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15070039CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15070039 939 COTTONWOOD DR CUPERTINO, CA 95014-4666 (369 17 044) HOMEOWNER . - MITT TIRD OWNER'S NAME: SBEN JINGYANG AND FU LIRE OWNER'S PHONE: 408-930-7633 LICENSED CONTRACTOR'S -DECLARATION License Class Lic. # Contractor HOMEOWNER BUILDER 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 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. 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 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 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 4115/2016 OWNER -BUILDER DECLARATION 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 compensation„ will do the work, and the structure is not intended or offered for 1.,_sale (Sec,7044, Business & Professions Code) ' z.` as owner of the property, am exclusively contracting with licensed �/ contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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. 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 Compensation laws of California. If, after making this certificate of 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 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. Sign t re 1 _ Date 4/15/2016 ISSUED: 04/15/2016 PHONE NO: PERMIT INFO: BLDG —ELECT _ PLUMB MECH — RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: CONSTRUCT (N) 245 S.F. SECONDARY UNIT (ATTACHED) Sq. Ft Floor Area: Valuation: $50000.00 APN Number: Occupancy Type: 369 17 044 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Avende Date: 04/15!2016 utbIA 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: 4/15/2016 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I 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 I use equipment or devices which emit hazardous 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 the Health & Safety Code, Lv,� Sec25505, 25533, and 25534. Owne or authorized agent: Date: 4/15/2016 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 Address ARCIHTECT'S DECLARATION I understand my plans shall be used as public records. Licensed CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION IMMF 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 101 (408) 777-3228 • FAX (408) 777-3333 - buildingaPcupeitno.org 9 ❑ NEW CONSTRUCTION ❑ ADDITION . ❑ ALTRRATTnN/TT ❑ uPVTCTnIJinT77PT?DT:T-) r)PTnTT.TAT 1)=T)TrrrV PROJECT ADDRESS q sq c�on C o W ATN T l�J7 PHONEp OWNER NAME S i9 ` ` ( �" 09 q" ® 1 ®3 E-MAIL C STREET ADI"'""° I+*-- +¢y� A ( i . p Y7 -y- - CITY, STATE, ; I FAX i T _f'C�w�IE\Ipf�1— 2- (R512n CONTACT NAME PHONE �^�JM5',E-MAlI. K t gam, RVeW Le STREET ADDRESS +� J► , � �❑��`0'1ANECR.AGEENTT CITY, STAT. _ Tp FAX El OWNER 1. OWNER -BUILDER ❑ CONTRACTOR ❑CONNTRAACTORAGENT -ARCHIIE�CT- ElENGA'EER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LICENSE NUMBER LICENSE TYPE I BUS. LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE CHITEC NGINEFRNA.ME (Z__ L'�4 LICENSENUMBER �rZP�l�a "lg�p BUS. LIC COMPANY NAME EMAIL \ 0®- FAX STREET ADDRESS [� CITY, STATE. ZIP 9NNO '®0 IA (VA PH01IE C4C&) 2$� DESCRIPTION OF WORK L� EXISTING USE - PROPOSED USE CONSTR TYPE 'I STORIES ,. f-� I I USE - TYPE I OCC. I SQ.FT. VALUATION (S) EXIST AREA EW nARI FLOOR�� EMO DAREA TOTAL NET AREA BATHROOM - KITCHEN- OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE ARFA: LJDETACH - ATTACH I N DR'ELLINGUNTTS: IS ASECOND UNIT YES SECOND STORY []YES BEING ADDED? E]NO ADDITION? No PRE-APPLICATION WYES IF YES, PROVIDE COPY OF I PLANNINGAPPL» NO PLANNING APPROVAL LETTER IS THE BLDG AN [] YES' EICHLERHOME? 3Z�FCEIVEDBY � ti_ � TOTAL V UATION: U W.0 ! _ V c By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I 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 building construction. I authorize representatives -of Cupertino to enter the above -identified property for inspection purposes. S ignature of Applican Agent: Date: 7117 / (ivy C SUPPLEMENTAL D\TFORMATIOIN RE UIRED Q = -- . _ �,.:_ ROI3TLRGSLIP:=. _ New SFD or Multifamily d-, ellings: Apply for demolition permit for =W ovER xl coilltTER BUILD cp> err existing building(s). Demolition permit is required prior to issuance of building vlEw permit for new building. C7�sTni�DalzD _ Commercial Bldgs: Protide a completed Hazardous Materials Disclosure r Icwolixs—_ form if any Hazardous Materials are being used as part of this project. = x Copy of Planning g Approval Letter or Meeting with Planning prior to x '` �v —IS -T _ ^-'I�-L+fA7QR - Iily'iT�iR SEFi'ER' . C'�. submittal