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10070161 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20325 PINNTAGE PKWY CONTRACTOR:CHUNG JUNG CHEN PERMIT NO: 10070161 OWNER'S NAME: CHUNG JUNG CHEN 20325 PINNTAGE PKWY DATE ISSUED:07/22/2010 4ER'S PHONE: 4082049468 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lie.# MECH r— RESIDENTIAL r— COMMERCIAL Contractor Date JOB DESCRIPTION:ADD A CLOSET TO THE DEN&MAKE ITA 3RD I hereby affirm that I am licensed under the provisions of Chapter 9 BEDROOM (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 Sq.Ft Floor Area: Valuation:$1500 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36947043.00 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 r� Date 2LO Signature Date 1p 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 Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). P_(C 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. Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this 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 California. If,after making this certificate of exemption,Iw error,auth � L 4 d agent: r r p become subject to the Worker's Compensation provisions of the Labor Code,Imus - C!Li/ Dater 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 relatinl. 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 -unify 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 granting 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. Licensed Professional Signature�Au Waia /1 OL U Date 4� z C CITY OF CUPERTINO 5 ITEMS OF 5 PERMIP RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36947043 .00 DATE ISSUED. . . . . . . : 07/22/2010 RECEIPT #. . . . . . . . . BS000010948 REFERENCE ID # . . . : 10070161 SITE ADDRESS 20325 PINNTAGE PKWY SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER CEUNG JUNG CHEN ADDRESS 2C325 PINNTAGE PKWY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : CEUNG JUNG CHEN CONTRACTOR TED - TO BE DETERMINED LIC # 00096 COMPANY TED - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- --------- 1BCBSC VALUATION 1, 500 . 00 1 . 00 0. 00 1 . 00 0 .00 1BREMRECEP NO. OUTLETS 1. 00 42 .00 0 .00 42 . 00 0 . 00 1EPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 .00 1STPLNCK HOURS 1 . 00 126 .00 0 .00 126 . 00 0 . 00 1TRAVDOC FLAT RATE 1. 00 42 .00 0. 00 42 . 00 0 .00 - --------- ---------- ---------- ---------- TOTAL PERMIT 253 . 00 0 . 00 253 . 00 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 253 .00 #2005 --------------- TOTAL RECEIPT 253 . 00 CITY OF CUPERTINO FEE ESTIMATOR--BUILDING DIVISION ADDRESS: I DATE: REVIEWED BY: APN: I BP#: *VALUATION: $1,500 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex APPLICATION 1 R3SFDADD/REM USE: '„ TYPE: � W fx a 00 3 � APPLIANCE/EQUIP TYPE CAPACITY FIE ID QTY BP FEES Recep/Switch/Outlets 1 BRE10RECEP 1 $42 TOTALS: $42.00 Elec.Plan Check 0.0 1 hrs $0.00 Elec.Permit Fee: I EPERMIT 7-1 Other Elec.Insp. I 0.0 hrs $42.00 NOTE: Thesein-fees are based on the preliminaryinformation available and are onlyan estimate. Contact the De t or addn'l o. FEE ITEMS (Fee Resolulion 09-051 Eff 7/1%09) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $42.00 PME Permit Fee: $42.00 Travel Documentation Fee: ITRA VDOC $Z.2.00 .� „_� ,; ,.1(,, .r,,t:- = hrs Standard Hourly Rate Bldg Stds Commission Fee: IBCBSC $1.00 $126.00 SUBTOTALS: r-7$1-7.00 $126.00 TOTAL FEE: $253.00 Revised: 6/30/2010 St OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPAF.TMENT-BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 (408)777-3228- FAX(408)777-3333- bj6dir):)QCuoertin0.org CUPERTINO Dear Property Owner(s): An application for a building permit has been submitted it your name listing yourself as the builder of the property improvements specified at: SITE kDDRq6S P H �Cw JAPN Tipi Z 111 WNE NAME OWNER/MDRESA DESCRIPTION OF WORK: 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 t.aving this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, i iitialed your understanding of each provision,signed, and returned this form to us at our official address indice ted. 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 VERIFICATII OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) L JJ- _1. I understand a frequent practice of unlicensE d 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 whi a 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 pr)perty. LAC 2. 1 understand building permits are not requirE!d to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. L,(4 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. L-06 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. L4 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 hundr0d dollars ($500), including labor and materials, I may be considered an"employer"under state and federal law. L 4C 6. 1 understand if I am considered an"employ Br"understate 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. LN(_ 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. LIQ C- 8. 