Loading...
11080078.. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20005 NORTHWIND SQ ' CONTRACTOR: BRYSON JULIETTE A IPERMIT NO: 11080078 OWNER'S NAME: BRYSON JULIETTE A 120005 NORTHWIND SQ j DATE ISSUED: 08/09/2011 G`.,'NER'S PHONE: 4084461952 L. LICENSED CONTRACTOR'S DECLARATION 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 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 -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law fo one of the following two reasons: 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, 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. 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. 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 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 must forthwith comply with such provisions or this permit shall be deemed revoked. 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, cncts, and expenses which may accrue against said City in consequence of the ng of this permit. Additionally, the applicant understands and will comply all non -point source regulations per the Cupertino Municipal Code, Section 9.18. i 11 CUPERTINO, CA 95014 PHONE NO: BUILDING PERMIT INFO: BLDG ELECT PLUMB MECH r— RESIDENTIAL f— COMMERCIAL f— JOB DESCRIPTION: INSTALL WHOLE HOUSE FAN WITH REMOTE, INSTALL GABLE VENT -NONSTRUCTURAL Sq. Ft Floor Area: I Valuation: $1000 APN Number: 31638001.00 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 with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for 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 6 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31638001.00 DATE ISSUED.......: 08/09/2011 RECEIPT #.........: BS000014375 REFERENCE ID # ...: 11080078 SITE ADDRESS .....: 20005 NORTHWIND SQ SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER ............: BRYSON JULIETTE A ADDRESS 20005 NORTHWIND SQ CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: JULIETTE A BRYSON CONTRACTOR ........ LIC # *OWNER* COMPANY BRYSON JULIETTE A ADDRESS 20005 NORTHWIND 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 1,000.00 1.00 0.00 1.00 0.00 1BREMVENFA NO UNITS 1.00 22.00 0.00 22.00 0.00 1BSEISMICR VALUATION 1,000.00 0.50 0.00 0.50 0.00 1MPERMITFE FLAT RATE 1.00 44.00 0.00 44.00 0.00 1TRAVDOC FLAT RATE 1.00 44.00 0.00 44.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 152.50 ---------- 0.00 152.50 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 152.50 --------------- 152.50 VOICE ID DESCRIPTION -------- ---------------------------- 303 ROUGH MECHANICAL 503 FINAL MECHANICAL ENERGY 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- #2537 VOICE ID DESCRIPTION -------- ---------------------------- 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL CITY OF CUPERTINO FFF. FSTIMAT()R - RITILDING DIVISION im,ADDRESS: 20005 northwind square QTY/FEE DATE: 08/09/2011 REVIEWED BY: bobs. BP FEES APN: BP#: 1BREMVENF "VALUATION: 1$1,000 "PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1 RMAP8 PERMIT TYPE: WORK SCOPE PME Unit Fee: APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Ventilation Fan 1BREMVENF 1 # $22 PME Unit Fee: $22.00 PME Permit Fee: $44.00 F71 Work Without Permit? 0 Yes E) No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $22.00 Strong Motion Fee: IBSEISMICR Mech. Plan Check0.0 hrs $0.00 Mech. Permit Fee: IMPERMIT Other Mech. Insp. 1 0.0 1 hrs 1 $44.00 ', AT.1% TL...... C .... .. .. xa nu #Gt^nntart tho Dont fnr addn'L info. FEE ITEMS (Fee Resolution 11-053 f ff.' 7.1.,']1) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $22.00 PME Permit Fee: $44.00 F71 Work Without Permit? 0 Yes E) No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 Strong Motion Fee: IBSEISMICR $0.50 0.5 hrs Admin./Clerical Fee $41.00 ]ADMIN Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $111.50 $41.00 TOTAL FEE: $152.50 Revised: 07/04/2011 I I o 00 7Y CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 1-1 (408) 777-3228 • FAX(408) 7 7-3333 • buildingCcDcupertino.org CUPERTINO I7 NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERNIIT # PROJECT ADDRES; I 0P E ��J M`) APN # 1001 j> OWJ NAME STREET ADDRESS �+ c4o� CITY STATE, ZIP FAX N CONTACT NAMEoL,iC TTr- A � � � �J P�'TV � T i G ' 1-/ S L E P YV `V 1C r) STREET ADDRESS :kCCT � 4©► W00-1) J� CITY, STATE, ZIP �v� �, leu C �Sf�i FAX 111 OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGE24T ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEJ AC- C 6 )� Iv 1 L wr LIC ENSE�N 4 -7 3 5 LICENSE646EK A ` BUS. LIC # C) COMPANY NAME LOFT C O NSI C lii`l J 1 k -M S E/ MAa.`E F T- COA5F C/sw_� 4J717t . w 671 FAX STREET ADDRESS 15 3 �; A-tmt41Q L A w CITY, STATE P s A_jZIJD " E CA 5 )1 � PHONE NO I? I ARCHITECT/ENGINEER NAME / LICENSE NUMBER BUS. LIC # COMPANY NAME IV /A--- E-MAIL FAX STREET ADDRESS If I CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 'P ^ t40 45 m VTT;;� ( ' \ STOi L L G aLC V V �r EXIST -NG USE PROPOSED USE CONSTR. TYPE k STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA yJ� �'f/Q �d q2- BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA I GARAGE AREA H DETACH ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES BEING ADDED? ❑NO SECOND STORY ❑ YES ADDITION? ❑NO PRE -APPLICATION [I YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: ) TOTAL VALUATION: PLANNING APDL f []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the prspperty 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 building, con tructio I a orize representatives of Cupertino to enter the above -identified pro erty for inspection purposes. 