12080097 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10260 DANUBE DR CONTRACTOR:CHENG EILEEN S PERMIT N0: 12080097
OW'NER'S NAME: CHENG EILEEN S 10260 DANUBE DR DATE ISSUED:08109!2012
OWNER'S Pl IONE: 4088261262 CUPERT'INO.CA 95014 PIWNENO:
❑ LICENSISD COMI'RACI'OR'S DECLARATION BUILDING PERMIT INFO: BLDG I-. ELECT r PLUMB F.—
License
Licaue Class Lie.U
RIECH r RESIDENTIAL r COMMERCIAL
Contractor Date
hereto•affirm Ill:,[ I am licensed under the provisions of Chapter 9 30B DESCRIPTION:REMOVE AND REPLACE(3)SINKS IN KITCHEN,MASTER
(Coil] with Section 7000)of Division 3 of the Bu.sincas S Professions BATHROOM,I[ALF BATI IROOM SINK.INSTALL
Codc and(hal my license is in full force and effect. (3)FLOURESCENT LIGHTS IN KITCI IEN.REMOVE AND REPLCE
1 hereby affirm under penalty of perjury our of the following two declarntiuns:
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•us provided for by
Section 3700 of the Labor Code,for the perhonnance orthe work for which this Sq.Ft Floor Area: Valuation:$12000
Permit is issued.
APPLICA\I'Clilt'1'IFICVI'ION APV Nurnbcri 36948024.00 Occupancy Type:
I certify that I have read this application mid state that the above information is
coned. I agree to comply with all city and county ordinances and state laws relating
to building constmetion,and hereby authorize representatives ofthis 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 hamiless 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 pemnit. Additionally,the applicant understands mid will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-paint source regulations per the Cupertino Municipal Code,Section
9.18.
Issuer) by: ✓r:/f1\/ .971i/� Dale: -9 '/
Signature Date r
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Lav formic of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the fulluwing nvm reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,to owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,mid die structure isnot intended or offered for sale(Sec.7044,
Business K Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business C Professions Code). ALL ROOF COVERINGS TO BF:CLASS"A"OR RE ITER
1 hereby affirm under penally of perjury une of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's IIA-/.,\RIHIUS MATERIALS ERIALS DISCLOSURE,
Compensation•as provided 1'or 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 Ibr which this permit is issued. California Health S Safety Code,Sections 25505,25533,and 25534. 1 MIl maintain
I have and will maintain Worker's Compensation Insurance,as provided for by cum pliance..'it h the Cupertino Municipal Code.Chu pier 9.12 and the Ilealdl S
Safrly Code.Seclinn 25532(x)should I store or handle harnrdous material.
Section 3700 0l the Labor Code,for the perlbnnance ol'Ihe stork for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Dlanagement District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino 3lunwtpal Cade.Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health S Safety Code,Sections 25505.25533,and 25534.
Connpansaion laws of Cail'ornis. If.utter making this cenilic:rte of exennption,1
beconne subject to the Worker's Compensation provisions of the Labor Code,I must O"" r er mthur-, em: �/
forthwith comply With such provisions or this permit shall be deemed revoked. Dale'
CONSTRIICI'ION LENDINGAGENCY
.U'1'LIG\N'I'CIiR'I'I PIG\'PION
I certify that I have read this application mid state that the above information is 1 hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances mid state 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 properly for inspection purposes.(We)agree to save
indenmitV and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,mid expenses which may accrue against said City in consequence of the
granting of this pemnit.Add'ti uaIty,the applica t understands and will comply
with all non-point source r• ulairyins per the Cupertino Municipal Code,Sectiah .\RCIII'I'IiCI"S DECLARATION
9.18. Sj �/ 1 understand my plans shall be used us public records.
Signature (z Date U 'O j Z Licensed Professional
OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•building0cuoertino.orci
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 JO OD e- 7 PN BP#
OWNER NAME OWNER ADDRESS
F' ee o r yc�oJ 3
DESCRIPTION OF WORK: &A rM
Slk C" i �pj�/pa
Par► &44A 4,94AC tolle . t/o e,f e i-rt C_ p 1 e 11ti fiKou4L
Weare 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.)
f,94-1. 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
insurance coverage for injuries to workers on my property.
i'W-2. 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.
iAQ. 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.
f(„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.
M,0. 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.
81/-6. 1 understand if I am considered an "employer"under slate 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.
t, -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.
41s C8. 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.
OwnerBuilderForm 2010.doc revised 04/14/10
OwnerBuilderForm 2010.doc revised 04/14/10
Tu ay.August 07,2012 i t`-' • I 1 7�
9:30 PIA jZECEIVEIJ
AUG 0 9 2012
5" BY:
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING
-
BUILDING DIVISION-CUPERTINO P-13VII
ARP'ROVED
This set of plans and specifications MUST be kept at the
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 specif! alons of the violation
LOT
beheld to permit or to be an approval
of any provisions/of any
Cit Ordinance or State Law.
