidays?k3f ep2tit)sato'nstriettinlnCorir2ti�ted3b'�aa'nomeowaer or resident of a single family dwelling using
domestic construction tools is allowed on holidays between the hours of 9:00am to 6:00pm.
DATE
Forlmore ormaton on noise control, please refer to Chapter 10.'48 of the Cunenino Municipal code,
wh.0�� r
can be accessed attin: ,w^.r Yv.a esa .cem'cuee—iino ca.
Ston, ater/Noise Contro[_2010.wc revised 09/22110
02/26/2012 13: 19 FAX 14083828008 'TSMC MAILROOM 7-1 Q001
02/26/2012 1.3: 12 FAX 14083828008 'T5MC MAILROOM 7-1 ®001
OWNER-BUILDER DISCLOSURE FORM �FACE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION COPY
1 G30D TORRE AVENUE•CUPERTINO.CA 95014-3255
CUPERTINO
(4)8)M-3228-FAX(406)777.3333•buildlnol@cuoe,
Deer Property Owner(s):
An application for a building penult has been submitted In your name listing yourself as the builder of the property
Improvements specified at:
BRE ADDRESS - APN BP# nD3
war «o C so 6 3 s o,o o{
OWNER NAME OWNER ADDRESS
�
C ( toaggc Teee C QSOI
DESCRIPTION OF WORK: fsg
We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of
your responsibllltles and possible risk you may Incur by having this permit Issued In your name as the Owner-Builder. We
will not Issue a bulldlnGi permit until you have read,Initialed your understanding of each provision, signed,and
returned this form to us, rt our official address Indicated. An agent of the owner cannot executethis notice unless
you,the property owner,obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEIZOMENT AND VERIFICATION OP INFORMATION
(DIRECTIONS:Please reed and initfol each statement below to signifyyou understand or verily this Information)
S,[&I understand it 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 materiel
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 homeowners Insurance may not
provide coverage for those Injuries. I em willfully acting as an Owner-Builder anti am aware of the limits of my
Insurance coverage for Injuries to workers on my property,
CL!a2. I understand buliding permits are not required to be signed by property owners unless they ere responsiblo for
the construction and are not hiring a licensed Contractor to assume this responsibility.
LlISO. I understand as an"Owner-Builder'I am the responsible party of iecord 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.
C Q4. I understand Contractors are required by law to be licensed and bonded In California and to list their license
numbers on permits and contracts.
g�+ orhfrnflar`�
If Iemploy or otherwise engage any persons,other then California Ileensed Contractors,and the
• tote a u o m �qr7slructlon Is at least five hundred dollars($500), Including Taber and materials, I may be
yy Y�]r7
co fdBre�a °efnployor understate and federal law. y
nen 6. I undo dJLJs nconalde ed a��Eemployor under state and federal law, I must register with the state and
l�f$d govem nf!wltl7holB'payrolhta os,provide worke s'compenseUon dLaebllliy Insurance,and contribute to
unemploymen4rcompeneetlon to ea ch''`o'mployee.'Ialso understand my failure to abide by Nese laws may subject
me to serious financial ralf'�vVED
This�Z.Cllunderstand unAet.:Csllfom7elGbnttactor"s=$tete License Law,an Owner-Builder who builds single-family
resldaOtla7structuras.cannot-IegaJly_bupd them:wfth:ths Intent to offer them for sale, unless all work Is performed by
Jobn�nsey°auticon 130 or��aDd thernurabsOgfratructures does not exceed four within any calendar year,or all of the work
rn ,• .�.�w a,. ..1-1
therehon�wrtnout approSar�I al�icsed ge�erelibuilding Contractor.
[(g8.I unde(ste�dAes�tndOwrlefi Bulldardtilsell thelproparty for which this permit Is Issued, I may beheld liable for
The any finan'�lal or parson��l Injukearsustajjlediby4. . ML bsequent owners)that result from any latent construction
bedeiWd'4Rtfib"�','vork'm"anst7p or{ri01ef19 s.
of any provisions of any City Ordinance or State Law.
