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15090203CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7443 STANFORD PL CONTRACTOR: LAW PATRICK Y AND HO PERMIT NO: 15090203 DOREEN OWNER'S NAME: LAW PATRICK Y AND HO DOREEN 7443 STANFORD PL DATE ISSUED: 09/30/2015 OWNER'S PHONE: 4088020737 CUPERTINO, CA 95014 PHONE NO: ® LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ CONSTRUCT (N) 240 S.F. SHED IN REAR YARD AREA License Class Lie. # Contractor 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. Sq. Ft Floor Area: Valuation: $8000 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 APN Number: 35932037.00 Occupancy Type: 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 EXPIRES IF WORK IS NOT STARTED permit is issued. WITHIN ISO RMIT ISSUANCE OR APPLICANT CERTIFICATIO I certify that I have read this application and state that the above information is J 3.1 1, 111 S F ST CALLED INSPECTION. correct. I agree to comply with all city and county ordinances and state laws relating– rlss—,aby: to building construction, and hereby authorize representatives of this city to enter ate: 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 RE -ROOFS: all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 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 Signature Date inspection. Signature of Applicant: Date: OWNER -BUILDER DECLARATION ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE compensation, will do the work, and the structure is not intended or offered for I have readthe hazardous materials requirements under Chapter 6.95 of the sale (Sec.7044, Business & Professions Code) California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain 2. 1, as owner of the property, am exclusively contracting with licensed contractors to compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & construct the project (Sec.7044, Business & Professions Code). Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air I hereby affirm under penalty of perjury one of the following three declarations: contaminants as defined by the Bay Area Air Quality Management District I will t. I have and will maintain a Certificate of Consent to self -insure for Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation, as provided for by Section 3700 of the Labor Code, for the Health & Safety Code, Sections 25505, 25533, and 25534. performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as for by Owner ora d agent: r 1 provided Date:' Section 3700 of the Labor Code, for the performance of the work for which this —z permit is issued. 3. I certify that in the performance of the work for which this permit is issued, I shall CONSTRUCTION LENDING AGENCY not employ any person in any manner so as to become subject to the Worker's I hereby affirm that there is a construction lending agency for the performance of work's Compensation laws of California. If, after making this certificate of exemption, I for which this permit is issued (Sec, 3097, Civ C.) become subject to the Worker's Compensation provisions of the Labor Code, I Lender's Name must forthwith comply with such provisions or this permit shall be deemed Lender's Address revoked. ARCHITECT'S DECLARATION APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I understand my plans shall be used as public records. correct. I agree to comply with all city and county ordinances and state laws relating Licensed Professional 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 CONSTRUCTION T APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 ®buiidar�o u3ct�t�er+ino orcl ❑ NEW CONSTRUCTION r ADDITION ❑ ALTERATION/ TI ❑ REVISION / DEFERRED ORIGINAL PERMIT ■ PROJECT ADDRESS 1443 57, -,o a -R "'yo Cear - APN # � 9 `' � '® - OWNER NAME PHONE E-MAIL T ICK +.S � �� %'a�$C STREET ADDRESS p� l CITY, STATE, ZIP _ FAX CA 95 CONTACT NAME ffi (f R l Ci , �J 9 PHONE GAP o z o 7J � EMAIL C '1"6i /C A AA: 7 STREET ADDRESS �9�p p� CITY, STATE, ZIP ,p a QiRe � 71,vo ?6-a I FAX FA iKOWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER E3 DEVELOPER ❑ TENANT CONTRACTOR NAMB- I--- 5CL 5lt'&l__ __-- e�, LICENSE NUMBER �� 1 _ LiCENSE.TYPE- - _ Cz 5 BUS-.4AC-#- - COMPANY NANM SFE� f/vc E-MAIL $ST4C.91 �r FAX STREET ADDRESS 7 T S ��i�s ! si Gc 1 CITY STATE, ZIP �t>��Cl2 �� YO2-10 PHONE � �s ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME 'T ( uF l 11vc E-MAIL R1 IaS CZ TkFF3I E;) FAX STREET ADDRESS 1777 CITY, STATE, ZIP AEIViI_ PHONE S933 DESCRIPTION OF WORK f2 X 2Q EXISTING USE PROPOSED USE - CONSTR. TYPE # STORIES - Eh-(Pf Y LO- ( -5 To ieA-L2:- AU, x 1 J USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA , NEW FLOOR AREA �/ I DEMO AREA TOTAL NET AREA .L (�Q �� Alt A Z 40 Rao a - e) BATTIROOM KITCHEN - OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA - DECK AREA.... .. TOTAL DECKIPORCH AREA GARAGE AREA: k1A ATTACH # DWELLING UNITS: ISA SECOND UNIT DYES SECOND STORY 13YES - BEINGADDED? ❑NO ADDITION? ®NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDGAN ❑ YES IVEDBY:. - TOTAL VALUATION: PLANNINGAPPL# ONO PLANNAIGAPPROVALLETTER EICHLERHOME? - - t ecoo By my signature below, I certify to each of the following: I am the property owner or autho act on er's behalf I have rea s application and the information I have provided is correct. I have read the Description of Work ar tt i is accurate. ee to ply with ail applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the abo -identified eriy for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CRECK TYPE ROI313xG Slip [ OVFR-TM-COUNTER ❑ WILDING PLAN REVIEW _ New SFD or Multifalnily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building, ❑ EXPRESS ❑ PLANNING PLAN REVIEW — Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑: PUBLIC WORM form if any Hazardous Materials are being used as part of this project. ❑ :LARGE 11FM-DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ -NmioR ❑ SAMTARY SEWER DISTRICT submittal of Building Permit application. ENVIRONMENTALREALTH BldgApp_201 1. doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 7443 STANFORD PL DATE: 09/30/2015 REVIEWED BY: MELISSA APN: 359 32 037 BP#: PERMIT TYPE: Building Permit PLAN CHECK TYPE: PRIMARY SFD or Duplex WORK CONSTRUCT N 240 S.F. SHED IN REAR YARD AREA *VALUATION: 1$8,000 Alteration f Repair rPENTAMATIONUSE: ERMIT TYPE: 1GENRE SCOPE 1.1-i £1, ire rin £ Tee: tt(F r 'lle lE /,2sp, Other Plu in is�:>. tltt er Flee, tl s{ . iL{e£`YI. h7st". Fee: PiZ7 nb. Imp, Fee: P' ec;. jf sp. Fee: $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -(E) Reg. 0 OT0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Ccar:struc tion 'Taly: ALbnir7isir'utive Fee: C Work Without Permit? 0 Yes (D No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure A lvvl r: i nis esumate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc. ). These fees arP himpt1 nn the TYO)1lniHnYlf iH fnrmntinx nrrn>Inhlo nc.�l nrn nr,Ar n ncHa., .tn / n.,f . t 4L T .,t f . 1 Fz 77 :z F FEE ITEMS (Fee Resolution 11-053 f . 7/1/13, ,Rech Plan i. heckf'B171n1b.. Man (_IzeL,k fj7Ce3 ( 11C'{X .Pi llt7t J . Pe, ,w i 1 Fee: 1.1-i £1, ire rin £ Tee: tt(F r 'lle lE /,2sp, Other Plu in is�:>. tltt er Flee, tl s{ . iL{e£`YI. h7st". Fee: PiZ7 nb. Imp, Fee: P' ec;. jf sp. Fee: lvvl r: i nis esumate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc. ). These fees arP himpt1 nn the TYO)1lniHnYlf iH fnrmntinx nrrn>Inhlo nc.�l nrn nr,Ar n ncHa., .tn / n.,f . t 4L T .,t f . 1 Fz 77 :z F FEE ITEMS (Fee Resolution 11-053 f . 7/1/13, FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # $430.00 Shed ISHED Suppl. PC Fee: Reg. 0 OT0,0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -(E) Reg. 0 OT0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Ccar:struc tion 'Taly: ALbnir7isir'utive Fee: C Work Without Permit? 0 Yes (D No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure A Irr�%E?l.{}c°arJrellc�lc{r I Vc'.: Strong Motion Fee: IBSE1SMICR $1.04 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 ITBTCITzLS: $2.04 $430.0016A'; FEE: $432.04 Revised: 07/02/2015 M 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(Mcupertino.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 elaLe dAPN 3 S�9 2 � U 3 �- sa 7Q -z-o-3 OWNE AME r0) rip OWNER ADDRESS._ = DESCRIPTION OF WORK: 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.) 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 insurance coverage for injuries to workers on my property. VM 2. 1 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. 17-L3. 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. ,"4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. k -,L4-5. 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. 9"+ 6. 1 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. Q"-4 7. 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 performed under contract with a licensed general building Contractor. 1� 8. 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.doc revised 04/14/10 U�A_9. 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 (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. (N10. 1 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. V�A 11. 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 information 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 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: 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 owners signature. Property Owner's Signature: D ate: OwnerBuilderForm 2010.doc revised 04/14/10