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B-2016-1206CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1206 22805 POPLAR GROVE SQ CUPERTINO, CA 95014-2653 (342 33 012) O�N�Iz OWNER'S NAME: CLARK BONNIE J TRUSTEE & ET AL DATE ISSUED: 01/19/2016 OWNER'S PHONE: PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor Date X BLDG —ELECT —PLUMB MECH X RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: Installation of 5'X5' skylight above stairway. I hereby affirm under penalty of perjury one of the following two declarations: 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. z. 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 Sq. Ft Floor Area: Valuation: $2000.00 this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: rect. I agree to comply with all city and county information is co;.-rect. ordinances and state laws relating to building construction, and hereby 342 342 33 012 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 PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION. Code, Section 9.18. Issued by: ]�� • /�• %� Signature Date Date: OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1. I, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: z. I, as owner of the property, am exclusively contracting with licensed Date: contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the z. I have and will maintain Worker's Compensation Insurance, as provided for California Health & Safety Code, Sections 25505, 25533, and 25534. I will by Section 3700 of the Labor Code, for the performance of the work for which maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the this permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I shall not employ any person in any manner so as to become subject to the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Worker's Compensation laws of California. If, after making this certificate of the Health & Safety Code, h ns 25505, 25533, and 25534. exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall Owner or authorized agent: be deemed revoked. Date: � r APPLICANT CERTIFICATION (ttI (b CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is-issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant ARCHITECT'S DECLARATION understands and comply with all non-point source regulations per the ' I understand my plans shall be used as public records. Cupertino Munic' al Code, Section 9.18. Licensed / Professional Signature Date�_(9 M f CCNSTRUC T ION PERMIT APPLICATION GONi}JtUi�l1_t 1' lOEV�LOPhJiEf�! t D=PAP, flVicf\f T">'BUiCDIh-G DJVISFON _... _.... _. 1.0300 TOR;RE AVENUE - CUP.ERTINO, CA 0,5014-3255. C U P E FtT t NO (408) 777-3228 • FAX (408) 777-3333 rl - buildlno cuDeno.Org El NEW CONS RUCj 10211 0 ADD! i ION ❑ RIEWISION / DEFERPEDi GRIGi?NpL PER?sI`I ?Ro,-rrrADD?Wss .22�-0S pop(ar ( I.F3Nn �l+'iIv'2 oV?._R 11AIJE CISNA 3n ; 2 Cl.m� •STREP ADDRESS CITY, SEA z <x 2 2 0S` Po (,'AEC G �- re� �o .CA- °iso e CONTACT NAVE P'301,7= E-?✓ <-1?. GJ\4 vlt CQA4� I t� 8 3 R-5 STIRMEL fLDtL-S5 22�iC�� PO��CY� C`��1N2 Ci?Y, 5^ is Z5P CT ` ,b 1 I FAX x0vii-Ex l]. 0w),-BUI_DER ❑ 01%4.-ER,AGEI T ❑ C01\rn,�L4CTOR ❑ Coln?i.ECTORAC-D' ❑. h? ='ECT ❑ �'G -R ❑ D1_L0? ❑ -� C01v'Tk.CTORTAI.4? I LILTS A1J143'aR I L1C�'SSTYF's I BUS. -LICA FAX S71BET ADDR ESS CI -1-Y, STAT--, ZI? PHOh2 f•.RC:UTiB-C-1 �NGB:?F Nf� 3 I LICENSET 3? SER I BU'S. LIC R CO)12.QIY NAME V.4LUAT10\1 Fes. i 0 STREET ADDPISSS I C7 Y. a IA i E, ZIP DEMO D.SCR3 T 10\1 OF WORK EXISTTNIGUSB ROPOSED,UtS-I COh's,Zi ni ?E f 6STs I 2 L'Sa I nPa I OCC. I SQ.FT. I V.4LUAT10\1 Fes. i 0 N7 -1v FLOOR DEMO TOTAL l,REA Ar A /-REA. I I-PaA. I BATI-MOOMI KriCFI-E-N oir^R RE-MODEL.�REA R -n- 40D=LAREA ^'MMODSLjC-ZA PORCH /,RBA DECK ARA TOT: I..DECK/POR C -i ARZA O 'DACE r?