10090055 pERTINO L,UILDING PERMIT PERMIT NO:
JULIE 10090055
CITY OF. CUCONTRACTOR:S14ERMAN SHIN&
SU
DATE 812010
ISSUED.09/0
BUILDING ADDRESS: 7457 DE FOE DR
745 DE FOE DR PHONE No:
AN SHIN&R1LIE SU CA 95014306
'EWSNAME SHERM CU'ERTINO, �.. PLUMB
OWNER'S PHONE: 4088610982 IT INFO:
BLDG ELECT r �.-
TION Bi�ILDING PERM RESIDENTIAL� COMMERCIAL
CTOR'S DECLARA MECH
LICENSED CONTRA'
Lic.# SERVICE UPGRADE 200 AMP
License Class Date j,:)B DESCRIPTION:
rovlsions of Chapter 9
Contractor Professions
I hereby affirm that I am licensed under the p
V1 Section 7001)of Division 3 of the Business&
(commencing license is in full force and effect.
Code and that my two declarations:
penalty of perjury one°f the following Valuation.$800
I hereby affirm under p ificate of consent to self-insure for Worker's
Section 3700 of the Labor Code,for the Sq,Ft Floor Area:
I have and will maintain
asarPro ded for by tis issued. ancy Type:
Compensation, rovided for by Occup
enation Insurance,as P
performance of the work for which this p� APN Number:35924014.00
Labor Code,for the performance of the work for which this
I have and will the Lan worker's Comp NOT STARTED
Section 3700 `7�lORK IS N
permit is issued• T CERTIFICATION PERMIT EXPIRES IF PER
CE OR
APPLICAN OF PE IT ISSUAN
t 1 have read this application and state that
the o and state laws relating jTHIN 180 DAYS CALLED
INSPECTION.
1 certify the and county to enter w YS FROM LAST CA
agree to comply with all city representatives�re�agree to save
correct.1 ag d hereby authorize rcP . (We) 180 DA
to building construction,an for inspection purposes. ud judgments Date:
of Cupertino against liabilities,j g
upon the above mentioned property
harmless the City against said City in consequence of the
inde1rmtfY and keep accrue ag ds and will comply
and expenses whict may the applicant understands
costs, ermit. Additionally, Cupertino
Municipal Code,Section Issued y
granting°t tlrrs p ration per the Cup
with all non-point source regu
9.18. Date- RE-ROOFS: If a roof is
roofing being installed'
A,11 roofs shall be inspected prior to any agree to remove all new materials for
r tore without first obtaining an inspection,I
TION installed
OWNER-BUILDER
DECLARA inspection. Date:
exempt from the Contractor's License Law for or,e o imsp Applicant*1 hereby affirm that I am ens;tion, Signature of App IV'OR BETTER
two reasons:or my employees with wages as their sole comp0� CLASS
the following ro ertY> ROOF COVERINGS TO BE
1,as owner of the p P or offered for sale(Sec• ALL
will do the work,and the stru°tune is not intended cont to rs to
profession Code) contracting with licensed ALS DISCLOSURE
Business& am exclusively `7 HAZZARDOUS MATERI ter 6.95 of the
professions Code).
1 as owner of the property, Business&pro uirements under a ap
(Sec• Sections 25505,25533,and 25534. 1 will maintai
construct the project three 1 have read the hazardous mCate ale req ter 9.12 and the Health&
of per
one of the following Safety Chap
Penalty p California Health&Cupertino Municipal Code,
I hereby affirm under p compliance with the Cup should I store or handle baz t hazardous air
declarations: bor Code,for the Safety Code,Section 25532(x) or devices which M nagement District i will
and will maintain a Certificate of Consent to self-inure for Workers should I use equipmentr Quality ter Dist and the
I have iOvided for by Section 3700 of the I Additionally, the Bay Area Ar Q al Code,Chap
tion,as p permit is issued. rovided fo'by contaminants as defined by Cupertino
municipal
compensation hence with the Cup 25533,and 25534•
performance Olt he work for ke cS Co pensation Insurance,as p maintain comp C°de,Sections 255059
1 have and will In erforrnance of the work for which this Health&Safety c�( O
of the Labor Code,for the p 1 shall O
Section 37W ennit is issued, O r or' a Date:
permit is issued• ect to the Wo6 er's
that in the performance of the worst obecom Bulb p tion,I ING AGENCY
I certify manner so as this certificate of exerr p
not employ any Pers°n m any Labor Code,I must CONSTRUCTION LEPID eTforrnance of w
If,after making agency
for the P
Comp enation provisions of the nl rev ak
Compensation laws of California. permit shall be deemed
subject to the Worker's Comp affirm that there is a coSs�tru3097 CndC) g
become subj rovisions or this p I hereby it is issued
forthwith comply with such p for which this Perm
CERTIFICATION tion is Lender's Name
APPLICANT d state that the above inform:
application an ordinances and state aws relating Lender's Address TION
that I have read this app and county to enter
1 certify 1 with all city Tesentatives of this ci y ARCHITECT'S DECLARA►
agree to comply authorize rep a to save
correct.I and hereby purposes.(We).