2 Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRE PLAN CHECK TYPE ROUTING SLIP _ New SFD or Multifamily dwellings: Apply for demolition permit for 'TRE -COUNTER 1!'BUELDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building E_� permit for new building. 11 EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PuBLIcwoRxs 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 ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENV MOMY NTAL HEALTH B1dgApp_2011.doc revised 06/21/11 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • buildina5cupertino.oro 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 , c^ + APN BP# OWNER NAMEJL)LJ6J7; A. b1� soo OW vk()005 ��1��b�1�-�b� `�} � �RT_11�11 ���1 DESCRIPTION OF WORK: 11) S'" (_ i. vi 1�-v�-� V � `r �"� - �' �' �% FA rJ 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.) to1. 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. 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. n 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. 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. A-5. I 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. c161" 6. 1 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. ,jy�L7. 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 performed under contract with a licensed general building Contractor. JW8. 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. Oii,79e1'Builde7'FO7"772 2010.doc revised 04/14/10 9. 1 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. A) 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. J-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. A12. 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.) 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 natur . 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: 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: C1vnerBullderForm 2010.docrevised04114110 N O R H P Q X. T 10880 Northpoint Way Cupertino, CA 95014 PH: 408-996-3734 FX: 408-996-0226 UNC Community Management 6840 Via Del Oro Suite 265 San Jose, CA 95119 PH: 408-229-6000 FX: 408-229-6001 Ms. Juliette Bryson 20005 Northwind Square Cupertino, CA 95014 July 20, 2011 Re: Architectural Review Dear Ms. Bryson, This is to inform you that the Architectural Review Application you submitted on July 11, 2011 has been approved by the Board of Directors. have enclosed a signed copy for your records. Thank you, Linda Starnes On Site Manager NORTHPOINT HOMEOWNERS ASSOCIATION ARCHITECTURAL REVIEW APPLICATION This form must be completed and submitted for review by the Grounds and Architectural Committee and approval by the Board of Directors before commencement of any property modifications which would result in: (1) a change in the exterior appearance of the unit, or (2) affect the structural integrity of the building or decrease fire safety code requirements. Completion of this form is not necessary for installation of: air-conditioning units, replacement windows or sliding doors, garage doors,. and satellite dish receives. Use a Property Modification Notification for the items listed above. Any other modifications require completion and submission of this form. Please Print Homeowner Name(s):_ Property Address: 2100013, I`Iorthvvin(j Squ r; Juliette A. Bryson Phone: GJ ago _l `'':) Application Date: July 1 1, 2011 Planned Completion Date: August 1 1 , 2011 Description of Modification(s): Install gable end shutter (Photo attached of such a shutter on `wally Acree's unit at 20004 Northwind Sq) to accommodate instalia,,ion of a whole house tan which wili require --Iaclitional ventilaiion. No other modification ue"y,ond �-:i hole deivlleer, ratte s ai Dove C)euruuil is lieeded. Please include, if possible, copies of brochures, blueprints, contractor's proposals, city permits, sketches, diagrams, etc. to facilitate the review process. You may be requested to attend the meeting of the Grounds and Architectural Committee when your application is reviewed. Any damages caused to property as a result of modifications will be the homeowner's responsibility. Homeowner is responsible for obtaining any required city permits. Homeowner has six (6) months to complete approved modifications and is responsible for notifying management upon project completion. P, 2,011 Homeowrt'er Signature(s) ----------------------------------- --------------------------------------------------------- --Official Use Only -- Architectural Review Recommendation:_-=f;::-1.� Date`1 Board of Directors Action: ��i z.�;� ;.., Date: Completion Verification by: Date: NORTHPOINT HOMEOWNERS ASSOCIATION 10880 Northpoint Way, Cupertino, CA 95014 FORM REVISED 5/2000 (408) 996-3734 Fax: (408) 996-0226