Loading...
12040109 CITY'OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1f 022013ONNY DR CONTRACTOR:GHOUL FA YSAL H PERMIT NO: 12040109 �PgUl,FA YSAL H 10220 BONNY DR DATE ISSUED:04/192012 CUPERTIN0,CA 95014 PHONE NO; p ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lick MECHF RESIDENTIAL r- COMMERCIALr Contractor Datc 1 hereby affirm that l am licensed under the provisions of Chapter COM DESCRIPTION:RE-ROOF REMOVE SHAKE AND REPLACE WITH (commencing with Section 7000)of Division 3 of the Business&Professions ROOFING OL RCLASS A 245Q Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: 1 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 Sq.FI Floor Area: Valuation:$7500 permit is issued - APPLICANT CERTIFICATION APN Number:35911044.00 Occupancy Type: I cenify that I have read this application and state that the above information is coffee(.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 PERMIT IRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN DAYS OF PERMIT ISSUANCE OR costs,and expenses which may acerae against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply 180 DAY ROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by: Date: Signature Dale OWNER-BUILDER DECLARATION RF--ROOFS: hereby affirm that 1 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 Appli Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(See 7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS'S"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS NIATERIAI S DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Ilealth&Safely Code,Sections 25505.25S33,and 25534. I will maintain 1 have and will 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 l will I certify that in the performance of the work for which this permit is issued,l shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,1 must Owner or authorized agent: /�/ forthwith comply with such provisions or this permit shall be deemed revoked. Dale: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 1 certify that 1 have read this application and state that the above information is 1 hereby affirm that Were is a construction lending agency for the performance of work's correct. 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 sour regulations per the Cupertino Municipal Code Section 9.18. 1 understand my plans shall be used as public records. i Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: p p PERMIT# OWNER'S NAM PRONE # GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 am not using any subcontractors: �� / Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum / Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35911044. 00 DATE ISSUED. . . . . . . : 04/19/2012 RECEIPT #. . . . . . . . . : BS000016581 REFERENCE ID # . . . : 12040109 SITE ADDRESS . . . . . : 10220 BONNY DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : GHOUL FAYSAL H ADDRESS . . . . . . . . . . : 10220 BONNY DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : HUI SEFTON CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : GHOUL FAYSAL H ADDRESS . . . . . . . . . . : 10220 BONNY DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 7, 500.00 1.00 0.00 1 .00 0. 00 1BSEISMICR VALUATION 7, 500 .00 0.75 0 .00 0 .75 0.00 1REROOFRES SQ FEET 24 .00 336 .00 0 . 00 336 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 337 .75 0 . 00 337.75 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 337. 75 VISA --------------- TOTAL RECEIPT 337.75 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ------------------ -------- ---------------------------- 309 EXTERIOR LATH 311 SCRATCH COAT 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228"FAX(408)777-3333" buildingOcuoertino.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 ADDRESS APN BP# o r'd OWNER NAME OWNERADDRESS J1.0. DESCRIPTION OF WORK: G 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 (DIR���/EECCCC�TIONS: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- 0cler" 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 homeowners 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. /y. 2. 1 understand building'permits are not required to be signed by property owners unless they are responsible for he construction and are not hiring a licensed Contractor to assume this responsibility. 4-ptect 3. 1 understand as an "Owner-Builder"I am the responsible party of record on the permit. I understand that I may myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. /tmbers -4. I understand Contractors are required by law to be licensed and bonded in California and to list their license on permits and contracts. t5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the otal 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. f46. I understand if I am considered an"employer"under state and federal law, I must register with the state and f ral 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. A7. 