Loading...
12030159CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20975 VALLEY GREEN DR CONTRACTOR: MORROW-MEADOWS PERMIT NO: 12030159 CORPORATION OWNER'SNAME: KORET FOUNDATION 1050 BING ST DATE ISSUED: 03/302012 OWNER'S PHONE: 4082530200 SAN CARLOS, CA 94070 PHONE NO: (650)634-0682 ❑ LICENSED CONTRACTOR'S DECLARATION .IOBDE.SCRIPTION: RESIDENTIAL COMMERCIAL. License Class Lic.4 UNIT 307- INSTALL WASH ERIDRYER HOOKUPS Contractor Dale 1 hereby affirm that l am licensed under the provisions of Chapter (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 penally 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 Sq. Ft Fluor Area: Valuation: $500 performance of the work for whichthis permit is issued. 1 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 APN Number: 32609041.00 Occupancy Type: 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR to budding construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save TII N. 180 DAYS FROM LAST CALLED INSP3U indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the '7 a Z. granting of this permit. Additionally, the applicant understands and will comply Issued by: `'Z Date.;3 with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. RE-ROOFS: Signature Dale 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: 1 hereby affirm that 1 em exempt from the Contractor's License Low for one of the fallowing Iwo reasons: AL1, ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 (Sec7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE. construct the project (Sec.7044, Business & Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Ilealth & Safety Code, Sections 25505, 25533, and 25534. 1 will 1 hereby affirm under penally (if perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(x) should I store or handle hazardous 1 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 Oualih' Management District performance of the work for whichthis permit is issued. will maintain compliance with the Cupertino hl unici al Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Ilealth & Safety Code, Sections 25505, 25533, a d 25534. Section 3700 of the labor Code, for the perfomnance of the work for which this Owner or authorized agent: Deter permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person inany manner so as to become subject to the Worker's Compensation laws of Cal ifomia. If, after making this certificate of exemption, 1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, 1 must 1 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 1 have read this application and stale that the above information is correct. I agree to comply with all city and county ordinances and slate 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 and keep harmless the City of Cupertino against liabilities, judgments. ARCIIITF.CT'S DECLARATION 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 nun-point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signalu Date_a3C)___/2 N CITY OF CUPERTINO 6 ITEMS OF 24 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32609041.00 DATE ISSUED.......: 03/30/2012 RECEIPT #.........: BS000016410 REFERENCE ID # ...: 12030159 SITE ADDRESS .....: 20975 VALLEY GREEN DR SUBDIVISION ....... CITY .:............: CUPERTINO IMPACT AREA ....... OWNER ............: KORET FOUNDATION ADDRESS ..........: 1050 RALSTON RD CITY/STATE/ZIP ...: BELMONT, CA 94002-2243 RECEIVED FROM ....: VILLAGES . CONTRACTOR .......: KATHLEEN RICHARDS LIC # 28064 COMPANY ..........: MORROW -MEADOWS CORPORATION ADDRESS ..........: 1050 BING ST CITY/STATE/ZIP ...: SAN CARLOS, CA 94070 TELEPHONE ........: (650)634-0682 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- -ADMIN ------------- ---------- HOURS -------- - 1.00 41.00 0.00 ---------- 41.00 ---------- 0.00 1BAPPLOTHE NO OF APPLIAN 2.00 130.00 0.00 130.00 0.00 1BCBSC VALUATION 500.00 1.00 0.00 1.00 0.00 19SEISMICR VALUATION 500.00 0.50 0.00 0.50 0.00 1MPERMITFE FLAT RATE 1.00 44.00 0.00 44.00 0.00 1TRAVDOC FLAT. RATE 1.00 44.00 0.00 44.00 0.00 TOTAL PERMIT 260.50 0.00 260.50 0.00 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • b.radinarcuoarinaara 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/e� ! APN 5� ` 0 S,y L7 BP,. OWNER NAME Z T U,U nv) OWNER ADDRESS DESCRIPTION OF WORK: 0- lloele 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.) 5-6. 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. 5 &12. 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. SV 3.1 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 cnumbers on permits and contracts. V 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. Si/ -6. 1 understand if I am considered an "employer" understate 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. l7. 1 understand under California Contractors=State License Law, an Owner -Builder who builds single-family_ re Idential 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. �_/_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 owners) that result from any latent construction defects in the workmanship or materials. OirnerduilderForm 2010.doc revised 04/14/10 59. 