of Building Permit application. _ ,� � >� � �=� ��-���; BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FF.F. ESTIMATOR - RITIL.nINf DlVICIn1V RESS: COTTONW00D DR DATE: 07/07/2015 REVIEWED BY: MELISSA jj&[YN: 369 17 044 BP#: VALUATION: 1$50,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: 2nd Unit? '. Yes No PENTAMATION 1 R3SFD2ND PERMIT TYPE: WORK CONSTRUCT N 245 S.F. SECONDARY UNIT ATTACHED SCOPE Permit Fee: TYPE OF FLR AREA OCCUPANCY TYPE: CONSTR. s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 245 $2,654.00 IR3PLNCK $1,666.00 IR3INSP I TOTALS: I 245 ( $2,654.00 $1,666.00 I Ivhch. Placa Check Phwib. Plan Clreefi Elea Plan Check .l tech. f erafil Fee 1'lurnb. Permi7 Fee: Elec. Perrrii Fee: Ofher Afec h, Irqrp. other Plumb Imp. 0they, Alec. Imp, ,lrle?ch, Insp. Fee: Phinlb. Insp. Fee: tlec. Ir>sl . I ee: NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13,) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,654.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,666.00 Suppl. Insp. Fee: Reg. 0 OTF0l hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1 #new units $684.98 Administrative Fee: E) Work Without Permit? 0 Yes • No $0.00 Advanced Planning Fee: IPLLONGR $34.30 Select a Non -Residential Building or Structure i T r at,el Z; oc°u;,nentafion 17ees°; Strong Motion. .Fee: 1BSEISMICR $6.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 sBTOTALs: $5,047.78 $0.00 µ TOTAlt, $5,047.78 Revised: 07/02/2015 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • buildincecuoertino.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 7 n ( �. _ ✓.......APN. q 1-7- . 0 0 ` � I �Pr t OWNER NAME f ,�. ... _ 0_WNER ADDRESS• l DESCRIPTION OF WORK: CONSrkU N vqMy�eQ T ( 1 ALP`( �� ,N��p�/y� 1 LJGL .' T�ICt .q 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. W's 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.) X1. 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. -. 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. �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 name instead of my own. _k4. 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. 4al 1 understand if I employ or otherwise engage any persons, otherthan California licensed Contractors, and the 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. +I understand if I am considered an "employer" under state and federal law, I must register with the state and -reerai 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. kI understand under California Contractors' State License Law, an Owner -Builder who builds single-family 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 perormed 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 a4 financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the v✓orkmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 r 19. 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 l may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or wvAv.cslb.ca.gov for more information about licensed contractors. l. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I t�hparty legally and financially responsible for proposed construction activity at the site address listed above. b al11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abfde l 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 in rmation-I 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 maybe in- civil court. Itis also important for yov-to understand that if an unlicensed Contractor or employee of that individual or firm is injured .while working on your property, you maybe held liable for damages. If you obtain a permit. as Owndr-Builder and wish to hire Contractors, you will be responsible for verifying whether or not-- those otethose Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construcfibh 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: 2 Date: (4- f ')-,0( (NOTE: The follov✓ing Authorization Form is required to be c -o- m-- p--l-e-t-e- W by the property ov✓neronly when designating -a-n---- agent nagent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZA T ION 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: O4"rerBuilderForm_2010.doo revised 04-/19/10 Cupertino Union School District 10301 Vista Drive, Cupertino, CA 95014 Tel (408) 252-3000 • Fax (408) 865-0326 N® 10730 Developer Impact Fee Compliance The Cupertino Union School District has adopted Resolution Nos. 1403 and 1404, imposing developer impact fee pursuant to Government Code 53080. Building Permit Request The City of CU 1�No has received a request for a Building Permit