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11090108CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11001 NORTHSKY SQ CONTRACTOR: VICTOR R. BELL PERMIT NO: 11090108 OWNER'S NAME: VICTOR R. BELL 11001 NORTHSKY SQ DATE ISSUED: 09/19/2011 OWNER'S PHONE: 4088294853 CUPERTINO, CA 95014 PHONE NO: LICENSED CONTRACTOR'S DECLARATIONr— BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. # MECH RESIDENTIAL COMMERCIAL Contractor Date 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: TWO(2)BATHROOM REMODEL(I 83SQFT) LIKE FOR LIKE, (commencing with Section 7000) of Division 3 of the Business & Professions REPLACE SEVEN(7)WINDOWS, ADD NEW GAS LINE TO KITCHEN STOVE TOP, REPLACE RUNNING BOARDS DUE TO 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 Sq. Ft Floor Area: Valuation: $13000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 31640003.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Issued Date: Signature Date GJ l OWNER -BUILDER DECLARATION RE -ROOFS: i nereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is the following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1, as owner of the property, or my employees with wages as their sole compensation, inspection. will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: Date: 1, 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: I have and will maintain a Certificate of Consent to self -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Section 3700 of the Labor Code, for the performance of the work for which this Safety Code, Section 25532(a) should I store or handle hazardous material. 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 1 certify that in the performance of the work for which this permit is issued, I shall maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health & Safety Code, Sections 25505, 25533, and 25534. Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, 1 must O n or,,�, rized a t•- 1'—.2 Date: forthwith comply with such provisions or this permit shall be deemed revoked. <L��CLI CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.) to building construction, and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address coy*s, and expenses which may accrue against said City in consequence of the ng of this permit. Additionally, the applicant understands and will comply ARCHITECT'S DECLARATION all non -point source regulations per the Cupertino Municipal Code, Section 9.18. I understand my plans shall be used as public records. Signature V �� l��c Y Date ( Licensed Professional 9 ITEMS OF 9 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31640003.00 DATE ISSUED.......: 09/19/2011 RECEIPT #.........: BS000014780 REFERENCE ID # ...: 11090108 SITE ADDRESS .....: 11001 NORTHSKY SQ SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............: VICTOR R. BELL ADDRESS ..........: 11001 NORTHSKY SQ CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: VICTOR(RICK)BELL CONTRACTOR .......: LIC # *OWNER* COMPANY ..........: VICTOR R. BELL ADDRESS ..........: 11001 NORTHSKY SQ CITY/STATE/ZIP ...: CUPERTINO, CA 95014 TELEPHONE ........: OPERATOR: patg COPY # : 1 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- -ADMIN ------------- HOURS ---------- 1.00 -------------------- 41.00 0.00 ---------- 41.00 ---------- 0.00 1BCBSC VALUATION 13,000.00 1.00 0.00 1.00 0.00 1BSEISMICR VALUATION 13,000.00 1.30 0.00 1.30 0.00 1PGASRES OUTLETS 1.00 65.00 0.00 65.00 0.00 1PPERMITFE FLAT RATE 1.00 44.00 0.00 44.00 0.00 1REMRESBAT SQ FEET 183.00 588.00 0.00 588.00 0.00 1STINSP UNITS 1.00 130.00 0.00 130.00 0.00 1TRAVDOC FLAT RATE 1.00 44.00 0.00 44.00 0.00 1WINREP EACH 8 7.00 392.00 0.00 392.00 0.00 TOTAL PERMIT ---------- ---------- 1306.30 0.00 ---------- 1306.30 ---------- 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- CHECK --------------- --------------- 1,306.30 -------------------- #702 TOTAL RECEIPT 1,306.30 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION iaADDRESS: 11001 northsky sq. DATE: 09/19/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$13,000 °PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: 0.0 PENTAMATION 1 R3SFDREM PERMIT TYPE: WORK sfd 2 bath remodel like for like replace 7 wimdows add new gas line to kitchen stove top, replace SCOPE running boards due to dryrot damage at deck location. Plumb. Plan Check 10.0 1 hrs $0.00 Plumb. Permit Fee: IPPERMIT Other Plumb Insp. 1 0.0 1 hrs 1 $44.001 NOTE. This estimate does not include fees due to other Depts (i.e. Public Works, Sanitary Sewer District, School District, etc.). These tees are hated on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS 0-ee Resohition 11-053 E(/. ' 1;'11,) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel, Bath (<=300 sf) $588.00 IREMRESBAT Suppl. PC Fee: (F) Reg. () OT 0.0 hrs $0.00 PME Plan Check: $0.00 = # Window / Sliding Glass Door $392.00 1 WINREP Replacement Permit Fee: Hourly Only? Q Yes 0 No $0.00 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00 0 # Plumbing $65.00 IPGASRES Piping, Gas <=4 Outlets PME Unit Fee: $0.00 PME Permit Fee: $44.00 Administrative Fee: ]ADMIN $41.00 Q Work Without Permit? Q Yes (E) No $0.00 Advanced Planning* l=ee: $0.00 0 hours Inspections $130.00 1sTINSP Inspection, Hourly E) Travel Documentation Fee: ITRA VDOC $44.00 StronL Motion Fee: 1BSEISMICR $1.30 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $131.30 $1,175.00 TOTAL FEE: 1 $1,306.30 Revised: 09/02/2011 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • buildinq(d,)CUpertlno.Orq ❑NEW CONSTRUCTION M ADDITION M ALTERATTON/TT F-1 RFVTCTf1111/flFFFR111:n nVTt rkTAt DCDILAVru PROJECT ADDRESS 110 5 APN # Z