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14060047m AI CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20123 NORTHCREST SQ CONTRACTOR: SCHMIDT MARC F PERMIT NO: 14060047 OWNER'S NAME: SCHMIDT MARC F 292 SHEARWATER ISLE DATE ISSUED: 06/09/2014 OWNER'S PHONE: 4088885009 FOSTER CITY, CA 94404 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL INSTALL (2) NEW 20 AMP DEDICATED 120 CIRCUITS, License Class Lic. # UPDATE ELECTRICAL IN GARAGE, INSTALL NEW GROUNDED Contractor Date #12 GAUGE WIRING TO GFI OUTLET 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: $915 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 31638077 00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PER � E7 .� WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN'1 AYSOF PERISSUANCE 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 FRO ST 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/ Issued by: Date: 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. 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. ❑� FJ 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 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 HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the 1 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 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 I 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 25905, 25533, a 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agen . Date: 6' S / permit is issued. I certify that in the performance of the work for which this permit is issued, I shall r not employ any person in any manner so as 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 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 918. Signat Date CUPERTIINO GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 D� MISC (408) 777-3228• FAX (408) 777-3333 • buildingo_cupertino.M \A ❑ PLUMBING j� MECHANICAL ELECTRICAL nMISCELLANEOUS PROJECT ADDRESS�� Z /� r I (� Cnr2pl�t APN # 314 %/ ? r D OWNER NAME / - V/� PHONE / %V 4 S- O ?.. (J E MAII, �,.D „ �� C.Dt//v� CCt,f' 2 T v �-'^^-wi 1- STREET ADDRESS CITY, Sp f�e r 1 f 6 ! / Y. 41 FAX CONTACT NAME / PHONE E-MAIL STREET ADDRESS - CITY, STATE, ZIP FAX ❑ OWNER OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CO CTO N L G�''// /� LICENSE NUMBER%/�� ([/ LICENSE TYPE BUS. LIC #2,5-2 /-1-T» G 'L6C 104 Alw !e (� 77bb SO & COMPANY NAME F"�eE // } L '% �q 1e��2GTr,c. �@G9 W.4zi7.l�IQ 7 FAX STREET ADDRESS�� " ! V CITY, STATE, ZIP/�'% , h4 �� %S0/ S PHONE `/4 ARCHITECT/ENGINEER NAME 7 LICENSE NUMBER / BUS. LIIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX MULTI FAMB.Y PROJECT INVAIDLAND ❑ YES 7PR(OCTIN ❑ YES IS THE BLDG AN ❑ YES BUI DING ❑ COMMERCIAL - URBAN INTERFACE AREA NO n'.'' ZONEE JZNO _ D EICHLER HOME? �NO DESCRIPTION OF WORKTee- a- j r e a � �js �. Q v,/ 7 0 - "j- f : 90114--L- e c rJ.!`a 2 TOTAL VALUATION: q/ R$ HY Yx _ By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on a owner's behalf. 7hqve read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to coM licable local ordinances and state laws relating to ing constructi I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED f z OFFTCE IJSE dNLY � � bVI:R TH�COTJNTEA x STANDARD U ' � IQ 2ARGL a MAJOR MEPMiscApp_2011.doc revised 06/21/11 Fm_� CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 20123 Northcrest Square DATE: 06/09/2014 REVIEWED BY: UNITS APN: 316-38-077 BP#: "VALUATION: $915 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Multi -Family Dwelling USE: Building is >3 Stories ® Yes Q No PENTAMATION 1 REAP10 PERMIT TYPE: wORK Install two new 20 -am dedicated 120 volt circuits. Route exposed electrical conduit on the garage wall SCOPE and ceiling space. Install new grounded copper #12 gauge wiring to each GFI outlet. See attached. APPLIANCE / EQUIP TYPE FEE ED he lz. Plan Check QTY UNITS BP FEES Plumb. Permit Fee: Recep/Switch/Outlets 1 BREMRECEP Other PlumbInsp_ 2 # $47 Elec. 111sp. Fee: Conduits 1BREMMISC Slrz.%Ill. Inv 11 ce 1 # $139 PME Unit Fee: $186.00 PME Permit Fee: $47.00 Construction Tax: F Administrative Fee: 1ADMIN $44.00 Work Without Permit? 0 Yes C) No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC $186.00 Strong Motion Fee: 1BSEISMICR NOTE: This estimate does not include fees due to other Departments (ie. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE he lz. Plan Check Plumb. Plan Check Elec. Plan Check 0.0 hrs $0.00 lie, h- Permit Fee: Plumb. Permit Fee: Elec. Permit Fee: IEPERMIT (T;rershfecit.lyas�,. Other PlumbInsp_ Other Elec. Insp. 0.0 hrs $47.00 'Vkch. hasp, Fee, Plumb. Imp. Fee: Elec. 111sp. Fee: NOTE: This estimate does not include fees due to other Departments (ie. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plar7 Checl`, I'ee: S!rppl. Pi, I-ee PME Plan Check: $0.00 Permit Fee: Slrz.%Ill. Inv 11 ce PME Unit Fee: $186.00 PME Permit Fee: $47.00 Construction Tax: F Administrative Fee: 1ADMIN $44.00 Work Without Permit? 0 Yes C) No $0.00 dva;7ced Planning Fees: Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 m $0.00 TOTAL FEE: $325.50 Revised: 04/01/2014 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT -BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building0cupertino.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 Z O/ 2 _? A- t G r, - J l- Y &t4 r APN 7 /� r 3 JP r p q BP# OWNER NAME rL ( G D J�nvH,`cL� WNER ADDRESS G� C4 /Yyd , DESCRIPTION OF WORK: T- J)W -/Wv 01CL, 7i1)—Qwt LohQN; { -in d W Ce;; �/ n¢w vD�n d� co er- iZ k e. w; r; 4o 6i'FS o J 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.) ,-I -r1.1 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. Ar -f 2. 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. AFr 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. AFf 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. 01 FS 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. Pff 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. 141 K 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. Ar'f 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 subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 tL)a 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. A L -r 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. kth 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. �� !' FI 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. 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 may be required to be presented when the permit is issued to verify the property owner's si natu . Property Owner's Signature: Date: /1Y ----------------- - -- - -- ----- ----------------------------------------------------- -- ------------------------------- The following Authorization Formsrequired 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 maybe required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010. doe revised 04/14/10 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS:20123 Northcrest Square PERMIT # OWNER'S NAME: Marc Schmidt PHONE #408 888-5009 GENERAL CONTRACTOR: 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 THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing X Electrical Eagle Electric Z 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 6-5 -/ Owner / Contractor Signature Date