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13090202CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10250 N DE ANZA BLVD CONTRACTOR: DANIEL TIANG PERMIT NO: 13090202 OWNER'S NAME: DANIEL TIANG 1561 HUDSON ST DATE ISSUED: 09/25/2013 OWNER'S PHONE: 4085980155 REDWOOD CITY, CA 94061 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT F PLUMB F License Class Lic. # MECH RESIDENTIAL F COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:. ADDITION OF GREASE TRAP (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 Sq. Ft Floor Area: Valuation: $1000 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. APN Number: 31626085.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save WITHIN DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities, judgments, ,180. 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by: Date: 9.18, Signature Date RE- ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is OWNER- BUILDER DECLARATION installed without first obtaining an inspection, I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self - insure for Worker's California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain Compensation, as provided for by Section 3700 of the Labor Code, for the compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & performance of the work for which this permit is issued. Safety Code, Section 25532(a) should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance, as provided for by Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will Section 3700 of the Labor Code, for the performance of the work for which this maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. Health & Safety de, Se lions 25505, 25533, and 25534. y: I certify that in the performance of the work for which this permit is issued, I shall i V not employ any person in any manner so as to become subject to the Worker's Ownex or rite �t Date Compensation laws of California. If, after making this certificate of exemption, I 1903 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. CO UCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued (Sec. 3097, Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address 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 granting of this permit. Add' nally, the pplicant understands and will comply I understand my plans shall be used as public records. with all non -point sourc a lations pe a Cupertino Municipal Code, Section 9.18. �' �� Licensed Professional Signature" Date (f' ✓ CUPERTINO r, CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building()-cupertino.org n r—i r—I /309 °°' LJ INr-W UkJINJ1IKuk.11V1N LJ AU J11 IVN LJ AI 1! KA11V1N / 11 LJ Kt5VJZIVIN / 1JC,r CKKC1J UfUUINAL rrrKIV111 3i PROJECT ADDRESS 0 D DE e / y /� Q J o /d� APN # 0 vet OWNER NAME aL yv e— r �-}�` �� j PHONE Z1 p 8 518 D' 5,r E -MAIL n• STREET ADDRESS 1 10 2` SIC) N :11 F Q s 1Z CITY, STATE, ZIP / U a t, no �A ®5a 1 q FAX CONTACT NAME r i e Z PHONELI0S 5-6gI b3 q J F9 M E -AIL STREET ADDRESS /„ ,� _ --E+ 1 A CITY, STATE, ZIP -1 L FAX ❑ OWNER OWNER - BUILDER ❑ OWNER AGENT ❑ 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 1 / m S C 65A ' fry I' i EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODELAREA ATTACH USE I TYPE I OCC. I SQ.FT. I VALUATION ,($) BEING ADDED? []NO ADDITION? []NO PRE- APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES REGEIYED BY `�,y,� r TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO r y d , yjir� i 5 By my signature below, I certify to each of the fo ing: I am the property owner or authorized agent to act on the property owner's behalf I have read this application and the information I have provid Is correct. I ha read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b '1 ' ruction. thorize representatives of Cupertino to enter the above -'dentified p�rop1erty for inspection purposes. Signature of Applicant/Agent: Date:��// SUPPLEMENTAL INFORMAT;ON REQUI713 _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. — Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO FORM Ti TF. F.CTTM A TnR — RTTIT .'nTNG DIVISION APPLIANCE / EQUIP TYPE 10250 n de anza blvd DATE: 09/25/2013 REVIEWED BY: larry s ,wiADDRESS: APN: BP #: 3� b� a— *VALUATION: $1,000 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: Commercial Building # PENTAMATION 1 CPGT PERMIT TYPE: WORK addition of grease trap SCOPE Suppl. Insp C'e e APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Interceptor, Ind. Waste 1BPINTERCE 1 # $35 Perrnit .h'ee: Suppl. Insp C'e e PME Unit Fee: $35.00 PME Permit Fee: $47.00 C onswuction Tax: Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes (E) No $0.00 TOTALS: A � � a $� 35 00 Strong Motion Fee: 1BSEISMICO Xfech. Flan Check A -fech. Permit Fee: Chher Alech. Insp. 11ech. In.sp. Fee: Plumb. Plan Check 1 0.0 1 hrs $0.001 Elec. Plan Check Plumb. Permit Fee: IPPERMIT I I F=lee. Permit I,-,-,e, Other Plumb Insp. 1 0.0 1 hrs 1 $47.00 1 Ocher Elec. Insp. Plumb. Insp. Fee: Elec. Insp. Fee: NOTE: This estimate does not include jeer due to other veparrments (Le. rtanning, ruouc rrurits, r[re, our[uury oewci u ra , ua .- n__wa_. L.. ...i sL., .,1:... xFn:sssn6nn nunnahlo and ara only an P.Qti►nate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11 -053 E . 7ff 11113) FEE QTY/FEE MISC ITEMS Plan Check 14 "cue: Suppl. PC [fee PME Plan Check: $0.00 Perrnit .h'ee: Suppl. Insp C'e e PME Unit Fee: $35.00 PME Permit Fee: $47.00 C onswuction Tax: Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes (E) No $0.00 Advanced Planning Fees: Travel Documentation Fee: 1TRAVDOC $47.00 Strong Motion Fee: 1BSEISMICO $0.50 Select an Administrative Item Bldw Stds Commission Fee: IBCBSC $1.00 °f $174.50 kI $0.00' -- �I'F)EEv. $174.50 Revised: 08/01/2013 County of Santa Clara Department of Environmental Health I= tECEIVED 1555 Berger Drive, Suite 300 S E P 242013 San Jose, California 95112-2716 (408) 918 -3400 www.EHinfo.org Name: September 20, 2013 Franklin Mendoza PROJECT NUMBER: SR0841773 10520 Johnson Avenue PROJECT NAME: DONUT WHEEL Cupertino, CA 95014 PROJECT ADDRESS: 10250 N DEANZA BLVD. CUPERTINO, CA 95014 Dear Mr. Mendoza: The drawings for the above noted remodeling project have been reviewed and approved by this department, subject to the following conditions: • The grease trap must be mounted so there is a gap of eight inches between the back of the grease trap and the wall. If this cannot