10080148CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10177 JUDY AVE
CONTRACTOR: YI-NING YANG
PERMIT NO: 10080148
OWNER'S NAME: YI-NING YANG
10177 JUDY AVE
DATE ISSUED: 08202010
OWNER'S PHONE: 4083935355
CUPERTINO, CA 95014
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lic. #
REMOVE WALL DOORS, WC SINK AND TUB IN GARAGE
Contractor Date
1 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.
1 hereby affirm under penalty of perjury one of the following two declarations:
1 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
Sq. Ft Floor Area:
Valuation: $2000
performance of the work for which this permit is issued.
1 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.
APN Number: 37507056.01
Occupancy Type:
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. 1 agree to comply with all city and county ordinances and state laws relating
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
/�� n -
�f"�� '
granting of this permit. Additionally, the applicant understands and will comply
Issued b y Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signature Date
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
l _� OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one 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 compensation,
will do the work, and the structure is not intended or offered fot safe (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
1 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(x) should 1 store or handle hazardous
1 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 1
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
q
uL Q 1�A/y� I
permit is issued.
Owner or authorized agent: Date:
certify that in the performance of the work for which this permit is issued, 1 shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, 1 must
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. 1 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,
ARCHITECT'S DECLARATION
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.
Signature Date
I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10625 JOHNSON AVE I ONTRACTOR: SKYLER CHANG & HUI I PERMIT NO: 10070190
OWNER'S NAME: SKYLER CHANG & HUI HUANG 110625 JOHNSON AVE I DATE ISSUED: 12/08/2010 1
OWNER'S PHONE: 4087779333 CUPERTINO, CA 95014 1PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT F PLUMB r—
License Class Lic. #
Contractor
Date
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 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.
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is
correct. 1 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,
costs, and expenses which may acerae against said City in consequence of the
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.
Signature Date
OWNER -BUILDER DECLARATION
7 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (See.7044, Business & Professions Code).
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
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
1 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.
1 certify that in the performance of the work for which this permit is issued, 1 shall
not employ any person in any manner so as to become subject to the Worker's
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 must
forthwith comply with such provisions or this permit shall be deemed revoked.
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
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant -understands and will comply
with all non -point sourccR regulations per the Cupertino Municipal Code, Section
9.18. ill
MECII r— RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: NEW SFDWL-2 STORY IST FLR(1505SQ)-2ND FLR(884.ISQ)
GARAGE(461 SQ);LANDSCAPE AREA(1975SQ) SANITARY IS
SUNNYVALE'S JURISDICTION.
Sq. Ft Floor Area: ! Valuation: $300000
APN Number: 37527014.00 ! Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, l agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner oAtk94agent:
Date: ).21 'O
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO BUILDING PERK UX -FF 46-::b -
BUILDING ADDRESS: 10625 JOHNSON AVE CONTRACTOR: SKYLER CHANG & HUI PERMIT NO: 10070190
HUANG
OWNER'S NAME: SKYLER CHANG & HUI HUANG 10625 JOHNSON AVE DATE ISSUED: 12/08/2010
OWNER'S PHONE: 4087779333 CUPERTINO, CA 95014 PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
'ReLICENSED
Class 1)
jjLic. #
Contractor 1.,11-A P k o, yrrti Date - . /�
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 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 whjphJthis
permit is issued. AAD
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
Upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
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. �n
Signature---���Y ' /\M't� Date '
❑ OWNER -BUILDER DECLARATION
1, hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
wil I 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 to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
1 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.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
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 must
forthwith comply with such provisions or this permit shall be deemed revoked.
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
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
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.
BUILDING PERMIT INFO: BLDG F ELECT PLUMB I—
M[ECH RESIDENTIAL COMMERCIAL
.TOB DESCRIPTION: NEW SFDWL-2 STORY 1ST FLR(1505SQ)-2ND FLR(884.ISQ)
GARAGE(461 SQ);LANDSCAPE AREA(1975SQ) SANITARY 1S
SUNNYVALE'S
JURISDICTION, (- p
Sq. Ft Floor Area: S Valuation: $300000
APN Number: 37527014.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued b . — Date: TZ—cr—
RE-ROOFS:
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.
Signature of Applicant: Date.
