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B-2016-1331 Permit, App, OwnerBldr Disc & PlansCITY OF CUPERTINO BUILDING PERMIT BUH.DINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-1331 898 BRENT DR CUPERTINO, CA 95014-4553 (369 24 025) OWNER OWNER'S NAME: KUOK KWONG YUI AND LO CHEUNG DATE ISSUED: 02/09/2016 OWNER'S PHONE: 408-777-0708 PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lie. # Contractor OWNER Date 02/09/2016 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: INSTALL 9.5' TALL PRIVACY PANELAT FRONT DOOR (8'LONG) I hereby affirm under penalty of perjury one of the following two declarations: r. 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: $350.00 this permit is issued. 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 APN Number: Occupancy Type: ordinances and state laws relating to building construction, and hereby 369 24 025 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 CALLE FCTION. Code, Section 9.18. Issued by: MELISSA NAME Signature Date 02109/2016 Date: 02/09/2016 OWNER-BU"ER DECLARATION RER 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 fast obtaining an inspection, I agree to remove all new materials for r. I, as owner of the property, or my employees with wages as their sole inspection. 11 \J 'compensation, will do the work, and the structure is not intended or offered 1 for sale (Sec.7044, Business & Professions Cade) Signature of Applicant: 2. I, as owner of the property, am exclusively contracting with licensed Date: 02/09/2,016 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 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 2. 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 emnphance 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 s. I certify that in the performance of the work fm which this pemut is issued, I material. Additionally, should I use equipment or devices which emit hazardous shall not employ my person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I 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 Cade Sections 25505, 25533, and.2�34. exemption, I become subject to the Worker's Compensation provisions of the Labor Code, Imust forthwith comply with such provisions or this permit shall r Jp Owner or authorized agent: d ,✓C be deemed revoked. Date: 02/09/2016 APPLICANT CERTIFICATION CONSTRUCTION I END G 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 will comply with all non -point source regulations per the I understand my plans shall be used as public records. Cupertino Municipal Code, Section 9.18. Licensed Signatur LrA'U Date 02/09/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255. ts 7 CCU PERTIN0 (408-I )) KVV777-3228 • FAX (408) 777-3333 - build!ngCa�cu pertlno.org _ ZQ (6 ' 1 7 I NF\rr nnNr QT'R n!`TInN ATN ^^ inI AT TFR ATTnNI l TT I RFVTST(1N /TIFFFRRFTI nRTCHNAT.PFRTQTTii PROJECTADDRESS Dri' APN# .®3 // Y / Q � ' L-U OPUIERNAME PHONE%', E-MAIL Dio STREET ADDRESSg . y CITY, STATE, ZIP�°�I 71�,.e JI fij y-G� J FAX qk j y l CONTACT NAME Tl I I� A /T T C /t \ J^r"I PHONE �� 15 � E-MAIL .STREET ADDRESS �V137T Llt mlW, T1V PX CITY, STATE, ZIP �vl FAX LUG Cq. ❑ OWNER OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGDdEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME oL,--, /bf%nt', — LICENSENUMEER LICENSE TYPE BUS. LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTIONOF WORK 't I95tkjj C,I I{Z o,�j feet py1 VaT_,e pr,,Ae( fAc,)IAr (Sur 11CY EXISTING USE PROPOSED USE CONSTR. TYPE STORIES USE TYPE OCC. SQ.FT. VALUATION (i) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODELAREA PORCHAREA DECKAREA TOTALDECK/PORCHAREA GARAGEAREA: DETACH ❑ ATTACH #DWELLINGUNITS: IS .4 SECOND UNIT ❑YES SECONDSTORY ❑YES BEI9G ADDED? ❑No ADDITION? ❑NO PRE -APPLICATION ❑YES E YES, PROVIDE COPY OF IS THE BLDG AN ❑YES REC TOTAL VALUATION: PLANWMGAPPL# ❑NO PLANTING APPROVAL LETTER EICHLERHOME? ❑NO By ury signature below, I certify to each of the following: I am the property owner or author¢e agent to act on the property owner's behalf- II 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 laws relating to b ding eonshuctioD I authoaiA representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicanUAgent: Gr%G Date: SUPPLEMENTAL INFORMA ION REQUIRED 'i=iaNCHECHnwE New SFD or Multifamily dwellings: Apply for demolition per for 0 ❑ existing building(s). Demolition pennit is required prior to issuance of building- oY ERcxxe cotnTER BUILnI\cPLA\ RLl IEu' pennitfornewbuilding. D EaTRESS ❑ PLANNING PLA REYIEN. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure fl 'sTa&n4Rn - PUBLTC AVORRS _ fonu if any Hazardous Materials are being used as part of this project, ❑ _ Copy of Plarming Approval Letter or Meeting with Planning prior to LARGE-,O s❑ nLn.IoR FIRE nePT=.` fl sA\ITARY san ER nrsxxtcT submittal of Building Permit application. € i _ - Q EN VIRONMENTAL HEALTH' Bldo 4pp_201 Ldoe revised 06121111 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777.3228 - FAX (408) 777-3333 - buildino(acupertino,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 ADDRESS .. .._.. .. .....:.. ... pl ..APN BP# OWNER NAME dmqz DESCRIPTION OF WORK:-- TKkt lj 02- feet erWA-e- i2allef ai front coyl ey 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.) . I 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. J y� 12. 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. Y3. 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. KJ4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. �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 ($600), including labor and materials, I may be considered an "employer" under state and federal law. � 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. `\ 17. I understand under California Contractors' State License Law, an Owner-Builderwho 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, q8. 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 cwner(s) that result from any latent construction defects in the workmanship or materials. Owner'BuilderForn1 2010.doc revised 04114110 I `+ L�9.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.csib.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 am the party legally and financially responsible for proposed construction activity at the site address listed above. K1. 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. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the nformation-i have provided on this form. Licensed contractors are regulated bylaws 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 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 note those Contractors are properly licensed and the status of theirworkers' 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 Property Owner's Signature: - ----------- --------- ----- -------------------------------------------------------------------------------- ------------------------- (NOTE: The fotiov✓ing Authorization Form is required to be completed by the property ov✓ner only when designafing 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: 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 verity the property owner's signature. Property Owner's Signature: Date: ONmerBuilderForm 2010.doc revised 04114110 Building Department CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax:408-777-3333 JOB ADDRESS: , )-" rj Ve PERMIT # OWNER'S NAME: ` PHONE # —V 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: ignature Please check applicable subcontractors and complete the following information: z—lc�ft-6 Date SUBCONTRACTOR BUSINESS N E BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry zz Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date Assessor's Parcel Number: \/ Name ofOwner:� Contact Person: '/ 1 w L-t• Tts71� � Phone: 6 •— 1—[I Jc Project Address: Scope of Work: q %2" Re4 Code Editions: 2013 California Residential Code 2013 California Plumbing Code 2013 California Mechanical Code 2013 California Electrical Code 2013 California Energy Code Coo �c� ovi It�u4w P� DA�� P GVp�R N� OFFICE a• - bvHLY:wN4' IS T N[� 7FEwce' d I TPr�tvr�T� p � NITY DEV LOPNIENT DEP: DIN;; CIVf: ION - ^ .,r_ TINOENT � �� RTINO APP VED be kept at the n.ItS i or . o rn3ke any. ons on ,a or to deviate ! Nfoval froi he St r i� B';i:ding Official. ,,e held and S' a ' '! "r SHAD NOT she.. I p , , a! cf the violation 4f vio Y -Ue�YQSSLIr�Uf Wp I 5/2- t 4pvsr , ��YpQi� t,�l�'ERTIN® � 201 y, �I 1 +inc Department 3 r 4 t (i �Q96 FoortNG 15`r REVIEWED FOR CODE COMPLIANCE Reviewed By: a C' Assessor's Parcel Number: Name of Owner:14 k k Contact Person: j)) i,\j L `CSA Phone: LIOS-T O6 -- Project Address: Scope of Work: Code Editions: 2013 California Residential Code 2023 California Plumbing Code 2013 California Mechanical Code 2013 California Electrical Code 2013 California Energy Code OCC ?CAV\C a (ULAP cov, S\CA.bvl Jpe- v-E) �f Cl lPERTINO 3 ^g Department lniz- REVIEWED FOR CODE COMPLIANCE Reviewed By. WCD, �11 2 -e V— 1 0 WALrtuHy � I STl NCB i° FENLc PrtIV%yT� �/-1fb�L vjocx% , SWI I � pr p SS�I tr-eA 0j 0d , 0 5/2- 3� 15" i t� B P,ANT py . 1��i S"✓ 1. L1INF,1t 9 