12040004 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10613 0ASCOIGNE DR CONTRACTOR:ZHU MEIDUO AND HU PERMIT NO: 12040004
HONGQI
OWNER'S NAME: /_HU MIi1DUO AND HU HONGQI 10613 GASCOIGNE DR DATE. ISSUED:04/02/2012
OWNER'S PHONE: 4088024052 CUPERTINO.CA 95014 PHONE NO:
❑ LICENSED CONT'RACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class Lic.q
MECH r RESIDENTIAL r COMMERCIAL r
Contractor Date
I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REPLACE REDWOOD FENCE(71-1101 X87')LENGTH)AND
(commencing with Section 7000)of Division 3 of the Business&Professions (3
Cade and that my license is in full force and effect. f{IGI{X20'LENGTI{IN FRONT)
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
performance of the work for which this 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 Sq.Ft Floor Area: Valuation:$2000
permit is issued.
APPLICANT CERTIFICATION APN Number:37528014.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep hamtless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9A8.9.18. //
Signre Dale Issued by: . ��/✓ '1/A%Gw Date: Al.a'/a.
W OWNER-BUILDER DECLARATION
RF.-ROOF'S:
1 hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Scc.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Workers HAZARDOUS MATERIALS DISCLOSURE;
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505.25533,and 25534. 1 will maintain
I have and rill maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code.Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should 1 use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code.Chapter 9.12 end the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,2553},and 25534.
Compensation laws of Cali fomia. If,after making this certificate of exemption.I
become subject to the Worker's Compensation provisions of the Labor Code,I must Own/er�pr aulhori d ant:�/
forthwith comply with such provisions or this permit shall be deemed revoked. ' ` Mlm ""le°--"1,1
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read[his application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
cored.I agree to comply with all city and county ordinances and stale laws relating for which this permit is issued(Sec.3097.Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as puhl is records.
Signature r/ 'v , / ` Date �Z �Z Licensed Professional
Gascoigne Drive
New Redwood Fence with 3'-0-Hiyhr
COMMUNITY DEVELOPMENT DEPARTMENT [VED
BUILDING DIVISION-CUPERTINO - Ewisrtng Redwood Fence with S'0"Nighr
APPROVES `R 201Z
kit tat the
This set of plans and specifications MUST be p BY;
Job site during construction. It is unlawful to make any
changes or alterations on same,or to deviate
therefrom,without approval from the Building Official.
The stamping of this plan and specifications SHALL NO 5''-0" s,o_
be held to permit or to be an approval of the violation
of any provisions of any City Ordinance or State Law.
BY J� /✓ f �T��
DATE
PERMIT NO.
i
n
S
10613 Gascoigne Dr.
10605 Gascoigne Dr.
E 4 Existing House
Existing House
PLOT P1ANg
CgECYED BI
DATE
I ATEv
All is
New Redwood fence with 7'-0'Nighf(See Detail) ' FFICE MR
'. ..,.,...._............... .._.. ....._..._..50.18P.L 1
t
OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE"CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228" FAX(408)777-3333• buildino(a)cuoertino.ora
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 ADDF $ APN BP#
OWNER AMMEIV
OWNE , DR 2S r; r1r, -
DESCRIPTION OF WORK: -ti- •!�
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
(DIRF�T
7IONS:Please read and initial each statement below to signify you understand or verify this information.)
1. 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
surance coverage for injuries to workers on my property.
�) 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for
e construction and are not hiring a licensed Contractor to assume this responsibility.
(((((( 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
umbers on permits arid contracts.
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.
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.foreach "employee." I also understand my failure to abide by these laws may subject
/��e)to serious financial risk.
=7. 1 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
/;(,� pperformed 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.
OmnerBuilderFmrmm 2010.doc revised 04/14/10
eeve
9I understand I may obtain more information regarding my obligations as an"employer"from the Internal
nue Service,the United States Small Business Administration, the California Department of Benefit Payments,
and the California Division of,lndustrial Accidents. I also understand I may contact the California Contractors'State
License Board (CSLB)at 1-800-321-CSLB (2752)or www.csib.ca.gov for more information about licensed
0ctors.
