12110154 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10403 SOMERSET CT CONTRACTOR:PENG CHUN-KAI AND LIN PERMIT NO:12110154
HSIU-TAI
OWNER'S NAME: PENG CHUN-KAI AND LIN HSN-TAI 10403 SOMERSET CT DATE ISSUED: I W9/2012
OWNER'S PHONE: 4089969378 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION r r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lie.p
MECH r RESIDENTIAL r COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMODEL(2)BATHROOMS(105 SQFf)
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one,of the following 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.Ft Floor Area: Valuation:$15000
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. APN Number:36929031.10403 Occupancy Type:
APPLICANT CERTIFICATION
I certify than have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS 140T STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply ` ,
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: J�AIV .Cl!!�t" Date:
9.18.
Signature Date
RE-ROOFS:
❑ OWNER-BUILDER DECLARATIONf All roofs shall be inspected prior to any roofing material being installed.If a roof is
"'a�iq installed without first obtaining an inspection,I agree to remove all new materials for
I hereby affirm that I am exempt from tb$'COnh"'aetor'sLicense Law for one of inspection.
the following two reasons:
1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
will do the work,and the structure is not intended or offered for sale(Sce.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the 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&Safety Code,Sections 25505,25533,and 25534. 1 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 Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety Code,Sections 25505,25533,and 25534.
I certify that in the performance of the work for which this permit is issued,l shall
not employ any person in any manner so as to become subject to the Worker's O or
Compensation laws of California. If,after making this certificate of exemption,I Date: 1 ?f{ 20/ -a—
become
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and slate that the above information is Lender's Name
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 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, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
I ��
C'�'J � - ( 211
CONSTRUCTION PERMIT APPLICA ION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTilO (408) 777-3228• FAX(408)777-3333•buildina(Mcuoertino.oro
❑ NEW CONSTRUCTION ❑ ADDITIONALTERATIOr1 ,N/� LP
TI ❑ REVISION/DEFERRED ORIGINALPERMrr#
PROJECT ADDRESS 10403 ! )Wmef J-1 CTAfY1 E) APNq 2!2_ /0 1 2 1 O (P
OWNERNAME 11 PHONE O/ J— ?�� E-MAIL
STREET ADDRESS D (� - ,^�/�' ITY, STATE,ZIP `(7 FAX
CONTACT NAM V- PHONE E-MAIL
STREET ADDRESS CITY,STATE, ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME ? LICENSENUbBER LICENSETYPE BUS.LIC#
G z t F
COMPANYNAME E-MAIL FAX
STREETADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME &MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK ke"G .1- C
EXISTING USE PROPOS USE CONSTR.TYPE 1 pSTOR]ES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA l� 3 !D 5 -
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA / REMODELARFA/
PORCHAREA I DECK AREA TOTALDECK/PORCH AREA I GARAGEAREA: UDETACH
❑ATTACH
#DWELLNGUNITS: IS A SECOND UNIT ❑YES SECONDSTORY OYES
BEIVGADDED? ,no ADDITION? O
PRE-APPLTCATION ❑YES IF YES,PROVIDE COPYOO`F' ISTBEBLDGAN
HORSE?/R—Ds"4AR---S " s TOTAL VALqUA
TION:PLANNING APPL# PNO PLANNING APPROVAL LETTER EICHLER
C/
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provideg is correct. I have read the Descri of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bu' ' o orize re rves o€EBpertino to enter the above [ified p operty for inspection purposes.
SignatureofApplicant/Ag -id Date: I I
SUPPL NTAL INFORMATIO REQUIRED
wROuT&I 1.EtP14
_New 5FD or Multifamily dwellings: Apply for demolition permit for
O\'Eh COUfyTER�-;� BUILDII.G PL4N R$ NO
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. kE:Vs'PIuSI, "�^e,; 4 4❑ ri;An'nING'p `RE\ \ ,. .
_CommercialBldgs: Provide a completed Hazardous Materials Disclosure ❑ s'c"w ""' �� � T +�� #OP�'us' LiC`°�oRls" � $
form if any Hazardous Materials are being used as part of this project.
❑ 1.A1;sCI; 4a r�ia�'N�S; 'J„� ❑f FD2E E 'ti,�'k `cr
_Copy of Planning-Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. � � ,. 4 ,ray r'1r,5 �t` I T2 Q�, ESty;sTR{p . �
.A"+�.t<, Y .u ai.`.ti.�s ✓.,`�:rY.:;;❑.ENVIRONh1 NTAL EtEA1:TH'. ,r,.,.
