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15060126 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20273 NORTHCOVE SQ CONTRACTOR:FUNG MICHAEL G PERMIT NO: 15060126 OWNER'S NAME: FUNG MICHAEL G 12585 MIRA LOMA WAY DATE ISSUED:06/18/2015 OWNER'S PHONE: 6502197210 LOS ALTOS HILLS,CA 94024-4710 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL REPLACE(E)SLIDING GLASS DOOR&(E)WINDOW IN License Class Lic.# BEDROOM(WILL MEET EGRESS PER CODE) 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:,$2400 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 APN Number:316410 1.00 Occupancy "I}pe: 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 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 181D F SPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will com te: with all non-point source regulations per the Cupertino Municipal Code,UZI 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 1 hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,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(Sce.7044, Business&Professions Code) as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE nstruct 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. 1 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 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent vDate: 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 Compensation laws of California. If,after making this certificate of exemption,) CONSTRUCTION LENDING AGENCY 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 9.18. Signature O&A kA Dat (�S CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 C U P E RT I N O (408)777-3228• FAX(408)777-3333•buildingacupertino.ora ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS �ay�y � V t P �, t� moi,,` APN# _ / O (� / OWNER NAME n4l E� ve " �4 S E RFySS •, ' IZYS ATE,Z[P ^A O FAX COb[TSICT NAKE PII�f�1E� M ! ICA . FAX �Z-WNER ❑ OWNER-BUILDER [3 OWNER AGENT ❑ CONTRACTORS ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT -N-''=TOR NAME I , LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONL ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION QF WORK EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) F.XISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCII AREA GARAGE AREA: DETACH ATTACII #DWELLING UNITS: IS A SECOND UNIT C]YES SECOND STORY 01 YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN EC TOTAL VALUATION: PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HO C .0 By my signature below,T certify to each of the following: Tam the property o cr or authorized a o act o property owner's behalf. I have read t is application and the information I have provided is correct. I have read the Description of Wor v is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction I orize representatives of Cupe tno to enter the abovg-ident'ted property for inspection purposes. aA �.l Signature of Applicant/Agent: , • 11 T Date: SUPPLEMENTAL INFORMATION REQUIRElkiPLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 20273 NORTHCOVE SQ DATE: 06/18/201.5 REVIEWED BY: MELISSA APN: 316 41 041 BP#: *VALUATION: 1$2,400 ;�;:PEIRMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or DuplexPENTAMATION 1GENRES USE: PERMIT TYPE: WORK REPLACE E SLIDING GLASS DOOR & E WINDOW IN BEDROOM WILL MEET EGRESS PER SCOPE CODE) ifech. flan Check Phunh. Plan Check Tec,Plan Check Fleclr Plumb. Pcrmit Pee: /slec. Permit Pe,, Other Alech. Insp. Other Plumb Inst Jrher lace. Insp. 11ech. Insp, Fee Plumb. hesp. Pee i:!ec.Insp.P'ee: NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc.). Thesefees are based on the prelimina information available and are only an estimate Contact the De t or addn 7 info. FEE ITEMS(Fee Resolution 11-053 Eff.' 711%73) FEE QTY/FEE T MISC ITEMS Plan Check Fee: $0.002 # Window/Sliding Glass Door Suppl. PC Fee: (j) Reg. OT 0.0 hrs $0.00 $431.00 I WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential 0 l'ruvel Doculnenlwion Fees: Building or Structure Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldp-Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $431.00 TOTAL FEE: $432.50 Revised: 05/07/2015 E. OWNER-BUILDER DISCLOSURE FORM LM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•building(alcupertino.org — CUPERTINO Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS 2 APN _ 0 // 1 BP#-2-210 '1-3 � 0 ONER NAME OWNER ADpRE$S �� 11/11 r iP'��ll DESCRIPTION OF WORK: -I- -;vp 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.) kt 1. 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. ykrP2. 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. T�3. 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. N�. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. �&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. )�l JC-6. I 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. 4f7. 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. r3► 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 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.cslb.ca.gov for more information about licensed contractors. 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. h(,f, 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. 2. 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 city may be required to be presented when the permit is issued to verify the property owners 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: Name of Authorized Agent: Tel No Address of Authorized Agent: 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 owners 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 owners signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/14/10 NORTHPOINT HOMEOWNERS ASSOCIATION PROPERTY MODIFICATION NOTICE Please indicate below which modification(s) are planned for your property. Provide brochure(s) if possible and a copy of any proposal(s), including the contractor's license number. Any modification not expressly listed herein, or not conforming to the restrictions and requirements listed herein for that modification will require an Architectural Review Application to be submitted to the Grounds and Architectural Committee and the Board of Directors for approval. Satellite Dish installation has a separate form to be completed and submitted for approval. Modification Restrictions and Requirements Air conditioning unit Unit will be designed for quiet residential use. Unit will be located within the enclosed yard of the property. There will be no part of the unit visible to common �! areas. Installed by a licensed contractor. � Replacement window/ Must be same size aperture and Sliding door location of existing window or sliding L)Q-r:5I peu;-�, door. Any necessary touch-up painting is the responsibility of the Homeowner. Installed by a license contractor. Garage door Must be windowless and in conformity with general architectural style of the complex. Repainting to conform to exterior color scheme is responsibility of the Homeowner. Installed by a licensed contractor. Any damages caused to property as a result of modifications will be the homeowner's responsibility. All prohibitions, restrictions, conditions, and rights of the Association enumerated under Article V of the amended and restated Covenants, Conditions and Restrictions of the Northpoint Homeowners Association are applicable to modifications Contained herein. City permits may be required. _ P/e Pyr* t Homeowners Name(s): Q ��-- 1� L;. Property Address: 0 br— I�CZJ Phone: -0((3 Date of Notification: ' 1-5-0 � Date of Completion: Homeowner has 6 months to complete the designated modi � tions and is responsible for notifying management upon project completion. 10ffjc��e Only Notification received by: / T Date: 6 /d Completion verified & approve by: Date: Form adopted 8/10/1999 Revised 5/00 Name Michael Fung, 650.219.7210 Job: 20273 Northcove Sq, Cupertino 4D , ` r:` Scope: 2nd Story Only Replace existing sliding door, like for like — t8 — �S PLANNING DEPT 1"INIQ ® COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION CUPERTINO APPROVED This set of plans and specificatio is MUST be kept at the AC job site during construction. It is unlawful to make any changes or alterations on tanne, or to deviate O therefrom, withcut approval fro the Building Official. The Stamping 1his plan and ations SHALL NOT be o o b Val of the violation Plan View f rov ce or State Law. T 'ERMIT it l S d { 3 39.00 58.00 Gv pepae 60.00 310.00 �� 1 � 2015NCE 0\ .P GODtation O� E�1EwEG R Reviewed BY �.— 60.00 3 10.00 , 3 10.00 —� t-3 9.00--0- 39.00 58.00 Ll2 8.00 Double Garage Door