ALL ROOF COVERINGS TO BE CLASS "A" OR BET'T'ER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Own e�o uthor ent:
Date
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Add
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date d Licensed Professional
d"TTrTH7 dAlM 0"- T4ATT.TTTT WT TtrTT
La
LAK A 'kYA` \_VA 1LA%,llILIN\U
FEE ES'TIMA'TOR - BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
Phunh. Plan Check
APN:
BP#:
Plumb. Pcn7nit Fm:
*VALUATION: $0
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
T0714L
FLOOR I?Ell:
111711'1?h. lnsp. T e'¢z
lP1ENTAMATION +�
]PERMIT TYPE:
WORK
PME Plan Check:
SCOPE
Permit Fee:
$0.00
Suppl. Insp. Fee Reg. 0 OT E0]hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax
Acoustical Fee: 0 Yes (F) No
$0.00
Work Without Permit? C) Yes 0 No
$0.00
Planning Fee.
$0.00
Select a Non -Residential
Building or Structure
0
1 i-avt�l DUCt!/nl'YEt(ttiOn Fees:a
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Std.s Commission Fee:
$0.00
SUBTOTALS:
$0.00
$443.001
TOTAL FEE: $443.00
NOTE: These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn 11 info.
FEE ITEMS (Fee Resolution 09-051 Ef 7/1/110)
tlfeclr. Plan C'h¢ck
Phunh. Plan Check
Elea. Plata Check
kch. Perth Fee:
Plumb. Pcn7nit Fm:
Elec. Perrrnit Fee:
Other A4ec.h. Irisp.Li
Other phinah Irup.
01her I lec. Insp.
.ilech. Insp, Fee:
111711'1?h. lnsp. T e'¢z
Elegy. Insp. Fee:
NOTE: These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn 11 info.
FEE ITEMS (Fee Resolution 09-051 Ef 7/1/110)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
400 s.f.
$443.00
Remodel, Other
IREMREs1
Suppl. PC Fee: 0 Reg. 0 OT 0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee Reg. 0 OT E0]hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax
Acoustical Fee: 0 Yes (F) No
$0.00
Work Without Permit? C) Yes 0 No
$0.00
Planning Fee.
$0.00
Select a Non -Residential
Building or Structure
0
1 i-avt�l DUCt!/nl'YEt(ttiOn Fees:a
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Std.s Commission Fee:
$0.00
SUBTOTALS:
$0.00
$443.001
TOTAL FEE: $443.00
Revised: 8/17/2010
u=RE r.+o
CONTRACTOR / SUBCONTRACTOR CONTRAcCTOR ]LRST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: I J 1 -77 IV'7 kvb'
PERMIT # /del' U
OWNER'S NAME: h-pli c) e- . C'V-19
PHONE #
GENERAL CONTRACTOR: IV 4-
BUSINESS LICENSE #
ADDRESS:
CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino (business license.
NO BUILDING ]FINAL OR ]FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL T]EIIIE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CU]P]ERTIlNO
BUSINESS LICENSE.
I ani not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the ffoRllo wring Information:
1
SUBCONTRACTOR
BUSENIESS NAI09ilE
B USENIESS Lff CIENSIE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
Date
0
CUPERTINO
OWNER -BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 " FAX (408) 777-3333 " building(alcuoertino.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 1,D P77
APN
OWNER NAMEOWNER
�� � - NI N 1
ADDRESS
DESCRIPTION OF WORK: 0 ✓(� tj#U's d67 `�_N
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
(DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.)
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
�pthe construction and are not hiring a licensed Contractor to assume this responsibility.
1_L_�_3. I 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.
'11l ` 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.
"'` ► 7. 1 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.
l8.'l 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
T�9. I 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 also understand 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 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.
11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
by II applicable laws and requirements that govern Owner -Builders as well as employers.
moi- 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 contractors are regulated by laws designed to protect the public. If
you contract with someone who does not have a license, 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 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 their workers' compensation insurance coverage.
CONS-rRUCTION LENDING AGENCY
(DIRECTIONS: Please complete the following construction 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 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 property owner's signature.
Property Owner's Signature: Date: V 40
---------------------------------------------------------------------------------------------------------------------------------------------
(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:
Address of Authorized Agent:
Tel No
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:
OwnerBuilderForns 2010.doc revised 04114110
I
d
CUPERTINO
COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION
10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 o building(a cupertino.org
Effective January, 1, 2009, Assembly Bill 2335 amends California Health and Safety Code,
Section 19825, regarding disclosures and verifications required for all applicants seeking Owner -
Builder construction permits. These new application requirements provide an enhanced level of
consumer awareness and protection for property owners accepting the risks associated with
Owner -Builder construction permits.
