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13040114 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10473 SCENIC CT CONTRACTOR:JOE SANDRA Q AND PERMIT NO: 13040114 KENNETH C OWNER'S NAME:JOE SANDRA Q AND KENNETH C 10473 SCENIC CT DATE ISSUED:04/15/2013 OWNER'S PHONE: 4089961881 CUPERTINO,CA 95014-2765 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL[] License Class Lic.# REPLACE(E)125 PANEL,SAME LOCATION.INSTALL 6 (N)RECESSED LIGHTS IN GARAGE AND ADD Contractor Date INSULATION 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. Sq.Ft Floor Area: Valuation:$2000 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:35707015.00 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 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 -� _ Date: granting of this permit. Additionally,the;applicant understands and will comply °edty'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,I agree to remove all new materials for inspection. 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 for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to 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 de ' es which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as definedIther 'Air 4 a ty Management District I performance of the work for which this permit is issued. will maintain compliance wno M i ' al Code,Chapter 9.I have and will maintain Worker's CompensationInsurance,as provided for by the Health&Safety Code, 25 3, d 25534. Section 3700 of the Labor Code,for the performance of the work for which this Date Owner or authorized agent 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 sous 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 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 thaf.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 ARCHITECT'S DECLARATION indemnify and keep hannles of Cupertino against liabilities,judgments, costs,and expenses ` ay acc a against s 'd City in consequence of the I understand my plans shall be used as public records. granting of this p it d tionally,' plic t understands and will comply with all non-po' t so rc regu#io per the pertino Municipal Code,Section Licensed Professional 9.18. Signature Date / �� CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION \k0 O 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 Q CUPERTihIO (408)777-3228•FAX(408)777-3333•building -) cuoertino.oro ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/-TI ❑ REVISION/DEFERRED \ORIGINAL PERMIT# PROJECT ADDRESS O '45C-64w, C:f APN# 3 G -� 0 ( 5- OWNERIte% N/i �G�.. PHONE EMAIL t ! !C-001AI -CO-4 STREl L�RFS `n �i CITY,STArE.ZIp �C 95a� + CONTACT NAME�� P 99 0r. Ar-19 • ��U �G1...^- , STREE CITY,STATE Zl�laO v ��t� 14V r.-leIJCC ,G, G_... s7 OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK t . W t .IW N� A#AP Xsrte-A40 61^4^G9- "CAO egas i2 3b 146W 110N) 4#4 GAS G0•LW G EXISTING USE PROPOSED USE CONSTR TYPE #STORES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO I TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODELAREA PORCH AREA I DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT :.❑YES SECOND STORY []YES BEING ADDED? ❑NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN [I YESBy' TOTAL VALUATION: PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? E]NO ZOoo By my signature below,I certify to each of owin I am roperty owner or authorize to a n roperty owner's behalf. I have read this application and the information I have p vided' co t I h e ad the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to 1 ction. a orize representatives of Cupertino to enter the above-ide ified p}�operty for inspection purposes. Signature of Applicant/Agent: Date: �S%tel suPPLEmENTAji!TNF5—RMATyR REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit forOVER-THE COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to El MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10473 scenic ct DATE: 04/15/2013 REVIEWED BY: melissa APN: 357 07 015 BP#: *VALUATION: $2,000 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY PENTAMATION 1 REAP2 USE: SFD or Duplex PERMIT TYPE: i WORK re lace a 125 panel, same location. install 6 n recessed lights in garage and add insulation SCOPE APPLIANCE%EQUIP TYPE FEE ID QTY UNITS BP FEES Services IBELEC200 100 Amps $45 Fixtures, Lighting 1BREMFixT 6 # $67 aFa $112.00 y, TOTALS: Lle A Plan Check Plumb. Plan Check Elec.Plan Check 0.0 hrs $0.00 L1ech.Permit Fee: Plumb.Permit Fee: Elec.Permit Fee: IEPERMIT Other,Wech.Insp. Other Plumb Insp. Other Elec.Insp. 1-2-OJ 0 f $45.00 .11ech.Insp.Fee: [Plumb. hal).Fee: Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc . These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff.' 711/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: ;Suppl.PC:Fee PME Plan Check: $0.00 Permit Fee: Suppl. Insp Fee PME Unit Fee: $112.00 PME Permit Fee: $45.00 Consiruction :Tcax: Administrative Fee: IADMIN $42.00 Work Without Permit? ®Yes (j) No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRAVDOC $45.00 i Stroniz Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission,Fee: IBCBSC $1.00 $245.50 $0.00 u - $245.50 Revised: 04/01/2013 a OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 GUPERTINO (408)777-3228•FAX(408)777-3333•buildinaCalcupertino.