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10100007 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20714 GARDEN MANOR CT CONTRACTOR:GUO WU ZHENG&CHEN PERMIT NO: 10100007 ZHEI4GZHEN `ER'S NAME: GUO WU ZHENG&CHEN ZHENGZHEN 2071.1 GARDEN MANOR CT DATE ISSUED: 10/01/2010 OWNER'S PHONE: CUP ERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUI"DING PERMIT INFO: BLDG r ELECT r PLUMB License Class Lic.# MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:WINDOW REPLACEMENT,NON-STRUCTURAL,5 (commencing with Section 7000)of Division 3 of the Business&Professions WINDOWS AND Code and that my license is in full force and effect. 2 DOORS. 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.F t Floor Area: Valuation:$4000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:36230070.00 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 `JVITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 80 DAYS FROM LAST CALLED INSPECTION. 9.18. ure Date Issut d by: Date: q1 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 rc ofs 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, instal ed 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, inspe,;tion. 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). / 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 performance of the work for which this permit is issued. I hav!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. Addis ionally,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 main ain 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 Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owns r or authorized agent: Date: o 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 here:)y affirm that there is a construction lending agency for the performance of work's gilding construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) the above mentioned property for inspection purposes.(We)agree to save Lend:r's Name iuuemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lend pr'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 ARCHITECT'S DECLARATION 9.18. Signature Date C 0 e( J I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: A01 I L+ Q A4.0 K) DATE: (O REVIEWED BY: APN: O—IO BP#: 0 10 0(0 *VALUATION: 1$4,000 xPERMIT TYPE: Building Permit PLAN CI IECK TYPE: Addition PRIMARY SFD or Duplex t 11-II, PENTAMATION USE: 1'1 r�r1t: .�hE�-��: PERMIT TYPE: 1GENRES WORK SCOPE I'l,In Cb, I,l t17 fiL'ft A rE'r.',jxl<Ilt l..iit:'(: �rci'r 1'�rrr±ril f<� F tr b. T'c�r 1'rf T i�zr, P, ow t;e 0[h,r lnoch. Irr"�> 0 olht>r("lo, Ins/,. NOTE: Thesefees are based on the preliminary information availa 51e and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolytion 09-05I E,f'. FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Window/Sliding Glass Door Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 $380.00 I WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-E) Reg. 0OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cons1rac ftoi,, 7'ax F-1 Acoustical Fee: 0 Yes (F) No $0.00 0 Work Without Permit? 0 Yes 0 No $0.00 E) Plannin Fee: $0.00 Select a Non-Residential 0 l 0ouillactliation Building or Structure I Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $380.00 TOTAL FEE: $381.50 Revised: 9/29/2010 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: TraciC COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 362300'70.00 DATE ISSUED. . . . . . . : 10/01/::010 RECEIPT #. . . . . . . . . BS0000:_1612 REFERENCE ID # . . . : 10100007 SITE ADDRESS . . . . . : 20714 GARDEN MANOR CT SUBDIVISION . . . . . . CITY CUPERT"NO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : GUO WU ZHENG & CHEN ZHENGZHEN ADDRESS . . . . . . . . . . : 20714 GARDEN MANOR CT CITY/STATE/ZIP . . . : CUPERT::NO, CA 95014 RECEIVED FROM . . . . : ZHENGZIIEN CHEN CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : GUO WU ZHENG & CHEN ZHENGZHEN ADDRESS . . . . . . . . . . : 20714 GARDEN MANOR CT CITY/STATE/ZIP . . . : CUPERT-NO, CA 95014 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -----••---- ---------- ---------- ---------- 1BCBSC VALUATION 4, 000 . 00 1. 00 0.00 1.00 0. 00 1BSEISMICR VALUATION 4, 000 .00 0.50 0.00 0.50 0. 00 1WINREP EACH 8 7.00 760. 00 0.00 760.00 0. 00 -----••---- ---------- ---------- ---------- TOTAL PERMIT 761.50 0.00 761.50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- --••----------------- CHECK 761.50 156) --------------- TOTAL RECEIPT 761.50 ID '06 cp ve v s r � � O x � 77 -------------- X l y 0 OWNER-BUILDER DISCLOSURE FORM is COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA X5014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333- buildirg(alcupertino.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 _T X71 q /,m-dep 6+ T77N BP# OWNER NAME�� 2_14 atil ?ham O NER ADDRESS ��/1 � /��`„A C7 f q��t� DESCRIPTION OF WORK: Vl/ n Y IU[�►�e�,�(' `t GI VVw' T ! T 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 tris 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. A i agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitti ig 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 persois is to have the property owner obtain an "Owner- Builder" building permit that erroneously implies that the pro:)erty owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and s jbject 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 a i 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 :>igned by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. h- 3. 1 understand as an "Owner-Builder" I am the respom,ible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a IicensE d 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 Ii,:ensed and bonded in California and to list their license numbers on permits and contracts. N-�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. _ y �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. /yl-7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the inter t to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does riot exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. '�_/8. 1 understand as an Owner-Builder if I sell the propert/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 04/14110 '2�v 9. 1 understand I may obtain more information regarding my obligations as an "employer"from the Internal Revenue Service, the United States Small Business Admini 3tration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also unc erstand I may contact the California Contractors' State License Board (CSLB)at 1-800-321-CSLB (2752)or www.csib.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner-Builder bu Iding 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. `U'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-3uilders as well as employers. X12. 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 contractc rs are regulated by laws designed to protect the public. If you contract with someone who does not have a license, tho, Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a resu t 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 th;ir workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lend ung 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. Vote: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: - -------------------------------------------------------------------------------------------------------------------------------------------- (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: OwnelBuilderForm 2010.doc revised 04/14/10 M1 ffomeowncns Mann Semen,Inc. 30 September 2010 Zhengzhen Chen &Guowu Zheng 20714 Garden Manor Court Cupertino, CA 95014 RE: GVT Homeowners'Association Window Replacement Dear Zhengzhen Chen &Guowu Zheng, Please accept this letter as permission to install dual pane windows in your home. As you know, they cannot have grid lines in the glass and must all be replaced throughout the home at the same time and all must be of the same style. They must open and close in the same manner as your current windovis. Please sign and return the enclosed indemnification agreement. If you have questions, feel free to contact me. Sincerely, Mori Craig Community Manager PC: Secretary, Board of Directors 1210 S.Bascom Avenue,Suite 220,:'ian Jose,California 95128 Phone(408)871-9500 (650)559-'g 020 Fa:(408)871-9515 Y CITY OF CUPERTINO PEKT CUINO GENERAL BUILDING PERI%MT APPLIC-4TION FORM Date: Building Address: , ?W (�rarde/h AI&nvrr CA qo r 4- 4+,�w Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes No HOA: (Exterior work only) Yes A No ❑ If Yes, ;3rovide letter from HOA Owner's Name: at eh Phone#: Contractor: G Phone: - _ _ Fax: Contractor License 4: - Cupertino Business License#: /; p Contact: -��it Zlvzv� c heo CJ �n`/ � Phone: .zone: Residential Commercial Job Description: W d rv� ace m e& ►�—s-r-ru. r t�/�.� v� Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/IIUV-A ❑ II/III B, IV-HT, -V-B Valuation: Square Footage: Project Size: Express ❑ Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. oints Achieved: - For help, contact Build it Green at www.builditgreen.or Revised 07/14/09