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12010127CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10416 PRUNE TREE LN OWNER'S NAME: LIU ALEXANDER C AND DOROTHY OWNER'S PHONE: 6504920857 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lia # 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 tinder 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 -print source regulations per the Cupertino Municipal Code, Section 9.18. Signature, Date IL OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Protessions Code). I hereby atiirrn tinder penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Corti pen 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 provided for by Section 3' 00 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 cornply 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 atnd 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 indetnnify 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 C !� Date )h�— CONTRACTOR: LIU ALEXANDER C AND PERMIT NO: 12010127 DOROTHY 1585 WESSEX AVE DATE ISSUED: 01/19%2012 LOS ALTOS, CA 94024 PHONE NO: BUILDING PERMIT INFO: BLDG ` ELECT PLUMB ,.... r...._ MECH £ RESIDENTIAL 1 COMMERCIAL JOB DESCRIPTION: REPLACE TUB AT MASTER BATH, NO ELECTRICAL,NO MECHANICAL Sq. Ft Floor Area: I Valuation: $8000 APN Number: 31633119.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued bye.. - Date: 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 9A2 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I 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, Sections 25505, 25533, and 25534. Owner or autho ed agen • q GL's Date: 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31633119.00 DATE ISSUED.......: 01/19/2012 RECEIPT #......... BS000015791 REFERENCE ID # ...: 12010127 SITE ADDRESS .....: 10416 PRUNE TREE LN SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 OWNER ............: LIU ALEXANDER C AND DOROTHY ADDRESS 1585 WESSEX AVE CITY/STATE/ZIP ...: LOS ALTOS, CA 94024 RECEIVED FROM ....; ALEXANDER C LIU CONTRACTOR ........ LIC # *OWNER* COMPANY ..........: LIU ALEXANDER C AND DOROTHY ADDRESS 1585 WESSEX AVE CITY/STATE/ZIP ...: LOS ALTOS, CA 94024 TELEPHONE ......... FEE ID U1`dIT QUANTITY AMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ----------------------- 1BCBSC VALUATION ---------- 8,000.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BSEISMICR VALUATION 8,000.00 0.80 0.00 0.80 0.00 1STINSP UNITS 2.00 260.00 0.00 260.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 261.80 ---------- 0.00 261.80 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- CREDIT CARD 261.80 -------------------- VISA --------------- TOTAL RECEIPT 261.80 ��-,�—,�,�-�—m7�� CITY OF CUPERTINO F,w- TTTP TCT1MATnP — RITTI.DING DIVISION L21ADDRESS: 10416 prune tree In. DATE: 01/19/2012 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$8,000 °PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARYSFD or Duplex p PENTAMATION PERMIT TYPE: USE: Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 WORK replace tub at master bath no electrical mechanical. $0.00 SCOPE NOTE: This estimate does not include fees due to otherDepartments (i.e. riannmg, ruouc murKs, Fere, aunuury aewei "Sauau, L _ .a iL ,.e: *-,r-.--#.*-- -#.* 7/..1./n -d - nniv nn octim"ta_ (Duan/ the Dent for addn'I info. FEE ITEMS (Fee Resolution 11-0.53 i ': 7,'!/11) FEE QTYIFEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes 0 No $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 Permit Fee: $0.00 tPME G Work Without Permit? Yes Q No $0.00 Advanced Plannin€ Fee_ $0.00 hours Inspections $260.00 ISTINSP Inspection, Hourly E) 0 Stronp, Motion Fee: IBSEISMICR $0.80 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: , $1.80 $260.00 TOTAL FEE: 1 $261.80 Revised: 1/01/2012 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - buildino5cuoertino.