1 understand as an Owner-Builder if I sell t ie 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. O�i,i7etBuilderFor77t_2010.doc revised 04/14110 to er"from the internments, arcing my obligations as an'employer" of Benefit Pay lifornia Dep anon reg the Ca L}i�9.1 understand 1 maY obtain more in contact the California Contractors'State • 1 Accidents.I also understand I may Service' the United States Sm Business Administration.ca,ov for more information about licensed Revenue S 275x. or ww N•cslb g and the Cala d�C DAB)at 1 800321 CSLB( License Bo lied for in my name,and understand that I contractors. e1 mit app at the site address listed above. onsible for prop,)sed construction activity I will abide am aware of and consent t san Owner-Builder building P construction activity,;��10.1 ail and financially resp ro:)posed con am the party legally responsible for this,p P to ers. legally and financiallyemployers. of the C 11.I agree that,as the party irments that govern Ovmer-Builders as well as emP y es to any L� deletions,or changes public.If by all applicable laws and requ of any additions, laws designed to protect the p regulated by be unable to 12.1 agree to notify the issuer of this Ce sed cor tractors are reg against unlicensed LNC= provided on this form. remedy 9 e have a license,the Contracto complaint.Your on{y Boar, may at information I have p tractor or If financial loss you maY sustain as 3 result of a comp be held liable for damages. you contract with someone who does not ha you to understand that if an unlicensed °n whether I not assist you with any ortant f�r y ro erty',you may be in civil court.it is also imp on our p P onsible for verifying Contractors may ou will',be resp f their workers' compensation insurance coverage• r-Builder and wish to hir:Contractors,y mg employee of that individual` n r firm is injured while�fiis you obtain a permit as licensed and the s those Contractors are properly information.) agency CONSTRUCTSOPNe EeLompleteEheCfollowing construction lending 9 permit is issued DIRECTION a�c for the performance of the work for which this p ( affirm that there is a construction lending a9 Y . 1 hereby (Sec 3097 CIV.) Londer Address:------- owner and ned by the prope�Y Lender Name: Ieted anof file prof►fy owner's driver's license, permit can be Issued,this form rnus�m'.eNote:A Copy resented when the p it is issued the p be required to be p Before a building ency responsible for issuing returned to the ag fable to the city may -Date: form notarization e r Wne�s s,�ation ��ureccep toveri the ro - ---- ----- -- -g- Propedy Owner's Signature: / _ when designating an <� et-- by the propel Ov►mer only _ ----m-� --- --------- --- - --- - - A-- . ation Form is required to be co p following I for a constructicn permit for the Owner-Builder). (NOTE O1�,ner to appy OWNER'S BEHALF agent of the Property CT ON PROPERTY T►ON OF AGE TO personal responsibility,It AUTHORI� to obtain an apply for, sign,and file the documents necessary e Owner,the execution towhP h I understand is my p Excluding the Notice to Person;to act as my agent(s) P authorize the following P ro ect. owner-Bui►der Permit for MY project, or Description of V'fork): Scope of Construction project( Project Location or Address: Tel No Name of Authorized Agent: ersonally filled out the Agent: fOnn notarization, or othe Address of Authorized A9 ropedY owner for the address luted above and P the property or oche of er ury that I am theF of the prOPe�y owner's driver's license, penalty P iul accuracy. Note:A copy Pe is issued to verify I declare under p be requir:d to be presented when the p above information and certify verification acceptable to the city may Date: signature. Property Owner's Signature: ownerBui.ldewor„i 1010.doc revised 0411' Ar � n °>Site DESIGN BULLETIN # 1 Arehitoettnti , Dteanias . Site Derelopiont HAU-CHING LIAO MIKE C H E N 937 LYNDE AVENUE RESIDENCE RENOVATION �)ARATOGA, CALIFORNIA 95070 20325 PINNTAGE PARKWAY TEL: (408) 483-1965 CUPER INOCALIFOR IA 95014 FAX: (408) 867-9331 68 DREW BY: CHECKD BY: DATE: DWG NO: SCALE: HAU-CHING HAU-CHING Jul. 21, 2010 1 /Al 1 /4 COMMENT: PROPOSED PARTIAL FLOOR PLAN QED AR�y� (CONVERT (E) DEN TO A 3RD BEDROOM) �v``' , l 1F17 :;1;>1 X5'�° I Al;t c)RL W"' 1 .�n T t t HE clTv P�HTINC�Ci)UI ANU OHDINANC 5L �1E1 DATE_._-' 2 �� SI D X 1 plans and spec ihcaUons MUST lEJ _ LD Thi set of p kept on the lob at all Mmes and it is BEDROOM 3 1 LD „ ul to make any changes or alterations same without written permission from PERG 1 artment,City of Cupertino. Building Dep d ifications tE) stamping o this Plan an spec ALL NOT be held to permit or b p an oval of the v+ol,'1 o,1�i anyprovisions O of any City Orillf an(.e or State Law- SD 61 lE) '4"X6'8' (E) (E) It'-61" SD LEGEND (E) WALL TO REMAIN, REPAIR AS F EQUIRED. 2X4 WOOD STUDS @ 16" O.C. W/ 1/2" THK. GYP. BD. ON BOTH SIDES (E) WINDOWS DUPLEX 110VAC OUTLET CEILING SURFACE MOUNTED LIGHT r LIGHT SWITCH D DIMMER SD 110V HOT WIRE SMOKE DETECTOR k�Ylsl'YL - T yL f ylt�l Cbt t s� aLtt" Y- �3 C- H CLU J !� ZZ , Z4� d 7 Lt-� z � - CITY OF CUPERTINO COF CUPETRINO GENERAL, BUILDING PERMIT APPL[CATION FORM �, � .� (..__ Date: Building Address:`7 P-invxto- 'I Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes No HOA: (Exterior work only) Yes ❑ No M If yes, provide letter from HOA Owner's Name- Pt hone# A (� Contractor: Z� C —� -"tom► Phone:,`_ Fax: Contractor License#: Cupertino Business License#: G1o�tact, Phone: (4C ') / �tCtti-C �,t ,�� L-i we Fax: (at2 Residential Commercial El Job Description: To acid c-, d trot tc tl•� Building Permit Info: Bldg Elect Plumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ IVIII B, IV-HT,V-13 31 r•► _ V luation: Square Footage: t SZ'_U C t ►�' Project Size: Express Standard ❑ Large 1:1 Major ❑ Green Building: Please complete relevant portion of the Green Bu' ding/LEED Checklist & attach it to the application or if applicable, include in plan set& the sheet index. [-joints Achieved: 1'For help, contact Build it Green at www.builditgr�,-en.or Revised 07/14/09 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: K PERMIT# OWNER'S NAME: ( tom. PHONE# ® GENERAL CONTRACTOR: sue BUSINESS LICENSE# ADDRESS: 5 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 THE GENERAL CONTRACTOR AND ALL SUBCONTFACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 7, 1.,2-2—r Z-0 IV I am not using any subcontractors: Si;nature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # 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