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11010020 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADAESS: 18691 NEWSOM AVE CONTRACTOR:KAI WANG PERMIT NO: 11010020 OWNER'S NAME: KAI WANG 18691 NEWSOM AVE DATE ISSUED:01/03/2011 O'"-JER'S PHONE: 4089464651 CUPERTINO,CA 95014 PHONE NO: C? LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT r PLUMB r License Class Lic.# MECH r RESIDENTIAL r COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:INSTALL TEMPORARY POWER AT EXISTING DETACHED (commencing with Section 7000)of Division 3 of the Business&Professions STORAGE STRUCTURE 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:$1100 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:37529028.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section // 9.18. Issued by:� Dater Signature Date OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: Business&Professions CoAe) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER con$tnwhe project(Sec.7044,Business&Professions Code). I hereby //affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of Califomia. If,after making this certificate of exemption,I Oto or authoriz agent: become subject to the Worker's Compensation provisions of the Labor Code,Ius Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments,, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION ing of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. ?-0 Licensed Professional Signatur r Date �� > OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333• buildinci(a)cupertino.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: q&.0/�- SITE ADDRESS I�bp, eW_- pP K&Ie, APN BP# OWNER NAME Vv 1 J ,,1 A_Aj OWNER A�RESS I 6 q � 'V DESCRIPTION OF WORK: 2 3 7q DHOR-- 7T Pv vv— A4 c'i ,`t7,5 CA 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 (DIRE .) IICTIONS:Please read and initial each statement below to signify you understand or verify this information VV 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. 1 understand building permits are not required to be signed by property owners unless they are responsible for th11e construction and are not hiring a licensed Contractor to assume this responsibility. w 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. `CJ 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. �-� 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. - 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. 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 *** OLD REPUBLIC TITLE COMPANY �C 1087 Meridian Avenue,Suite 68• San Jose CA• 95125• (408)266-5414 FAX(408)266-5415 ESCROW INSTRUCTIONS FOR DEPOSIT OF POWER OF ATTORNEY To: Old Republic Title Company Date: December 20, 2010 1087 Meridian Avenue, Suite 68 Escrow No.: San Jose, CA 95125 Escrow Officer: Old Republic Title Company, as Escrow Holder, is authorized and instructed to prepare and record a Specific Power of Attorney from Kai Wang to ShaLing Cho pertaining to real property briefly described as 18691 Newsom Avenue, Cupertino, CA 95014 The attached Power of Attorney is to be used for the interest of the undersigned for the following reason: Kai Wang to be out of country In the event the escrow fails to close, you are instructed to return the unrecorded Power of Attorney to: Kai Wang These instructions are to remain in f .. rce and effect until rescinded in writing. Signa 4;.. Kai Wang ShaLing Cho Accepted by: Old Republic Title Company Date: By: y 1 rf/ 1' CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 18691 newsom ave. DATE: 01/03/2011 REVIEWED BY: bobs. APN: I BP#: "'VALUATION: $1,100 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY /tll:�it, PENTAMATION 1REAP14 USE: SFD or Duplex i'[00R - RLIJ: PERMIT TYPE: WORK temp power at existing storage shed SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1 ERT<200 100 Amps $42 TOTALS: $42.00 fcch. Plan Chf:ck Phm Cbul" Elec.Plan Check 0.0 hrs $0.00 �.t>t r'',. P�>rnr r f'x>e>: 1'7rr nb, flo- zil F"(". Elec.Permit Fee: IEPERMIT L er,lfc�c�i. I zsP>. Otlfer f r't�r�nh fn"T) Other Elec.Insp. 0.0hrs $42.00 ch, j spJ� P'hirirh_ h;,p. FCC'. face Carp. Fco NOTE: Theseees are based on the preliminaryin ormation available and are onlyan estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 09-051 E,�f. /1.%IOj FEE QTY/FEE MISC ITEMS Plon Chc("4, FCC, S1r1)j)l. PC:'/"Ce 'A PME Plan Check: $0.00 �'et-tnit I�c�c' sulJ'>/. ITC F. PME Unit Fee: $42.00 PME Permit Fee: $42.00 C; CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37529028 .00 DATE ISSUED. . . . . . . : 01/03/2011 RECEIPT #. . . . . . . . . : BS000012386 REFERENCE ID # . . . : 11010020 SITE ADDRESS . . . . . : 18691 NEWSOM AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA OWNER KAI WANG ADDRESS . . . . . . . . . . : 18691 NEWSOM AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : KAI WANG CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY KAI WANG ADDRESS . . . . . . . . . . : 18691 NEWSOM AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ------- 1BCBSC VALUATION 1, 100 . 00 1.00 0 . 00 1. 00 0 .00 1BSEISMICR VALUATION 1, 100. 00 0 .50 0.00 0 .50 0 .00 1EPERMITFE FLAT RATE 1. 00 42 .00 0 . 00 42 . 00 0 .00 1ERT<200 UNITS 1. 00 42 . 00 0 .00 42. 00 0 .00 1TRAVDOC FLAT RATE 1. 00 42 .00 0 . 00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 127.50 0 . 00 127. 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 127.50 #702 --------------- TOTAL RECEIPT 127 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ----------------- 402 TEMPORARY POWER CITY OF CUPERTINO E TEMP POWER OF CUPERTINO PERMIT APPLICATION FORM APN # .3 -75-2 q- 02 & Date: 3 /F29 l Building Address: J &6g1 Mewsom 4vc, eAt( , C/�- 6?504 Owner's Name: Phone #: (R) P— q 4-6 4-6S 1 K4_r (AJ A (e-) 4og— 6 7,L(-q Contractor: -- Phone #: Fax #: Contact: ( '�l o) Z 6 o S� Phone #: Contractor License #: 13 S_ezqZ5 o ' �� .e l Cupertino Business License#: Job Description: JLM/S � C — S4vyar Residential Commercial Valuation (cost of project): 1 f�� Type of Constructi : N/ Quantity Fee ID Fee Description Fee Group Permit Type IERT>1K Res. Temp Power>1K E 1REAP14 Amps IERT<200 Res. Temp Power<200 E Amps IERT2001K Res. Temp Power 200-1K E Amps 1 EPERMITFE Electric Permit Issuance E 1 ELCPLNCK Electric Plan Check E 1BCBSC Cal Bldg Standards B ALL PERMIT _ Commission Fee TYPES 1BSEISMICR Seismic Residential B 1 TRAVDOC Travel & Documentation B Fee Revised 01/07/09