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: SITE ADDRESS I0+ 1 � Fi>?l AE- TJ1F_& LN APN 7 ` BP# OWNER NAMEOWNER $_D6a0Tt+ 1_1t4WLPSSEX ADDRESS L°S AL_r6S CkQ DESCRIPTION OF WORK: T 1 (t /ti&Te S. HALL P-,A-rW Tq 3 l40r —L NArtf 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.) A__L__1- I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - 4d2.q 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. 14-t— 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. k_-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. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. A(-5. 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. Art -6.1 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. AL -7. 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. /tL--8. 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. 01V77erBuilderForm 2010.doc revised 04/14/10 A-3. 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 Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cs[b.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 I am the party legally and financially responsible for proposed construction activity at the site address listed above. &�—T 1. 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 well as employers. _k�2. I 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 LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) 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 responsible for issuing the permit. Note: A copy of the property owner's driver's license, form 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: --------------------------------------------------------------------------------------------------------------------------------------------- (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 OWNER'S 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, form 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: OwnerBuilderForna 2010.doc revised 04/14/10 RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number: 316 — 3 �--1 I 1 Name of owner. Al&X h7v�,> DeROTHY L 1 U lkik -wit, Project address. - 1006 P� u &rC- 7 n L E I- G1_k-Pe�rz7 iN v Contact person. AL -EX L I (,L Phone. 'qq Z " cog S- 7 Fax. Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: r.. Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? YEN Is privacy protection planting required for the project? _ N Build it Green Total Points On what floor(s) is work being done? �A-c�Nb Ft-lZ Comm UMVDEVELOPMENTDEPAI TMWTO BUILDING DIVISIONN`-tCUPP Brief description of work. ZG T I LE A4A s T- G ►2 A of '() N A Lt_ t3 A-TARP5 - . Icy t at the /N• Mac-Ht�N� AL . LI L,1-� 7/ �t/Ei, � 12� sand spercifica io ! t p-- Iterations on same, or to deviate jo. ;i+e durmq cons ruction. It is un!awfu, to make an Code editions: 2010 CBC - N)2010 CFC (Y - N)2010 CM&O'" ' ora official. thera`'om��v4�� ap��oval from, Building 2010 CPC Y N) 2010 NEC (Y - N) SHALL. NOT ,� of this pian :",nd snecificafYons , v!oi:tion California Green Building Standards Code 2010 Tr,.. �'Y' ''c`� ,r + ,E ar, :f.V10roval of the t L� Ordinance or State Law. of a Z)v :.;c ��s of C City Effective 1/01/11 C u,,��- ., mow- 0. Y ) (� N1 P A0 e:n-- �� a 1� Plan Review Process Work Book Page -8- Revised 12/21/10 NEV VANITY SINGLE SINK MASTER BATH HALL BATH DOOR TO BEDROOM NOTE: 1. 2010 CALIFORNIA RESIDENTIAL CODE, MECHANICAL CODE, PLUMBING CODE, ELECTRICAL CODE, ENERGY CODE AND CALIFORNIA GREEN BUILDING CODE AS APPLICABLE TO THE SCOPE OF WORK. 2. WALL AT ALL SHOWER AND BATH TUB LOCATIONS SHALL BE SHEATHED WITH DENSSHIELD TILE BACKER, 3. INSTALL BATTERY OPERATED SMOKE DETECTOR IN EACH BEDROOM AND THE OUTSIDE HALLWAY. 