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 ` APN BP# OWNER NAME J OWNER ADDRESS IV,e�-77C DESCRIPTION OF WORK: C L � We are providing you with am 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 (DIR T NS:Please read and initial each statement below to signify you understand or verify this information.) riderstand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner wilder building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, 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 ncovide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my tricecoverage for injuries to workers on my property. nderstand building permits are not required to be signed by property owners unless they are responsible for uction and are not hiring a licensed Contractor to assume this responsibility. nderstand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that.1 may tect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her instead of my own. Vd .government, derstand Contractors are required by law to be licensed and bonded in California and to list their license n permits and contracts. nderstand if I employ or otherwise engage any persons, other than California licensed Contractors, and the of my construction is at least five hundred dollars($500), including labor and materials, I may be .an."employer"under state and federal law. understand if I am considered an"employer" under state and federal law, I must register with the state and withhold payroll taxes, provide workers' compensation disability insurance, and contribute to tsential yment compensation for each"employee." I also understand my failure to abide by these laws may subject rious financial risk. understand under California Contractors' State License Law, an Owner-Builder who builds single-family structures cannot legally build them with the intent to offer them for sale, unless all work is performed by 21serformed sed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work under contract with a licensed general building Contractor. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for 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 4th 9. nderstand I may obtain more information regarding my obligations as an"employer"from the Internal nue Service,the United States Small Business Administration,the California Department of Benefit Payments, e California Division of Industrial Accidents. I also understand I may contact the California Contractors' State tall ard (CSLB)at 1-800-321-CSLB(2752)or www.cslb.ca.gov for more information about licensed m aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I y legally and financially responsible for proposed construction activity at the site address listed above. gree that, as theparty legally and financially responsible for this proposed construction activity, I will abide able laws and requirements that govern Owner-Builders as well as employers. gree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the. 1..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. 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,t ' rm m t be completed and signed by the property owner and returned to the agency responsrtna s ng the. ermit. Note:A copy of the property owners driver's license, form notarization, or other verificaable to a city may be required to be presented when th ermit isissued to veri the ro ertowner's sin 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 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)16 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: 1 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: OwnerBuilderForm 2010.doc revised 04/14/10 1 i I ' -- 1=-- v/JICA �' - - - COMMU EVE40PIV ENT 65PXF TMENT - - - - - - BUILDING(D-IVIIjgNi-CCLPERTINO, -_ - - _ --- ----------- A P O Ep - - This set of pians and pec ficailons�MUST be kept at the - job sohanges or alteration . d 1� aoe�_or,u make any -- -- -- deviate t - ---- therefrom,without a0pro ai ffom the Suilding Official. - The stamping of this ptan nd s e ' ns SHALL NOT -- be held to permit of any provisi ofi rdir�ancq or Statq Law. BY -- DA PERMIT N0. -- - 90 �.e.� � 1 epaf7 F—i--- -- -- - - RE APR 15 2013 - - 't"er - '_— O R C OD Rev'eweq BY E COMP�I AN - - Ti—I CF 1 -- i - L_ . o � 141 Jf i I Gwzso. C' . -�- - I - �-!11 G - t i i i i J Pc -- A 1,�d T-/No- PR 'FOR 520, �n9 D��arnent i 3 DUE��MP -- - -- -- - -- - _ By. CIgNC� - i I ------- 0,47 j i �