10090263 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20719 GARDEN MANOR CT CONTRACTOR:SHI YU SUN&QING ZHU PERMIT NO: 10090263
SONG
'NER'S NAME: SHI YU SUN&QING ZHU SONG 20719 GARDEN MANOR CT DATE ISSUED:09/29/2010
OWNER'S PHONE: 4082073152 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lic.# REPLACE 5 DOUBLE PANE WINDOWS,&2 SLIDING
DOOR
Contractor Date *SEE NOTES*
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 declaration
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. Sq.Ft Floor Area: Valuation:$234216
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:36230074.00 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 relati ig 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 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Issued by: Date:
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.
RE-ROOFS:
nature 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 Date:
Signature of Applicant:
I hereby affirm that I am exempt from the Contractor's License Law for ons 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 compensat on,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors :o 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,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorizedagent- Date:
Date:
permit is issued.
I certify that in the performance of the work for which this permit is issued,I sh-,II
not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I r lust 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. 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 rely ting
building construction,and hereby authorize representatives of this city to entc r
;n the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
,.idemnify and keep harmless the City of Cupertino against liabilities,judgment;,
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.
Signatur�� Date / �
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The tampin spar meet, C.,ity �f Cupertino
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C2I be held tc>permit or to
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September 29, 2010
To Whom it May Concern:
The HOA for GVT in Cupertino has given permission to the residents of
20719 Garden Manor CT. To change their windows to the energy efficient
type of windows.
J ckie Boyle
President
GardenView Terrace HOA
FIL
OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPAF TMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINC,,CA 95014-3255
GUPERTINO (408)777-3228- FAX(408)777-3333• building(d_)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:
SITE ADDRESS r ,s C p ,�b APN BP#
OWNER NAME OWNER ADDRESS r Cir 2cD� CIV-If c/
DESCRIPTION OF WORK-
�a
We are providing you with an Owner-Builder Acknowledg nent 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 F ermitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS:Please read and initial each statement bE low to signify you understand or verify this information.)
5LrS 1. 1 understand a frequent practice of unlicensec persons is to have the property owner obtain an"Owner-
Builder" building permit that erroneously implies that-.he 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.
SYS 2. 1 understand building permits are not requirec to be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contral;tor to assume this responsibility.
1�y� 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.
SM 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.
5165. 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 lay. -
�66. 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.
S YS7. 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 )uilding Contractor.
5''S 8. 1 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
SY5 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 al 3o understand I may contact the California Contractors' State
License Board (CSLB)at 1-800-321-CSLB (2752)or,vww.cslb.ca.gov for more information about licensed
contractors.
S15 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.
$Y5 11. 1 agree that, as the party legally and financia ly responsible for this proposed construction activity, I will abide
by all applicable laws and requirements that govern Owner-Builders as well as employers.
ll , 12. 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 co itractors are regulated by laws designed to protect the public. If
you contract with someone who does not have a licer se, 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 fir 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 constructic n 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 mu:>t 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 property owner's signature.
Property Owner's Signature: ---�� Date: `1 2 a
---------------------------------------------------------------------- ----------------------------------------------------------------------
(NOTE: The following Authorization Form is required to he 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)tc 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 :)f 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
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: B]k: Lot:
APN . . . . . . . . : 3E230074 . 00
DATE ISSUED. . . . . . . : 05,/29/2010
RECEIPT #. . . . . . . . . : BS000011587
REFERENCE ID # . . . : 10090263
SITE ADDRESS . . . . . : 20719 GARDEN MANOR CT
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER Sl[I YU SUN & QING ZHU SONG
ADDRESS 20719 GARDEN MANOR CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : SIIIYU
CONTRACTOR LIC # *OWNER*
COMPANY . . . . . . . . . . : SHI YU SUN & QING ZHU SONG
ADDRESS 20719 GARDEN MANOR CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 2, 342 .16 2 . 00 0 . 00 2 . 00 0 . 00
1BSEISMICR VALUATION 2, 342 . 16 1.00 0 .00 1 . 00 0 .00
1WINREP EACH 8 1 .00 760 . 00 0 . 00 760 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 763 . 00 0 . 00 763 . 00 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 763 . 00 MC
---------------
TOTAL RECEIPT 763 . 00
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: I DATE: REVIEWED BY:
APN: BP#: *VALUATION: 1$2,341
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration Repair
PRIMARY PENTAMATION
USE:
SFD or Duplex PERMIT TYPE: 1GENRES
WORK
SCOPE
77 "F7 7277
0 7
Li
NOTE. Thesefees are based on the preliminary i2lormation available and are only an estimate. Contact the Deptfor addn 7 info,
FEE ITEMS (Fee Resolution 09-051 Elf 714.1110) FEE QTY/FEE MISC ITEMS
;0.00
Plan Check Fee: 1-= # Window Sliding Glass Door
Suppl. PC Fee: E) Reg. 0 OT O.q hrs 90.00 $380.001 1 WINREP Replacement J
PME Plan Check: 1.0.00
Permit Fee: 10.00
Suppl. Insp. Fee-0 Reg. 0 OT 0.0 hrs 1.0.00
PME Unit Fee: 110.00
PME Permit Fee: 30.00
Acoustical Fee: 0 Yes (F) No 9 0.000
Work Without Permit? 0 Yes E) No 9 0.00 E)
Planning Fee: 9 0.00 Select a Non-Residential E)
Oo�mncafolit)o Building or Structure 0
Stronp,, Motion Fee: IBSEISMICR 1.0.50 Select an Administrative Item
Bldg;Stds Commission Fee: IBCBSC 111.00
SUBTOTALS: 31.570 $380.001 TOTAL FEE: $381.50
Revised: 9/22/2010
aCITY OF 1"UPERTIN O
carr of
CUPEKTINO GENERAL) BUILDING
PERN HT APPLICATION FORM
APN# �) v Date:
Building Address:
C-4 U.
Mailing Address (if different from building address):
Are Hazardous Materials being used as part r+ nrr;pet? Yes No
HOA: (Exterior work only) Yes ❑ No LI yes, provide letter from HOA
Owner's Name: � Phone#:
zv1 315-2-
Contractor: �. Phone: ��
Fax: 6yd
Contractor License#:
Cupertino Business License#:
Contact: Phone:
Fax:
Residential Commercial ❑
Job Description: �P(a'
Building Permit Info:
Bldg C3�� Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy T e:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B _
Valuation: Square Footage:
�234Z. i6
Project Size: Express 2 Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green BUding/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.buildeen.or
Revised 07/14/09
z