10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I
e party legally and financially responsible for proposed construction activity at the site address listed above.
111. 1 agree that, as the party,legally and financially responsible for this proposed construction activity, I will abide
b all applicable laws andlrequirements 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 sustaiq as a result of a complaint.Your only remedy against unlicensed
Contractors may be in civil'court.'lt�is also important for you to understand that if an unlicensed Contractor or
employee of that individual or fine 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 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:ZYEZU
--- - - --- --- -- -- - ----- ----- ----- ---- - -- --- --
(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: Tel No
Address of Authorized Agent:
declare under penalty of;pedury that I am the property owner for the address listed above and I personally filled out the
above information and certifpits 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:
OwnerBuilderForm 2010.doc revised 04/14110
10300 Torre Avenue
Cupertino, California 95014
Telephone: (408) 777-3308
FAX: (408) 777-3333
Ci of
CUPEkTINO COMMUNITY DEVELOPMENT
'�
FENCE-APPROVAL
N1W, zorzo�Z
(DATE)
1-40A 'Q! H("
.
I am an adjoining property owner of i 4YNIE =
(NAME)
whose property is-located atO f 3 C7f}SC'o/Cv/V Z' �P• w, ///Yo 9/poi
(ADDRESS)
I approve (per Section 16.28.040,of the Cupertino Municipal Code) the allowance of a
foot high fence facing my property.
(8 FF. MAXIMUM)
SIGNED: � �) O
Name: f()//VYY/,5;
Address: /OiS ;F��CD/rxk PA .
T�
G:IPlanningWISCELLI FenceWence Approval Form.doc Updated 812512005
,a„
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37528014 . 00
DATE ISSUED. . . . . . . : 04/02/2012
RECEIPT #. . . . . . . . . : BS000016423
REFERENCE ID # . . . : 12040004
SITE ADDRESS . . . . . : 10613 GASCOIGNE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ZHU MEIDUO AND HU HONGQI
ADDRESS . . . . . . . . . . : 10613 GASCOIGNE DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : HONGQI HU
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : ZHU MEIDUO AND HU HONGQI
ADDRESS . . . . . . . . . . : 10613 GASCOIGNE DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 2,000 .00 1 . 00 0. 00 1 .00 0.00
1BSEISMICR VALUATION 2,000.00 0. 50 0. 00 0.50 0. 00
1FENCE>6FT LINEAR FEET 107.00 457. 00 0. 00 457.00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 458.50 0. 00 458.50 0.. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
---- --------------- --------------------
CREDIT CARD 458.50 AMEX
---------------
TOTAL RECEIPT 458 .50
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10613 Gascoigne Dr. DATE: 04/02/2012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: $2,000
'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration I Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: PERMIT TYPE:
WORK a lace redwood fence (Thigh X 87' length) and 3' high X 20' len th in front).
SCOPE
"./,. I'luu( b,e A- PLurll,. l'lou C"hn'A £Ir,:. P/,ur Ck"k
I1.,�:/r. /'drwrif Fee umb. /1:rulil/:�':
Ud¢•,',1/reds. lrr�l,. i)Ibrr/'hrmL/nsp. Udirr/:ler_Lup_
JIdrA. imp. hear_ l'IaurL. Lup. Frr: l'.(rr_frnp. Fdc:
NOTE: This estimate does not includelees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelimina information available and are only an estimate Contact the Dept for addn I info.
FEE ITEMS (Fie Resohninn 11-053-LU. 711111/ FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 107 I.f. Fence
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $457.00 IFENCF_>6FT I Fence,Non-Masonry>6'
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee Q Reg. Q OT O,p hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
n'll('(I(W TILL '.