described as follows: loResidential Development Project ❑ Commercial/Industrial Development Project Name of Developer: L" �� Q � Project Address: q l q C )fir %ot Description: Weu) %cA\6 W\\k /, Square Footage: 2 55 Lot/Parcel #: �-�- q �� - Qq9 Permit* 1501 OOM Date: 416 wc By: ity Authorized Representative Square footage will be verified by the city prior to issuance of a building permit; fees may be adjusted accordingly. Important Notice: Cupertino Union School District gives no credit for total demolition of existing square footage area, which makes way for new construction as mandated in the Government Code Sections 53080, 53080.6 and 65995. SCHOOL DISTRICT DEVELOPER IMPACT FEE CERTIFICATE OF COMPLIANCE The authorized representative of the Cupertino Union School District has reviewed the City of - Building Permit Request described above and hereby certifies that the developer or authorized representative has met the requirements of the District's Developer Impact Fee requirements. Dated: By: Authorized Representative Cupertino Union School District Fee: $ Certificate not valid without Check No.: District seal, initial, and date. Facilities Planning - White City - Yellow Requestor - Pink Accounting - Gold The City of FREMONT UNION HIGH SCHOOL DISTRICT 589 WEST FREMONT AVENUE SUNNYVALE, CALIFORNIA 94087 408-522-2200 Developer Impact Fee Compliance Building permits will not be issued without a completed Certificate of Compliance Building Permit Application has received a request for a Building Permit described as follows: New Residential Development Residential Addition (501) sq. ft. or more ^ Commercial Development Name of Owner / Developer: L Project Address: ))q cokAww A)(,we Lot/Parcel # ')4.rl i1- Oqq Square Footage: 2 �—,6 Description: QCU 'xawA Lit Permit / Plan Check # 4 O 9 Date: +1� Ilk r By: 1.1-�V1, �t�(1Y e City Building Inspector Square footage verified by the city prior to issuance of a building permit; fees may be adjusted accordingly. Feeder Elementary District _A `� ................... --............ ..........._.....t1 ._...... SCHOOL DISTRICT DEVELOPER IMPACT FEE CERTIFICATE OF COMPLIANCE The authorized representative of the Fremont Union High School District has reviewed the City of l t : t-' ✓1 Building Permit Request described above and hereby certifies that the developer or authorized representative has met the requirements of the District's Developer impact Fee requirements. Dated: 1"1 ` 1 S - I G- By: Certificate not valid without District Seal, Initial, and Date Distribution: Facilities Planning -White City - Yellow Fremont Union High School District Authorized Representative Fee $ -3d I � Requestor - Pink Accounting - Gold Dev. Impact Fee Compliance (Rev. 11/22/05) [12/08 - 1000) CUPERTINO Building Department CITY OF CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3228 • FAX: (408) 777-7606 OFFICIAL NOTIFICATION OF NEW SUITE NUMBERS TO: All Agencies FROM: City of Cupertino DATE: February 01, 2016 RE: New/ Change of Address APN #369-17-044 Please note the following new address: 937 Cottonwood Dr is adding an attached 2nd unit. The main house will remain 937 Cottonwood Dr and the new 2nd unit will be 939 Cottonwood Dr. The new address will take effect 15 days from the date of this letter. See attached map. Please update your records accordingly. If you have any questions, please call me at (408) 777-3246. Sincerely, Susan Winslow Administrative Clerk Cupertino Building Dept 408-777-3246 or suew@cupertino.org Idress Labels ass Labels - line Roads lays City of Cupertino lf rr� h '�i t SCALE 1 :956 r^ 50 0 50 100 150 f� FEET N Monday, January 25, 2016 8:3 CUPERTINO Date: 7/8/15 Building Department CITY OF CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3228 • FAX: (408) 777-3333 OUTSIDE AGENCY PLAN CHECKING FEES Agency Name: 4 -LEAF Permit Number: 15070039 (New 2nd Unit) q3 % Project Address:-9al'COTTONWOOD DR Plan Check Fees: $1,725.10 Hourly plan check fees: Number of hours: Plan check based: 1St & 2nd plan checks included in initial plan check fee: $1,725.10 (Agency Fee -65 % already calculated) 3rd plus plan checks: Number of hrs ($143.00 per hr, 2hr min. minus 10%) Please attach this form with the number of hours spent on the 3rd plus plan checks and send with the plan check comments or if plans are approved, with the plans & approval letter. Please email the plan check comments to: Melissan(&cupertino.org 'Please do not give plan check comments directly to the customer. We don't give out the comments until we have all of them back from each department.