12100027 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10935 NORTII VIEW SQ CONfRACrOR:XIANG FANG AND KEJUN PERMIT NO: 12100027
SONG
O\\'NFR'S NAMI.: XIANG FANG AND KEJUN SONG 10935 NORTIIVIFW SQ DA'Z'E ISSUED: 10/032012
OWNER'S PHONE: 9497353365 CUPERTINO.CA 95014 PI ONE NO:
❑ LICFNSF.D CON'TRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT rl PLUMB r
License Class Lie.N r r C.,MECII RESIDENTIAL COMMERCIAL
Contractor Date
hereby affmrnrthat I am licensed under(he provisions of Chn pier 9 •1013 DESCRIPTION: BATHROOM RCb1ODCL(40 sQFr)AND REMODEL DEN
(commencing with Section 7000)of Division 3 of the Business& Professions INTO
Code and that my license is in full force and effect. BEDROOM(88 SOFT)
hereby affirm tinder Penn[[)of perjury one of the fallowing 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
perforhmmce 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 die work for which this
permit is issued. Sq.1:1 Floor Area: Valuation:$10000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is ARN Number:31636001.00 Occupancy Type:
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
indemnify and keep harmless the City of Cupeninoagainstliabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
graining of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Date Issued by: Date:
O\\'NFI3-RIIILUF.R UICCL.\R.\'PION
I hereby affirm that I am exempt from the Contractor's License Lawfor one of RE, ROOFS:
Ilene following lou reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed withom first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(See.7044, inspection.
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE Civ\SS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's IIA"/.ARDOUS NIATERIAI S DISCLOSURE
Compensation,as provided for by Section 3700 of thc Labor Code,for the
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Ilcalth&Safety Code.Sections 25505,25533,aimd'5534. 1 will maintain
Section 3700 of the Labor Codc,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.1_and the Ilcalth&
Safety Code,Section_553_(a)should I store or handle hazardous material.
permit is issued. Additionally,should 1 use equipment or devices which emit hazardous air
m
I certify that in the performance of the work for which this permit is issued,l shall conminanls as defined by the Bay Area Air Qualiq'Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws ofCalifomia. If,atter making this certificate ofexemption,I Ilcalth&Safety Cade.Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,1 must
Forthwith comply with such provisions or this permit shall he deemed revoked. Owner or authorized agent:
Dale:
.\PPLIC.\NT CF;R'1'IPIGx"PION CONST'RUCI'ICLN LENDING AGENCY
I certify that I have read this application mid state that the above information is
correct.I agree to comply with all city and county ordinancesarid state laws relating, I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this pemhit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCIIITF.CI"S DECLARATION
9.18.
/O_ 3 , I 1 understand my plans shall be used as public records.
Signature Datc
Licensed Professional
12-10
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX (408)777-3333•buildino(G)cupertino.oro
❑ NEW CONSTRUCTION ❑ ADDITION ❑ AI:I'1?RATION/TI G❑ REVISION/DEFIiRRED ORIGINAL PERMIT4
PROIECr ADDRESS O 3r r� /• �� APINq ( 3/6 - 3��D0%
OWNERNAME f//an FANCr � Ke -u,, c1O1VCr PHONE(941)75
�753'3pS E-MAIL ke unsan uc/ �9^+��•
STREET ADDRESS O �� IV
ortL/ � CRY,STATE,ZIP r�T-r-O ^� 9soI FAX
CONTACT NAME /ie •u^ r • PHII&q.� 31 �36s l• &`MAIL
STREET ADDRESS �s J �1 (-• CITY•ST TE, ZIP C FAX
4 w-' T
VIWNER O OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER O TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSETYPE BUS.LIC0
� lL
COMPANY NAME E-MAIL FAX
.STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC N
COMPANY NAME E-MAIL. FAX
STREET ADDRESS CITY•STATE,ZIP PHONE
DESCRIPTION OF WORK / /
-1J:z// //ten area /!n t/Lt G'I.,�n Too/��I �v CL 4WIO r"�P�Joortl
�7re hw,e�er bp�rOOm da=t/Ironn to -(Wo. LY+dh"Oms 6y OU ✓un.'
/�"" P/IgP
OAe 'f0�(mac:-/ , 0rte "11V-6. /1/0- J_ &Jeelor.