I /' — 140 " oO 3 OWNER NAME� i Oy- l k� PHONF�� ��'y��_ E Vjoajk�L40 tea`\• rn STREET ADDRESS l \00 t NoY� CITY STATE, ZIP A FAX —. Y �O CONTACT NAME `, 1 O ^ , PHONE 929-148-S E-A'B'vb¢.lt L4octg�a,; STREET ADDRESS P.O. BOX 3 1.1 CITY, STATE ZIP s A 1 �� CA 9 023 FAX ❑ OWNER OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME O ,J J� LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-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 `` 1 k tV\C "TO `l -ccA- b o av4s on of Lck is `„na_ A o s4v-%\ . EXLSTING USE PROPOSED USE CONSTR. TYPE7TOREs USE TYPE OCC. SQ.FT. VALUATION (S) EXLSTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM REMODEL AREA 1973 KITCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECKMORCH AREA GARAGE AREA DETACH I ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES BEING ADDED? []NO ADDITION? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # []NO PLANNING APPROVAL LETTER IS THE BLDG AN [] YES EICHLER HOME? ❑ NO RECErVED BY: TOTAL VALUATION: /� / -:S © Oo By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the prpperty 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 relatit buil 'ng construction. I authorize representatives of Cupertino to enter the abo e-identiified property for inspection purposes. Signature of Applicant/Agent: ( /�Q.(�� Date: SUPPLEMENTAL INFORMATION REQUIRED pLpr( CHECK TYPE ROUTING SLIP L rovER THE 11!I--BUIL61NG New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building -COUNTER PLAN REVIEW permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REvIEw _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WoRKs form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ M JOR ❑ SANTTARY submittal of Building Permit application. SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 Yi CUPERTINO PROJECT DATA - RESIDENTIAL COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(&cupertino.org Existing Proposed Floor Area: First Floor: s.f. s.f. Second Floor: s.f. s.f. Garage � S. s.f. TOTAL: s. f. S-rz 1-o Are there at least two 10 feet by 20 feet clear spaces inside the garage? y N ¢ C5 w u°r3 Cl 4 Is privacy protection planting required for the project? y N w. Governing Codes: 2010 California Building Code (based on the 2009 International B1 2010 California Residential Code (based on the 2009 International 2010 California Plumbing Code (based on the 2009 Uniform Plum 2010 California Mechanical Code (based on the 2009 Uniform Me 2010 California Electrical Code (based on the 2009 International E 2010 California Energy Code 2010 California Green Building Standards Code Cupertino Municipal Code m c f�C a U +' .Y 2 N w -2 3-- o ..y E '> rn .fl ° 7 oco E m Q �`cai LIJ o w N E 2) o o to a ti Cw ode 0 ( CL v2m .o N '? Cd .r ek 0 (a 0 Code wo Z ca L w 3 0. '0 Ch 0 ° C o +. m 'Co a m o m � � m O o J � 2 .o CO a) U):5 0 0 �_ w o E ,` 0 C)- v �ro0 (0 0 V va, o o� 0 50- 0) to cZ -� 0 0 E0CL z A O UJ CC ,CD m o a F- ProjectData-Residential.doc revised 03/09/11 21" 3: 41t b%&ocw, tflcVA � I15" w 1k- O CW CLw k2 A mu%+ - L� kc ro r L;, VA - 11001 WOV-415k� Sq.,C►W--k►v+ot CA n�j/ 17L/ Lt71�l ub: 19 10880 Northpoint Way Cupertino, CA 95014 PH: 408-996-3734 FX: 408.996.0226 UNC Community Management 8840 Via Del Oro Suite 265 San Jose, CA 96119 PH: 408-229-6000 FX: 408-22"oo1 4089960226 Mr. Bell / Ms. Betty Meyer 11001 Northsky Square Cupertino, CA 95014 September 2, 2011 NORTHPOINT Re: Property Modification o Same size double window replacement o Kitchen Bay window/patio side o Garage door replacement Dear Mr. Bell, PAGE 02/02 This is to inform you that the above property modifications have been approved once you have become the owner of 11001 Northsky or have written permission from the property owner to do the modifications. Please note that any damage to property caused by the modifications is the responsibility of the homeowner. Any upkeep or repair on any modification is the responsibility of the homeowner. Please obtain any required City permits Contact me at the Northpoint office when painting is required.. ® f >i FI �. Thank you, I L Emu Linda Starnes �jT-- On Site Manager 408-996-3734 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinc d-)cuperhno.o -1 c-1� Dear Property Owner(s): - An application for a building permit has been submitted in your name listing yourself as t e uiFd_er__oTM property improvements specified at: SITE ADDRESS AlN • BP# 11 DO 1 �� - ,c k-7 S CJA 7j OWNER NA\ j C 1 \ OW ER ADDRE9® ,_,0Z7 DESCRIPTION OF WORK: S b T 1� ���^c7 a� pt, 99-" C..9i'va"W( 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.) J 1� 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. Q�? 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. VQ, 3. 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. VQ -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. y(� 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. 'V Q,.)6. 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. vv;L7. 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. �. 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. OivnerBuilderForm 2010.doc revised 04/14/10 0 N. 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. 34-10. 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. V � 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. A412. 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 n tur Property Owner's Signature: Date: 9110d t 1 --------------------------------------------------------------------------------------------------------------------------------------------- (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: GWnerBuilderFonn 2010.doc revised 04/14110