11040223CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22437 ST ANDREWS AVE
CONTRACTOR: ERIC ENG
PERMIT NO: 11040223
OWNER'S NAME: ERIC ENG
22437 ST ANDREWS AVE
DATE ISSUED: 04/29/2011
OWNER'S PHONE: 4087253888
CUPERTMO, CA 95014
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lic. #
REMDOEL 82 SQ FT TO M. BATH AND HALLWAY
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
Sq. Ft Floor Area:
Valuation: $5100
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
APN Number: 35604018.00
Occupancy Type:
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 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 D=M LAST CALLED INSPEC ON
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Date: 1 /
granting of this permit. Additionally, the applicant understands and will comply
Issued by:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signature Date
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.
OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "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, am exclusively contracting with licensed contractors to
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
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Secti "s 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this21
Owner or authorized ager - Date:J-21-11
permit is issued.
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
CONSTRUCTION LENDING AGENCY
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.
vt
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 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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue 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 source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
21 - l
Signature Date
0
3 ITEMS OF 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35604018.00
DATE ISSUED.......: 04/29/2011
RECEIPT #......... BS000013331
REFERENCE ID # ...: 11040223
SITE ADDRESS .....: 22437 ST ANDREWS AVE
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OWNER ERIC ENG
ADDRESS ..........: 22437 ST ANDREWS AVE
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
RECEIVED FROM ....: ERIC ENG
CONTRACTOR .......: LIC # *OWNER*
COMPANY ..........: ERIC ENG
ADDRESS ..........: 22437 ST ANDREWS AVE
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
TELEPHONE ........:
OPERATOR: SylviaM
COPY ## : 1
FEE ID UNIT
QUANTITY
AMOUNT PD
-TO -DT
THIS REC
NEW BAL
-----------------------
1BCBSC VALUATION
----------
5,100.00
--------------------
1.00
0.00
----------
1.00
----------
0.00
1BSEISMICR VALUATION
5,100.00
0.51
0.00
0.51
0.00
1REMRESBAT SQ FEET
1.00
1140.00
0.00
1140.00
0.00
TOTAL PERMIT
---------- ----------
1141.51
0.00
----------
1141.51
----------
0.00
METHOD OF PAYMENT
AMOUNT
REFERENCE
NUMBER
----------------- ---------------
CHECK
1,141.51
--------------------
1064
---------------
TOTAL RECEIPT
1,141.51
W
CITY OF CUPERTINO
[M-07 FF.F FSTIMATOR — BUILDING DIVISION
NnTF• Thovo foov aro havod nn tho nroliminary infnrmatinn availahle and are anly an estimate. Contact the Dent for addn'l info.
FEE ITEMS Wee Resolution 09-051 Eff, "1,�"l �l
ADDRESS: 22437 saint andrews ave.
DATE: 04/29/2011
REVIEWED BY: bobs.
APN:
BP#:
r VALUATION: 1$5,100
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Du lex
USE: p
Suppl. PC Fee: (2) Reg. 0 OT
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
WORK
To Clear Code Enforcement Case: sfd remodel hallway and master baths
SCOPE
NnTF• Thovo foov aro havod nn tho nroliminary infnrmatinn availahle and are anly an estimate. Contact the Dent for addn'l info.
FEE ITEMS Wee Resolution 09-051 Eff, "1,�"l �l
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
=s.f.
$570.00
Remodel, Bath (<=300 sf)
IREMRESBAT
Suppl. PC Fee: (2) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -0 Reg.
0 OT0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Acoustical Fee:
0 Yes (F) No
$0.00
0
E)
Work Without Permit? E) Yes 0 No
$570.00
Pianning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
Strong Motion Fee:
IBSEISMICR
$0.51
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$571.51
$570.00
TOTAL FEE:
$1,141.51
Revised: 04/01/2011
CUPERTINO
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION - CUPERTINO
PROJECT DATA - RESIDENTIAL APPROVED
COMMUNITY DEVELOPMENT DEPARTMENT S;I�5 i.Ipp u ecifi . It is s MUST be kept at ty
� action. It is unlawful to make an
10300 TORRE AVENUE - CUPERTINO, CA 95014-3g5�f-11::;)s or alterations on same, or to deviate
(408) 777-3228 • FAX (408) 777-3333 • building4bepalitnac„c M hoot approval from the Building Official.
�'�rnr:'nc of this Tian and sm cif!cations SHALL NOT
o, to be an ap'; oval of the violation
r. r v,,.< c3�s o an rr„rance or ate Law.
PROJECT ADDRESS APIA# `� J� t Y
22-43-7 5a:�,,-r Av, ews Aye r c
OWNER NAME EV,,, (r PHONE `�...� ✓ c' CoM
STREET ADDRESS 2 2 �4-3� /n1 AV -1
Cr -4e
STATE, W ; �A FAX
/4444, 3�Tt, - e✓'1-ino Cx /
APPLICANT NAME/y. y ! PHONE E-MAIL
l� Y l� E! � f tf It C e. N C d MAI'
STREET ADDRESSCITY, STATE, ZIP FAX
2243`7
5a,111 AHdvpw> Aved Cis e✓hng s0
❑ OWNER OWNER -BUILDER ❑ OWNERAGENT 11CONTRACTOR ❑ CONTRACTOR AGENT 1:1 ARCHITECT ❑ENGINEER 1:1 DEVELOPER ❑TENANT
EXISTING USE(S):
S
PROPOSED USE(S):
OCCUPANCY(S):7
C2
TYPE OF
U
PARCEL
J
CONSTRUCTION:
AREA:
FIRE
Y N
wUI AREA: Y
N
FLOOD AREA: Y
N
SIESMIC AREA: Y N
SPRINKLERS:
Existiniz Proposed
Floor Area: First Floor: s.f. s.f.
