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B-2016-1336CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-1336 7805 BOLLINGER RD CUPERTINO, CA 95014 (359 22 077) OWNER -BUILDER OWNER'S NAME: Wesley Shao (Shan Wesley Trustee & Et AI ) OWNER'S PHONE: 408-416-1737 LICENSED CONTRACTOR'S DECLARATION License Class Lie. # Contractor OWNER -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 6/6/2016 hereby affirm that I am exempt from the Contractor's License Law for one of the Blowing two reasons: m. 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 sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 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. 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. 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 -pain urce regulations per the Cupertino Municipal Code, Sectiop,9.1A. Date 6!6/2016 DATE ISSUED: 06/06/2016 PHONE NO: (562) 802-1100 BUILDING PERMIT INFO: X BLDG —ELECT X PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: INSTALL 2 (N) PATIO COVERS; (N) GARDEN SINK, WET BAR SINK AND BBQ SINK; INSTALL (N) DESIGNATED GAS LINE TO BBQ REVISED SCOPE OF WORK - INSTALL 3 (N) PATIO COVERS, BBQ SINK; INSTALL (1) DESIGNATED GAS LINE TO BBQ. 4/1/16 Sq. Ft Floor Area: I Valuation: $120000.00 APN Number: Occupancy Type: 359 22 077 PERMIT EXPIRES IF WORK IS NOT STARTED WITIIIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM by: 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: 6/6/2016 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 Munici al Code, Chapter 9.12 and the Health &Safety Code, Sectio , 533, and 25534. Owner or authorized agent: Date: 6 2016 UC 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 ARCHITECT'S DECLARATION understand my plans shall be used as public records. Licensed Professional 0 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777`3228 • FAX (-408) 777-3333 • building2cupertino.org El NEW CONSTRUCTION ❑ ADDITION l_J ALTERATION I TI n REVISION I DEFERRED ORIGINAL, PERMIT # PRORiCTADARESS 7805 Bollinger Rd. -7APNN OWNER NAME fQB-MAFIJ1{^J4 bJt ra sjaia STREET ADDRESS 7805 Bollinger Rd. CITY, STATE,ZIP Cupertlno, CA 9501-4 FAX CONTACT NAME Greg Bogart PHONE 714-206-2088 E-MAIL Christa@socalrooms.com STREETADDRESS 1072 N. Kraemer PI CITY, STATE," Anaheim, CA 92806 ��562-802-11.01 ❑ OWNER ❑ OWNPR•BUILDER © OWNERA40MT CA CONTRACTOR ❑CONTRACTORACENT 13 ARCHITECT 13 ENGINEER 13 DEVELOPER 1I TENANT CONTRACrORNAMESotlthem Calinforina Rooms, Inc. LIMNSENUMBER 827937 TLICIMETYPE 8 BUS. I.ICff COMPANYNAMB Same E-MAIL christa@socalrooms.com FAx 562-802-1101 STREET ADDRESS 1072 N. Kraemer Pi OITY, 8TATE,.ZIP Anaheim, CA. 92806 PHONE 5e2-802-1 100 ARCHITECTIENGINFER NAME LICENSE MM M BU& I'M COMPANYNAMH s EivfAtr C FAX .PCZ g 1Z (141 STREET?DHSS' �� CrrY, S ATE IP PROM DESCRIPTION OF WORK Install r# now patio covers CjZ tQ"4 EXISTIMUSE - PROPOSED USE CON PE N STORIES USE TYPE OCC. SQ FT. VALUATION ($) EXISTO AREA NEW FLOOR AREA DEMO. AREA TOTAL NST AREA _ .. BATHR M REMODEL.AREA KITCHEN IL MODELAREA OTHER RUMUMLAREA PORC[i AREA TOTAL DECKIPORCH AREA DECKjig GARAGE AREA; DETACH ATTACH A DWELLINOUNITS:.A SECOND UNrr ❑YES, SECONDSTOEINGADDEO? [3NO ADDITION? LINO PRE -APPLICATION []YES IFYES,PROVIDECDPYOP PLANNINGAPPLN 13NO PLANNING APPROVAL LETTER IsTIIERLI7GAN AYES rietwEitno 7 No VEDS ( , r A1.VALUATI (�,.�fijl,J'}� Vy��j � By my signature below, I certify to each of the f g: la e pm er or authoriz agent to act: on the property owner's l have read this application and the information I hove pr d is correc av the scription of Work and verify it is accurate. I agree to comply with all applicable local Ordinances and laws state relating ilding con on, thorize repr entatives or i to enter the above -idled pr erty for inspection purposes. Signature of ApplicantlAge Date: SUP E ORWY4 N D PLAN CHECK TYPE ROUTING SLIP Now .I'fl'Zi Or Multi y dwelling • pply for demolition permit for Q OVER �td'BUII,DING existing buitding(s}. erinolitiou permit is required prior to issuance of building -'RHE -COUNTER PLAN: REVIEW permit for new building.,� EXPRESS '. PLAN REVIEW _ Commercial i3ldgs.. Provide a completed Hazardous Materials Disclosure form ��❑/j. JOt, STANDARD ,Y�d,/PLANNIl�IO 'L6 PU9LIC WORKS �. if any Hazardous Materials are being used as part of this project. 