"The Legislature hereby finds and declares that there is an urgent and statewide public interest in
assuring that building contractors comply with the Contractors License Law... and provisions of
law relating to Workers' Compensation Insurance for building construction, that property owners
are informed about, and protected from, fraudulent representations, liability for worker's injuries,
liability for material and labor costs unpaid by contractors, licensing requirements, and
employer's tax liabilities when improving their property as owner -builders"
Important information you need to know BEFORE,pulling your permit!
The term "Owner -Builder" can mean three different things:
"Owner as Worker", "Owner as Contractor" or "Owner as Employer"
Understand each has Benefits or Risk, and it is possible to combine them!
Hiring a California Licensed Contractor means you do not personally perform any of the construction work, the
permit is not taken out in your name, you are not personally responsible for the construction and you are not an
Owner -Builder. Instead, you become a "Customer" and California law provides you the benefit of protection from
poor workmanship, failure to finish the job and financial risk due to worker injury.
Benefit(Risk: Highest Benefits and the Least amount of Risk
Owner -as -Worker is a type of Owner -Builder where you personally perform the construction work, the permit is
taken out in your name and you are personally responsible for the construction management, knowledge,
workmanship, and completion of the job. You benefit by not paying others to perform this work for you and your
risk depends on your own ability to complete the job successfully.
Benefit/Risk: _': �n t;lr with Lo -.v Financial Risk
Owner -as -Contractor is a type of Owner -Builder where you personally act as your own General Contractor, the
permit is taken out in your name and you hire California licensed sub -contractors to perform portions of the
construction work. WARNING: The benefit of protection provided by law when you hire only California licensed
sub -contractors can tum to serious financial risk if you hire unlicensed contractors to perform any of the work.
Benefit/Risk: I' < c ct _ flT, and Significant Financial -Risk _
Owner -as -Employer is a type of Owner -Builder where you pay any individual to perform any construction work
valued at more than $500.00, the permit is taken out in your name and you are personally responsible for their
employment requirements, supervision, performance, safety and welfare while on your property. WARNING: Cost
savings benefit can turn to serious financial risk if you fail to deduct payroll taxes or provide workers compensation
insurance for each worker.
Benefit/Risk: i �'; with Significant Financial Risk
Over 20,000 consumer complaints are filed each year. Many complaints relate to
owner/builder projects and include workmanship and workers' compensation issues
Homeowners suffer financial harm due to defective workmanship and injured employees.
OwnerBuilder 2010.doc revised 06/08/10
Following are alarming examples of what has occurred with Owner -Builder permits:
Example 1: Homeowner received insurance money to rebuild burned -down home.
■ Owner/Builder permit pulled to rebuild structure.
• Unlicensed contractor built substandard structure — must be torn down and replaced.
■ Estimated financial injury is $225,000.
■ Additional financial injury - IRS threatened to tax insurance payout if house not
completed by the end of the year.
Example 2: Brother-in-law had active license but filed an exemption from Workers Comp.
■ Owner -Builder hires brother-in-law to install a new roof.
■ Employee falls and sustains multiple spinal and extremity fractures as well as a head
injury and remains in a coma to this day.
■ The Owner -Builder, who has sold the home, is now a defendant in a lawsuit for
reimbursement for benefits paid to the injured worker.
Example 3: Employee of contractor without Workers Comp is hired by Owner -Builder to
install septic system and suffers injury that results in permanent disability.
• The Owner -Builder did not have a homeowner's insurance policy on the house against
which to submit a claim.
• The Owner -Builder is now a defendant in a lawsuit for reimbursement for benefits paid to
the injured worker.
Did you know — unlicensed persons frequently have the property owner obtain an "Owner -
Builder" building permit which erroneously implies that the property owner is providing his or
her own labor and material personally?
Did you know — your homeowner's insurance may not provide coverage for injuries
sustained on your property by an unlicensed contractor and his/her employees?
Did you know — if you are considered an "employer' under state and federal law, you must
register with the state and federal government, withhold payroll taxes, provide workers
compensation and disability insurance and contribute to unemployment compensation for
each "employee"?
Did you know — that if you fail to abide by these laws you may be subjected to serious
financial risk?
OWNERS BEWARE AND CONSIDER THE RISK BEFORE ACCEPTING FULL
RESPONSIBILITY FOR YOUR CONSTRUCTION PERMIT
OwnerBuilder 2010.doc revised 04112110
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or if applicable, include on the plan set & the sheet index.
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