Loading...
15090050CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10257 GLENCOE DR CONTRACTOR: TRACY HSU PERMIT NO: 15090050 OWNER'S NAME: TRACY HSU 22333 SANTA PAULA AVE DATE ISSUED: 09/09/2015 OWNER'S PHONE: 4084645030 CUPERTINO CA, 95014-2835 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] INSTALL TEMPORARY POWER License Class Lie.# 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 Sq. Ft Floor Area: Valuation: $400 Code and that m license is in full force and effect. y I hereby affirm under penalty of perjury one of the following two declarations: APN Number: 32630016.00 Occupancy Type: 1. 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. 2. 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 PERMIT EXPIRES IF WORK IS NOT STARTED permit is issued. WITHIN 180 DAYS OF PERMIT ISSUANCE OR APPLICANT CERTIFICATION 180 D YS F LED INSPECTION. 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 relatin q Xy to building construction, and hereby authorize representatives of this city to ente ssued Date: _4 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 ROOFS: granting of this permit. Additionally, the applicant understands and will comply with All roofs shall inspected prior to any roofing material being installed. If a roof is r o all non -point source regulations per the Cupertino Municipal Code, Section 9.18. installed without first obtaining an inspection, I agree to remove all new materials for Signature Date inspection. Signature of Applicant: Date: OWNER -BUILDER DECLARATION ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIALS DISCLOSURE compensation, will do the work, and the structure is not intended or offered for I have read the hazardous materials requirements under Chapter 6.95 of the sale (Sec.7044, Business & Professions Code) California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain 2. I, as owner of the property, am exclusively contracting with licensed contractors to compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & construct the project (Sec.7044, Business & Professions Code). Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air I hereby affirm under penalty of perjury one of the following three declarations: contaminants as defined by the Bay Area Air Quality Management District I will t. I have and will maintain a Certificate of Consent to self -insure for Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation, as provided for by Section 3700 of the Labor Code, for the Health & Safety Code, Sections 25505, 25533, and 25534. performance of the work for which this permit is issued. Owner or thorized a 2. I have and will maintain Worker's Compensation Insurance, as provided for by Date: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. CONSTRUCTION LENDING AGENCY 3. 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 I hereby affilin that there is a construction lending agency for the performance of work's Compensation laws of California. If, after making this certificate of exemption, I for which this permit is issued (Sec. 3097, Civ C.) become subject to the Worker's Compensation provisions of the Labor Code, I Lender's Name must forthwith comply with such provisions or this permit shall be deemed Lender's Address revoked. ARCHITECT'S DECLARATION APPLICANT CERTIFICATION I understand my plans shall be used as public records. 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 Licensed Professional to building construction, and hereby authorize representatives of this city to enter 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 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. Signature Date al CUPERTINO GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 10-7 (408) 777-3228 • FAX (408) 777-3333 • buildina(G cupertino.orcl/ C�� jf I G)DO 7, PLUMMING ❑ MECHANICAL ❑ ELECTRICAL ❑ MISCELLAATEOUS PROTECT ADDRESS f Q �n I� co APN R Z� OWNER NAME "ON" ON O8— -3a E AIL rIV5u(�i) STREET ADDRESSF.AX 2i3- o a �.�e. CITY TATE, ZIP e cA 8- z CONTACT NAME Tra-etCG-�C�iJJ �� PHO —44p ' �d E-MAII� '"Cj'j� STREET ADJIS� 3 O C Z I.C�CGI CITY, TATE, ZIP \�p 1 AX Z ❑ OwER OWNER-BURDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TE' ANT CONTRACTOR N.AAE /, LICENSE NUMBER LICENSE TYPE BUS. LIC COMPANY MARE E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCMTECT/ENGI°SER NAME LICENSE NUMBER BUS. LIC R COMPANY MAME E-MAIL FAX -- — STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX BUILDING: ❑ COMMERCIAL ❑ MULTI -FAMILY PROJECT LN WI DLANTD ❑ YES PROTECT IN ❑ YES URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK T CIW 2Y Ngo 1 -- TOTAL TOTAL VALUATION: �V By my signature below, I certify to each of the following: I am the property owner or au ed agent to act oil ad this application and the infonnation I have provided is correct. I haver d the Description "Ork and veri gree to comply with all applica al ordinances and state laws relating to 0 * Pell, struction. I e representatives mo to enter the above -id ntified property for inspection purposes. Siggmatwe of ApplicandA;ent: Date: G7 /6 PLEMEN lXFORMATION REQUIRED LJ LSI E" ATEP1likApp_2011.doc revised 06121/11 C V41 CITY OF CUPERTINO W—WE FEE ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 10257 GLENCOE DR DATE: 09/09/2015 REVIEWED BY: MELISSA UNITS APN: 326 30 016 BP#: *VALUATION: $400 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: Amps PENTAMATION 1 REAP14 PERMIT TYPE: WORK INSTALL TEMPORARY POWER SCOPE Suppl. Insp APPLIANCE / EQUIP TYPE FEE ID Phak1b. Plan C:'hec QTY UNITS BP FEES Elec. Permit Fee: IEPERMIT Temporary Power 1ERT<200 Other Elec. Insp. El hrs $48.00 100 Amps $48 Permit Fee: Suppl. Insp PME Unit Fee: $48.00 PME Permit Fee: $48.00 Construc lion Tax: Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes (D No $0.00 TOTALS: A Travel Documentation Fee: 1TRA VDOC $48.00 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution I1-053 Eff. 711113) tlech. Plena Check Phak1b. Plan C:'hec Elec. Plan Check 0.0 hrs $0.00 4dech. Permit Fee: Plumb. Permit Fee: Elec. Permit Fee: IEPERMIT Otter it iech. Insp. Other Plunab .Insp. Other Elec. Insp. El hrs $48.00 4ircrt_ Ir��i�_ l'ec> /',!' a?3 Inv). Fee: t NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution I1-053 Eff. 711113) FEE QTY/FEE MISC ITEMS Plan C'heck.Fee; �"ttPpl. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. Insp PME Unit Fee: $48.00 PME Permit Fee: $48.00 Construc lion Tax: Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes (D No $0.00 £clvaneed Planning .Fees: A Travel Documentation Fee: 1TRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg; Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $190.501 $0.00 TOTAL FEE: $190.50 Revised: 07/02/2015 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: D G ce) PERMIT # J OUB OWNER'S NAME: Y PHONE # 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 Please check applicable subcontractors and complete the following information: Date / Controtor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation ��, �11L ?� 4 �- 3 v 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 / Controtor Signature Date AAM 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 (Mcuoertino. ora 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 ADDRESS7...APN. �27 ... / — ©i b BP S—LZ�f OO� OWNER NAM _ ..:. OWNER AD ES b DESCRIPTION OF or 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.) W1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - r' 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. 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for t e 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 p tect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license tubers on permits and contracts. -9/-5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the t tal 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. I6. I understand if I am considered an "employer" under state and federal law, I must register with the state and feral 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. 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family re idential 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. l8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for a financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction d fects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 717 9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal evenue 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 wv✓w.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 the party legally and financially responsible for proposed construction activity at the site address listed above. /_11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide all applicable laws and requirements that govern Owner -Builders as well as employers. For 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the mation l have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If ontract 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 maybe 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 signature. Property Owner's Signature: ����f, I Date: CJ/St // c)_ I -- - -- - -- -- - --- ------------------------------------------------------------------------------------------ (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 pen -nit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/14/10