=.5: D=, AC3 I .�A T ThCi I I I I �. D1 T� L7.G uTTIS: is A. -SECOND UNIT ❑ Y=S I SECOND STORY DYES BEING ADDED? LE NO I fl f DDIT10N? �2\0 PP LD?LICAT10 YES u 1 S, PROVIDE COPY Or (] ?L<�?.fIOAP?Lm ❑'0 arl�'hL>\Gf3?iOVF.L I�1ia. I IS THE BLDG ATS ErCY.LER50h4E? ❑ rS �i�0 DEI ��ix c kw�yl U t TOT?1. V s i UATION: ay ,ry slE 78 Z re Oelow, Lce: �i_y ao flaCR OI ine SClfO i4 �: izm ine property ovmtr or authonzed ?Gent to act on the proper ; ow-ner's behalf I have read this application and the information I have provided is cor-, ect. I have read the DescIliption of VYork and verify it 1s acvlza`e I PET a to -comply -with all zDplic_.ble ]ocal e; einances and state laws r W; a to bui]din auction: I author reps esent_tives'of Cupertino to enter the above- ide timed prope;-y for inspection purposes. Sim1a:i±re ofADD] icent/A_ent: Date:. /I/rb SL-PPI:,E��1\rTr.L DNrORA,ATiO'-N P-H:QUT _- T) 2i :Or: exist -In a i -,v T rfiOlition I-miti's .required priory P of buLlding 0�4 rt`T =CO BL � G�Ld�Rn'3` iia _pe:Ti:it for neW b ii].ail,1. '] }• 7 � i 7 CO mrrc.ai 3Jdgs: Prov -;de a corrplem d Flaz dofus 1`!, i^ _ :. c.c ..I clS �.SC.C- -�3' ��? ��'�€-, . . I'-L=3^cieL•"Ei- �-F�O 'rCS� „ts "r� for -1 if — y Hazardous Ma`eria1S a be;,— used as part Of h:S plOjeCt. ?n �' v: `e° �s�tt�k � MW� Copy 0 Plzen -+� f' orzovcl Leiter Or with Pl_ri iLi ,g prior t0 L•]J ..�:2J OI;J3t ..dL.g P..:iT_11t n Dl.cEt n. c -,;" t,1 -, a p ; w�1...{'i^•�'.Yi.Sr. a."-�1r"II x.'0_2011. doc revised 06/2!1 CITY OF CUPERTINO Ww FFF, FCTIMATOR - RITILDING DIVISION imlADDRESS: 22805 Poplar Grove DATE: 01/19/2016 REVIEWED BY: Sean APN: BP#: "EVALUATION: 1$2,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 GENRE USE: $0.00 PERMIT TYPE: WORK Installation of 5'X5' sk li ht above stairway. Suppl. Insp. Fee: Reg. Q OT 0,0 SCOPE $0.00 - e'eh. /'ion F.'L't3c. is: F1,1 , pr'i• li I","e: 313?FY I-rnI i`ee: #:iF'i;, .t3frlYa t: r'xP'. NOTE. This estimate does not includefees due to other Departments (i.e. Planning, Public works, tire, sanitary sewer District, scnoot District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for attan't info. FEE ITEMS (Fee Resolittion .1.1-053 .Fff. 717/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.001= # Skylight $431.00 1SKYL<10SF <= 10 s.f. Suppl. PC Fee: (D Reg. 0 OT 0.0 T_h;s $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee: Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 i3' ti"idf.'alfsD?CT.ti. r Clliil171S'1:"t 1f`t'�' Fe'e' 0 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential E) Building or Structure 0 A ' dve t {; Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Suds Commission Fee: IBCBSC $1.00 SUBTOTA�S=, $1.50 $431.00 TOTAL YEE: $432.50 Revised: 01/01/2016 ZEN CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • building(a,cuoertino.org — Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS * -1 Y,'L APN_.. BP# OWNER NAME :.. n : 0 NE ADQRES$ ,.. DESCRIPTION OF WORK: We are providing you with an Ownet-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.) 'rl 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. 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. Com. 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. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. C'2"5. I 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. /1 . 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. IAK,7. 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. C: 1 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. doe revised 04/14/10 Dt6LW. I 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 (CS LB) at 1-800-321-CSLB (2752) or wvAv.cslb.ca.gov for more information about licensed contractors. rm, `1'0. I 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 agree that, as the party legally and financially responsible for this proposed construction activity, I will abtde all applicable laws and requirements that govern Owner -Builders as well as employers. 