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13020015CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7875 CREEKLINE DR CONTRACTOR: ERIC TANG PERMIT NO: 13020015 OWNER'S NAME: ERIC TANG 7875 CREEKLINE DR DATE ISSUED: 02/052013 OWNER'S PHONE: 6508880868 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL _ REMODEL KITCHEN, NEW CABINETS, COUNTERTOPS, License Class Lie. # ONE Contractor Date NEW OUTLET RECEPTACLE. NO STRUCTURAL I hereby affirm that I am licensed under the provisions of Chapter 9 CHANGES, NO (commencing with Section 7000) of Division 3 of the Business & Professions LIGHTING FIXTURE CHANGES, (E) APPLIANCES 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: $18000 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 36217050.00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180,D F PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 D AST CALLED INSPECTION. upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may aceme against said City in consequence of the ed Date: granting of this permit: Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18. - Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection_LWEe ova all new materials for inspection. OWNER -BUILDER DECLARATION Signature of Aya1i_ jaw-_ a - Ihereby affirm that I am exempt from the Contractor's License Law for one of !�G the following two reasons: - ALL ROOPCOVERINGS TO�VLASS "A" OR BETTER 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) - I, as owner of the property, aexclusively contracting with licensed contractors to m HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business& Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I 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 Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Sectio o 5 534. I have and will maintain Worker's Compensation Insurance, as provided for by for this the Health & Safety Code, \\ ` Section 3700 of the Labor Code, for the performance of the work which Owner or authorized agent: DatyQ permit is issued. I 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 CONSTRUCTION LENDIN GENCY Compensation laws of California. If, atter making this certificate of exemption, I become subject to the Worker's Compensation provisions of the 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, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and stat that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building wnswction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accme 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 sou ce regulati per the I inn Municipal Code, Section Licensed Professional 9.18. C Date Signature . CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 " buildinorcDcuoer ino.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: CU? Qr4i„o, ON 95o 1 I SITE ADDRESS ^p� LtI M APN BP# OWNER ADDRESS �.�,ly n Qa WDpa SyOY,e pa r�WQ 33'1 (LQ p OWNER NAME &C. -Tarx DESCRIPTION OF WORK: ki)LC trV1'C AB( blew CW10 A-ef New COUYI O.'LQ NE -J Uv('ie-t- ule o - Yt a Ut `v eAft' 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. IRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) AV 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. /2 2. 1 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. 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. �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. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the to al 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. I understand if I am considered an "employer" under state and federal law, I must register with the state and fe eral government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." 1 also understand my failure to abide by these laws may subject me to serious financial risk. 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 pellormed 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 04/14/10 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.csib.ca.gov for more information about licensed contractors. 110. 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. e1. 1 agree that, as the party legally and financially responsible for this proposed construction activity, 1 will abide by al applicable laws and requirements that govern Owner -Builders as well as employers. M, 2. 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.) 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 I e pe : A copy of the property owner's driver's license, form notarization, or other verification accep a to the ciwired to be presented when the permit is issued to verifythe roe owner's signature. Property Owner's Signature: Date: - - - - - - - - - - - - - - - e-- - - — - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - e-- -c-o- - - - - - - - - d-- - - - - - - - -p- - - - - - - - - - o-- - - - - - - - - - - --- - - - -n- -d- - - - - - - — - - - - -a- - - - - (NOTE: The following --A-- uthorization Form is required fo be mpleted by the property owner only when designating an agent of the property owner to apply fora 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: Address of Authorized Agent: Tel No 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 properly 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: Oi+nerBuilderForm 2010.doc revised 04114110 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ^ Q 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �O v C^UPERTINO (408))- 777-3228 • FAX (408) 777-3333 • buildino(G�cuoertino.oro \ I1 NFw Cr)NSTRII(-.TT0N I I AUT)TTH)N F1 AT.TRITATION/TT F1 RFVT1.T0W/DEFERRED r)RT(:INALPF.RMTTft 141 PROIECf ADDRESS-��. Cf.