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11050054 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10220 VISTA DR CONTRACTOR:CHU YAO K AND HUEI- PERMIT NO: 11050054 LAN C OWNER'S NAME: CHU YAO K AND HUEI-LAN C 10220 VISTA DR DATE ISSUED:05/09/2011 ER'S PHONE: 4084890591 CUPERTINO,CA 95014-2024 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT' PLUMB r License Class Lic.# MECH r RESIDENTIAL F COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: 10220&10216 VISTA DR-TO CLEAR CODE (commencing with Section 7000)of Division 3 of the Business&Professions ENFORCEMENT Code and that my license is in full force and effect. CASE;REPAIR EXISTING SIDING REPLACE WITH WOOD SIDING,NO CHANGE TO THE ESTETICS OF THE BUILDING 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. Sq.Ft Floor Area: Valuation:$7000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:31624017.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date _. Issued b3�: Date: 141 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Co ,I must forthwith comply with such provisions or this permit shall be deemed revoke I Own r oraho rized a :� ate: /1) APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of mrk's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name i-- inify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the Lender's Address 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. ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signatur Date t � � Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 C U P IEwRT 1 N t? (408)777-3228 • FAX(408)777-3333•building a.cugertino.org !) c�- ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS APN# 0NAME PHONE(M3) /y l�rQ E-MAIL STREET AD GESS CITY, TATE,ZIP • lQ 14 -F CONTACT N EG SHO `� _p w E-MAIL JS U J 41, S T D SS r /0 CITY,STATE, ZIP ) F O _D ❑ OWNER OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACrORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACT-OR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMME COMPANY NA) 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 F WORK ELY riA .✓ 4�P -7�xe ��k 6!e n_41 EXISTING U E PROPOSED LSE ONSTR TYPE #STORES R1 I` E IVB � Fo �F Wvnz EXISTG NEW FLOOR DEMO TOTAL R w� AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER 3 % t {� " x. C` REMODEL AREA REMODEL AREA REMODEL AREA J PORCH AREA DECK AREA TOTAL DECK/PORcH AREA GARAGE AREA: ❑ DETACH z � ❑ ATTACH � X DWELLING UNITS: IS A SECOND UNIT ❑YESSECOND STORY ❑YES BEING ADDEDT ❑NO ADDrrIONT ❑NO PRE-APPLICATION ❑ YES IF YES,PROVIDE COPY OF PLANNER'S NAME: I:,E�I�IEpt$Y x �%'r�ALbUc4TLON ,. ., PLANNING APPL X ❑NO PLANNING APPROVAL LEI-CER " .` 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 'fi 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 buildin(Zonstruction. I au epresentative Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED , bvsi - a62- �0 � �. _New SFD or Multifamily dwellings: Apply for demolition permit for iteo �Ru�t(mE�u existing building(s). Demolition permit is required prior to issuance of building14 permit for new building. ❑ _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure0 Sxalviiaisn k ❑ Prisrswcxucs form if any Hazardous Materials are being used as part of this project. ❑ T.fiSGE � �°13 � g _Copy of Planning Approval Letter or Meeting with Planning prior to ,MAJOR ❑ SiIV1FeYItY&SBVRE1t.DLSTAICT submittal of Building Permit application. BldgApp 2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10216 vista dr. DATE: 05/09/2011 REVIEWED BY: bobs. F01 APN: BP#: "VALUATION: 1$7,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 GENRES USE: PERMIT TYPE: WORK To Clear Code Enforcement Case: repair existing siding replace with wood siding, no change to the SCOPE estetics of the building. F-1 LLJ I NOTE. Thesefees are based on the prelindnary information available and are only an estimate. Contact the De t or addn 7 in o. FEE ITEMS (Fee Resolution 0.9-051 l?jf. 71'1i10� FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1,000 s.f. Siding Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 $760.00 ISIDEOTHER All Other PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.e Reg. 0 OT F0,01hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: Q Yes G No $0.00 0 Work Without Permit? E) Yes 0 No $760.00 G P(annin Fee: $0.00 Select a Non-Residential Q Building or Structure 0 i Stronjz Motion Fee: IBSEISMICR $0.70 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $761.70 $760.00 TOTAL FEE:" $1,521.70 Revised: 04/29/2011 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31624017. 