1 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 _icense Board (CSLB) at 1-800-321-CSLB (2752) or www.cs[b.ca.gov for more information about licensed contractors. 5V-10. 1 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. ._V11. 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. �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 LENDING AGENCY (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 responsible for issuing the permit. Note: A copy of the property owner's drivers license, form notarization, or other venfrcation acceptable to the city may be required to be presented when the permit is issued to verify the Property owner's s' nature. Property Owner's Signature: Date: 0367 -----`--------------------- ------------------------ -----------------------------=---------------------------------- - -- (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 construct/on permit for the Owner -Builder). - I AUTHORIZATION. OF AGENT TO ACTON PROPERTY OWNER'S BEHALF Excludirig the Notice to Property, Owner, the'ezecution of which I understand is my personal responsibility, I hereby authorize the following persons) t6 -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_ta s..... :; - Tel No Address of Authorized Agent ' e.: • 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,iis_accuracy Note.,A copy of the property own&es driveYs 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 owners signature. Date: OwneiBuilderForm 1010.doc revise 04114110 CONSTRUCTION PERMIT APPLICATION - COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING Dh.'ISIGhI 10300 TORRE AVENUE -CUP ERTINO, CA 95014-3255 C{ NERT)Nq (408) 777-3228 • FAX (408) 777-3333 • buildincOcuoertino.cro ❑ NEW CON57RI T=)N 7 AnnrTMV F-1 e„ -a.-. 1 ________ By my signature bel ow, I certify to each of the following: I am the property Davey or authorized agent to act on the property owners behalf. I have read this application and the information I have provided is comct I have reaO the Description of Work and verify it is accurate I agree to comply with all applicable local ordinances and state laws relating to budding con on. I/%yGa rapres"Ves of Cupertino to enter the above iden�tilfied property for inspection purposes. Siguanae ufApplicanHAgent C— � Date _ . SUPPLEMENTAL'1NFOAMfi,T10NRF . New SFD or Multifamily dwellings: Apply for demolition permit for - e)dsting building(s). Demolition permit is required prior to issuance ofbuildiag perlit foruew building.`- _ Commercial Bldgs: Provide a completed Hazardous MaterWs Disclosure form if any Hazardous Materials are being used as part of this project _Copy of Planning Approval Letter or Meetiag with Planning prior to submittal of Building Permit application. - _ Bldglpp 201J.doc revised 03/16/11 ?Fo'_'CT ADORES" zD� rr� ,ee,�d© � ► APN: ORti TlA1rC--. LD pion= E-MAM _ S=TADDP Ess CITY TATE, ZIP / FAX CONTACT [:Atvlt' (J 1 STFI=AMMSS / /or itr r. ATF CITY ZIP FAX OWNER ❑ OWIhR-B=ER ❑ OW AGENT ❑ CONn ACr0R ❑CONTRACTORAGENr ❑ ARCHITECT ❑ ENGZam1 ❑ DEVELOPER ❑ TENANT CONIRAOt'OKN&J,M - - .. MCENSE MEdBER - 1JCENSETYPEt1 HUS. LICA 3 LAS If O CO.NPANY C4b C E-MAll. FAX STREET ADDRESS ., r . TATE. ZIP a PHOTS ARCHTTECT/ 014EERNAMa IICENSENUMBER Eus. uc o COMPANYHAME E-MAM' .• .FAX STREET ADDRESS CITY, STATE ZTP PHONE DESQUP'TION OF WORK FXISmIGtISE PRDPDsm ISE CONSTR TYPE f s -roam �y+"-• '^u"'G' : .'- ; .iN.� _ . F (6F'[/ �• i•- �^`�T" Wim T .' � D �O .I' � �ATIOL�. •. EXISTG N'EW FTDGR DEMO AREA q AREA AREA -y . TiET'VIFA aS` %�" B ".-+A�.�,9ef 3i.'ti�S•``�'.YtS �'K"� h BATHROOM RRCF¢TI .BEMODEL AREA RE Mm AREA 07FDiRR .. —�-•`�g&^��'•.': �;: =-.''T�'y�' .�' ,_-' -'t:. �'`�i ?,.E; REMODEL AREA ?C4." -. '•L"��.�'�fi '�-!'�' ,,y .':_3�y PORCHAREA DECK AREA.. TCTALZECLWRMARFA. .GARAGEARFA: ❑DETACH ❑ ATTACH ''-...� �'I-F �eA sFC^�'^,—sErS.�ryy �,1"'k�` � ��ys�H F� t Da'FD.WDUMIS 15ASECOtO UMI YFS sECOT[D SrORV •oC ❑IRI HFIIK. MDmt NO ADDIi" sj.-i''"�.. ❑ " j tY %` Y L: meq. YAT T Pa£�VPLICpnpy ❑ No 6YD. PROVIDECOPYOF' PWlNF]C9 NAME � BF1�Y �5,, i A Vir1.DA M-M1M@.UAP%.I NO PL1M¢WAPPAOVALLpI R ['A ^.pkv' jPe}t.{t`��S�Y�?�yj?�i% t By my signature bel ow, I certify to each of the following: I am the property Davey or authorized agent to act on the property owners behalf. I have read this application and the information I have provided is comct I have reaO the Description of Work and verify it is accurate I agree to comply with all applicable local ordinances and state laws relating to budding con on. I/%yGa rapres"Ves of Cupertino to enter the above iden�tilfied property for inspection purposes. Siguanae ufApplicanHAgent C— � Date _ . SUPPLEMENTAL'1NFOAMfi,T10NRF . New SFD or Multifamily dwellings: Apply for demolition permit for - e)dsting building(s). Demolition permit is required prior to issuance ofbuildiag perlit foruew building.`- _ Commercial Bldgs: Provide a completed Hazardous MaterWs Disclosure form if any Hazardous Materials are being used as part of this project _Copy of Planning Approval Letter or Meetiag with Planning prior to submittal of Building Permit application. - _ Bldglpp 201J.doc revised 03/16/11