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10060082 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10281 WESTACRES DR COTaRACTOR:CHAROEN AND WINNIE PERMIT NO: 10060082 K05OLCHAROEN O%VNER'S NAME: CHAROEN AND WINNIE KOSOLCHAROEN 206(7 PARADISE DR DATE ISSUED:06/14/2010 L 4ER'S PHONE: 4082578954 CUPERTINO CA,CA 950144063 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BU LDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# r MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOR DESCRIPTION: RETILE SHOWER STALL IN MASTER BATH(60SQ)&TILE (commencing with Section 7000)of Division 3 of the Business&Professions TUE Code and that my license is in full force and effect. SUR ROUND IN HALL BATH(60SQ) 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. f 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 Sq. Ft Floor Area: Valuation:$1000 permit is issued. APPLICANT CERTIFICATION APN Number:35911035.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 D S FROM L CALL D INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by: �ate: Signature Date OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All -oofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: inst:filled without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, insf ection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Sigi,ature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to — 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: HAZARDOUS MATERIALS DISCLOSURE 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 I ha ve read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. Cal fornia Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by con pliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safi!ty Code,Section 25532(a)should I store or handle hazardous material. Adr litionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Hea Ith&Safety Code,Sections 25505,25533,and 25534. 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 Ow aer 2r aorized nt / b forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for vhich this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Ler der's Name up--the above mentioned property for inspection purposes.(We)agree to save i iify and keep harmless the City of Cupertino against liabilities,judgments, Ler der's Address cc., and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I un derstand my plans shall be used as public records. Signature Date 6114 0 Liomsed Professional CITY OF CL PERTINO 3 ITEMS OF 3 PERMIT FECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35913035 . 00 DATE ISSUED. . . . . . . : 06/14 /2010 RECEIPT #. . . . . . . . . : BS00( 010626 REFERENCE ID # . . . : 1006( 082 SITE ADDRESS . . . . . : 10281 WESTACRES DR SUBDIVISION . . . . . . CITY CUPEF.TINO IMPACT AREA . . . . . . OWNER CHAROEN AND WINNIE KOSOLCHAROE ADDRESS . . . . . . . . . . : 2060" PARADISE DR CITY/STATE/ZIP . . . : CUPELTINO CA, CA 95014-4063 RECEIVED FROM . . . . : WINN] E T KOSOLCHARO CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : CHAR(�EN AND WINNIE KOSOLCHAROE ADDRESS . . . . . . . . . . : 2060" PARADISE DR CITY/STATE/ZIP . . . : CUPEPTINO CA, CA 95014-4063 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---- ------ ---------- ---------- ---------- 1BCBSC VALUATION 1, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 1, 000 . 00 0 .50 0 . 00 0 . 50 0 . 00 1REMRESBAT SQ FEET 120. 00 570 . 00 0 . 00 570 . 00 0 . 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 571 .50 0 . 00 571. 50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------------------- CREDIT CARD 571 .50 VISA --------------- TOTAL RECEIPT 571 . 50 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION 99 10300 TORRE AVENUE•CUPERTINO, CA 95314-3255 CUPERTINO (408)777-3228•FAX(408)777-3333• Dui dint cUDertlnc.or: 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 Id Z I,!/a*0-ed .7 -, APN BP# OWNER NAME OWNER ADDRESS 2V �1J� GL DESCRIPTION OF WORK:Alw 1& 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 permittirnj authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to s gnify you understand or verify this information.) 1. 1 understand a frequent practice of unlicensed person;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 workinc 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 si 3ned by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to a:sume this responsibility. L>K O(i 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. 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. 0�(,U165. 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(6500), including labor and materials, I may be 16e considered an "employer' under state and federal law. CCL 6. I understand if I am considered an "employer" under s:ate and federal law, I must register with the state and ral government,withhold payroll taxes, provide workers'compensation disability insurance, and contribute to unemployment compensation for each "employee." I also and:rstand my failure to abide by these laws may subject me to serious financial risk. 7. 1 understand under California Contractors'State Licen 3e Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent `o offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does nct 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 property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequen:owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 1010.doc revised 04/14/10 (_ kLo)�9. I understand I may obtain more information regard ng my obligations as an"employer"from the Internal Revenue Service, the United States Small Business Admi iistration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also u iderstand I may contact the California Contractors'State License Board (CSLB)at 1-800-321-CSLB (2752)or www.cslb.ca.gov for more information about licensed �c�oD,ntractors. y�r�10. I am aware of and consent to an Owner-Builder h wilding permit applied for in my name, and understand that I am the party legally and financially responsible for propos 3d construction activity at the site address listed