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13010038 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10861 E ESTATES DR CONTRACTOR:LEE THOMAS K ET AL PERMIT NO: 13010038 OWNER'S NAME: LEE THOMAS K ET AL DATE ISSUED:01/04/2013 OWNER'S PHONE: 4085067686 �fA �H}?hGH Gq 9. 01 LI PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class Lic.N MECH r RESIDENTIAL fz COMMERCIAL r Contractor Date . I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE AND REPLACE NINE(E)WINDOWS&TWO(E) (commencing with Section 7000)of Division 3 o the Business&Professions SLIDING DOORS 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. 1 have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$9000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APPLICANT CERTIFICATIAPN Number:36922021.00 Occupancy Type: ON I certify that 1 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 to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9'18' Issued by: _:59�xy ��lCZZ Date: Signature Date OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm 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. I,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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker'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 Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's 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 hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,atter making this certificate of exemption,I Owneraut orir g t become subject to the Worker's Compensation provisions of the Labor Code,I must Date: 4A12013 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION 1 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 property for inspection purposes.(We)agree to save Lender's Address indemnify and keep hi mtless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Adiflu ally,the applicant understands and will ebmply with all non-point source ulati s per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. q Signature Date / .GQ� Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION Q� 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 l U CUPERTINO (408)777-3228• FAX(408)777-3333•buildinacDcuoertino.oro `� ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT PROJECT ADDRESS o Qh/ E. E5Me t. APN M 3469 .— 2 2 — 0 2 OWNERNAME Thorns Lee ,Julia Sefo L/ PH'O/N6 se6��6s6 &"L"L 'Sefo_g92yahao,cor,., STREETADDRESS DOVI /T/• - rtrs DfCiQvel- CITY,ST�TE,ZIP ,ne eA gS01�1 FAX N/A CONTACT NA 0pnA5 Lee � l4kq Seto PHONE ,A3/ � T�MAIL STREET ADDRESS/O p// IF. E-�f� eS ki Ve CITY,S&E, ZIP f N FAX N/A AOWNFR ❑ O OWNER-BUILDDER ❑`/OGtWNER AGENT 11 CONTRACTOR ❑('CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ick fdva IL LICENSEE NUMBER LICENSE TYPE BUS.LICK COMPANYNAME5- nJo50- FAQS ZT ?—0/ /3 STREET AD R,EAS2 01brier) our CITY,STATE P S0� !� PHON OS n V� ARCHITECT/ENGINEER NAME 'I LICENSE NUMBER /n (• IG BUS.LIC k f' J COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP/ PHONE i DESCRIPTION OF WORK - 1/�c O vi),dow nom/ 2 doors EXISTING USE PROPOSED USE CONSTR.TYPE 1 4STORIES USE TYPE OCC. SQ.FI'. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTTER REMODEL AREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTALDECK/PORCH AREA GARAGE AREA DETACH ATTACH N DWELLING UNITS: IS A SECOND UNIT YES SECONDSTORY 0YES "1 BEING ADDED? TIO ADDITION? Imo PREAPPLICATTIION OYES IFYES,PROVIDECOPY OF ISTHEBLDGAN YES RECEIVED TOT VALUATION: PLANNINGAPPLd X�O PLANNING APPROVAL LETTER EICm,ERHOME4 ANO ac t 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 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 b 'Id' Ctl n. I orize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature ofApplicant/Agent Date: SUPPLEMENTXL INFORMATION REQUIRED `t�i;.,j,P'L(N CRECK-TYPE .ai+! ,RounNG SLJP. _New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building oven-THEcouivTER BUILDING PLAN REVIEW permit for new building. -'EXPieESS JO PLANNING PLAN REVIE ' -,`- _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑,,sTANUARD ❑ PUBLIC,WORKS form if any Hazardous Materials are being used as part of this project. ❑`J LARGE .77� FIRE DEPT, _Copy of Planning Approval Letter or Meeting with Planning prior to •'s �I `� ❑ MAlOR ,❑ SANITARY SEWER DISTRICT >, submittal of Building Permit application. ENVIRONMENTAL HEALTH