B1dgApp_2011.doc revised 06/21/11
. _ RECEIVED
NOV 2 9 2012
SCOPE OF WORK: Bathroom Remodels BY:
Project shall comply with the 2010 California Building (Base code 2009 IBC), 2010 Residential (2009
IRC), Plumbing(2009 UPC), Mechanical (2009 UMC), Electrical (2008 NEC), Fire (2009 IFC)and Energy
Codes(2008 Building Energy Efficiency Standards)\
Energy code mandatory lighting measures:
1. All permanently installed high efficacy luminaires shall be switched separately from low efficacy
luminaires. (150(k)(7))
2. Permanently installed luminaires in bathrooms, garages, laundry rooms and utility rooms shall be
high efficacy luminaires OR are controlled by an occupant sensor(s)certified to comply with
Section 119 that does not turn on automatically or have an always on option. (150(k)(10))
Plumbing plan notes:
3. Water closets shall have an average water consumption of not more than 1.28 gallons per flush.
(CPC 402.2)
4. Shower heads shall have a water flow not to exceed 2.5 gallons per minute. (CPC 402.1.1)
5. Faucets in kitchens, wet bars, lavatories, laundry sinks, etc shall have a water flow not to exceed
2.2 gallons per minute. (CPC 402.1.2)
6. Shower stalls shall have a clear interior finish area of 7.1 sq.ft. and be able to accommodate a
minimum 30 inch circle at the threshold level. These clearances shall be maintained up to a
height of 70 inches above shower drain. (CPC 411.7)
7. Shower compartments and walls above bathtubs with installed shower heads shall be finished
with a smooth, nonabsorbent surface to a height not less than 72 inches(6 ft). (CRC R307.2)
8. The maximum hot water temperature discharging from the bathtub, shower and whirlpool bathtub
filler shall be limited to 120 degrees Fahrenheit. The water heater thermostat shall not be
considered a control for meeting this provision. (CPC 414.5&418.0)
9. A 30-inch clear width for water closet compartment and 24 inch clearance in front of water closet.
(CPC 407.5)
Electrical Plan Notes:
10. The installation of smoke alarms in all of the following areas shall be provided: (R314.3)
a. On the ceiling or wall outside of each separate sleeping area in the immediate vicinity of
bedrooms.
b. In each room used for sleeping purposes.
11. The installation of carbon monoxide alarms in the following areas shall be provided: (R315.1)
a. Approved carbon monoxide alarms shall be installed outside of each separate sleeping
area in the immediate vicinity of the bedrooms and on every level including basements in
dwelling units that have fuel-fired appliances or attached garages.
12.At least one 20 amp branch circuit shall be provided to supply bathroom receptacle outlets. Such
circuits shall have no other outlets. (CEC 210.11(C)(3))
13.All receptacles in bathrooms, garages, accessory buildings, outdoors, crawl spaces, unfinished
basements, kitchens(where receptacles serve counter top surfaces), laundry, utility, wet bar
sinks (within 6 feet of the edge of the sink), shall have ground-fault circuit interrupter(GFCI)
14. Inotection. (CEC 210.8)all areas specified in 210.52, all 125-volt, 15-and 20-COMMUNITY D L�oPM N=qeM MAWS
tamper-resistant receptacles. (CEC 406.11) RO F4 tS
APPROVED
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.
Thestamping of this plan and specifications SHALL NOT
be held to permit or to be an approval of the violation
FFICE COPY, BY of any provis ons of any C�inyf Ordina�n/ce or State Law.
��A/✓ %/�f�i/T
.^' DATE
PERMIT NO.
i
it
l is
1 i
_ � I
/fLST: �GOO� ��CoND `id0/2
OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•bulldingecu Dertino.orQ
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 CqO et4, �- APN BP#
OWNER NAME �'V � I OWNER ADDRESS 1
�F'�/,�llG 1
DESCRIPTION OF WORK: Q I S
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. 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.
2. 1 understand building permits are not required to be signed by property owners unless they are responsible for
eonstruction and are not hiring a licensed Contractor to assume this responsibility.
-k`• 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.
I� 1 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.
,. IA. I 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.
W.9/funderstand 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.
8. 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 04114110
LW 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.
X1_10. 1 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.
4✓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.
AV(2. I 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 property owner's si atu
Property Owner's Signature: Date: 11 2
----- -- --------------- --- ---- ---- - -------•------------------------•----- ------t-hie---------------- -- only ---- ------------------
(NOTE: The following Authorization Form is required to be completed by 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 drivers 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:
OwnerBuilderForm 2010.doc revised 04114/10
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C O P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: ' :j C PERMIT# % O/:S
OWNER'S NAME: PHONE#
GENERAL CONTRACTOR: Y e✓ BUSINESS LICENSE#
ADDRESS: ,Qim - CITY/ZIPCODE: H
*Our municipal code requires all businesses working in the city to have a City of Cuper 'no 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.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
V 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
OCo actor Signature Date