BY -. - 7
DATE 9�� Q 7
PERMIT N0. /. GG u
U C
�P 11
Unfiled Notes Page I
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I
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10260 Danube Dr DATE: 08/09/2012 REVIEWED BY: Sean
\ APN: BP#: 'VALUATION: $12,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTANLATION
USE: SFD or Duplex PERMIT TYPE: 1RPFIX
A
WORK Remove and replace 3 sinks in kitchen master bathroom half bathroom sink. Install 3 flourescent
SCOPE lights in kitchen. Remove and replace entry and hallway lights (3) . Remove and replace shower stall.
beech. flan Check Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check 1 0.0 1 hrs $0.00
,Nech.Permit Fee: Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: /EPER,NIT
Other Alech.Insp. Other Plumb Insp. 0.0 hrs $45.00 Other Elec. Insp. 0.0 hrs $45.00
.Nech.Insp.Fee: P/mnh. hmp. Fee: Clcc.Insp.Fee:
NOTE: This estimate does not include fees Clue to other Departments(i.e. Planning, Public Works, Fire,Sanitn!r Server District,School
District,etc.). These fees are based on the preffininarl information available and are onh,an estimate. Contact the De ! or att(itt'l in o.
FEE ITEMS (Fee Resolution 11-053 E1L' 7/l/1l) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 4 # Plumbing
Suppe. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $40.00 IBPFUTURE Fixture or Trap
PME Plan Check: $0.00 5 Electrical
Permit Fee: $0.00 $67.00 IBRE,% Fixtures, Lighting
Suppl. Insp. Fee:Q Reg. 0 OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PML' Permit Fee: $90.00
Construction Tux:
Administrative Fee: 10,11IN $42.00 0
Work Without Permit? 0 Yes Q No $0.00 0
Advanced Planning, Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fee: ITR.WDOC $45.00 Building or Structure 0
Suong,Motion Fee: IRSFISAIICR $1.20 Select an Administrative Item
Bldc Sids Commission Fee: IBCBSC $1.00
SUBTOTALS: $179.20 $107.00 TOTAL FEE: 1 $286.20
Revised: 07/01/2012
1ZO� UUR �
CONSTRUCTION PERMIT APPLICATION 11
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228• FAX (408)777-3333 • buildingecupertino.oro
❑ NEW CONSTRUCTION ❑ ADDITION it ALTERATION/TI ❑ REVISION/DEFERRED
� ORIGINAL PERMIT N I
PROJECT ADDRESS ^^ APN# ��,{�( I I-(IO — (D2—L+
OWNER NAME r1 ee 1n lle)4Ll PHONE �' / 2 E-MAIL e,, ee✓l. SG�'IevL i4 r/r
STREET ADDRESS (00260 /Z)0nihe- l{ CIT Y, STATE,Z ^Jn-b CA
pO / I FAX COW
CONTACT NAME _ eP j_ en PHONE* SaA e SE-MAIL
�STT/REET ADDRESS �l CITY,STATE, ZIP FAX
W OWNER ❑ OWNER-BUILDER Cl OWNER AGENT ❑ COMRACrOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER CI TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSETYPE BUS.LICA
E2 G c
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME / ^ LICENSE NUMBER BUS.LIC 0
COMPANY NAME /v (� E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
oozititylop rctb, ne--rNo e ec_ lu yd
GIGta vc.,e ✓)')a- p v bei-t Too f aid Cou n e v C'ab;,>1
th Yom i 5 vl*, 61)We'y bare- . amd eou,J1 e o a i—d Cab, N et .
EXISTING USE PROP0 ED USE CONSTR.TYPE I #STORIES
USE TYPE OCC. SQ.Ff. VALUATION(S)
EXISTO NEW FLOOR DEMO f/ TOTAL
AREA AREA - AREA NETAREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
[]ATTACH
#DWELLING UMTS: IS A SECOND UNI r 1:1 YES STC 0NUORORI ❑YES
BEINGADDED? 1:1 NO ADDITION? E]NO
PRE-APPLICATION CITES IF YES,PROVIDE COPY OF IS'I'III.BLDG AN ❑ITS RECEIVED YI
[]NO ... TOT VALUATION:
PLANNINGAPPLM NO PLANNING APPROVAL LETTER F.ICHLERHOAIF.? ONO / U�a
An/- _ VVV
By my signature below,I certify to each of the following: I am the properly 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 buil ingns ction. 1 authorize representatives of Cupertino to enter the above-identIfiled Top-Jert�y for inspection purposes.
Signature of Applicani/AgenC rys' Date: 00 o`Ci 2—
SUPPLEMENTAL
SUPPLEMENTAL INFORMATION R EQUIRED _rL\Ncu
ECh'I'YPE _ -..__ .. •_ROUTING SLIP
_New SPD or Multifamily dwellings: Apply for demolition permit for 'r1 DYER-TUC-COUNTER lioann'G PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building T -
permit for new building. ❑ E:S uEss r 'f❑ i Lnn;�IN'd.PLAN REVuw.
_Commercial Bldgs: Provide a completed I IaZardous Materials Disclosure ElsT,iNDAkD EIPuuL Cwouss
form if any Hazardous Materials are being used as part of this project. _❑ L%RG _ _ ❑ 'FIRE DKPT
_Copy of Planning Approval Letter or Meeting with Planning prior to '❑ vAJOR El 'SAm I'ARYSF.\PER DISTRICT
submittal of Building Permit application. 1 -- -
❑ .ENVIRONMENTAL 1IF\1:1'IL
B1dgApp_20/1.doc revised 06/21/11