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15030132CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10751 CARVER DR CONTRACTOR: YI JONG YE ET AL PERMIT NO: 15030132 OWNER'S NAME: YI JONG YE ET AL 10751 CARVER DR DATE ISSUED: 03/20/2015 OWNER'S PHONE: 4082557247 CUPERTINO, CA 95014 PHONE NO: JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ LICENSED CONTRACTOR'S DECLARATION 200 AMP PANEL UPGRADE 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 Valuation: $1500 performance of the work for which this permit is issued. Sq. Ft Floor Area: I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 37535005 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 WITI AYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 DA\7LAST CALLED INSPECTION. upon the above mentioned property for inspection purposes. (We) agree to save 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. [V/ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER C� the following two reasons: 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 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 defined by the Bay Area Air Quality Management District I Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and performance of the work for which this permit is issued. the Health & Safety Code, Sections 25505, 25533, and 25534. 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 Owner or authorized agent:K�O�) Date: t permit is issued. certify that in the performance of the work for which this permit is issued, I shall CI 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 apyjlmt understands and will comply with all non -point source regulationsa Cupertino Municipal Code, Section Licensed Professional 918. Date 3 Signature CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ty� 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a-)cupertino.org F- PLUMBING ❑ MECHANICAL ELECTRICAL 0 01 ❑ MISCELLANEOUS MEP MISC PROJECT ADDRESS `e APN # � � r OWNER NAME fTX PH E-MAIL STREET ADDRESS CITY, , Z11111 FAX Q ca CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME I 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 USE OF ❑ SFD .,DUPLEX ❑ MULTI-FAMII,Y PROJECT IN WII,DLAND ❑YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: El COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK U�tW!�, ^- �IvC—L \ O i c"o TOTAL VALUATIO _ p �� RECEIVEDB3 -mak w011, v� C/t��� By my signature Belo , I certify to each of the following: I am the property owner or a agent to act on the property w ehalf. I have read this application and the in onnation I have provided is correct. I have read the qXserill6o5n of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin construction. I autho ' presentatives of Cupertino to enter the above -identified property for inspection purposes. Signature ofApplicant/Agent: -- Date: SUPPLEMENTAL INFORMATION REQUIRED oF>FzcE USE oi;r 1 OVER THE COUNTER ��' . EXPRESS��: *fir STANDARD 2N GEs,s MR N Jots' MEPMiscApp_2011.doc revised 06121111 CITY OF CUPERTINO ►r,-7rl ivivio IVcrrll%rr A •rnD - RTTTT.nl1VC' nIVICInN APPLIANCE / EQUIP TYPE FEE ID QTY/FEE dr UNITS DATE: 03/20/2015 REVIEWED BY: Mendez 1wADDRESs:.10464-earver I BP#: *VALUATION: 1$1,500 APN: 1'ertnat Fee: S1q)/Il. Insrl Fee 77l *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair SFD or Duplex ------j-PRIMARY PENMIT TY ON 1 REAP2 PERMIT TYPE: USE: $48.00 Constr fiction Tax: TOTALS: WORK 200 amp panel upgrade 1120 q� $48.00 Work Without Permit? ® Yes 0 No $0.00 SCOPE i APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Services 1 ERT<200 100 Amps $48 1'ertnat Fee: S1q)/Il. Insrl Fee 77l PME Unit Fee: $48.00 PME Permit Fee: $48.00 Constr fiction Tax: TOTALS: — 1120 q� $48.00 Work Without Permit? ® Yes 0 No Mech. Plan CAwck ,Wech. Permit I i"e: Oihcr .-Wech. Insp. kleclz. CxsP. I•ee: Plarab. Plan Check Elec. Plan Check 10.0 1 hrs $0.00 Plumb, P6,r mil Fee; Elec. Permit Fee: IEPERMIT 0111er Plumb InstED--I-- Other Elea Insp.0.0 hrs $48.00 Plumb. bash. T=ee:: lslec. Imp, Fe(s : —_ n___ Cl—..--n-0s..4..4 Qnt.nnl NOTE: This estimate does not tnctuae fees aue to otner vepartments (ii lLua/uiLg, 1 au- --a u -a , ..6. r'natart tho Dont far addn'I into. Ulstrtet, etc.. 'Inese ee3 are o�eu v.. ssc P.. FEE ITEMS (Fee Resolution 11-053 E . 7ff /1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Su/rlrl. P( Fee PME Plan Check: $0.00 1'ertnat Fee: S1q)/Il. Insrl Fee 77l PME Unit Fee: $48.00 PME Permit Fee: $48.00 Constr fiction Tax: Administrative Fee: ]ADMIN $45.00 Work Without Permit? ® Yes 0 No $0.00 Advanced Planning 1*'r:es:' i Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item $0.00 `� tF..� $190.50 Bldg Stds Commission Fee: IBCBSC $1.00 $190.50 Revised: 02/14/2015 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 1'03007ORRE AVENUE •'CUPERTINO, CA 95014-3255 CUPERTINo (408) 777-3228 • FAX (408) 777-3333 • buildingecupertino.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. 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.) -'tt-'. 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. 12.1 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. ti 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 v/ 7e 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. __V/_5. I 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. J6.1 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. J7.1 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 i_s Performed under contract with a licensed general building Contractor. V 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 _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 1 may contact the California Contractors' State License Board (C -SLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. t' 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. 1. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws-and_requirements th. at govern Owner -Builders as well as employers. J12. I agree to notify the -issuer of.this:form.immediately-of.any additions, deletions,. or changes to any of the information I have provided=onthis form._.Lice.nsed.,contractors are regulated by laws designed to protect the public: if you contract wiftsomeonewho%does not -have a:;license, the Contractors' State License Board may be unable to assist you with any financial.:loss- you may sustainas_a result:of-a complaint. Your only remedy against unlicensed .Contractors may be in civil;court Itis also- important foryou to -understand that if an unlicensed Contractor or employee of that individual -or firm- is injured while working on yourproperty, you may be held liable for damages. If you obtain a permit as Owner Builderand wishto•-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 drivers 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:��/ l� Date: (NOTE: The following Awth-6 n­ia- iw Form is required to be c -o- m-- pi-/-e-t-e- d 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 Ager 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. 1 Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/14/10