be achieved, the grease trap must be flush mounted with the floor. Thi proval shall expire by limitation and will become null and void if the construction, reconstruction, alteration, or other work authorized by this approval is not commenced within 180 days from the date of approval. Please retain one copy of the approved drawings on the job site. A FOOD FACILITY CONSTRUCTION CARD has been attached to the job copy and must be posted with the other building permits. Present at least two (2) copies of the drawings to your local building official for the required permit application and approval. Any change to the drawings as a result of reviews by other jurisdictions must be brought to the attention of this department as soon as possible to avoid construction delays. Please be advised that you are responsible to contact this office to arrange a construction inspection before rough plumbing signoff, installation of equipment, and upon completion of the project. You will also be asked to submit a mechanical exhaust system performance test, if such a system is present, before we can finalize the project, The original submittal fee(s) includes up to two (2) inspections. Additional fees may apply to any further inspections or site visits. In the event the project is not ready for a scheduled inspection, please provide at least 24 hours advance notice to avoid additional charges for canceled inspections /missed appointments. The Final Inspection for the project cannot take place until the balance for all Plan Check- related work is PAID IN FULL, and the enclosed Application for a Permit to Operate has been completed and is on file with this office. Failure to meet this /these requirement /s will result in the cancellation of the Final Inspection. Please note: Rescheduling will be subject to availability. All food handlers are required to obtain a food handler card within thirty (30) days of hire (with certain exceptions). Contact this Department for more information. If you have any further questions or would like to call for an inspection appointment, please contact the Department at (408) 918 -3400, between 8:00 a.m. and 5:00 p.m., Monday through Friday. Very truly yours, Katherine B. Avila, REHS Senior Environmental Health Specialist Plan Review and Construction Unit cc: City of Cupertino Building Department Owner Board of Supervisors: Mike Wasserman, District 2 Vacant, Dave Cortese, Ken Yeager, S. Joseph Simitian County Executive: Jeffrey V. Smith - �, A%, CC cn it 0. CL • s1v z�A COP ova$ DIM 1AP AMA, ooAsr rA410 A yu 11OW Q? LLi '40) CE D �a ;CA (0) 9 8 0, C3 cfj us B Z CC cn it 0. CL • s1v z�A COP ova$ DIM 1AP AMA, ooAsr rA410 A yu 11OW N O File e2 ,x s I �:� �� 6-5 'N1�� 0 . . Components Composants Components for:/ Composants pour:/ Componentes de: 2 0GPM - 25 PM 3920A02 20GPM (1.26 LPS / Us / L/Seg) 3925A02 25 GPM (1.6 LPS / Us / L /Seg) 3925A03 25 GPM (1.6 LPS / Us / L /Seq) ITEM ' Part No: Nombre Description / Descripcion Numero cle la piece Numero Numero cle parte 1 - Latches #3920A -9 - Attaches - Pestillos 2 - Reinforced polypropylene cover #3920A -2 - Couvercle en polypropylene renforce de nylon - Cubierta de polipropileno reforzado 3 - Rubber gasket #3920A -5 -Joint en neoprene n y -Junta de hule �o 4 - Removable polypropylene baffles #3920A03 -3 �. - Chicanes amovibles en polypropylene N - Deflectores de polipropileno desmontables v 5 - One -piece tank #3920A03 -1 - Reservoir en une piece - Tanque de una sofa pieza Components for: / Composants pour: / Componentes de: o n n o J Z CUPERTINO OWNER- BUILDER NOTICE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 - FAX (408) 777 -3333 • 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: Passible Benefit with Low 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 turn to serious financial risk if you hire unlicensed contractors to perform any of the work. Benefit/Risk: Possible Renefit 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: Possible Benefit 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 06108110 CUPERTINO OWNER - BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building (aDcupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the b improvements specified at: El FILE IV of the property SITE ADDRESS I �.% 1 �� APN BP# OWNER NAME OV�N DRESS & Iw n (�jCf DESCRIPTION OF WORK: -iv G� L 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. I 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. 42.1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. U3. 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. a.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. V5. 1 understand if I employ or. otherwise engage any persons, other than California licensed Contractors, and the al tovalue 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. I understand if I am considered an "employer" under state and federal law, I must register with the state and fe eral 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. q7. 1 understand under California Contractors' State License Law, an Owner - Builder who builds single - family idreential 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. 4i 8. I 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 04114110 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 also understand 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 contractors. L110. I am aware of and consent to an Owner - Builder building permit applied for in my name, and understand that I am the parry legally and financially responsible for proposed construction activity at the site address listed above. r �11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner - Builders as well as employers. T2. I 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. 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 t ermit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptabl o th city may e 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 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: 10 Name of Authorized Agent: _A.)- Address of Authorized Agent: _t RPM ,f Tel No �02)d -sZ -81 q3 11 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 e: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may re ired to b presented when the permit is issued to verify the property owner's signature. / Property Owner's Si na Date: �r f��2 p Y 9 OwnerBuilderForm 2010.doc revised 04114110