12070114 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10143 LOCKWOOD DR CONTRACI.O:WONG PAKMAN AND PERMIT NO: 12070114
WANG 17EN-IIUA TRUSTE
OWNER'S NAME: WONG PAKMAN AND WANG FEN-HUA TRUSTE 10143 LOCKW'OOD DR DATE ISSUED:07/172012
OWNER'S PDONE: 4082575592 CUPERTINO.CA 95014 PDONF.NO:
❑ LICENSED COMIRACI'OR'S DFCLA RA'T'ION BUILDING PERMIT INFO: BLDG r ELECT I- PLUMB r:
License Class Lie.H
MECII RESIDENTIAL COAIi\IERCLAL r
Contractor Dale
hereby affmmn that I am licensed under(hc provisions of Chapter 9 JOB DESCRIPTION:ADD ELECTRICAL OUTLET TO DLTACIiED GREENHOUSE
(commencing with Section 7000)of Division 3 of the Business S Professions
Cute and(hal nnlicense is in full forte and effect.
hereby affirm under penally of perjury one of(he follmving tsvo 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, ti ft floor Arca: Valuation:$200
I have and will maintain Worker's Compensation Insurance,as provided for by q
Section 3700 of the Labor Code,for the performance of die work for which this
permit is issued. APN Number:34214030.00 Occupancy'1'ype:
APPLICANT*CERTIfIC\T'ION
I certify that I have read this application and state that the above information is
correel. l agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES [F WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon[lie above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indenmifyand keep hamplessdie CityofCupertinoagainst liabilities'
judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,ani expenses which may acerae against said City in consequence of the
granting of this permit. Additionally,the applicmn understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by4--__:7 -- Date:
9.18.
Signature Date
RE-ROOFS:
OWNER-I111ILDER DECLARATION 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 nay materials for
1 hereby affirm that Iran eyenppt from the Cunlrartor's License Law for one of inspection.
the(allowing Iwo reasons:
I,as owner of the property,or my employees with wages as their sole conpRnsation, Signature of Applicant: Date:
will do the work,and the structure is not intended or oBired for sale(Sec.7044,
Business S Professions Code)
I,as owner of the propeny,.am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business R Professions Code).
hereby affirm under penally of peijurs'one of the following three IIA%ARDOUS NIATERIALS DISCLOSURE
declarations: 1 have read(be hazardous materials requirements'under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self insure for Worker's California Health S Safety Code.Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code.Chapter 9.12 and the Ilealth C
performance ofthe work for which this permit is issued Sufe(y Code.Section 25532(a)should I store or handle harrrdous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or Devices which emit hwnrdous air
Section 3700 of the Labor Code,for the performance of the work for which this coram ilia tits as defined by the Bay Area Air Quality Management Dis(ric( I will
mninmin compliance with the Cupertino Municipal Cade,Chapter 9.12 and the
Perini[is issued. d2
Lcerlily That in the performance ol'dmc work for which This permit is issued I shall []call[]S Safely Cua Sections 55(15,25533.and 25534.
not employ any person in any manner so as to become subject to the Worker's Owner or ih unri u e 1 j 7 �!Z
Conmpensation Imes of Calilbmia. If,after making this cenificate of exemption,I i�. Date:
become subject to the Worker's Compensation provisions of the Labor Code,I mus(
forthwith comply with such provisions or this permit shall be deemed revoked. C(INS"IRl1C110N LENDING,\CM:NCI'
I hereby affirm that there is a construction lending agency for the performance of pork's
A I'1'LICAN'I'CIi IfI'I TIC,\'PION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application mid state that the above information is Lender's Name
correct.I agree(o comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter Lender's Address
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 0011C ARCI I ITECI"S DECLARATION
granting of this permit.Additionally,the applicant mnders(ands and will comply I understand nay plansshall be used as public records.
with all 11011-point source regulmius per the Cupertino Municipal Code,Section
9.18. 7 Licensed Professional
Signature. wt�l h Date 7 I / )2
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10143 lockwood dr. DA'Z'E: 07/17/2012 REVIEWED BY: bobs.