00 DATE ISSUED. . . . . . . : 05/09/2011 RECEIPT #. . . . . . . . . : BS000013405 REFERENCE ID # . . . : 11050054 SITE ADDRESS . . . . . : 10220 VISTA DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : CHU YAO K AND HUEI-LAN C ADDRESS . . . . . . . . . . : 10220 VISTA DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2024 RECEIVED FROM . . . . : FENG JUI SUN CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : CHU YAO K AND HUEI-LAN C ADDRESS . . . . . . . . . . : 10220 VISTA DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2024 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 7, 000 .00 1. 00 0. 00 1.00 0. 00 1BSEISMICR VALUATION 7, 000. 00 0. 70 0. 00 0 .70 0. 00 1SIDEOTHER SQ FEET 1, 000. 00 1520. 00 0. 00 1520 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 1521.70 0. 00 1521.70 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 1, 521.70 #451 --------------- TOTAL RECEIPT 1, 521. 70 MAY-01-11 11:50PM1 FROWINTERO REAL ESTATE 406-191-ST01 T-878 P.001/001 F-618 1 QYIiNSR-SUtLDER DISCLOSURE IFOPJA COWWMMITy OWVjLOpWW pe pARTMti:NT•BUILDING OMMON 10.300 tORRE AVENUE•Cl1PEKnNO,CA 9+01432x6 (408)7?7,Vn-FAX(4M)777-3933' llimit CUPERTtN0 [lose PrctpartY OWner(s): r name listing yourself as the builder of the property An applikalion for a building permit hes been submitted in you g Y� improvernerft apecfMtd at: Bps B ADO � V&1;61 2W oWNM Ao Yr A 41 atsecad VIOM i4 4, zo so ON srs ��tr�p a fr-Ui+�'Ida�At Atrld4nga6on 44AV� o� aware vW'r/ your rt�sponsi Mjee and possible fWk You Maly by�r8 this perndt issued In your name as the OrmarBuilder. We QS will not4esus a butitling permit until you haw read,InWoled YWT UnderrOmdIng of each provision,signed,and returned this form do res at aur ofArtial address Indicated. An agent of the owner cannot won to this motlee unless you,the property owner,obtain ftnel prior epprovaf of the penrittdng auftlitty. MYNE&§ACIQiilylAfLa ME" T ANO1F1C&--nom OF INEg M MON (DIRECT70N3:Meese reed$,tar lrddaf eeclr 3M&Mtrt brow io slgnJ&you understand or vor*thft inFormadon.) f 1.1 undetotlnd a frequent practice of unilcensed persons is to have the proparty owner obtain an"Owner- BulWar building permtt that envneouily implies that the property owret Is prq+komg his or her own labor and material personally,1,e s on owner-Builder,may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed parson and hit or her employees While working on my property. My homeowner's insurance may not provide caverege for those lnjurfes.I am wi fUlIy acting as an owner•Builder and arm aware of the limits of my Insurance omwege for Injuries to workers on MY Prop". 2_I understand building permits are not required to be signed by properly owners unless they are riasponwble for the oorstruction and are not hiring a HcenmW C.orftMrto assume this responsibility. -V..,,3_I understand ens an'Owner-Bufldor'I am the responsible party of record on the permit.I understand that I may protect myself from potential financial KW 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 Califomia and to list their license an permits and contra. -&L-6.I understand if 1 employ or atherMas engage any persons,other than Celtbmia licensed Contractors,end the total value of my construction is at least flue hundred dollars OW),including labor and matwtlih,(may be considered an"employer"under state and federal low. -A/—B_i understand if I am considered an"employer'understate and fedeml law,I must regivor wlthh the state and federal government,withhold payroll taxes,provide workers'compensation disability insurance,and contribute to unemployment compensation far each-empioyse.-I also understand my f llure to abide by these laws may subject me tD serious linanatal risk. -JJ-1 understand under Calllbmia Contracbm'State I.irerlse Law,an Ownerrl-Builder who builds VIngle-%mRy residential sir ucturcns Cannot legally build them with the intent to offer them for ale,unim err work is pertormed by ficensed subcontractors and the number of structures dose not exceed four within any calendar year,or all of the work is psrPormetl under oonU*a with a licensed general building Contractor_ —4-18-t understand as an Owns'Butldsr if 1*0 the pmporty for which this permit is issued,l may be held liable for any financial or personal inlurfes sustained by any subsequent owner(R)that result from any latent ccir** lGUon defects in the workmanship or mat"I& Ow►mrBadld�rFann_2WO.