4. INSTALL A BATTERY OPERATED CARBON MONOXIDE DETECTOR IN THE HALLWAY IN THE BEDROOM AREA. 5. HOTMOP SHOWER PAN IF IT IS NOT PRECASTED, AV. i. 10416 PRUNE TREE LANE PROPOSED PLAN 2� APPROX 98' APPROX 34.5' APPROX 73' '�UOR TO BEDROOM APPROX 70' APPROX 28' 60' 3� HALL BATH 10416 PRUNE TREE LANE EXISTING CUPERTINO STOR WATER POLLUTION CONTROL AND NOISE CONTROL 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 - ouilding(�cuoertino.orc GENERAL INFORMATION All construction work must meet certain conditions related to maintaining environmental quality and public health and safety. This policy described the two most common inquiries regarding construction: Stormwater Pollution Control and Noise Control. STORMWATER POLLUTION CONTROL State law requires that the City of Cupertino, along with 12 other Silicon Valley cities, Santa Clara County and the Santa Clara Valley Water District control stormwater pollution. Educating local residents and busunesses and enforcing stormwater pollution control laws are key parts of the City's compliance efforts. r 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 contractor share ultimate responsibility for activities occurring at a construction site and will be held responsible for any environmental damage caused by subcontractors or employees. For more information on construction -related stormwater requirements, see the Stormwater Quality Regulations section of the City of Cupertino website at: http: /w-�ti-wcuoertino or- index.asl)x?page=487 COMMUNITY NOISE CONTROL Construction noise is limited to: • Residential daytime noise levels from complaint site — 60 dBAl,, • Non-residential daytime noise levels from complaint site — 65 dBA lv r a jljy Daytime hours are defined as being between the following hours: • Weekdays — 7:00am to 8:00pm ------- • Weekends — 9:00am to 6:00pm Construction, other than street construction greater than 750 feet of a residential area, is prohibited on holidays, except that construction conducted by a homeowner or resident of a single family dwelling using domestic construction tools is allowed on holidays between the hours of 9:00am to 6:00pm. For more information on noise control, please refer to Chapter 10.48 of the Cupertino Municipal code, which can be accessed at httn://-v r-w--,v.amlezal.com/cupertino ca_ Stormwater/Noise Control 2010.doc revised 09/22/10 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildincl(c)cugertino.org F NF.W CONSTRI ICTION n ADDITION n ALTERATION / Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS o 1 (0 TaE& LAI /\/ APN # 31 3 � , i l l OWNER NAME A x ` i r1 7µJ L I I>olu; PHONE (j.fT _ I (7 • -� '[ (�- C �3S E-MAIL (� X_ I l,(C A(~dv.CCiv. STREET ADDRESS (S� } I � r_S5 S k /L 2i �/ jTV CITY, STATE, ZIP c,5 A LTU S �A 4 U Z 14 C FAX CONTACT NAME A�tx LI U PHONE -] E-MAIL E-MAIL silex_ GC LQ �d�vc. STREEET ADDRESS (� A_ (� f CITY, STATE, ZIP Le, c A uioS CA c? �/ �tU-Z `❑ENGINEER FAX OWNER ElOWNER-BUILDER❑ OWNER AGENT 11 CONTRACTOR 11 CONTRACTOR AGENT ❑ ARCHITECT ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME &LeIJ N,4 AJ LICENSE NUMBER g3 � 6 y `"'ll 5 LICENSE TYPE BUS. LIC # COMPANY NAME i c- Nt;�u S C ri S �,2u �-T,c�% E-MAIL FAX STREET ADDRESS f (,� +�-t ^7 mclL( D /4, j d ,T Iv fjlf G CITY, STATE, ZIP S � _ ` J -c S e C A 6 1 Z /, PHONE %[O T# �J l ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 12 E—T I LL A-1 AS I CSL A%J (� D LL- RA -r(4 S Alsw 7k,13 Nu T/LI LAL Nd L tf7/1V Nd Gdlhliv1 c -A It EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKJPORCH AREA GARAGE AREA: LJDETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY []YES BEING ADDED? ONO ADDITION? ❑NO PRE -APPLICATION [:]YES IF YES. PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: ` TOTAL V LUATION: _ (a'] PLANNING APPL # [-]NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO 6 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 const bion. I authorize representatives of Cupertino to enter II.e above -identified property for inspection purposes. Signature of Applicant/Agent: Date SUPPLEMENTAL INFO ATION REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for PIAN existing building(s). Demolition permit is required prior to issuance of building cOI WMR $U_"1NG REVIEW permit for new building. ❑ EXPRESS ; ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ Punuc WomG form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ r:ERE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY -SEWER DISTRICT' submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH. BldgApp_201 Ldoc revised 06/21/11