\ APN: BI'#: VALUATION: $200
*PERMIT TYPE: Electrical Permit PLAN CIIECK TYPE: Alteration /Addition / Repair
PRIMARY PENTAIIIATION
USE: SFD or Duplex PERMITTYPE: 1REAP10
A1
WORK add electrical outlet to detached greenhouse.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Recep/Switch/Outlets 1BREMRECEP 1 # $45
TOTALS: $45.00
klech. Plan Check Plnerb. Plan Check Elec. Plan Check 0.0 1 hrs $0.00
Meth. Permit Fee• Plumb. Permit Fee: Elec. Permit Fee: IEPERAHT
other Much.lisp. Other Plumb lisp. Other Elec. Insp. 0,0 hrs $452
0
He.&Insp. Fee: Plnmh. hap. Fee: Fier.hup.Fee:
A'OTE: This eainuae does not include jeer elite to other Departments(i.e. Planning, Public II'orks, Fire,Sanitary Server District,School
District,etc.). There fees are baser/on the preflininart•in onnation available and are onh,an eviiinate. Contact the Dept for aeldn'I info.
FEE ITEMS (Fee Resolution 11-053 F_1C 711111) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check: $0.00
Permit Fee:
Suppl. Lisp Fee
PME Unit Fee: $45.00
PME Permit Fee: $45.00
Consnttction Tar:
Administrative Fee: 1ADMIN $42.00
Work Without Permit? O Yes Q No $0.00
AdYeencecl Planning Fees:
Travel Documentation Fee: ITRA rnDOC $45.00
i
Strong Motion Fee: IBSEISHICR $0.50 Select an Administrative Item
Bldg Sids Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $178.50 $0.00 TOTAL FEE: 1 $178.50
Revised: 07/01/2012
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 ADDRESS jOjLA? Lock' Woon -DR APN / BP##
OWNER NAME f}I�MA�� `,Ifl�C' OWNER ADDRESS /o /t/3
D 1/3 Lfl CfCL.IOQp 1\
DESCRIPTION OF WORK: W
nn �t rc R cF�� oaTl-� TO D�Tj�cl{�p C 2��NHores�
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.)
/D" 1. I 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.
/OA2. I 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.
N3'` 3. I 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.
4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license
nr�u bers on permits and contracts.
to5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
tovalue of my construction is at least five hundred dollars (5500), including labor and materials, I may be
considered an"employer" under state and federal law.
ff�6. 1 understand if I am considered an"employer" under state and federal law, I must register with the state and
al 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.
1s! 7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family
ential 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.
!81 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for
anyfinancial or personal injuries sustained by any subsequent owner(s)that result from any latent construction
defects in the workmanship or materials.
OII'nerBuildel'Forvn 2010.doc revised 04/14/10
dt.
" '9: I understand I may obtain more information regarding my obligations as an "employer'from the Internal
Re enue 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.ca.gov for more information about licensed
contractors.
p
10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name,and understand that l
am e arty legally and financially responsible for proposed construction activity at the site address listed above.
by11. 1 agree that, as the party legally and financially responsible for this proposed.construction activity, I will abide
applicable laws and requirements that govern Owner-Builders as well as employers.
Qvk 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
hf mation 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 maybe 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 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: 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:
OwnerBuilderFonn 2010.doc revised 04/14/10
RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number: C�.1
Name o f owner.
P!}�M Wo�C IUL 16 2012
'1 ,�..,
Project address. 101q-3 LoCk fDoi) J) Q
Contact person. �Ak-"f� W 0 NC7 Phone. ����� 2-S- 7-t/ 2
Fax.
Net square footage of lot. LD-�
Existing Proposed
Square footage: First floor: 21213 ZQJl3
Second floor:
Garage: 40
TOTAL: 2,47 2AT-7
C1
Are there at least two 10 foot by 20 foot clear spaces inside the garage? DY N
Is privacy protection planting required for the project? Y N
Build it Green Total Points
On what floor(s) is work being done? Ta 01�.