EXISTING USE PROPO'EDUSE CONSTRTYPP. NSTORIES
MLS �/�„T � USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTS r7� NEW FLOOR DEMO !/ TOTAL ve//��
AREA AREA AREA NET AREA MQ L 93 129
BATHROOM KrTCHII OTHER p
REMODELARIM elo REMODELAREA REMODELAREA U, '
PORCHAREA DECRAREA TOTAL DECKANJRCH AREA GARAGEAREA: HDUTACH
ATTACH
N DWEWNG UNITS: LSASECONDUXTT ❑YES SECON'DSTORV YES
BEING ADDED' []NO ADDITION' [JNO
PRE-APPLICATION OYES IF YES,PROVIDE COPY OF IS TILE BLOC AN ❑Yes RECEIVED Y: TOTAL VALUATION:
PLANNINGAPPLN ONO PLANNINGAPPROVAL I.ER F.ICHLERHOME! ONO �r� '040
By my signature below,)certify,to each of the following: 1 am the property owner or authorized agent to act on the pmpeny owner's behalf. 1 have read this
application and the information 1 have provided is correct. I have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local
ordinances Bad state laws relating to building construction. I authorize m nmtives of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicanJAgenc Date: /6 ^o-z- — 7A/L
SUPPLEMENTALINFORMATION-REQUIRED PLANCHECKTYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit forOVER-THE COUNTER BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PWNNmr PLAN REVIEW
_Commercial Bldgs: Provide a completed livardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE ❑ FIREDEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. ❑ MAJOR El SANITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
B1dgApp_2011.d,oc revised 06/21/11
Print Date: September 26, 2012 10:05 AM Page 1
OMB Approval No. 2502-0265 B. TYPE OF LOAN
e•wlll'lII6 A U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 1. [ J FHA 2. [ J RHS 3. (X ] Conv. Unins
5ti'IIIIIII,� SETTLEMENT STATEMENT
4. [ ] VA 5. [ ] Conv. Ins
O6. FILE NUMBER: 7. LOAN NUMBER:
Chicago Title Company 12-98318002-LLC 0298291105
8. MORTGAGE INSURANCE GSE NUMBER:
C. Note: THIS FORM IS FURNISHED TO GIVE YOU A STATEMENT OF ACTUAL SETTLEMENT COSTS. AMOUNT$PAID TO AND BY THE SETTLEMENT AGENT ARE SHOWN.ITEMS MARKED
"(P.O.C.)"WERE PAID OUTSIDE THE CLOSING;THEY ARE SHOWN HERE FOR INFORMATIONAL PURPOSES AND ARE NOT INCLUDED 1N THE TOTALS.
D. NAME&ADDRESS OF BORROWER: E. NAME&ADDRESS OF SELLER: F.NAME Bt ADDRESS OF LENDER:
Xiang Fang and Kejun Song The Stoddard 1999 Living Trust Dated May 12,1999 Suntrust Mortgage, Inc.
439 Del Medio Ave #14 10935 Northview Sq. 24422 Avenida De La Cadota, #300
Mountain View, CA 94040 Cupertino, CA 95014 Laguna Hills,CA 92653
G.PROPERTY LOCATION: H.SETTLEMENT AGENT: I.SETTLEMENT DATE
10935 Northview Sq. Chicago Title Company September 28, 2012
5671 Santa Teresa Blvd.,Suite 206
Cupertino,California 95014 San Jose,CA 95123
408 972-7016 DISBURSEMENT DATE:
PUCE OF SETTLEMENT: September 28, 2012
5671 Santa Teresa Blvd.,Suite 206
San Jose,CA 95123
J. SUMMARY Of BORROWERS T PANSAC77ON K SUMMARY Of SELLERS TRANSACTION
,100:,GROSS AMOUNT:DUE_'FROM_BORRO_WER 400.GROSS'AMOUNT DUE;TO SELLER A
101.Contract Sales Price 468,770.00 401.Contract Sales Price 468,770.00
102. Personal Property 402. Personal Property
103.Settlement charges to borrower(line 1400) -132.66 403.
I04. 404.
105. 405.
Adjustments for Items Paid by Seller in Advance Adjustments for Items Paid by Seller in Advance
106. City/Town Taxes 406.City/Town Taxes
107.County Taxes 407. County Taxes
108.Assessments 408.Assessments
109. HOA Dues fr 9/28/2012 to 10/1/2012 31.20 409. HOA Dues fr 9/28/2012 to 10/1/2012 31.20
110. 410.
111. 411.
112. 412.
113. 413.
114. 414.
115. 415.
116. 416.
117. 417.
118. 418.
120.GROSS AMOUNT DUE FROM BORROWER 468,668.54 420.GROSS AMOUNT DUE TO SELLER 468,601.20
200[,AMOUNTS_PAID BY OR.IN.BEHALF OF BORROWER 500..REDUCTIONS IN AMOUNT DUE TO SELLERS%,%'-;aJ jF F r''
201. Deposit Or earnest money 14,550.00 501. Excess deposit(see instructions)
202. Principal amount of new loan(s) 371,770.00 502. Settlement charges to.seller(line 1400) 55,359.22
203. Existing loan(s)taken subject to 503. Existing loan(s)taken subject to
204. 504. Payoff to Wells Fargo Bank 80,473.98
205. 505.
206. 506.
207. 507.
208. 508.
209. 509.
