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15030069CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10598 STERLING BLVD CONTRACTOR: YE FEI AND ZHANG PERMIT NO: 15030069 ZISHAN OWNER'S NAME: YE FEI AND ZHANG ZISHAN 10598 STERLING BLVD DATE ISSUED: 03/11/2015 OWNER'S PHONE: 4088399905 CUPERTINO, CA 95014 PHONE NO: JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ LICENSED CONTRACTOR'S DECLARATION INSTALL TEMP POWER 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: $500 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 37523025 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 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 2 Issued by Date: 3' �� S—, 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. 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 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 with the Cupertino Municipal Code, Chapter 9.12 and performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by will maintain compliance the Health & Safety Code, Se 25505, 255 and 25534. v3/ t Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: 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 so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I Code, I I hereby affirm that there is a construction lending agency for the performance of become subject to the Worker's Compensation provisions of the Labor must work's for which this permit is issued (Sec. 3097, Civ C.) forthwith comply with such provisions or this permit shall be deemed revoked. 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 r the Cupertino Municipal Code, Section Licensed Professional 918. "3/i'/L°1 SignatureS� Date CUPERTINO GENERAL PERMIT APPLICATION ,tea MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777=3228 • FAX (408) 777-3333 - buildingCakupertino.org ❑ PLUMBING ❑ MECHANICAL ❑ ELECTRICAL " MISC el ❑ MISCELLANEOUS PROJECT ADDRESS F vel( Ck e ♦ N -,J C vz OWNER NAME 1 PHONE —Q J� E-MAIL w ' 0 O VP @ a 04 1 �W STREET ADD .. �� CITY, STATE, ZIP) F /< 1 ( i V LA J CONTACT NAME_ NE c / E-MAIL (aVF c'- C4 STREET D CITY, STATE P FAX r Xc OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTORS ❑ CONTRACTOR AGENT ❑ ARCHTTECT ❑ ENGMTR ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME I LIC E ER LICENSE TYPE IZ BUS. LIC Csj NAME E-MAIL FAX STREET ADDRE QQ ( v CITY, STATE, ZIP �(� g -J( �7^ ` PHONE ARCHITECT/ENGINEER NAME O LICENSE NUMBER BUS. LIC # COMPANY NAME D+i% (©W / n r 1 (� V 4 EMAIL �'/�h fweo JC ��, �� in Ix ( FAX STRE DRE r� for CITY, S TE1,ZIP �U� PHONE --4271020 _ O USE OF ❑ SFD DUP ❑ MULTI-FAM.LY PROJECT IN WILDLAND ❑ YEF PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK .0 , Y Y, p r v t,` gerr' oo4 6L, o(C S TOTAL VALUATION: E VED B- v v e By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's be alf. I have 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 comply with all applicable local ordinances and state laws relating to building constru au z entatives of Cupertino to enter the above -i entified property for inspection purposes. Signature of Applicant/Agent: Date: D 3 2-6 SUPPLEMENTAL INFORMATION REQUIRED ,W Yf` U 4\.mEXFRE'S {h�i .mc E..2a_ aE� 2�rsd k' OR MEPMiscApp_2011.doc revised 06121/11 ,d M CITY OF CUPERTINO 1VVU T`i 1 QTIIVI A T(lR — RI TII ,DING n1VIRION APPLIANCE / EQUIP TYPE ADDRESS: 10598 sterling blvd DATE: 03/10/2015 REVIEWED BY: Mendez $01 APN: BP#: "'VALUATION: $500 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Du lex p $48 PENTAMATION 1REAP14 PERMIT TYPE: i USE: Sippl, Insp Fee WORK install temp power PME Unit Fee: $48.00 SCOPE $48.00 APPLIANCE / EQUIP TYPE FEE ID - - QTY/FEE QTY UNITS BP FEES Temporary Power 1 ERT<200 100 Amps $48 1'ennit 1�'tre: Sippl, Insp Fee PME Unit Fee: $48.00 PME Permit Fee: $48.00 C,onsirbichon I ax Administrative Fee: 1ADMIN $45.00 Work Without Permit? ® Yes (E) No $0.00 TOTALS:,, Travel Documentation Fee: 1TRAVDOC $48.00 Strong Motion Fee: IBSEISMICR kch, Plan Check Mech. Permit Fee: Other Hech. (rasp. ,Creat. Msp. Fee: Plumb, Plan ('/reek Plumb, Permit Fee: 01her Plumb Inst). Plumb. Insp. 11'ee: Elec. Plan Check 10.0 1 hrs $0.00 Elec. Permit Fee: IEPERMIT Other Elec. Insp. 0.0 hrs $48.00 NOTE: This estimate does not include fees due to other Departments (ie. rtanntng, ruauc rvurtcs, L'LrG, Jure{LUry JG -.1 Lw.aa y ,...t., .,., v dm"to 47nntiwt the Dent for addn'l info. " IfLI.e, ..