14080015-Permit CancelledPatricia Garcia
From: naiyu pai [nypai@paiaccountancy.com]
Sent: Monday, March 09, 2015 1:52 PM
To: Patricia Garcia
Cc: msgfamily@gmail.com
Subject: building permit
Dear Patricia,
Zd 55 4U L1,q 0-7-
From:
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As we talked over the phone, I am sending this email to request a cancellation of permit # 14080015.
We applied the permit to replace the electric main switch however we did not have a qualified subcontractor to do the
work hence no work has been done. I am sending this email to cancel the permit. Thanks.
Naiyu Pai
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20655 ACADIA CT
CONTRACTOR: PAI NAI Y AND HELEN
PERMIT NO: 14080015
OWNER'S NAME: PAI NAI Y AND HELEN
20655 ACADIA CT
DATE ISSUED: 08/04/2014
OWNER'S PHONE: 4089338530
CUPERTINO, CA 95014-1755
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REPLACE (E) 100 AMP PANEL, SAME LOCATION
License Class Lic. #
Contractor Date
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: $1500
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 32656019 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
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITIHN 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 DAY ALLED 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
C (�
Date: O /
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
RE -ROOFS:
9 18.
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
Date'
Signature of Applicant:
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)
as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (See.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 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 Cup mcipal Code, Chapter 9.12 and
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
the Health & Safety Code, Secti 2550 , 255 ; nd 25534.
Owner or authorized age Date:
permit is issued.
Certify that in the performance of the work for which this permit is issued, I shall
'not employ any person in any manner so as to become subject to the Worker's
CONSTRUCTION LENDING AGENCY
ompensation 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.
pplicant understands and will comply
granting of this permit. AdditioKsper
with all non -point ourcerrulatihe Cupertino Municipal Code, Section
Licensed Professional
9 18.
l
Signature Date
w9mmT,
GENERAL PERMIT APPLICATION (A
Li-jiCONUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIGI� IWEP
rg 10300 TORRE AVENUE • CUPERTINO, CA 55014-3255 O�
408 777-3228 • FAX (40B) 7-17-3333 - building cuoatno_orc m I S
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By my sisslab-'re below, Ice iy to each of the followin;: I u,e property ovMtr or authorized ag nt to act on t1ne rropefty o•,, ner`s behalf. I have read this
applic€tion and the infor zaton I have provided is c ect I read the Description of Work and veay it is acmzmte. I agree to comply ti _ 5 all applicable local
ordinances and state laws relating t0 b uc0 cno orize representatives of Cupertino to enter rhe above-idend_-;ed grope; :y for isaecuon purposes.
S i gnatlre of ApplicarSL} tent: Date:
SUPPLEVEEI♦rTA.L?��i-TION
-Law
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h EPB1'sc1p.p.2011.doc revised 06/21/11
CITY OF CUPERTINO
WE FEE ESTIMATOR - BUILDING DIVISION
20655 ACADIA CT
FEE ID
DATE: 08/04/2014
REVIEWED BY: MELISSA
IlaADDRESS:
APN: 326 56 019
BP#:
*VALUATION: 1$1,500
PERMIT TYPE: Electrical Permit
1 ERT<200
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: SFD or Duplex
Amps
PENTAMATION
PERMIT TYPE: 1 REAP
WORK
REPLACE E 100 AMP PANEL
SAME LOCATION
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Services
1 ERT<200
100
Amps
$48
PME Unit Fee:
$48.00
PME Permit Fee:
$48.00
.j
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes (F) No
$0.00
TOTALS:
i
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
t:e..h. 1'E>t m;l fee:
ofloe';, 1111' c"rt. In ,
t. c,jc , h? 3. 1 E t-':
llfiwih. Plan C'he:cik
Nurnh. 1'ef snit Tee".
