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12080253 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20609 SHELLY DR CONTRACTOR:CHEN HUNG AND CHYU PERMIT N0: 12080253 LINGLING ON;NEIR'S NAME: CHEN HUNG AND Cl IYU LINGLING 20609 SIIELLY DR DATE ISSIJED:08242012 ON;NER'SPHONE: 4152711214 CUI'FRTNO,CA 95014-2923 PI IONS NO: ❑ LICENSED COY fRACI'OR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB F- License Class Lic.p RIECII r RESIDENTIAL r COMMERCIAL r Contractor Date hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALLATION Of(12)RECESSED LIGHTS IN LIVING (Coil]nencing a ith Section 7000)of Division 3 of the Business& Professions ROOM AND HALLWAY Code and that my license is in full force and effect. hereby affirm under penalty of perjury one of the following,Iwo 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 pernit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Sy.Ft Flour Area: Valuation:$1200 Section 3700 of the Labor Code,for the perfomtance of die work for which this Permit is issued. AI'N Number:35911020.00 Occupancy 9'ype: APPLICANT CERTIFICATION I certify that I have read this application and stale that the above information is correct. I agree to comply with all city and count)•ordinances and state Imes relating to building construction,and hereby authorize representatives ofthis city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned properly for inspection purposes. (We)agree 10 save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accmc against said City in consequence ol'thc Igp DAYS FROM LAST CALLED INSPECTION. granting ofthis permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section UU" '' 9.18. Issued by: �0q1V Z/4T//H Date:�•a7 r� Signature Date ❑ ( O\YNIiR.IIIIILDcR IIECLARxi'ION B17-11001;S: All roofs shall be inspected prior to any roofing material being installed.If a roof is hereby al7irm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 1,as owner of the property,or my employees with wages.s their sole compensation, will do the work,and the structure is not intended or offered lar sale(Sec.7044, Signature of Applicant: Date: Business&Professions Code) 1,us owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). .\LL ROOF COVERINGS TO BE Cl.\SS"A"OR BETTER hereby affirin.under penalty of perjury one of the following three dcdaroliuns: ILAZARIIOUS JIATERL\LS DISCLOSURE I have and will maintain a Certificate of Consort to self insure for p'orker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California I leallh&S:dety Code,Sections 25505,25533,and 25534. 1 will maintain performance ot.the work for which this permit is issued compliance with the Cupertino Nlmmicipal Coda Chapter 9.12 and the Ilndth& I have and will maintain Workers Compensation Insurance,as provided for by Safety Code.Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit ha¢ardous air contaminants as defined by the Ray Aron Air Qualit Management District t will permit is issued. maintain compliance with file Cuprrtino Municipal Code,Chapter 9.12 and the I certify that in the performance of die work for which this permit is issued,I shall Health&S:dety Code.Sections 25505,25533,and 25534. not employ an)'person in my manner so as to become subject to die Worker's Compensation law's of California. If,alter making this certificate ofexempllon,I Owne Ir aatll(1zed. ear. become subject to the Worker's Compensation provisions of the Labor Code,I must _11• forthwith comply with such provisions or this permit shall be deemed revoked. IX)NS'1'Rum'ION 1-IiN DINC.\GENCI' \PPI-IC.\N'I'CIiR'I'I PIC,\'1'10\ I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned properly for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupenino against liabilities,judgments, costs,and expenses which may accme against said City in consequence of the ARCHITECT"S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulatiams per Cupcnino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Sigt isOWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333"buildino(lacuoertino.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 2 O 6o OPT" P APN BP# UN OWNER NAME /_/ OWNER ADDRESS l� Q -H ' pC uP- _r4 410 DESCRIPTION OFWORK: C r CA FS'C t S (O CFL Recess0 d et 1A is l 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.) 2L1. 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. 1, 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. L2. 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. ,3. 1 understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that 1 may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her naa�me instead of my awn. /\4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. A-5. 