4C�I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information -I have -provided on this form. Licensed contractors are regulated by_.iaws 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 maybe in- civil court. If 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 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 note 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 verificatio ceptable to the city may be required to be presented when the permit is issued to verify the property owners sig re, r _ b.,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: 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: Owne)'BuilderForm 2010.doc revised 04/14110 am sI20FM`,�fill: �v( kA A � Q N 1:ZZA r-- Q 'a kA Q N BASIS OF DESIGN: VELUX VCS solar venting Curb mounted skylight Fasten to curb with screws furnished with skylight Shealhing- Underlayment Note I & 3 VELUX ECL Saddle Flashing I _ T —�— ..� ._ � Curb VELUX Solar Panel ELEVATION and Ron Sensor VELUX ECL Sill Flashing \ lib 1/4" Max \ \ ��-^ . 1`\�� v \ I \\\\ Headers or blocking VELUX ECL y Underla menl er4 ` as required per code(s) VELUX ECL Head Flashing otlI &1 3f- \\\\\\ \ \ / - N Step flashing ---BASIS OF DESIG14: Nola 7 A 3 placed between underlayment VELUX VCS solar venting \ \ Asphalt ,-i Curb curb mounted skylight Asphalt shingle \\ / shingle_��( ,—Fasten to curb with straws furnished with skylight r \ Underlayment Not,, 11 Fc 3 II(I - j l Insulation SECTION A—A I II I Vapor harrier Finish material I I I I Note 2 I I ( I 1. Underlayment to be folded up aaains4 all sides of curb. 2. Vapor barrier should be used to avoid moisture. I I I 3. Wrap curb in underlayment. VELUX recommends use i-- I I - I of VELUX type 2UZ 216 odhesiv(, underlayment. I II I Ij VCG �� ECL (� -•-� Asphalt ��r'� shingles r- Light shalt Insulation ----' Vapor barrier - I tato 2 Finish material SECTION B—B `Blacking as required per rode(s). Insulate carefully around shaft is on instrument of service, and is provided for informationol use 2008 VELUX GROUP aVELUX 1418 Evans Pond Rood Greenwood. SC 296a9 1-800-88-VELUX sky -1`10. t Mon.gemmt Nw..VELUYIJSA.com N.— Dot. Drown by JIMJuf 2013 Checked b WO Ju 2073 Drowing No. VCS -02-0613 VCS--Residential/Commercial Roof Section (Light Shaft and As halt Shingles) VELUX 1s a registered trademark ENGLISH: Maintain illustrated clearances between skylight frame and critical areas such as valleys, ridges, slope changes and roof -to -wall - intersections. ESPA&OL: Respete los espacios libres ilustrados entre el marco del tragaluz y areas cr ticas tomo limahoyas, cumbreras, cambios de inclination e intersectiones de techo y pared. FRANPAIS : Respecter le d6gagement illustre entre le cadre du puits de Iumiere et les endroits critiques tels que noue, faitage, variation d'inclinai- son et intersection de toiture et mur. F�lGUSH L6ght shaft �pplicatioei ESPA QL Ap11caG�n cis! huecei d� 4iai` : Aid his POuetour du p>sits d idirn6 s _, _P� No jWIkfIFAtI ;'Jicdas:d+�! a�clia 8 VELUX DE ANZA OAKS HOMEOWNERS ASSOCIATION December 7, 2015 Connie Chan Lot 043, 22805 Poplar Grove Square Cupertino, CA 95014 Dear Connie, Regarding your recent Architectural Application dated November 20, 2015 to install 2 skylights, I am pleased to inform you that the Architectural Committee has reviewed & approved your request. Sincerely yours, ffstiYau Association Manager DE ANZA OAKS HOMEOWNERS ASSOCIATION C/O MAVERICKS REALTY MANAGEMENT 268 BUSH STREET, #4200, SAN FRANCISCO, CA 94104 (415) 691-7663