to>,nildmg construction, for inspection pure ad ments, public records.
he above mentioned property of Cupertino agarnt liabilitucJ J of the lens shall be used as
and keep which m the crty against said City in conseq 1 understand my P
r- which may accrue ag licant understands and wi ll Sectio
costs,and expenses t Additionally,the aPP Cupertino
Municipal Coc le,Section
of this perrm' per the Cup Licensed professional
granting oint source regulations �
with all non-p �
9.18. / �T Date 0
Signature
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk.: Lot:
APN . . . . . . . . : 35c24014 . 00
DATE ISSUED. . . . . . . : 09/ 08/2010
RECEIPT #. . . . . . . . . : BS000011412
REFERENCE ID # 10090055
SITE ADDRESS . . . . . : 7457 DE FOE DR
SUBDIVISION . . . . . . .
CITY CUERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SH3RMAN SHIH & JULIE SU
ADDRESS : 7457 DE FOE DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4306
RECEIVED FROM . . . . : SHERMAN SHIH
CONTRACTOR LIC # *OWNER*
COMPANY . . . . . . . . . . : SHERMAN SHIH & JULIE SU
ADDRESS : 7457 DE FOE DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4306
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------------
----------
----------
---------- ----
1BCBSC VALUATION 800. 00 1. 00 0 .00 1. 00 0 . 0
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 . 00 0.00 127. 00 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- ---------------
--
CREDIT CARD 127 .00 VISA
---------------
TOTAL RECEIPT 127 .00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
__ _ -------- -------------------------
-- --------------------------- -
103 UFER 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
01APN: BP#: VALUATION: $800
FPERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION 1 REAP2
SFD or Duplex 1''1.(1Of t It 1�3: PERMIT TYPE:
USE:
WORK
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Services 1 ERT<200 100 Amps $42
TOTALS: $42.00
af,,jr. 1''Icrnr t`Ir,:(k
1't<<„rl>. 1'1«r� `,�_? Elec.Plan Check 0.0 hrs $0.00
1'lur�E,. Pc n2it Faz: Elec.Permit Fee: IEPERMIT
��rf , n, Int.1 Other Elea Insp. 0.0 hrs $42.00
f);Itc'r 11eah. In'
/','i4rirf,. Tr, (�,�.. I;Icr` Inch. 1"'C'
Bial" 1<.°r�: 7;.
NOTE: These fees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 in fo.
FFEEEMS (fee Resol tion 09-�51 Eff '%7i1Oj FEE QTY/FEEMISC ITEMS
Man Clwck
1,,ee
PME Plan Check: 50.00
PME Unit Fee: $12.00
PME Permit Fee: $12.00
C"onso-11ciion ,ax
lc�ouslii°Without
t Pe I~~it?
"C', T=
Work Without Permit? 0 Yes � No $0.00
—7=
Plrlrlrtirl�.r f'`�'c's:
Travel Documentation Fee: ITRAVDOC $42.00
Select an Administrative Item
kBI'di4
ong Votioll
Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $' 27.001 $0.00 TOTAL FEE: $127.00
Revised: 9/01/2010
OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPAR"-MENT- BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO. CA 95014-3255
(408)777-3228-FAX(408)777-3333-.)uildina(a)cupertino.org
CUPERTINO
Dear Property Owner(s):
An application for a building permit has been submitted in a our name listing yourself as the builder of the property
improvements specified at:
AP BP# as.'