1 LARGE GE q 1!TRE nle'r Copy of Planning Approval Letter or Meeting with Plalming prior to L 1:1© ,� / Yff submittal ofl3uildingPermit application. A t3 sA E DISTIUCT N 1 ENVIRONMENTALIIEALTH BldgApp 2011.doc revised 06/21/11 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (4081777-3333 - building(cDcupertino.org Dear Property Owner(s): An application for a building permit has been improvements specified at: SITE ADDRESS OWN DESCRIPTION OF in your name listing yourself as the builder of the property APN k� We are providing you with an Owner -Builder A knowledgment 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. (DIRECTIONS: Please read and initial each si Bt rrfa . 1 understand a frequent practice of er" building permit that erroneously it personally. I, as an Owner -Builder, may N an unlicensed person and his or her emplc provide coverage for those injuries. I am v insurance coverage for injuries to workers di?. I understand building permits are r onstruction and are not hiring a licem 93. 1 understand as an "Owner -Builder ro t myself from potential financial risk name instead of my own. 4. I understand Contractors are requi s on permits and contracts. 5. 1 understand if I employ or otherwi: lue of my construction is at least fig considered an "employer" under state and Z6. 1 understand if I am considered an e 1 government, withhold payroll taxes unemployment compensation for each "en me to serious financial risk. (L7.I understand under California Cont tial structures cannot legally build t licensed subcontractors and the number o is performed under contract with a Iicensei 8. I understand as an Owner-Builder'l ncial or personal injuries sustainec defects in the workmanship or materials. below to signify you understand or verify this information.) inlicensed persons is to have the property owner obtain an "Owner - plies that the property owner is providing his or her own labor and material held liable and subject to serious financial risk for any injuries sustained by gees while working on my property. My homeowner's insurance may not Ilfully acting as an Owner -Builder and am aware of the limits of my m my property. required to be signed by property owners unless they are responsible for Contractor to assume this responsibility. am the responsible party of record on the permit. I understand that I may y hiring a licensed Contractor and having the permit filed in his or her by law to be licensed and bonded in California and to list their license engage any persons, other than California licensed Contractors, and the hundred dollars ($500), including labor and materials, I may be �deral law. 'employer" under state and federal law, I must register with the state and provide workers' compensation disability insurance, and contribute to ployee." I also understand my failure to abide by these laws may subject actors' State License Law, an Owner -Builder who builds single-family em with the intent to offer them for sale, unless all work is performed by structures does not exceed four within any calendar year, or all of the work general building Contractor. I sell the property for which this permit is issued, I may be held liable for by any subsequent owner(s) that result from any latent construction Owne7BuilderForm 2010.doc revised 04/14/10 I understand I may obtain more inf enue Service, the United States Small and the California Division of Industrial Ac License Board (CSLB) at 1-800-321-CSLE contractors. �210. 1 am aware of and consent to an e parry legally and financially respon 0 11. 1 agree that, as the party legally a applicable laws and requirements th 412. 1 agree to notify the issuer of this ation I have provided on this form. L you contract with someone who does not. I assist you with any financial loss you may Contractors may be in civil court. It is also employee of that individual or firm is injury you obtain a permit as Owner -Builder and those Contractors are properly licensed ar CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the fol I hereby affirm that there is a construction I (Sec 3097 Civ.) Lender Name: )rmation regarding my obligations as an "employer" from the Internal Business Administration, the California Department of Benefit Payments, ;idents. I also understand I may contact the California