1 understand under California Contractors'State License Law, an Owner-Builder who builds single-family edential 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 ny financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OirnerBuilderForm 2010.doc revised 04/14110 9. 1 understand I may obtain more information regarding my obligations as an "employer"from the Internal venue 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.csib.Ga.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that a the party legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide 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 bylaws 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 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 si nature. Property Owner's Signature: Date: - - - - - ----------- ------- --------------------------------- - ----- -- -- - — ---- - -- ---- -- (NOTE: The following Authorization Form is required to be completed by the pro pert -y owrier- -onl- - y when- - - designating- - -an--- agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATIOMOF.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: 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: OirnerBuilderForm 2010,doc revised 04/14110 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10220 Bonny Drive DATE: 04/19/2012 REVIEWED BY: Sean APN: BP#: "VALUATION: $7,500 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF USE: PERMIT TYPE: WORK Remove shake and replace with composition roofing 2400 sq ft). SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 2,400 Lh,:h. 1'!nn('iirck P/unrh. Plmr CheeA filer% Plan Chcck ,lh rar. Perruit Fee: Plumh. PCI-mit Fcc: li4z. Permit Fee: Ocher.)tech. hnp- Ocher Plumh In,n'p. 01her lifer. i, p. dtcrh.ln,p. Pce Phanh, htep.Fre: filer. Insp. F'0' NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelitnWina information available and are on an estimate Contact the De t or addn'!info. FEE ITEMS (Fee Resolution 11-053 Efl. 71111 U FEE QTY/FEE MISC ITEMS Plan Chock Fee: SlIppl. PC Fre Pll u n h.I,bl ech.Il i l ec Permit Fee: $336.00 Sit/)/)/. /lisp Fee Phunh.;ihlcclrJElcc I'luuch.hldech.IlSlec Purmil Fee: C'onsnrnnun Ta.r: it dmillishrnire Fec. Work Without Permit? O Yes Q No $0.00 Advanc ell Plucnrit,g Fte_s: T)WI'cl Uoccunenla(iun Fees: Strom, Motion Fee: IBSEISMICR $0.75 Select an Administrative Item 13Ide Stds Commission Fee: IBCBSC $1.00 j 1 SUBTOTALS: $337.75 $0.00 TOTAL FEE: 1 $337.75 Revised: 04/01/2012 CONSTRUCTION PERMIT APPLICATION COMMUNfTY DEVELOPMENT DEPARTMENT• BUILDING DMSION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)7773228• FAX(408)777-3333• buildina(alcuoertino.orD ❑NEW CONSTRUCTION. ❑ ADDITION ALTERATION/1'T ❑ REVISION/DEFERREDORIOINALFSUaT# PROJECT ADDRESSa,Z2 hnox-116 G - AP I / / �1 awNIIt NAME -5aG e - y�yl °"� off- .,,Z E-MAR �,Se���l® � ATF STREETADDRESS SY�SoNE ZIu/ FAeXfes �/.41Z / L/o�w�©�!r0 O CONTACT NAME STREET ADDRESS CITY STATE, Z@U�H . FAX Ti ❑OwNER ❑ OWNFR-HUIIAER OWNER AGENT ❑ CON =B. ❑ccvTRAcroRAGENT ❑ ARcm= ❑PNazmm ❑ DEVELOPER ❑TzN! CONTRACTOR NAME n G LICFNSENUNMER LICENSE TYPE BUS.LICA COMPANY NAMEN 1" .� G &MAB. FAX STREET ADDRESS CITY,STATE,IIP PHONE ARCHITECOENOINMNAME LICENSE NUMBER Bus Uc/ CQMPANY NAA05 &MAR FAX STREET ADDRESS CITY.STATE.ZIP PHONE DESCRIPTION OF WORK O �✓ � O 30 EXISTING USE PROPOSED USE GONSIA TYP SMPM OD USE' TYPE DCC. SQ.FT. VALUATIONS) ERSrO NEW FLOOR DEMO AL AREA AREA AREA NET AREA - BATRROOM KOIIOi]Y OTHER REMODEL AREA REMODELAREA FLEMODELAREA PORCHAREA D=AREA TOTAL DECrUPOMMAREA G OEARE& 0ETACII ATTACH I DWELLING UNITS: 6A SECOND[IMT YES SECOhn STURY ES Y aM IONO ADDIZIOM FO PRE-APPLICATION [YES IQYES,PROVIDECOPYOF. IS TIM BLDG ANRECEIVEDB : - TOTAL VALUATION FLANNINOAPPLI ET NO PLANNING APPROVAL LETTER KICHLIMEO&ON T D By my sigoatee below,I certify to each of doe followmg: .I am the Property owner Or authorized anent M act on the pr Tmtyowaery behalf.,f have read dos application Bad the mforucadou I have provided is cIDect I have crud the Descdpti=of Wark and verify it is arsorate. I agree to comply widt all applicable local Ordinances and state laws relating to bm7 ' g wpstac ion. I amI ' representatives of Caperdno to mgr the above-i ed property fm hupecCcp proposes. Sigrranm of ApplieandAgent Date: SUPP INFORMATION REQUIRED PLAN CHECK TRPK AOPIDYG SLIP New SFD or Multifamily dwellings: Apply for demolition permit forOVER TEM-COUNIB'R TuUDUfG p*•v ExvMw atistiag building(s). Demolition permit is required prior to issuance ofbuilding permit for new building. ❑ KEFasss ❑ PLANPNGPLANREVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS farm if any Hazardous Materials are being Used as part of this project ❑ fARGZ 0 M DEFT _Copy of Planning Approval Letter or Meeting with Planning prior to ' submittal ofB Permit ❑ eL170R ❑ SANITARY 4EwP1T OGSTRICS lid application. ❑ ENVIRONMENTAL MALTH_ BlogApp_2011.doc revised 06/21/11