FDESC;RIPTION
40FWOR�K:
Z — �'I
r ,
CC� OWNER A)DRESS e % j yv o
1( e J V^
C
We are providing you with an Owner-Builder y incur by h rent and Information
issued in you name as the Owner-Builder. We
your responsibilities and possible risk you may incur by having this pan
will not issue a building permit until you dress indica-:ed.have read, ir An agent of the ownergannot ex r understaninof eachc ed you cute th snnotge un�lessd
returned this form to us at our official a royal of the permitting authority.
you,the property owner, obtain the prior app
AC AND VERIFICATION OF INFORMATION
OWNER'S A
(DIRECTIONS:Please read and initial each statement billow to signify you understand or verify this information.)
e property owner
ain an "Owner-
1. I understand a frequent erronce eously im Ilicensed es that theersons is to property ownerishpro providing his or her otwn labor and material
wilder"building permit that errone y p
personally. I, as an Owner-Builder, may be held liabl--and subject to serious financial homeof or any
s insur-ince may ed by
an unlicensed person and his or her employees whil_working on my property. Y
provide coverage for those injuries. I am willfully actilg 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
Ke' construction and are not hiring a licensed Contactor to assume this responsibility.
that I
!�6 3. I understand as an"Owner-Build k I hminhe,j esponsible party of randrhav ng the permit filed ind on the permit. I th sdor her may
ote
prct myself from potential financial ns y 9 licensed Contractor
name instead of my own.
�4. 1 understand Contractors are required by lair to be licensed and bonded in California and to list their license
numbers on permits and contracts.
5. any persons, other than California licensed Contractors, and the
I understand if I employ or otherwise engag:
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.
� I understand if I am considered an"employe=r" under state and compensationfederal
law,
I mity ust
insurance, with
and contribute to
fed ral government,withhold payroll taxes, provide workers'understand my failure to abide by these laws may subject
unemployment compensation for each"employee
me to serious financial risk.
11
I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
rf
residential structures cannot legally build them with the oes ntotooffer them for sa ,exceed four within any less a workcalendar year, or alls pe rmed ofof thework
licensed subcontractors and the number of structu es
is performed under contract with a licensed general building Contractor.
I may
I understand as an Owner-Builder if I salnt�- which
thatresupermit
ltafrom any latent constrdctioble for
any financial or personal injuries sustained by y subsequent owner(s)
defects in the workmanship or materials. OwnerBuilderForm_201 0.doc revised 04/14110
9. 1 understand I may obtain more information regardi-ig my obligations ascan "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. 1 also understand I may contact the California Contractors' State
License Board (CSLB)at 1-800-321-CSLB (2752)or www cslb.ca.gov for moreinformation about licensed
contractors.
_4!�_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 proposi:d construction activity at the site address listed above.
`h1. 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.
1:� 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
n this form. Licensed contractors are regulated by!laws designed to protect the public. If
information I have provided o
you contract with someone who does not have a license, :he Contractors' State;License Board may be unable to
re:�ult of a complaint.Your only remedy against unlicensed
assist you with any financial loss you may sustain as a
Contractors may be in civil court. It is also important for you to understand that k an unlicensed Contractor or
employee of that individual or firm is injured while workinc 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 fending agency information.)
I hereby affirm that there is a construction lending agency fcr 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 p perty owner's si nature.
Date:
Property Owner's Signature:
(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 perm t for the Owner-Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of wt ich 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: -M --
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 listedabove and I personally filled out the
above information and certify its accuracy. Note:A copy of -he property owner's drivers 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
CITY OF CUPERTINO
` REPIPE/SEWS SERVICE
CUPEkTINO PERMIT APPIACATION FORM
APN# Date:
Building Address: _
-745 7 ,D1 ,2_ D e OK• CA 9JG/(/
Owner's Name: JJ S
j ,� Phone#�
SAe rYn a-y 1 � l / 4
Contractor: /I Phone #:
C10�
Fax #:
Contact: Phone#:
Fax#:
Contractor License#:
Cupertino Business License#:
Job Description: /
Residential Commercial ❑
Valuation:
C �--
Project Size: ExpressStandard Large Major
El
Green Building: Please complete relevant portio a of the Green Building Checklist & attach it to the
application or if applicable, include in plan set S; the sheet index.
Green Building Points:
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCSEWER Commercial b-jilding P 1CPSS
sewer/sanitary sewer
1BPREPIPE Commercial r(!-pipe per fixture P 1CPRP
1PGASCOM Commercial Cas Piping System P
1-4 Outlets
1BCBSC Cal Bldg Standards Commission, B ALL PERMIT
Fee TYPES
1BSEISMI OM Seismic Commercial P
Revised 01/07/09