BldgApp_201 Ldoe revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10861 E.Estates Dr DATE: 01/04/2013 REVIEWED BY: MELISSA APN: BP#: /QQ j 'VALUATION: $9,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1GENRES woRK REMOVE AND REPLACE NINE E WINDOWS &TWO E SLIDING DOORS SCOPE '.tt�Mul Meek Plan Check Plumb. Plan Cheek Elec. Plea Check Xlech. Perini!Fee: - Plumb. Petmil Fee: Flec.Pena Fee: Other,tfech. Insp. Other Plumb Insp. Li I Other Elec.Insp. Me&Insp. Pec: Plumb. hisp. Fee: Elcc.Insp. Fee' NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District etc. . Thesefees are based on therelimin information available and are only an estimate. Contact the De t for addn7 info. FEE ITEMS(Fee Resolution 11-053 Eff 7/1/121 FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 = # Window/Sliding Glass Door Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $533.00 IWINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction lids: Administrative Fee: Work Without Permit? O Yes 0 No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential Travel Documentation Fees: Building or Structure I Strong Motion Fee: 1BSEISMICR $0.90 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $1.90 $533.00 ; a ;° TOT;ALFEE: $534.90 Revised: 10/01/2012 /p�6/ ��sf Es� s dri✓e 9SQ Liorhas `ee r"kef Se7�0 MaSlivr ;; dna;ilppt KItG�e� ;enoF I! Masia Hall _ l 6(n;hrpowi ! 6aiti�onm � 1 � p CL LU r 3 ' 13�d�ann ��lrooni 1'`+h�+y/ ' S�pra9P ��r�e S�tal%h9 G�gOr 7� LLMky N �j �° LM U OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildina(a),cuoertino.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 APN BP# OWNER NAME y/�tDONsleeJ�u//A Q OWNER,rADDRESS DESCRIPTION OF WORK: te l CE 6r fndp S -i .2 shdinf doers. 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- uiider"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. V2. 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. V3. 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. 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license l uQmbers on permits and contracts. k-o• 5. I understand if I employ or otherwise engage any persons,other than California licensed Contractors, and the Otal 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. I understand if I am considered an"employer"under state and federal law, I must register with the state and ederal 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. V—=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 Ails performed under contract with a licensed general building Contractor. 4M-Y^,8 I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for n 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 , Y-P. 9. 1 understand I may obtain more information regarding my obligations as an"employer"from the Internal avenue 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 Boardt(CSLB)at 1-800-321-CSLB(2752)or www.es[b.ca.gov for more information about licensed contractors. A10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name,and understand that I m 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 y�all applicable laws and requirements that govern Owner-Builders as well as employers. ,u -12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the nformation 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 accept ity may be required to be presented when the permit is issued to verify the property owner's si natu . Property Owner's Signature: Date: (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: OwnerBuilderForm 2010.doc revised 04114/10 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone:409-777.3228 CO`1rTTR�ACTPRISURCONTRACTOR LIST JOB ADDRESS: 141MV-Sdski'.S . eSy7 ve PERMIT# C7 © 3 OWNER'S NAME: T L, ? •"" ' i k. j PHONE# $d 7 "W3 933.2- GENERAL CONTRACTOIti 7 V BUSINESS LICENSE# ADDRESS: 1402 ' l�j1r'`. l J=t, CITY/ZIPCODE: /Z *Our municipal code requirmill businessesworking 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. I am not using any subcontractors: Signature Date Please check applicable subcontractors aad complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE# Cabinets &Millwor`k`''• Cement Finishing .. Electrical Excavation Fencing Flooring/Carpefmg'.! Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing s Masonry Painting/Wallpaper' Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor�Signature Date d.