Loading...
12120054CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7930 FALL CT CONTRACTOR: FU KEH -YUEH PERMIT NO: 12120054 OWNER'S NAME: FU KEH -YUEH 7930 FALL CT DATE ISSUED: 12/11/2012 OWNER'S PHONE: 4087180730 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT F PLUMB F License Class Lic.# Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 (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. 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. APPLICANT CERTIFICATION 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 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 Cupertino against liabilities, judgments, 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 9.18. Signature Date 9 OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1 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 Section 3700 of the Labor Code, for the performance of the work for which this 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 become subject to the Worker's Compensation provisions of the Labor Code, i forthwith comply with such provisions or this permit shall be deemed revo APPLICANT CERTIFICATION 1 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 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 Cupertino against liabilities, judgments, 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-poiato4e,6 regulations per the Cupertino Municipal Code, Section 9.18. //>^ /% '" 1 MECH F RESIDENTIAL r COMMERCIAL I— JOB DESCRIPTION: INSTALL NEW 200 AMP PANEL Sq. Ft Floor Area: I Valuation: $2400 APN Number: 36213007.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE- ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance 1jth the Cupertino Municipal Code, Chapter 9.12 and the Health &Safety CoA, Sections 25505, 25533, and 25534. CONSTRUCTION LENDING AGENCY I he y affirm that there is a construction lending agency for the performance of Aork's or which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional ;T X CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildingO.cuoertino.org 11.,t,.,--1- 1­7 . =rTff AXTV- A T FTtTrrTRTf eT MvT.gr7TT.ANF(1TIR MEP m isc PROTECT ADDRESS !: I A.PN %`�( ,ry �/ �. _ 0 C5 s 1AY OWNER NAME PHONE e 3t? E -MAII eft i,( d� v—AFioe —QA- t;(�tC ec� STREET ADDRESS — ? CITY, STATE, ZIP t FAX ^ L (�x 4tie CONTACT NAME ? PHONE E -MAIL STREECADDRESS CITY, STATE, ZIP FAX OWNER ❑ owmm- BTmDER ❑ OWNERAGm, -r ❑ CONTRACTOR ❑ CONTRACTOR AGENT. ❑ ARCI-1TECT ❑ ENGWEER. ❑ DEVELOPER ❑ T`ZNAN`T CONTRACTOR NAME /�i (� LICE.'QSE NUMBER LICENSE TYPE BUs. LIC R COOMPANY NAY! E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARC HITEE MEN GIN ER NAME LICENSE NUMBER ( BUS. 13C# COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD . DUPLEX ❑ MULTI- FAMILY PROTECT IN WTLDIAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ Y=S BTJILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONTE ❑ NO I ECHI.ER HOMM ❑ NO DESCRIPTION OF WORK TOTA.LVALUATION: �� A,v I RECEIVED BY: 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 providc4As correct I have read the Description of Work and verify it is accurate. I agree to comply rrith all applicable local ordinmices and sate laws relating to buildi, cons5p ti, -I. L� r°�rese upertino to enter the a identifiedprope „y for inspection pu;�oses. �f1� Signature of Applicant/Agent: % f / / -Date: - PPLEI,fNTAI RMA REQUIRED OFFICE USE ONLY OVER-THE-COUNTER r I ❑ EXPRESS U ❑ STANDARD U ❑ LARGE ❑ MAJOR A,PlvfucApp_2011.doc revised 06121111 CITY OF CUPERTINO OF F F QT1X4 A TnR - RT TII ,DING DIVISION APPLIANCE / EQUIP TYPE 7930 fall ct. DATE: 12/11/2012 REVIEWED BY: bobs. igADDRESS: *VALUATION: $2,400 APN: *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair jS PRIMARY SFD or Duplex 1 ERT <200 PENMIT TY ON 1 REAP2 PERMIT TYPE: USE: Amps $45 i17_ WORK install new 200 amp panel SCOPE APPLIANCE / EQUIP TYPE FEE ID �'t �� �- �'����� �- 'i�x�c�� QTY UNITS BP FEES Elec. Permit Fee: IEPERMIT - I Services 1 ERT <200 Other Elec. Insp. 7f�n 200 Amps $45 i17_ -L.. D:.. S111)1)1. htSl) Fee PME Unit Fee: $45.00 PME Permit Fee: $45.00 ("MIS11'IWfiOP1 1 i7T': Administrative Fee: IADMIN $42.00 Work Without Permit? 