Adjustments for Items Unpaid by Seller Adjustments for Items Unpaid by Seller
210. City/Town Taxes 510.City(Town Taxes
71 t. I1nPd Cnunty Taxes fr 7/1/2012 to 9/28/2012 951.20 511. UnPd County Taxes fr 7/1/2012 to 9/28/2012 951.20
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10935 Northview Square DATE: 10/02/2012 REVIEWED BY: Sean
APN: IBP#: 'VALUATION: $10,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM
USE: PERMIT TYPE:
WORK Bathroom remodel 40 sq ftand remodel den into bedroom 88 sq ft).
SCOPE
,Neth. Plan Check Plumb. Plan Cheek Elec.Plan Check
Alech.Permit Fee: Plumb.Permit Fee: Elec. Permit Fee:
Other Alech. In p. Otter Plumb Insp. Ll I Other Elce.Insp. Li I
Alech,limp.Fee: Plumb. htsp.Fee: Elec.Insp.Fee:
NOTE: This evdinate does not include jeev due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc). These feev are baser/on the prelintinan information available and are adv an estimate. Contact the De t or addn'I info.
FEE ITEMS (Fee Resolution 11-053 E8' 7/1711/ FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 88 s.f. Remodel,Other
Suppl. PC Fee: Q Reg. Q OT 0.0 hes $0.00 $400.00 /REMRESOTH
PME Plan Check: $0.00 40 s.f. Remodel, Bath (<=300 so
Permit Feer $0.00 $600.00 IREAlRESenr
Suppl. Insp. Fee,0 Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tac:
Administrative Fee: 0
Work Without Permit? O Yes Q No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fees: Building or Structure 0
i
Strong Motion Fee: IBSEISMICR $1.00 Select an Administrative Item
Bldg Sids Commission Fee: IBCBSC $1.00
SUBTOTALS: $2.00 $1,000.001 TOTAL FEE: $1,002.00
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• buildina6cuoertino.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 S�0 APN d0 ��
OWNER NAME OWNER ADDRESS S'uR/C r7r7R4� CII /��
Ke,un SONG /013r w
DESCRIPTION OFWORK:
6I0n n Area lv d!f 6/w y-i,+tvam /fis 1k Nas*,J&/ro
vm inh 2 ,,Wmf.
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.)
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
S- 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for
/Thh cconstruction and are not hiring a licensed Contractor to assume this responsibility.
t` S• 3. 1 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. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
$. 5. 1 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.
S 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 for each "employee." I also understand my failure to abide by these laws may subject
/me to serious financial risk.
LS• 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
is performed under contract with a licensed general building Contractor.
K•S' 8'1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may 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.
O,rnerBuilderForm_2010.dac revised 04/14/10
9. I understand I may obtain more information regarding my obligations as an"employer"from the Internal
Revenue 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.cslb.ca.gov for more information about licensed
contractors.
�10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I
am 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
by all applicable laws and requirements that govern Owner-Builders as well as employers.
,6. 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 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 properly owner's signature.
Property Owner's Signature: Date: /002 20/2
61
— ---- ----- --- - --- ---- ------------ ------- ----completed - ---------------- -- -- --------- ---- ---- --- ----
(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:
OwnerBuilderFornt 1010.doc revisedO4114110
:RESIDEN'PIAL PROJECT COVER SHEET
Assessor's Parcel Number:
Name ofowner. KefUri�� 4aaq FANS'
Vtq
Project address. 10� CA IS
Contact person. Phone.
Fax.
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces inside the garages Y N �T
Is privacy protection planting required for the project? /1�N
Build it Green Total Points -
On what floor(s) is work being done?
Brief description of work. C/11nrt flu den// 2rea %� �r'✓r'n /A'451vom -/o a ��J
C4Gn� -V / ruler 6errnrm to /ir4t4oln 7'D ry
( r+'�S
nadr/,'.�J, 8yle ✓a�•1"/Y tau
o .e 6&-tA -h-b . o 'r'�1-f Exiei%er u,'Cbe c�rnw�rcJ' o /
Code editions: 2007 CBC N)2007 CFC �C, �lN)2007 CMC N)
2007 CPC ®- N)2007 NEC ` - N) CUPERTINO
COMMUNITY DEVELOPMENT DEPARTMENT Building Department
BUILDING DIVISION-CUPERTINO
Effective 1/1/08 APPROVED OCT 0 3 2012
This set of plans and specifications MUST be kept at the
Job site during construction. It Is unlawful to make any REVIEWED FOR CODE COMPLIANCE
changes or alterations on same,or to deviate Reviewed By:
therefrom,without approval from the Building Official.
The stamping of this plan and specifications SHALL NOT
be held to permit or to be an approval of the violation
of any provisions
ofof/any
lCity
nOrdinance or State Law.
BY err J O�
DATE '/6
6—
PERMIT NO. ` 0 Z
Plan Review Process work Book Page-8-Revised 8/05/08
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