Second Floor: s.f. s..f.
Garage s.. s.f.
TOTAL: S.
Are there at least two 10 feet by 20 feet clear spaces inside the garage? Y N
Is privacy protection planting required for the project? Y N
Governing Codes: 2010 California Building Code (based on the 2009 International Building Code)
2010 California Residential Code (based on the 2009 International Residential Code)
2010 California Plumbing Code (based on the 2009 Uniform Plumbing Code)
2010 California Mechanical Code (based on the 2009 Uniform Mechanical Code)
2010 California Electrical Code (based on the 2009 International Electrical Code)
2010 California Energy Code
2010 California Green Building Standards Code
Cupertino Municipal Code
ProjectData-ResidentiaLdoc revised 03/09/11
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION - CUPERTINO
APPROVED
T'r-IF set of plans and speclfic_':Iions MIUST be kept at the
dut it i ccrnstrutior- It ,,';-H?aWfLd to make any
-,ri or t� devia,4e
vvihou'; avt�cwE:! l -;u% Bulid'clg Official.
T i :.E thit ern. ,cations HALL NOT
c, a, v,,a 1 o f V,, c v: c at i � n
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C 11) "j" of i Y ;C-mue or 'l-Itate Law.
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CUPERT'INO
OWNER -BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a cugertino.org
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 Z7A T 7
n 5A, h.'r vk{e,,5 Al jc
/6—
APN
BP#
OWNER NAME /- r (_l
ie �
�1
OWNER ADDRESS 2 2_L� 3 2 Sa,w r /Ay\&fevj "� 1 /� l e -
DESCRIPTION OF WORK:e-
nn O ke- 664- t G
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 -
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. I 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.
a3. 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
numbers on permits and contracts.
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.
( L 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.
PQC� 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
is performed under contract with a licensed general building Contractor.
0
V—/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
-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.
2-10. 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.
[A- 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.
�12. 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 veri the property owner's sk'qoa re.
Property Owner's Signature: Date: 4 - 2cl - 1 1
-------------------16-----------------------------------------------------------------------------------------------------------------------
(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 04/14/10
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
14n81 777-3228 • FAX (408)777-3333 • building(@-cupertino,org
CUPERTINO
I
[:]NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑
REVISION / DEFERRED ORIGINAL PERMIT # //0 / V vv✓
PROJECT ADDRESS 22437 Saint Andrews Ave.
APN # --ww ll.i c) I $ -
OWNER NAME Eric Eng
PHONE 408-725-3888
E-MAIL EricEng@gmail.com
STREET ADDRESS 22437 Saint Andrews Ave.
CITY, STATE, ZIP
Cupertino, CA 95014
FAX
CONTACT NAME Eric Eng
PHONE 408-725-3888
E-MAIL EricEng@gmail.com
STREET ADDRESS 22437 Saint Andrews Ave.
CITY, STATE, ZIP
Cupertino, CA 95014 TFAX
181 OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECr ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NA E
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 Remodel BathroomN �"
> N ✓uTi 1v1 LA- (A- � KA k 5 iL(C V � � 1—vl V t. WA
EXISTING USE
Yes
PROPOSED USE
CONSTR.TYP E
# STORIES
U
EXISTG
NEW FLOOR
DEMO
TOTAL
"
... .:
#...
Y
�'
AREA
AREA
AREA
NET AREA
'>
..':.:'.
::::
BATHROOM 58 q ft
KITCHEN
OTHER f'1
REMODEL AREA", y
REMODELAREA
REMODELAREA
..::
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: ❑ DETACH
-....
#DWELLING UNITS:
IS ASECOND UNIT ❑YES
SECONDSTORY ❑YES
-
B. ADDED7 ❑ NO
ADDITION7 ❑ NO
--. -
PRE -APPLICATION ❑ YES
IF YES, PROVIDE COPY OF
PLANNER'SNAAE:
RECEIVEDBY txx
PLANNING APPL# ❑ NO
PLANNING APPROVAL LEITER
/AjT�•jg,,�j
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 b#ve read the Description of Work
and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to �!!Il// Ig COthorize representatives of Cupertino to enter the above-identiafied for inspection purposes.
'
property
Signature of Applicant/Agent: /
Date:
SUPPLEMENT INFORMATION REQUI
pLAN t�fEC&TYPP
MING
/
New SFD or Multifamily dwellings: Apply for demoli unit for
existing building(s). Demolition permit is required prior to issuance of building
Qy�Bs�tcam'titci
permit for new building.
Iraeea>,ss
Ur>I.�lunvc r�AN ItEVI.-.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
C 3ifilit>Il
❑ t't3Cclxiit
form if an Hazardous Maters'als are being used as part of this project.
':
`k;ai iEIHE
n A roal with Planning prior t0
Co PY of Planning PP v Letter or Meeting 8P
A <`EWI�.i#18
submittal of Building application.
..,:..
BldgApp_2011.doc revised 03/16/11