&a re►dsed 04114/10 MAT-OQ-11 01:60PM FRON-11MRO ORAL ESTATE 408-317-5701 T-973 P-002/003 F-653 9.I understand€may obtain M"Irlb� obligaftna as an"ernployerr from titre InterrOl augnassAdministra Revenue Servloe,the Unttad BMW Small tion.the CaIAllomta department of 13eherftt payrrferrLq, I nay contact to CaMnle License Board(C�t_B)aatt 11 0 LS(2 52)orof Industrial Aoddsnt!L I lwww.c bOD ec8 gw llbf more intbrmat�n abs licensed , contiumm V 10.1 am aware of rid cmeent to an Owl uilder building permit&&led for in my name,and understand#W I am the party qty and tlnandaly responsible for prapoaed eon&uctlon edirrity at 1ha site address hated above. 11.1 agree that as the party fegaiy and financially responsible for this proposed cormaw ion activity.I wilt abide by applicable brow and requirernenb that govern Owner-0uliders as well ars employers. 12.1 agraG to notify the issuer of this form immediatsly of any addWons,deletions,or d=V"to any of>»e inforrnaI'm I have provided on thio►form-IJcen8d corltYatMMro areguladed by Laws dasign@d W lid fie puellc.If you oontrs4 wNh someone who Doris riot halve a license,the ConbackW State Lic elve Board may be unable to assist you with any iinfttt mial load you play sustain as a result of a complaint.Your only remedy against unlicensed Contraefors may be In civil court it is afro important for you to undorstand that 0 an unlicensed Contractor or amployee of that€ndlvidual or firm is injured while wodOng 41i Your fxvPOdY,You nay be held liable for damages.tf you obtain a permit as Owner-Sunder and wish th hire COrdracm,you wil be responsible for voxify€ng whether or not these Corti Idols are property licensed and Ta atatus of their workers'mon insurance coverage. CY (DIRECTIONS.Please compMtb the lblioWlizg Constructw rendlrop awncy brfor7Md6n.) I hereby*Mom that(here is a conartrucbon lending agency for the performance of Un wQ,*for which this permit Is Issued (Sec 3097 Cb.) Lender Name: under Address: - - Bofors a building prxrr+R can be Issued,tthf9 form must be complet5ed and signed by they Property owner and retUrned to the agency responsible for Issuhtig the permit, Note.A copy of the property owner's drNrors Lbanse, fon»mtertzwkn,or other vwflfc sW som phible to the d(y may be required tv be presented when ttw permit is issued to the Awrrer'e PropOamer's Slgnature �: Date: erty ..... ��............•.......................................................... (Ar07E: The fallowlrp Avthorttetion Farm rtt r+cgrdred to be oorrrplefed by Ehe properly orvrter only when deslgnadsg b1! agent of the property owner to apply for a conamxdon porn*11;r the Owner-&AV.0- AMORMT10141 OF AGENT TO ACTON PROPERTY OWNER'S BEHALF Excluding the Notice to Property owner,the exootation of which I uneleestand to my pamonal nmoonsibility.I hereby authorize the foilowing parson(s)to act as my agents)to appty W.sign,and file the documents neoemory to obtain an Own"utlder Permit for my project Scope of 06netmoon Project(or Deocription of Wodcr Project Location or Addreae:,/O��,�..7.I Nome of Authorized Agent: &&d Al QSe__ S:( Tel No Address of Authorized Agent: ?-"t AOLXLeaa _2B��" � ��,421 , 1 declare under penalty of pediiry that I am the properly owner for the address listed above and I parsonelly filled out the above information and cerdty Its son racy,NOW A copy of the property owners driver's license,form noterizatfon, or ower verificatlon acceptable to the cr7y rney be required m be praswftd when the pa mot la issued to vanly the proper*owneris signartune. Pmparhr owroes Wgnatu!e. Date' — �l Ow►,s BjFA arFw17 2010.doc mWsd 04/74/10 City of Cupertino Building Department 5/5/2011 Dear Sir, We are Chu,Yao Kuang&Chi, Huei Lan Owner of 10216,10220 Vista Dr, Cupertino, Ca 95014. We like to authorize my realtor Ms. Feng Jui Sun(Nancy Sun)to talk to you and apply the city permit to renovate the exterior walls&landscape of my property. Sincerely, �ULL,Yao ang&Chi, Hu#flLan 10216,10220 Vista Dr, Cu no,Ca 95014 n