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15060152 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1102 MILKY WAY CONTRACTOR:PARKVIEW EDGE PERMIT NO: 15060152 PROPERTIES LLC OWNER'S NAME: PARKVIEW EDGE PROPERTIES LLC 2015 MANHATTAN BEACH BL100 DATE ISSUED:0623/2015 OWNER'S PHONE: 3106403070 REDONDO BEACH,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL REMODEL 2 BATHROOMS(80 S.F.),KITCHEN REMODEL License Class Lic.# (90 S.F.),INSTALL NEW ELECTRICAL/LIGHTS(15), Contractor Date OUTLETS(45),REMOVE AND REPLACE(7)WINDOWS AND 1 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: 1 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:$50000 1 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:36220006.00 Occupancy Type: 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 D FROM LAST CALLED INSPE TIO . indemnify and keep harmless the City of Cupertino against liabilities,judgments, /16V' IAN costs,and expenses which may accrue against said City in consequence of the �� granting of this permit. Additionally,the applicant understands and will comply Issued by: ti� Dater 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. b OWNER-BUILDER DECLARATION I 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 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) 1,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 1 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 nt or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined b -Bay Area r Quality Management District I performance of the work for which this permit is issued. will maintain compliancC,Sect* t Cu rtino icipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Cod 5 3 and 25534.Section 3700 of the Labor Code,for the performance of the work for which thisOwner or authorized ag Date: " permit is issued. I certify that in the performance of the work for which this permit is issued,I shall .V�JI 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,I 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 1 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 thi dditionally,the applicant understands and will comply with all onA4oint sa lations per the Cupertino Municipal C e,Se tion Licensed Professional source 9.18. 6 / Signature Date ` CONSTRUCTION PERMIT APPLICATION 150(0015a COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•building(cDcupertino.org CUPERTINO ❑NEW CONS iRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT PROJECT ADDRESS I o- V' 1 't APN# OWN7_ 1 I��\ eiU C11,;' (r 7 E•IVLAIL S DESS .4_ .-}. � `R_ .i I CIT i C>7F� FAX CONTACT NAME40"L S P531 ��' ( CITY,STA Alt *VS 3 13 OWNER ❑ OWNtR-BUILDE,RXWNER AGENT ❑ CONTRACTOR 11CONTRACTOR AGENT ❑ ARCHITECT ElENGINEER 11 DEVELOPER ❑ TENANT CONTRACTOR NAME 'I�, I LICENSE NUMBER LICENSE TYPE BUS.LIC# ve COMPANY NAME EMAIL FAX STREET ADDRESS I CITY,STATE,ZIP PHONE ARCIUTECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS P CITY,STATE,ZIP PHONE 1 � � lei J t 11" ��Cil f do J�r wl ^rF�y �G�� 1 lie- re E STING USEPROPOSED USE CONSTR.TYPE I k STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR, DEMO TOTAL AP.EA AREA AREA NET AREA BATHROOM. 5(1 KITCHEN. �' OTHER. REMODEL AREA QI0 REMODEL AREA_�/o REMODEL AREA PORCH AREA ((DEEck AREA TOTAL DECK/P/ORCH AREA I GARAGE AREA: 0 DETACH ❑A T TACH #DWELLING UNITS: ISA SECOND UNrr ❑YES SECOND STORY ❑YES -- BEINGADDED? NO ADDITION? ANO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES I ED BY T UATION: PLA'N'ING APPL r ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO - £ ) By my signature below,I certify to each of the following: I am the properr or authorize agent to act on the properl 1 owner's be ialf, I have read this application and the informationWve .rovid Vcrr��hav re d the Description of Work and verify it is accurate. I a ee to comp with all applicable local ordinances and state law relattI a or' representatives of Cupertino to enter the , �ident Fi ro for jets purposes. VInLI Signature of Applicant/Agent: SUPPLEMENTAL INFORMATION REQUIRED RE '' Q FzANC1Cx1P , �313QGSL,_ New SFD or Multifamily ciNvellings: Apply for demolition permit for r`OYER�'HE-COUNTER'- � r .UILbII�G PLS REY existing building(s). Demolition permit is required prior to issuance of building � � permit for new building. _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure fe form if any Hazardous Materials are being used as part of this project. ,, —U Copy ._ _Copy of Planning Approval Letter or Meeting with Planning prior to - OR pL� SER R I T submittal of Building Permit application. Bldg4pp_201 Ldoc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 1102 Milky Way DATE: 06/23/2015 REVIEWED BY: Paul APN: 362 20 006 BP#: 'VALUATION: $50,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: __TPERMIT TYPE: WORK Remodel 2 bathrooms 80 S.f. Kitchen Remodel 90 S.f.), Install New Electrical/ Li hts 15 Outlets SCOPE (45), Remove and Replace (7) Windows and (1) Slider door ,Meth. Plan Check P111/11h. flan Check Elec. Plan Check 0.0 hrs $0.00 Mech. Permit Fee Plarmh, Pelmir Elec. Permit Fee: IEPERMIT Other rllech.Insp. F-1 I Ocher Plumb Insp. Other Elec.Insp. LLO hrs $48.00 14ech. hasp. Fi>e