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. X_6. I understand if I am considered an "employer" under state and federal law, I must register with the stale 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. __�_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. X8. 1 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. OivnedlailderFarni 2010.doc revised 04/14/10 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 20609 Shelly Dr DATE: 08/24/2012 REVIEWED BY: Sean \ APN: 1311#: `VALUATION: $1,200 *PER1\111T TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTANIATION USE: SFD or Duplex PERMITTYPE: 1REAP11� WORK Installation of 12 recessed lights in living room and hallway. SCOPE APPLIANCE/EQUIP TYPE FEE 11) QTY UNITS BP FEES Fixtures, Lighting 16REMFIXT 12 # $67 TOTALS: L $67.00 Meth. Plan Check Phanh.Plan Check Elec. Plan Check 0.0 hrs $0.00 hfech.Permit ree: Plumb. Permit ree: Elec. Permit Fee: IEPF-RLflT Odhe•,tech. lnry. Other Plumb Insp. Ll I Other Elec. Insp. 0.0 hrs $45.00 .Ifech.limy.ree: Plumb. hep.Fee: Elce.Insp.Fee: NOTE: This ectitnate does not includejees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Server District.School District,etc.). These ees ore base/on the prelhninai,3 information available and are onlP an estimate. Contact the Dela for uddn'I info. FEE ITEMS (ree Resolution 11-053 ED' 7/1711) FEE QTY/FEE MISC ITEMS Plan Check ree: .Supp/. PC ree PME Plan Check: $0.00 Penni!Fee: Suppl. Insp ree PME Unit Fee: $67.00 PME Permit Fee: $45.00 Consnwction Tat-: Administrative Fee: MI)MIV $42.00 Work Without Permit? O Yes Q No $0.00 Advanced Plating Feer: Travel Documentation Fee: ITR,rnnOC $45.00 Strove Motion Fee: IBSFISMICR $0.50 Select an Administrative Item 131da Sids Conu»ission Pce: IBCBSC $1.00 SUBTOTALS: $200.50 $0.001 TOTAL FEE: $200.50 Revised: 07/01/2012 IZ�� v2 �3 GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M I sc GUPERTINO (408)777-3228 • FAX(408)777-3333•builldiino pncupertino.org ❑PLUMBING ❑h1ECl1ANICAI- IC{IiLliCl'IiICAL ❑MISCELLANEOUS PROIECr ADDRESS 2 QO oNa(`/a?T �r P R S_PN�a 1JO OWNER NAME PIIONiE/' / E-MAILHA C� (9S REITFADDRFSS CFFY, STAT , FAX ZIP C u PER, lAd CAIF X CONT.\Cf NANO //&('A /V //r �/�(..•/L�E�I/ P4IONE • /s_a"-1 E-MAIL u /I�� �'� r ^n STREIFTADOR[SS 1 O 6 /o ? -s-/-/C/ / Ylr `.,� CITI',STATE ZIP �•�/,�RT/,(JJ, C/ ,f}f-I FAX C: IN KIWNER X OWNER-BUILDHR ❑ OWNER AGENT' 1 ❑ C'ON'RACfOR ❑CONFRACIOO/RAGFM ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAMEfJ LICENSE NUMBER LICENSETYPE BUS.LICM " i dt c COMPANY MANE E-MAIL FAX STRErr ADDRESS CITY,SrATE,ZIP - PHONE ARC[IITECDENGINEERNAME /1. LICENSE NUMBER BUS,LICM COMPANY NAME E-NAIL FAX STREET ADDRESS CRY,STATE,ZIP PHONE USE OF SFDor DUPLEX ❑ %IUI-TI-FAMILY ILDLAND YES OCr IN ❑YES ISTUFBIDGAN ❑ YFS OBUILDING: FjCOMMERCIAL ..,K,'FACE AREA N ZONE ly NO EICHLER HOME? NO DESCRIPTION OF WORK L�llihPoo P" 11 �-Q, A C_i 5- YT Hal v !� c H7 RI CAT Hall pp . x/ ll k)ca �e 'FcC ii i Ear H ScerL.' �4 f S 1J.'1 / 40' L Ze c e s-5 z.d S' • U r TOTAL VALUATION; ep .— RECEIVED BY: By my signature below,I ccrtily to each of the following: I am the grope y ovvner or authorized agent to act on the property m\ncr's behalf. I have read this application and the information Ihave provided is correct. I hav cad t Description of Work and verify it is accurate. I agree to comply withal]applicable local ordinances and sate laws relating to build tg constr clion. I a oriz a resenatives of Cupenino to enter the above �-identified property for inspection purposes. Signature of ApplicanUAgenC Date: SUIIIII.I.MIiN'I'AI. NIzOILMA'I'ION REQUIRED OFFICEUSEONLY OYER=fur.-cr UN'1'ER P • �h • j ❑ EXPRESS 'J ❑ STANDARD El LARGE.i • 6 ❑ MAJOR MEpA4fscApp_2011.doc revised 06121/11 10'4^_. __ 18'4^ Family Room i7 Kitchen AUG 2 4 2( 7 C A— BY: N Living Room e o in o • I Hall way _.q.p._ o CO"P"V L_. o " — .18.4. .._ _ .._ __.. _ _ _• m ��eim m C o HUNG CHEN 20609 SHELLY DRIVE CUPERTINO,CA 95014 DATE: 8/23/2012 11 Way e Mt4 IdJ`J1ISUd.tl�c{4.1r-Lh�L11�1i�J�y�7ng j �0�N�21"1U OUC°1��U C°IUl! •`�.+- r GE 13-Watt Ener y CFL 10. Ey SmartDraw!- purchased copies print this or document without a watermark. ' GE 26 watt EnerlfyWePmftrtdraWAOm or call 1-800-768-3729. 5-4- . . . . . . . . . . . . . . . : : : : : : .x.0609 5�HELL1 iDiti.-iE : : : : : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . { Uf?LR11fVb C, 9 0.1.!: : : : : : : : : : . .............. ............... ........ If : : . : . : : : : . . : : : : : : : : : .DAT_: 3(2:3(20;12. v Halo Lighting H7RICAT Remodel Air-rite IC Housing by halo Li 9 ting 9 9 : : { E 17 hlau i 6,gv ,. 1iai i : : : : : . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............................. .............. _ ........ GE .26 Wc,iti ERer(�;� Smut Crl-: : : . : : : : : : : . : : : : : : : : : : : . :