15090149CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20650 PARK CIR CONTRACTOR: yam, ,/ 1^ y� PERMIT NO: 15090149
uM A • t ` u1CT�- oP N xA.
OWNER'S NAME: NIU JIMMY CHENG CHUAN AND NANCY HSU ',W OaL AN G SwM DATE ISSUED: 09Q2/2015
OWNER'S PHONE: 4083987743 I rix' PR --1 I rAc C!9. Y)A I PHONE NO:WCV� I
,CJ LICENSED CONTRACTOR'S DECLARATION
License Class C' IZ Lic. # l)�
Contractor OfWZLi 1/4� p
Date / 2 Z-
1 hereby affirm that 1 am licensed under the provisions of Chapter 9
(commencing µ ith 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:
t. 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.
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
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. 1 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
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 re ati ns per the Cupertino Municipal Code,
/Section
—9.18.
Signature Date / L L l
❑ OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
t. 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 (Sec.7044, Business & Professions Code)
2. 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
1 hereby affirm under penalty of perjury one of the following three declarations:
i. 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. 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
permit is issued.
3. 1 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, I
become subject to the Worker's Compensation provisions of the Labor Code, 1
must forthwith comply with such provisions or this permit shall be deemed
revoked.
APPLICANT CERTIFICATION
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
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
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
4 PLEX - INSTALL 12 WINDOWS AND 3 PATIO DOORS -
TOTAL (3 WINDOWS IN EACH UNIT AND PATIO DOOR M
UNIT# 1,2,4)
Sq. Ft Floor Area: I Valuation: $15000
kl'N Number: 32632016.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM /L�AST� CALLED INCS�PECTION.
Issued by: ��C s- �" Date: L
RE -ROOFS:
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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should 1 use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Ilealth & Safety Code, Sections 25505, 25533, and 25534.
Ownerofize agent:
Date: �f -2
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Professional
1
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildina(I)cuoertino.org
❑ NEW CONSTRUCTION ❑ ADDITION 4�1 .ALTERATION / TI ❑ REVISION/DEFERRED ORIGINAL PERMIT r
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OWNER AGENT
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CONTRACTOR NAME7�
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A_RCHITECTiENGINEER NAME
LICENSE NUMBER
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DESCRIPTION OF WORK
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E\1STUvG USE PROPOSED USE CONSTR TYPE
I STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
-
BATHROOM
KITCHEN
OTHER
REMODEL AREA.
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DE-CKIPORCH ARE
GARAGE AREA: LJ DETACH
❑ ATTACH
I
K DWELLING U'. JTf
IS A SECOND UNIT ❑YES
SECOND STORY ❑YES
BEING ADDED? ZaNO
ADDITION? ONO
PRE -APPLICATION []YES IF YES. PROVIDE COPY OF
IS THE BLDG AN ❑YES1�BYl�
-
TOTAL. VALUATION:
PLANNINGAPPLN ❑ L NO PLANINT4GAPPROVALEITER
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By my signature below, I certify to each of the following:
I am the property owner or authoriz d agent to act on the property owner's behalf. 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 lays relating to buildi nstru tion
I authorize representatives of Cupertino to enter the above-. entified property for inspection purposes.
Signature of Applicant./Agent:
Date: -2 —
SUPPLEMENTAL MIFORMATION
REQUIRED
1—KE I\,CHECK�TS,�E t ,
_ ROUTING SLIP` 'tom`:
-`
❑
New SFD or Multifamily dwellings: Apply for
demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building
P
_0� ER THIsCOiJ ITER
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BI II DLNG PL AIr REVIER
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PtiAATL�GPLAN REY7E .
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_ Commercial Bldgs: Provide a completed Hazardous
Materials Disclosure
4V? TAI\'DARRD of
❑ �IiBLrcYvoRhs
form if any Hazardous Materials are being used as part of this project.3�
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Copy of Planning Approval Letter or Meeting with
Planning to
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❑ FIP.E DEPT -
_
prior
_ -R`- '--_'
❑
submittal of Building Permit application.