OvmerBvilderForni 10/0.doc rrvked 04/14/10
BY
DATE
PERMIT NO.
� • :I,Itrll`Jln Illt,i..l� M,.XM
02/26/2012 13:19 FAX 14083828008 TSMC MAILROOM 7-1 f¢J002
` muiwrn uuesl m.e»
02/26/2012 13:1.3 FAX 141083828006 'rsmc MAILROOM 7-1 fQI 002
tip 9. I understand I may obtain more Information regarding my obligations as an'employer"from the Internal
Revenue Service,th0 United States Small Business Administration,the California Department of Beneflt Payments,
and the Callfomla Division of Industrial Accidents. I also understand I may contact the California Contractors'State
License Board(CSLI3)at 1-800-321-CSLB (2752)or www.cslb.ca.gov for more Information about licensed
contractors.
til i 10, I am aware of and consent to an Owner-Bullder building permit applied for In my name, and understand that I
am the party legally and financially responsible for proposed constructlon activity at the site address listed above.
fW11.1 agree that,as the party legally and financially responsible for this proposed construction activity, I will abide
by all applicable laws and requirements that govern Owner-Builders as wall as employers.
012.1 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 ere 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 dvll 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,youmay be held liable for damages.If
you obtain a permit as Owner-Builder and wish to hire Convectors;you will be responsible for verifying whether or not
those Contractors am properly licensed and the status of their workers'compensetlon Insurance coverage.
CONSTRUCTION LENO(;YO AOENCY
(DIRECTIONS:Please complete the following construction lending agency Information.)
I hereby affirm 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 rssponslble for Issuing the permit. Note:A copy of the property owner's drivers license,
form notarization, or other verification acceptable to the city maybe required to be presented when the permit Is Issued
to verify the property owr+er's signature. '
Pro9s ..0Wp.WisrSl9a?hrke_c n r r- _ Date i s �W 2
BUILDING DIVISION-UUl'th i Iry
.......:.---• f'•'}r .............................. ........""•"--.............................. ............._.....
(NOTE: The folionUhg'A�ilhorhatj°n Form Is required to be completed by the property owner only when designating an
This oo iiiae p opagy 1�afOb �y �g^sffuotfotl permit for the Ot+mer•Builder).
job site during construction. It is unlawful to make any
changes or UTHOIv7ZATIUMOR AGENT TO ACT ON PROPERTY OWNER'S BEHALF
th-retro .vgio�:approval from the Suttdtng.Qmpl . ._.. .. .. ....... .... .
Excluding the Notice to Property Owner,the executlon ojwhich I understand Is my personal responsibility, I hereby
Th�aut()•prize, aQol{Wflttgtparsbn(s)•xb''adll&6�irry���nt{�sd apply for,sign,and file the documents necessary to obtain an
�gOiv€pot ufldernPaggrfobrng pioject.,al of the violation
f rAp of Co n ° yP eiFt�A51�W§�RgP82fl tkr ne» w,a op_ anti bath, reemapr p Off;c 54,VC
o an � 3r� 1
Project Location or Address:, !041¢ (.'cfa �!/-'..r �'„n (No((4
OANa e o,Authoclzed:Ageru—C a•.+ Tel No 40 8 3T 8 to 97
PEAdAdresssbf7lathorfzed-Agon: o�$S Q yr Tree (� CuP�✓ no Ck 9So14
I declare under penalty of perjury that I em 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, form notarization, or other
verification ecceptable to the city may be required to be presented when the permit Is Issued to verify the property owner's
signature.