-Z. 1/.eue eeu -- v.w..w v.r r....r. ..............I FEE ITEMS 6Fee Resolution 11-053 E . 7ff 11113) . -_ ___-_----- -- ------- FEE - - QTY/FEE MISC ITEMS Plan Check Fee: scppI. P(,, Fee PME Plan Check: $0.00 1'ennit 1�'tre: Sippl, Insp Fee PME Unit Fee: $48.00 PME Permit Fee: $48.00 C,onsirbichon I ax Administrative Fee: 1ADMIN $45.00 Work Without Permit? ® Yes (E) No $0.00 ,4dvanced Pl arming Fees: Travel Documentation Fee: 1TRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 M_ $190.50 $0.00 v TO _ AL>I!EE $190.50 Revised: 02/14/2015 OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE � CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX -(408) 777-3333 • building Ca�cupertino.org CUPERTINO 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 P BP# off. ...,Id OWNER NAME _OWNER,AD E (l I✓ ej` pts ci) ,_ L. DESCRIPTION OF WORK: '':_ ot Weare provldln`iy u1it1an caner-Bu�er Ac nowiedgme nd Informati 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 untilyouhave 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- ilder" 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. V 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. 13. 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. �l 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. i I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the WETvalue 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. ti 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 rnvW serious financial risk. 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. 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 04/14/10 Z9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal venue 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 (CS,LB) at 1=800-321-CSLB (2752)7or_www.cslb.ca.gov for more information about licensed contractors. 610. 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. "i 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 that govern Owner -Builders as well as employers. 2. I agree to notify theissuer,of this -form immediately of any additions,. deletions, or changes to any of the information I have provided on.thisform. Licensed contractors are regulated by laws designed .to protect the public. If you contract with someone -who does not-have-A]icense, the.Contractors' State License Board maybe unable to assist you with anyfinancial :loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may bein-civil. court. It is also important for -you to understand that if an unlicensed Contractor or employee of that individual or=firmis-injured whileworkingon 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: �l 0 t t l L& 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 verifv the oropertv owner's signature. _1 - Property Owner's Signature: ,/ Date: Of) , - N / v (j' ------------------------------------------------------------------------------------------------------------------------------------------- (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 CityCupertinoof 1,059v.-�'rli,�eq �lrcl� CUPERTINO uildina neoartment a ' � 2M REVIEVVFwL` -t;)i.. (;ODE COMPLIANCE Rewewe,d By. //—e vr— �' Basemap Labels Abc Street Names Secondary Address Labels Primary Address Labels Freeway Basemap 9 Street Centerline County Major Roads - County Freeways DU Aerials - Sept 2013 .'�`,.!''TY DEVEI-OPMENT DEP Cai'Ii.lCN-Gt1PERTIN APPROVED 1, _ Specifications MUST be keppt �t6�e ;:: Lotion. It is ung rola y An pame or tm t# c`'tffGf i, 50: ` t a '::'i'v iI (morn the BuildiOfficial. 100 150 "` . ':� �;r1 specificatioSF��1..L NOT } t'a b-, akX1 0731 of '!'a v clotien ` 'y I : o Law. 51C lzr http://gissvr/cupertinointranet/home/mapFile.aspx Wednesday, March 11, 2015 8:34 AM