Plumb. hasp. Fee 1:lec. Insp. Fee: 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'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1113) FEE QTY/FEE7 MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel, Bath(<=300 sf) Suppl. PC Fee: (F) Reg. © OT 0.0 hrs $0.00 $645.00 IREMRESBAT k, A PME Plan Check: $0.00 F 90 s.f. Remodel, Kitchen(<=300 sf) Permit Fee: $0.00 $645.00 1 1REMRESKIT Suppl. Insp. FeeQ Reg. o OT 0.0 hrs $0.00 15 Electrical PME Unit Fee: $0.00 $72.00 IBREMF/XT Fixtures, Lighting PME Permit Fee: $48.00 = # Electrical Construction Tax: $173.00 IBREMRECEP " Recep/Switch/Outlets Administrative Fee: (ADMIN $45.00F$43 # Window/Sliding Glass Door Work Without Permit? © Yes E) No $0.001.00 I WINREP ; Replacement Advanced Planning Fee: $0.00 Select a Non-Residential E) Travel Documentation Fee: ITRA VDOC $48.00 Building or Structure i Strom Motion Fee: IBSEISMICR $6.50 % Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $149.50 $1,966.00 TOTAL FEE: $2,115.50 Revised: 05/07/2015 k. OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO c1 (408)777-3228• FAX(408)777-3333•building cupertino.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 DS / _TA `= BP# ��[ /�I OWN A t .eLf V S d 1V <C/ V1 DE OF .� I G lL ' 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 (DIR TIONS:Please read and initial each statement below to signify you understand or verify this information.) 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 in prance coverage for injuries to workers on my property. 02. 1 understand building permits ermits are not required to be signed by property owners unless they are responsible for t construction and are not hiring a licensed Contractor to assume this responsibility. W 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 e instead of my own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license n mbers 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 Pidered an "employer" under state and federal law. . I understand if I am considered an "employer" under state and federal law, I must register with the state and fe eral 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 serious financial risk. o . 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 erformed under contract with a licensed general building Contractor. 8. 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 defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 3 I understand I may obtain more information regarding my obligations as an "employer"from the Internal enue 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. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I e 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 irinmation applicable laws and requirements that govern Owner-Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the l 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 mus ompleted and signed by the property owner and returned to the agency responsible for issuing th ermit. te:A copy of the property owner's driver's license, form notarization, or other verificatio accept ble t ity y required to be presented when the pe mit i issued to verifythe property owners si na re. Property Owner's Signature: 12 % Date: 5 - -------------------------------------------------------------------------------------------------------------------------------------------- (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 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: OwnerBuilderForm 2010.doc revised 04/14/10 -- EIVED] Parkview Edge Properties, LLC N 23 2015 Lou r Suite#100 Redondo Beach,CA 90278 Phone: 310-640-3070 Facsimile: 310-640-3090 Wednesday June 22, 2015 Re: 1102 Milky Way. Cupertino,Ca 95014 To Whom It May Concern: This letter is to verify that William Rahal is authorized by our company as vroverty supervisor. Mr.Rahal is authorized to view,access, sign for,file for,and pull any general rehabilitation permits,electrical permits,plumbing permits,property plans and any other required general permits needed for the following property: 1102 Milky Way. Cupertino,Ca 95014. 1 thank: you in advance for your assistance and prompt attention to this matter. If you should have any questions please feel free to contact me at 310-640-3070 03� C"UPERTINO nuilcling DepartmentSincerely. JUN 2 3 2015 REVIEWED FOR CODE COMPLIANCE Reviewed : T4W'awvt� Gre^Jds^J^�- President n k'J JUN 23 0 � � BY: � 2 D C)Lk LJe5 FICE COPY COMMUNITY DEVE�ENT DEPARTMENT BUILDING DIVISION - CUPERTINO APPROVED This set of plans and specifications MUST be kept at the - CUPER INO job site during construction. It is unTawful to make any Building De artment changes or alterations on same, or to deviate therefrom, without approval from the Building Official. A 015 The Stamping of this plan and specific�itions SHALL NOT of any p sions of any City State Law, RE4WED FOR CODE COMPLIANCE L3 yeeviewed By: T zWVp! DATE _ PERMIT # G CUPERTINO i Building Department JUN 2 3 2015 REVIEWED FOR CODE COMPLIANCE U� Reviewed By: Tpw vw 3LI) � � ►r v (All 1 33 CUPERTINO �l�✓ (�(� s Sullding Depadment 0a JUN 2 3 2015 REVIEWED FOR CODE COMPLIANCE Reviewed By: rou Lco nn\� �J 1 (2ec6V Oe(a 0-4- (k) 7&