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SAIvTTARY SEWER DISTRICT
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❑ E\lTRO\11 E:\TAL FiF..4L IA
BldgApp_2011.doc revised 06/11111
��,������������ CITY OF CUPERTINO 15MN91�1'—flAI FFF FCTIMATOR — BUILDING DIVISION
ialADDRESS:
20650 Park Circle E
QTY/FEE
DATE: 09/22/2015
REVIEWED BY: PAUL
Plan Check Fee:
APN: 326 32 016
BP#:
'VALUATION:
1$15,000
-PERMIT TYPE: Building Permit
Suppl. PC Fee: Q Reg. Q OT
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
Multi -Family Dwelling
Buildino is PENTAMATION 1GENRES
>3 Stories O Yes (0 No PERMIT TYPE:
USE:
$0.00
WORK
4 Plex - Install 12 windows and 3
patio doors - Total 3 windows in each unit and patio door in
SCOPE
Unit#1,2,4)
PME Unit Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, rubric woms, rrre, aanuary newer "imricv, .3ci,vvi
District etc I These fees are baser/ on the nrelimina in ornration available and are only an estimate. Contact the De t or adrin'l info.
FEE ITEMS (Fee Resolution I1-053 l:(l' ' l 13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
=#
$574.00
Window / Sliding Glass Door
IWINREP Replacement
Suppl. PC Fee: Q Reg. Q OT
0.0
his
$0.00
PME Plan Check:
$0.00
Permit Fee:
Suppl. Insp. Fee -.0 Reg. Q OT 0,0 his
$0.00
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
onstructlon Tax.
:Jrnijrislr(Wv(! FCC
O
0
Work Without Permit? O Yes Q No
$0.00
Advanced Planning Fee.
$0.00
Select a Non -Residential
Building or Structure
E)
0
"ravel Uocuunctualion F0
Strong_Motion Fee: IBSEISAIICR
$1.95
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.95
$574.00
TOTAL FEE:
$576.95
Revised: 07/02/2015
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Address
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building0cuaertino.org
C,QWfi�n b 'A 1 _ H Permit
�r k r�l�, w • # of Alarms Smoke: 1- z C
FILE
Asa iO/Vg
PERMIT CANNOT BE F'INALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
X
X
On every level of a dwelling unit including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
1 have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
.i
C�nd kcaz
h 1�
Si nature......:.. ............ .....C'L .... Qom...... �J�t"...................... Date: �..12- (,t.C
ContractorName:
ilf
Sinatur .. Date
lZj l .1...
Smoke and CO forn:.doc revised 03/18/14
�SZ.fytJ
Owner Name
WATER -CONSERVING PLUMBING FIXTURES VILE
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 11
!11 J
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(40 777-3228 • FAX L408)-777-3333 • building d-)cupertino.org /�� n 'l'
(_f
-0(mnn m V 1 Permit No. / l� U
Address PQ 1L I C Wyy
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
`�Vo Go to Question 2.
2. ``Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its
plumbing, installation of water -conserving plumbing fixtures is not technically feasible?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
11��Io Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
�J`No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
❑ No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
'f i'l'es My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. P e check ONE of the following:
y property is a single-family residential real property. See Civil Code Section 1101.4.
On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures
to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non-
compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether
operty undergoes alterations or improvements).
y property is a multifamily residential real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water -
conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
❑ My property is a commercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements).
I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's
installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the
table on the following page.
I Owner or Owner Agent's Signature:, . V,'ty�` {–\C+kYTt c4Cl f— C " Date: 1111). Ik.\ I
upon compietmg ana signing i us t.errncate, prease return it to the tsuuarng urvrsron in oraer to nnar your Dmrarng permit.
SB407 2015.doc revised 08126115