Chile. P>urnb /rf.v
llhanb. hisp. tee -
Elec. Plan Check 10.0 1 hrs $0.00
Elec. Permit Fee: IEPERMIT
Other Elec. Insp. 1 0.0 1 hrs 1 $48.00
1'16'c 1nF''c-':
NOTE: This estimate does not include fees due to other Departments ('tie. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc )_ Thece fees are haved an the nreliminary information avadahle and are only an estimate_ Contact the Dent for addn'l infer_
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13)
FEE
QTY/FEE
MISC ITEMS
1 i ("heck ,t 't: :
1`111)t'. i'(.` _g''e'c
PME Plan Check:
$0.00
PME Unit Fee:
$48.00
PME Permit Fee:
$48.00
.j
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes (F) No
$0.00
cfL'c ,7f_'e,'C? I'tf t"tJ;tYit ''e'es:
i
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
k 5178 GALS
$190.50
$0.00 TOTAL FEE:
1 $190.50
Revised: 07/10/2014
CUPERTINO
OWNER -BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building cDcupertino.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 ADDRESSe
APN S-; — D!
L�,t<j
BP# o3 00l
C o�� 6t
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OWNER NAME
b_4
OWNER ADDRESS
C� c
C ,.MAI
,LJLJi
DESCRIPTION OF WORK:
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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.)
�d�
_.te1- 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.
t'
2. I 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.
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.
64. I understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
Contractors, and the
totaTvalue of my construction is at least five hundred dollars ($500), including labor and materials, I may be
considered an "employer' understate and federal law.
V6. 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.
I7. I 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.
1"t P8. 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.
OwneYBuilderForm 2010.doc revised 04/14/10
��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.csib.ca.gov for more information about licensed
contractors.
v�L0. 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.
!�211. 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.
UtE12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
inf rmation 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 citay be required to be presented when the permit is issued
to verify the property owners signature.
Property Owner's Signature: ZAP Date: <3 MI
----------------------------------------------------------------=--------------------------------------------------------------------------
(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:
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 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. doe revised 04/14/10
CUPERTINO
PURPOSE
UTILITY RELEASE REQUEST FORM %J
COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION
�-
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building ancugertino.org
For residential single family or duplex construction, there are cases where gas and electric utilities are
requested to be released prior to the issuance of the certificate of occupancy. Upon approval from the
building inspector, the City of Cupertino is allowing both utilities to be released prior to the final sign -off of
the building.
INSTRUCTIONS.
1. Download this form at: hM2://wwNv.cupertino.org/index.aspx?page=297.
2. Complete the form and obtain signatures from both the owner of the property and the primary contractor.
3. Fax, E -Mail, Mail or hand deliver the original signed form to:
City of Cupertino
Building Division
Attn: Utility Release Request Form 408-777-3228 office
10300 Torre Ave. 408-777-3333 fax
Cupertino, CA 95014 building, (ckupertino.ort?
4. Schedule a Gas Meter Release inspection (#403) and/or Electric Meter Release inspection (#404). Please
note, a Gas Test inspection (#506) is required prior to or at the same time of the Gas Meter Release
inspection.
BUILDING INFORMATION (Please complete the following information):
APN / G
- X71 1
BLDG PERMIT #: O OD 1 S
DATE:
SITE
ADDRESS: Zl) CGL G( (G' �
� Lw �
OWNER'S NAME: �1
Ai -6, PA (
ONE #:
FAX #:
tom$ cl 3 3 $ S j
MAILING ADDRESS (if different from site address): 3 6 t_
n JE.#:
C�
P-(, (�)�� c ,�
CONTRACTOR:
NC
PHO
FAX #:
CONTACT:
PHONE #:
FAX #:
I request the City to release my utilities prior to obtaining a final inspection approval for the building. I fully understand the occupants of
the building canno move int/the reWence until they receive all of the required final sign -offs and the City has issued a certificate of
occupancy for th uildin
Owner: .................... Print:......0.l( (. !?... �............................ Date.................................................................... .............
Contractor: ... ......................... r...........................I....... Print:......................................................................... Date:..............................
UtilityReleaseForm_2011.doc revised 08/09/11
Building Department
City Of Cupertino
10300 Tone Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U PE RTI N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST,
JOB ADDRESS: CT
PERMIT # -.1C10Y0013
OWNER'S NAME:
PHONE # d'
GENERAL CONTRACTOR:
BUSINESS LICENSE # "J/4
ADDRESS: C
CITY/ZIPCODE: C c.. 9
*Our municipal code requires all businesses working in the city to have a City of Cupertino bdsiness 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:
Daie
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 141
Daie