Property Owners Signature: 0� Date: �! 4-� >•0(Z
RECEIV FDD
MAR ONmerBuilderForn1 7010.do re ised04/14/10
r , I —T--�
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 950143255 /,cuperdno.org
CUPERTINO (408)T7-3228• FAX(408) T7-3333 • building(@cuperdno.orD / pZ
(I'NEW CONSTRUCTION ❑ ADDITION Q ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMCr N
PROJECT ADDRESS I ) 4 )t--+ Vi {-l: Dr
pAPN 4 3 ( 6 3 I3(1,o f
OWNER NAME . C 1. N _1 E� D LA PHONE /O p 3 i n �O D? E-MAD. I N
gVlp DL `{ O ^ ( 04�S�Oa/� q�oJ. CaM
STREET ADDRESS )o O 1 O 5 f Q�pe( Tree. L� RTY• STATE Z[P r•. F�'f rN J Cr'` S Q(¢ FAX
CONTACT NAME PHONE �-(A r
Lo cqi 0" 4i%B 39B (og EMwR 10Q'.5--0(40 4h Cf D-Com
STREETADORESS yOI85 Pe rYree LVA CITY.STATE IIP 1, fN C. �i>1714 FAX
❑.OWNER 10 OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONrRACTORAGENT ❑ ARCH= ❑FNGINEER ❑ DEVELOPER ❑TENANT
LICENSENWIBER. LICENSE TYPE BUS.LIC#
COMPANY NAME E-MAR FAX
STREETADDRESS CITY.STATEII
, P PHONE
ARcHrT2tAEamtNEm"uho LICENSE NUMBER BUS.TIC#
COMPANY NAME :[
AMEFAX
E-
STREET ADDRESS CITY.STATE.TIP PHOtiE
DESCR[PITON OF WORK
eµ v (,C_
DOSTINGUSE pp 3 PROPOSED US I CONSTA TYPE fS10
I'— 3 ON USE TYPE OCC. SQ.FT. VALUATION(S)
A°SL-0 AREA S� °EZ° S -0 AREA S�Cj /Z3 Lt V3 >� S--LD )Oo�
BATHROOM IQ ODE O'ITnR �V
REMODLR ARE REMODEL AREA REMODELAREA V
PORmr AREA OEIXAAEA TOTALDECR/PORCHAREA I GARAGEAREA DETACH
ATTACH .
#DWELLING UNM: IS A SECOND UNTr YES SECONMSTORY YES
BEING ADDMOM UNO
PRE.APPUGTION ❑YFS oyEs PRovmECOPY OF mTHE BLDC AN �l YES RE BY: TOTAL VALUATION: S
PLANNINGAPPL#�O PLVtNINGAPPROVALTFTTER EICHLERHOIlZ? *NO / ,may OO p
By my signature below,I certify to each of rhe fallowing: I an the property owner or authorized a¢ent to 6Ct on the prpperty owner's behalf.-1 have read this
-applieadun and the infamudid¢I have pmvidcd'is carsecL I have read The Damption of Wark and verify it is accurate. I agree to comply with all applicable focal
ordinances and state laws relating to building construction. I authorize representatives of Cupertino m enter the above-identified property for inspection purposes.
Signattim ofApplicant/Agent e/� - { -t Daze: I /-7/1
SUPPL12, N AL INFORMATION REQUIRED PIAN CHECK TYPE ROUTING SLIP
N or Multifamily dwellings: Apply for demoliti frlrfifor ��,�{off �ZIIN�PCAN RE
existing bmldm Demolition permit is required Issuance of building
permit forneWbuilding. ❑ EXPRESS ❑ PLANIUNG PLAN REVIEW
_Commercial Bldgs: Provide mp azardOUS Materials Disclosure ❑ STANDARD• ❑ PUBLIC WORKS
farm if any Hazardous M s ane being used as f this project ❑ LARGE ❑ tura bE�
_Copy o mg Approval Letter or Meeting with PlanDiDg ta>•� ❑ MAloR ❑ sAxrrARYsEwER DiSnucr
sub ' of Building Permit application.
❑ ENVDtOrotE,YTAL HP.ALTa
B1dglpp2011.doc revised 06121/11