above. k11.11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide y all applicable laws and requirements that govern Owner-Builders as well as employers. con 12. I agree to notify the issuer of this form immediate y 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 re:ult of a complaint:Your only remedy against unlicensed Contractors may be in civil court. It is also important for yc u 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 heir workers'compensation insurance coverage. CONSTRUCTION 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 in 9y 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 ccmpleted 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: L_I rn '�'� �)' U OwnerBuilderFonn 2010.doc revised 04/14/10 RESIDENTIAL PROTECT COVER SHEET Assessor's Parcel Number: Name of owner. (:24AR QEAJ & WINA/l C kc,,20t_C'HAl2o LA/ Project address. /02-RI (.c1( TiRER chre Contact person. Cf�AP_0 6- V (M t� Phone. tqCR) 404 -2_W0 Fax Net square footage of lot. Existing Proposed Square footage: First floor: 1,400 Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside :he garage? Y NAPPFi�;.ED IN ACCORDANCE VVITIA I HE CITY OF Is privacy protection planting required for the project? Y N CUPERTINO CO SAN ORDINANCES DATE (�, O Build it Green Total Points SIGNED__ fi This set of plans and s ications MUST s 1s work being done? be kept on the job at all times and it is On what floor (s) g unlawful to make any changes or alterations on sa without n,permission from DA Brief description of work. �/�oc.�e,� �� KA of c6u rtino. SHALL NOT be held to pe it or to be an approval of the violati any provisions of any Gity Ordinance or State Law. Code editions: 2007 CBC (Y -N)2007 CFC (Y -N)2007 CMC (Y- 2007 CPC (Y -N)2007 NEC (Y -N) Effective 1/1/08 BYE Plan Review Process Work Book Page-8-Revised 8/05/08 NtP�s � tiAt-L BA T�-1 s Ley O U T - - - 1 r � u Vol N .�o� LA)IN b0 tAJ 3� '0ri (,46#) Skow v `r Shouxn/ 316 d 4v -DOOR TJ -DOOR I z VVII - -- y MASTEK &ED --- t DooR Rik LL Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY of Fax(408) 777-3333 DT Building Department All Cupertino building permits must meet certain conditions related to maintaining environmental quality and public peace and safety. The two most common conditions are described below. STORMWATER POLLUTION CONTROL State law requires that Cupertino, 12 other Silicon Valley cities, Santa Clara County and the Santa Clara Valley Water District contrcl stormwater pollution. Educating local residents and businesses and enforcing stormwater pollution control laws are key parts of the City's compliance efforts. Stormwater pollution prevention: It's L p to US In northern Santa Clara Valley, storm drains flow directly to local creeks and San Francisco Bay, with no treatment. Stormwater pollution is a serious problem for wildlife dependent on our waterways, for people living near streams and baylands, and for the local water supply. Common sources of stc rmwater pollution include: • Dripped oil, fuel, and antifreeze frori vehicles and heavy equipment; • Construction debris, including dirt, concrete and paint; • Landscaping runoff containing pesti(:ides or weed killers; and • Any material dumped or spilled into streets or storm drains The property owner and the contractor sha-e ultimate responsibility for activities occurring at a construction site and will be held responsible for any environmental damage caused by subcontractors or employees. For more information on construction-related stormwater requirements, see the Stormwater Quality Regulations section of the City of Cupertino web site at: httg://www.cupertino.org/city aovE!rnment/delartments and offices/ environmental services COMMUNITY NOISE CONTROL The basic noise control requirements for construction sites are as follows: • Typical construction work hours are: - Weekdays - 7 a.m. to 8 P.M. - Weekends - 9 a.m. to 6 p.m. • Construction other than street construction is prohibited on holidays. • Residential daytime noise levels from complaint site - 60 dBA • Nonresidential daytime noise levels from complaint site - 65 dBA For more information on noise control, please see Chapter 10.48 of the Cupertino Municipal Code, which can be accused at http://www.amlegal.com/cuE)ertino ca/ Greg Casteel Building Official / Uv �' ac� �`� CITY OF CUPERTINO ADDITION/REMODEL CUPERTINO FEE SCHEDULE APN# Date: f 2A 10 Is a 2"d unit beingadded? Yes ❑ No If es, lease fill out the pe mit a lication for 2nd unit. Building Address: 3- ° g �� GtJ �� Mailing Address (if different oin buildin address): 2 a 6 a'7 Phone# Owner's Name: r �� ' � ) 25`741�� `� Phone#: Contractor: Fax#: Cupertino Business License: State Contractor License#: Phone#: Contact: Fax M Landscape Ordinance Compliance: Landscape area in sq. ft. (includes all irrigated areas): If 2,500 sq. ft. or less, compliance with the Landscape Water-Efficiency Checklist is required. If more than 2,500 sq. ft., a complete Landscape Project Submittal is required. Compliance Method: ❑ Plant Type ❑ Water Budget Building Permit Info: Hillside ElBld . 9 Elect. ❑ Plumb. [� Mech. F-1 Job Description: Addition-What is being added?(Be Specific): What is being remodeled (not including addition)? Remodel Includes Re-Roof: Yes ❑ No ❑ If yes list number of squares Remodel Includes Structural: Yes ❑ No ❑ Do you have the pre-application planning appro-,al? Yes ❑ No ❑ If yes, please provide a copy of your planning a )roval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen Bat ` Otl.er O Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B Valuation: Please check this box i the project is a Project Size: Express [Standard ❑ Large ❑ Maj�r ❑ second-storyaddition ❑ Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, Green Building Points Achieved: include in plan set & the sheet index. Revised 05/18/10 CITY OF CUPERTINO ADDITON/F EMODEL CUPERTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft 1 PLMPLNCK Stand Alone Plumbing P Pln Ck (hourly) 1BCBSC Cal Bldg Standard:; B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic ResidentiEI B 1 TRAVDOC Travel & Documentation B 1BUSLIC Business License B