Brief description of work. Ao �LK71fIL4, gyl-t7 —ro T&TAoll-D �jQzzNlEeudZ
Code editions: 2007 CBC (Y - N)2007 CFC (hY�- N)2007 CMC (Y- N)
2007 CPC (Y - N)2007 NEC 46D N) CUPERTINO
Building Department
DEVELOPMNT
Effective I/I/0$COMMUNITY
BUILDING DIVISIONS UPERTINO DEPARTMENT
JUL. Is 17 2012
APPROVED
This set of plans and specifications MUST be kept at the REVIEWED FOR CODE COMPLIANCE
Job site during construction. It is unlawful to make any Reviewed By: f
changes or alterations on same,or to deviate
therefrom,without approval from the Building Official.
Tho stamping of this plan and specifications SHALL NOT
be held to permit or to he an approval of the violation
of any provisions of any City Ordinance or State Law.
By _�h ��,r-A
D ATE
PERWIIT NO. 20 0j
Plan Review Process Work Book Page-8-Revised 8/05/08
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Building Department
JUL 17 2012
RE WED FOR CoD E COMPLIANCE
I9 'Reviewed By: �cb f
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'PLOT PLANS
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GENERAL PERMIT APPLICATION M E P
Ell CCINIMUNITY DEVELOPMENT DEPARTMENT t BUILDING DIVISION
10300 TORRE AVENUE t CUPERTINO, CA 95014-3255 M ' /�
CUPERTINO (408)777-3228 • FAX(408)777-3333 • building0ruoer�ino.ora v\
❑PLUMBING ❑MECNANjCAL ®ELECTRICAL ❑MISCELLANEOUS
PROTECT ADDRESS 10143 Lock!„Jo�ol, Dk I AP"� - o3(c /
OWNER NAME �k MSN /
W9 AJ PHONE(``„8) Zt- -rrZ
S—L=ADDRESS CITY,STATE,ZIP FAX
o 1LI43 L�oCktjob D -Ae /�Gk `&,e7iyw , CA, 95oly l /
CONTACT NAME /T'I I-'I rT-J t�tv 0 AIC //�� PHONE /`f-��J L J-t �_1 Z E-MAIL /
STREET ADDRESS 1oly,j Loek"ot)o p/A CITY,STATE. �GtI �1CTrvo eFl 4soli FaX Ci
❑OWNER jLOWNER-BURDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCIC ECT / ❑ENGDrEE.a ❑ DEvVEUOPEA ❑ retAM
CONTRACTOR NAME 0/6 LICENSE NUMBER LICENSE TYPE I BUS.!IC4
COMPANY NAME E-MAIL FAX
STREET ADDRESS I CITY,STATE,ZIP PHONE
ARCHTTECr/ENGLNEER NAME LICENSE NUMBER I BUS.LICK
COMPANY NAME' I E-MAE. I FAX
STREET ADDRESS I CITY.STATE.ZIP I PHONE
USE OF Jffi SFD mDUPr cz ❑ MULTI-FAMILY PROIERW WR.DLVfD ❑ YES PROTECT IN ❑YES IS THE BLDG AN ❑ YES
BUR.ONG: C]COMMERCIAL I URBAN Q+TERFACEARE{ ® NO FLOOD ZONE I@ NO EICHI&R•HO'ME: ANO
OESCR)PTION OF WOR% n 7 Q� /t I C n L I D zTn c,1 I� G D z&'v � J_uS Z
-Y C I� /Q D u �� I To L 1. l IV CI- ` /L r-(Q
TOTALVALUATTON: ' .� I RECEIVED BY: J
By my signature below,I ccrdty to each of the following: I am the property owner or authorized agent m act an the property owner's behalf. I have read thi,
application and the information I have provided is correct 1 ha tend the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building cons 'on. [h r/iu�re resenmdves of Cupertino to cnter the above-identi5ed(pmpe:.y for inspection puhposcs.
Signature of Applicant/Agen[ WIA-/—l.� Date:
SUPPLEb11NTAL INFOR,4LATION REQUIRED OFFICE USE ONLY
v OVER-THE{OUYTER
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Cl ECPRESB
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❑ STANDARD
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❑ 3LVOR
NLIEP.Vuc4pp_20/l.doc revised 06/7//71