0 Yes Q No $0.00 TOTALS: -T-= Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not includefees due too �r e. r�ann�ng, �uo�r� rrvrna, ��•...�•y -� - -- -..__, __.____ .•_ _ _u.__:._,.- ..:..! .......s:..., .. ..:InEln nrr•/ nro nn /v nn o.cilmlltP_ Contact the Dent for addn'1 info. District, eta . inese ees are oases on she reurrursur FEE ITEMS (Fee Resolution 11 -053 Ef. 7,%1112) /c,11. Plcin k �'t �� �- �'����� �- 'i�x�c�� Elec. Plan Check 0.0 1 hrs $0.00 Plan Chcck h "(IC: T'11,aib. P sir Fcc: Elec. Permit Fee: IEPERMIT - I Orix-1- Ale ch. lase �)r;,��r Plr,�ri�', In"", -L- Other Elec. Insp. 7f�n A9cch. Itts7�. ( e: F'Irrrrr >. l,,�y�. ref': I7 ", /nsvj" l 'u, i17_ -L.. D:.. NOTE: This estimate does not includefees due too �r e. r�ann�ng, �uo�r� rrvrna, ��•...�•y -� - -- -..__, __.____ .•_ _ _u.__:._,.- ..:..! .......s:..., .. ..:InEln nrr•/ nro nn /v nn o.cilmlltP_ Contact the Dent for addn'1 info. District, eta . inese ees are oases on she reurrursur FEE ITEMS (Fee Resolution 11 -053 Ef. 7,%1112) g-f, ,.................». FEE •� �•- - -- - QTY/FEE -• -- - MISC ITEMS Plan Chcck h "(IC: :S11J)p /. PC P c e PME Plan Check: $0.00 Perinit I`(,e: S111)1)1. htSl) Fee PME Unit Fee: $45.00 PME Permit Fee: $45.00 ("MIS11'IWfiOP1 1 i7T': Administrative Fee: IADMIN $42.00 Work Without Permit? 0 Yes Q No $0.00 ��Lll 'i1a1C'E'111'ltaf "tflfl'1�,r 1`t'e':S: -T-= Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item B1d�LStds Commission Fee: IBCBSC $1.00 SUBTOTALS: $178.50 $0.00 TOTAL FEE:, $178.50 Revised: 10/01/2012 CUPERTINO OWNER- BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • DuiljingacuDartino.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 — ,� APK ,Z' '3 - &,, qP! E7 v ! D Q C� OWNER NAME OWNER AD ASS DESCRIPTION OF WORK: Ino LOA, I , I - J 6/-- — 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 - ilder" 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 construction and are not hiring a licensed Contractor to assume this responsibility. 3. 1 understand as an "Owner- Builder" I am the responsible party of record on the permit. I understand that I may p ect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 1 ' 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license r mbers on permits and contracts. f 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the t a 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. qfd r 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and al 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. 7. 1 understand under California Contractors' State License Law, an Owner - Builder who builds single - family r sidential 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 erformed under contract with a licensed general building Contractor. t 8. 1 understand as an Owner - Builder if I sell the property for which this permit is issued, I may be held liable for "a a inancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 6r4,nerBuilderFonn 2010.doc revised 04114110 P 9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal 'R�v�nue 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. . Iam aware of and consent to an Owner - Builder building permit applied for in my name, and understand that I a k10 e party legally and financially responsible for proposed construction activity at the site address listed above. !'1 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide applicable laws and requirements that govern Owner - Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the \ in ation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If y 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 signature. Property Owner's Signature: - —? Date: / ______________________ ______________tom - ._.sue_________ ________ _______________________________ (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: 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 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: 0ivnerBuilderForm 2010.doc revised 04114110