��i 1iy�OC- CV PCIfhl10U 170/1 APQN# �6% C) S!� L&MAH,S (r OVINERNAME e( -`C L7a� PHONF/b�l%� O��' �� GOV IY�CQI'eCZ WVl �`fCU%ViCQ✓ie+ STREETADDRESS `IA �zQa WOO) Sk. PAh rrY, STATE, ZIPp ea1J00) C.i" / CA%0&6 U r` FAX C -TQ CONTACT NAME ! ^ � C PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX OWNER OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSENUMBER LICENSE TYPE BUS. LIC# COMPANY NAME &MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK tkr�Rn "MOW NevJ v\P,InJ Cu:>h�av pNe tne� � `� CabM.e.-t-11 0Vk\� use C,,� o_k J 7Yr� -v r a-4 v o SSV G S ENIS7]NG USE PROPOSED USE CONSTR TYPE #STORIES 6iA-tm ti fe 02ek USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG � NEWFLOOR DEMO TOTAL AREA I / o AREA �A- AREA NET AREA 1600 BATHROOM KITCHEN /` OTHER REMODELAREA REMODELAREA �V/ REMODELAREA PORCHARFA DECK AREA TOTALDECK/PORCH AREA GARAGEARPA: DETACH ❑ATTACH # DWELLING UNITS: ISASECONDUNIT ❑YES SECONDSTORY YES BEINGADDEDT ONO ADDITION? ONO PRE -APPLICATION OYES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES C,a'xK�"`�'4 aRr .; TOTA VAkUATION: PLANNINGAPPL# ONO PLANNING APPROVAL LEITER EICHLERHOME? 0 N `� 'iVY./l By my signature below, I certify to each of the following: I caner or oriz ag act on, roperty owner's behalf. I have read this application and the information I ha co av the DSlicription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil ' g coattnGft'on. th nfatives of Cupertino to enter the above -identified p pe for inspection purposes. Signature Date: ofApplicant/Agent SUPPLEMENT INFORMATIONREQU &NeA'wca _ New SFD or Multifamily dwellings: Apply for demoliti permit for �' ' @x her °� y VER 7HE-COUNTER'";� §3E ]s- % ti . '�� g ❑ BUILDING PLAN RENEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑''Fa"rxess`"av ❑irLn Nlrec LArvttEVi oi _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. 41'sr ND u `' 'F❑ �❑rusLlc o Ks C " `�j Erni _ Copy of Planning Approval Letter or Meeting with Planning prior to c ©, MAaoRx '..y ❑ D>;Px$ :' t D75rRtcT3y� submittal of Building Permit application. �y ���>a'�'�.�., �f4"`is �aNrrAtsE)vER ❑�`{ENVIRONS N'1'ALH ALTI[ B1dgApp_201 Ldoc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, tire, sanitary Fewer utstrict, senoot ze,,..,, r t.—ed.... th....er...:....... :..lo...,oHo., nvnaahle and are nnlv an estimate Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E , 71f /1112) ADDRESS: 7875 CREEKLINE DR DATE: 02/05/2013 REVIEWE Y: MELIS MISC ITEMS APN: 362 17 050 BP#: 'VALUA 18,000 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex Meeh. Permit Fee: PENTAMATION 1 R3SFDREM USE: Other Plumb Insp. PERMIT TYPE: WORKREMODEL KITCHEN NEW CABINETS COUNTERTOPS ONE NEW OUTLET RECEPTACLE. NO SCOPE STRUCTURAL CHANGES, NO LIGHTING FIXTURE CHANGES, (E) APPLIANCES NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, tire, sanitary Fewer utstrict, senoot ze,,..,, r t.—ed.... th....er...:....... :..lo...,oHo., nvnaahle and are nnlv an estimate Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E , 71f /1112) FEE QTY/FEE MISC ITEMS Plan Check Fee: illech. Plan.Check Plumb. Plan Check Flec. Plan Check Meeh. Permit Fee: Plumb. Permit Fee: Elec. Permit Fee.' Other Afecch. Insp. - Other Plumb Insp. Other Flce. Insp. Li Alech. Insp. Fee: Plumb. Insp. Fee: Elec. Insp. Fee., NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, tire, sanitary Fewer utstrict, senoot ze,,..,, r t.—ed.... th....er...:....... :..lo...,oHo., nvnaahle and are nnlv an estimate Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E , 71f /1112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F 160 s.f. $600.00 Remodel, Kitchen (<=300 sf) IREMRESKIT Suppl. PC Fee: Q Reg: 0 OT 0.0 1us $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. FeelD Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consrniction Tax: Administrative Fee: 0 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 Travel Docaunentation Fees: Strong Motion Fee: 1BSEISMICR $1.80 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 le . $2.80 $600.00 "E!4�TtOAI:'FE14 $602.80 N Revised: 01/01/2013 M CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cnneriin, PA OSA7.1_eeer Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: qg . 0-e I h 2.d!.. QuV"f%O CFk 450 R PERMIT # OWNER'S NAME: ' t✓ri c, 'fowl PHONE # GENERAL CONTRACTOR:. BUSINESS LICENSE # ADDRESS: 2l�tt 0_�lAftp Sha4, P4Ltw CITY/ZIPCODE: gebwooa C44nF ek T ta5 *Our municipal code requires all businesses working in the city to have a City of cuperuno ousmess ncense. 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 applicableesubcontractors and complete the following information: —_�-^�-a L Date 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 —_�-^�-a L Date Tckv\ �g 5 Cree0\vAe. Oc-, CuQert+na V",ro (-e V.i cln en £r:'V �m.3<�sh+v .a4� t}+xxyy�'r�`✓i�t z�'+` OO i��, J000 Ir N (10 —_ Th9 OF F any O,y AF TF 9�rTti >>qopy, Ct-,m*+,r- flop , )OL+ same 7S ,Rtofq �prr�OON �?!,•. S°rc ripe �� rc-, �A 1 X90 ._ Gt tip on atio � ��tiT ,qel Fth%s. uro'S%t° Reid ods°� rt's's�'/ iarF�o� �0ood��s�bek e qq�O iOdti do idle d �P rd; LdrO Ons dn0 Flh S/Y � qa y F, �-.052013 e6C FICE 6X154 n3