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12080198
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20609 SHELLY DR CON'IRACI'OR:CHEN HUNG AND CIIYU PERMIT NO: 12080198 LINGLING O\\'NFR'S NAME: CHEN HUNG AND CHYLI LINGLING 20609 SHELLY DR DA'Z'E ISSUED:08/17/2012 OWNER'S PI IONS: 4152711214 CUPERTINOCA, 95014-2923 .PHONE NO: ❑ LICENSED COM'RAC'FOR'S DECLARATION JOB DESCRIPTION: RESIDE\IIAI.El , COMMERCIAL. License Class Lie.N REMOVE FLOURSCENT LIGHT IN KITCHEN AND REPLACE Contractor Date WITH 6 ENERGY RECESSED LIGHTS 1 hereby affimn that I am licensed trader the provisions of Chapter 9 (emnnaencing with Section 7000)of Division 3 of the Business& Professions Code and thin nay license is in full force and effect. hereby affirm under penally of perjury one of the follmving 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 performance of the work for which this permit is issued. Sq.FI Floor Area: \'situation:$600 1 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 ,U;\Number:35911020.00 Oreupanrv'1'ype: permit is issued. ArPL1CAN"r CE:R'r1F1CA'I'ION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. l agree to comply with all city and county ordinances and state laws relating WITHIN �0IDAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DA SROM LAST CALLED INSP TION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the grunting of this permit Additionally,the applicant understands and will comply Issued It Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. R4:ROOFS: Signature Date All roofs shall be inspected prior to may roofing material being installed. If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Lase for one of the following two reasons: ALL ROOF COVERINGS TO RE CLASS"A"Olt li4 ITEIR 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HA-LARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Ilcallh&Safet'Code.Sections 25505,25533,and 25534. I will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino\l unicipal Code.Chapter 9.12 and the declarations: I Icall h&Safety Code.Section 25532(a)should I score or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bar Area Air Quality Management District I performance of the work for which this permit is issued. trill maintain compliance with the Cupertino Nlunifipal Code.Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the I Icallh&Safely Code Sections 15M5. .533 nd 25534. Section 3700 of the Labor Code,for the performance of the work for which this Uali� Owner ur nuthnrizeJ agnnl: r. permit is issued. 1 certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I CONS'1'Itl1 -I'l ON LENDING AGENCY become subject to the Worker's Compensation provisions of die Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Cie C.) Lender's Name APPLICANTCF.RTI FICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state Lacs 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 ,\RCIII'IliCl"S DECLARATION and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations er the Cupertino Municipal Code,Section Licensed Professional 9.18. jJ. '7 Signature ate O , �. CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 20609 Shelly Dr DATE: 08/17/2012 REVIEWED BY: Sean \ APN: BP#: WALUATION: $600 *PERp11T TYPE: Electrical Permit PLAN CIIECK T)'PE: Alteration /Addition / Repair PRIMARY SFD Or Duplex PENTAMATION 1REAP1 USE: pPERMITTYPE: A (YORK Remove flourscent light in kitchen and replace with 6 energy compliant recessed lights. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Fixtures, Lighting 1BREMFIXT 6 # $67 TOTALS: $67.00 Afech.Plan Check Phunh.Plan Check Elec. Plan Check 0.0 1 hrs $0.00 Mech.Permit Fee: Plumb. Permit Fee: Elec. Permit Fee: 1FPFRMIT Other•,tfech.Insp. Other Plumb lo-'P. LJ I Other Elec. Insp. 0.0 hrs $45.00 Me.ch.hap.Fee: Plumb. loyp.Fee: Flee.Insp. Fee: a\'07'1,,: This estimate does not includejeev cote to other Departtnenis(i.e. Planning, Public IPorks, Fire,Sunitnq•Sewer District,Schon/ District, etc.). These feav are baser/on the trellnriean in ornrntion available and are onh'an estinnue. Contact the Det or uddu'I info. FEE ITEMS (Fee Resohtion I1-053 E(L 7/1/11) FEE QTY/FEE M SC ITEMS Plan Check Fee: Supp/. PC Fee PME Plan Check: $0.00 Permit Fee: Supp/. Insp Fee PME Unit Fee: $67.00 PME Permit Fee: $45.00 Consnvcdon Tac: Administrative Fee: 1ADMIN $42.00 Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRA I DOC $45.00 A Strong Motion Fee: 1BSFISMICR $0.50 Select an Administrative.ltem Bldg Stds Commission Fec: IBCRSC $1.00 SUBTOTALS: $200.50 $0.00 TOTAL FEE: $200.50 Revised: 07/01/2012 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: mocl W.Pa PERMIT# (1 OWNER'S NAME: 03xpt PHONE # 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: �! Z naure 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 / Own Contractor Signature Date �9. 1 understand I may obtain more information.reaardino mv.nhlinatinns ac nn"emnlnvor"frnm.fhc.inlornni. } OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333• buildinar5cunertino.org 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 a O j O '7 .51-1 /^� APN BP# OWNER NAME /, ,r/!; w_C— OWNER ADDRESS HU41(!; <�w_C—,-Vr o DDREESQ O Y� `LO' R C A` �� V DESCRIPTION OF WORK: /VV V Z &` �° 4P A ! u < ✓` !/V f e roc75 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- ui er" 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. 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for t e construction and are not hiring a licensed Contractor to assume this responsibility. k3. 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. _X4. 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. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the tota 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. ��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. 2�_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. 2( 8.'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. OwnerBullderForM 2010.doc revised 04/19/10 GENERAL PERMIT APPLICATION �1 D M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 Y M I CUPERTINO (408)777-3228• FAX(408)777-3333•building(okuoertino.org \ V SC ❑PLUMBING /J j❑' mralANICAL OVI.ECTIiICAL ❑MISCELLANEOUS PROJECT ADDRESS 'l Q /©9 Sr-7 C..C L 1� p APN 1 - 5 A I t U 2O OIVNCft NAME /JL•// air 1 / n / / JE t PIIONE/r /-S 2'7Tl_1-1/ 1� E-\ll.\IL/�/A� _ ® j7��- /\O/A.1 STREET ADDRESS Za 609 S E�`�I�Y\ OP CITY, STATE..ZIP C U P(C( k ( L`) O I:2A` I FAX copy/ CONTACT NAME /J/[/ , (/ of— L/ �1/ ] f� PIIONt4 F 27/ _ h /4 E-NTAIL /J/ ACJ ® p/-� CIO STREETADDRFSS�-o 6 /OV[ S1-1 C-`_,_ ,-]V P CITY.STATE.7- _1( /Tc e-A 1 PAX ( �J OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑COM1TRACIOR AGENT 11 ARCHrRCT ❑ENGINEER ❑ DEVELOPER ❑TENANT CON, CTORNANIE LICENSENUMBER LICENSETYPE BUS.LICH COMPANY NAME &FLAIL FAX STREET ADDRESS CITY.STATE ZIP PHONE ARCHRECF/ENGINEER NAME LICENSE NUMBER BUS,LIC N COMPANY NAME E-NIAlh FAX STREET ADDRESS CITY.STATE ZIP PHONE USE OF SM.,DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ,❑Yis ISTIIILRLDGAN ❑ YES BUILDING. ❑COMMERCIAL URBANINIERFACEAREA NO MOODZONE NO EMILIA HOME! NO DESCRIPTION OF WORK / G / ; ; C C kif tS C 400 X es r 5 TOTAL VALUATION: O� �T RECEIVED BY: G�J� By my signature below,I cenifn•••ify to each of the following: I am the property owner or authorized agent to act on the propeny 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 building co suuctionr [a horizc representatives of Cupertino to enter the above-identified property/for inspection purposes. Signature of Applicant/Agent: Date: / 7 C SUPPLEN1 BN'1'AI.INI'ORMATION..REQUIRED OFFICE USF-ONLY OVER-IDE-COILNI PR a ' �' ❑ EXI'NF_SS ❑ STANDARD U i ❑ LARGE 'a ❑ .MAJOR ,11X•P,11isc.I 1)1201 Ldoc revised 06/21/11