,Ilbninwnvnivc I i t, O
Work Without Permit? Yes (j) No $0.00 E)
Advanced Planning Fcc: $0.00 Select a Non-Residential E)
7r,lrcl llncnu/rnmli„n [crew Building or Structure O
Strong-mot_1011 I'ec: /BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.50 $457.00 TOTAL FEE: $458.50
Revised: 1/19/2012
CONSTRUCTION PERMIT APPLICATION 1P 0
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014.3255
CUPERTINO (408)777-3228• FAX(408)777-3333• buildlnD(dCUDertino-orD
❑NEW CONSTRUCTION ❑ ADDITION - ALTERATION 1 TI ❑ REVISION I DEFT= ORIGINAL PERMIT p
PROH3C1'ADDRESS,vif AFNS ' + O
I. o Qp — e 1t� /� I I q� )
OWNERNAME BN,/ QI� il � PHONE —$pt. —4tS'-> EMAIL �oShtx0.hlA,�
STREET ADDRESS //��YY + ^ CITY. SPATE ZIP �1 i n FAX
CA
CONTACT NAMEB/ "� 84 p4r. PHONE — `� E-MAIL
STREET ADDRESS Q/� , , QTY,S7ATE, ZIP n'D y FAX
❑OWNER 4 W0 E -BUBDER OWNERAGENT ❑ coNTRACIOR ❑CONTRALTORAGilr ❑ ARCHRECP ❑ENGINEER ❑ DEVEIAPER ❑T ANT
CONTRA OR NAME LICENSE NUMBER LICENSE TYPE Bus.LIC 4
COMPANY E-MAIL FAX
STREET ADDRESS CITY.STATE.ZIP PHONE
ARCHTTECDENG1MEER NAME LICENSE NUMBER BUS.UC M --
COMPANY HAMM E-MAIL FAX
STREET ADDRESS CITY,STATE.ZIP PHONE
DESCRIPTION OF WORK n 1 _ ^ A vA WftA C / O/ (J,` I /t r
'10 '— Q Ill 8 ,G;[OI
I'W3 r , f[tdr- qa-mot
/O h C l
EJGSTING VSE PROPOS USE- COHSIR TYPE pSTORtFS
_tjlr?, — �� USE TYPE OCC. dQFT. VALUATION(5)
E%STO NEW MOOR DEMO TOLAL
AREA AREA AREA NET AREA
BATHROOM KrrCHEN - I OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PoRCHAREA DECKARFA TOTAL DECK R GE AREA:-H DETACH
ATTACH
I DWELLING UNDS: C'OND UMT YES• SECONDSTORY YES
BEING ADD®t ❑NO ADDITION' ❑NO
PAE-APPLI ON ❑YES rE YES,PROWDE COPY OF rSTHEBLDGAN ,. ❑YES RECEIVED TOTAL VALUATION
PLANNIt APPLO
[]NO PLANNING APPROVAL LETTER. ®CWXRHOMir? "❑NO .(/ N
13y my signature below,I certify to each of the following. I am the property owner or authorized a¢cnJt to act onndtl a prpperty.owner's behalf•I have rtad this
application and the information I have provided is correct I have read the Description of Work and verify it is accurate. [agree to comply with all applicable local
ordinances and smote Taws relating to building construction. I authorize representatives of Cupertino to enter the above-idcatilled property for inspection purposes.
Signature of Applicant/Agent Date;
SUPPLEMENTAL INFORMATION REQUIRED PLAN CRECBTYPR ROUTINGSLIP
_New SFD or Multifamily dwellings: Apply for'demolition permit for �OVER-THE-COUNTER ❑ BUILMING PLAN RrV[EW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PLANNING PLAN RKVIEW
Commercial Bldgs: Provide a completed Hazardous Mateiials Disclosure ❑ STANDARD ❑ PUBLIC womo
form if any Hazardous Materials are being-used as part of this project. ❑ LARGE ❑ Frac DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application: El MAsox 11 SANrIARY 9ER'Elt DISCAICf
❑ KN.'Dtormmrrw,:a.Era
BldgAPP_201 Loot:revised 06121/71