Contractors' State (2752) or www.csib.ca.gov for more information about licensed ner-Builder building permit applied for in my name, and understand that I le for proposed construction activity at the site address listed above. I financially responsible for this proposed construction activity, I will abide govern Owner -Builders as well as employers. orm immediately of any additions, deletions, or changes to any of the censed contractors are regulated by laws designed to protect the public. If ave a license, the Contractors' State License Board may be unable to sustain as a result of a complaint. Your only remedy against unlicensed mportant for you to understand that if an unlicensed Contractor or J while working on your property, you may be held liable for damages. If Nish to hire Contractors, you will be responsible for verifying whether or not d the status of their workers' compensation insurance coverage. lending agency information.) ing agency for the performance of the work for which this permit is issued Lender Address: Before a building permit can be issued, thi form must be completed and signed by the property owner and returned to the agency responsible for iss 'ing the permit: Note: A copy of the property owner's driver's license, form notarization, or other verification accepts / he citv may be required �to be presented when the permit is issued to verify the property owner's sin r Property Owner's Signature: Date: ----------------------------------------------------- (NOTE: The following Authorization Form is agent of the property owner to apply for a co Excluding the Notice to Property Owner, the e authorize the following person(s) to act as my Owner -Builder Permit for my project. Scope of Construction Project (or Description Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: I '/ ------------------------------------------------------------------------------------ uired to be completed by the property owner only when designating an action permit for the Owner -Builder). i of which I understand is my personal responsibility, I hereby ) to apply for, sign, and file the documents necessary to obtain an Work): Tel No 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 requi�ed to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwneYBuilderForm 2010. doe revised 04/14/10 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone, 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: PERMIT # _ -1 -"-20 OWNER'S NAME: PHONE # S 2' GENERAL CONTRACTOR: 3�-Qj�1 i� 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: Signature Please check applicable subcontractors and complete the following information: Date Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing V SA N co'_ &21 66,5 Cj 31 Electrical Excavation Fencing Flooring / Carpeting Linoleum /Wood Glass / Glazing .5 C_ 9 z % � 3 Heating Insulation Landscaping 6S Lathing Masonry Painting / Wallpaper Paving_ SOFA (,6 Plastering Plumbing 66 Roofing 92% 3 Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date \/ // WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE I l�- wst./9ss COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)7 7-3228•FAX(408)777-3333•buildinqAcupertino.orq Owner Name 4 / 1 Permit No, j �' _p r 3 Address -7 c f �y/i eem, 4 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. 7kNo 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. g° No 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. Vi 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. ❑ Yes 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. S' Please check ONE of the following: 71, My 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 property undergoes alterations or improvements). ❑ My 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- I 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 plumbmg 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 Cahforma 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 it table on the following page. Owner or Owner Agent's Signature. . Date r�Ch Upon completing and signing this Certificate,please return it to the Building Division in order to final your buil.'ing permit. SB4072015.doc revised 08/26/15 's ,t SMOKE I CARBON 1‘110140XID:E ALARMS 1 lor.; OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT,DEPARTMENT*BUILDING DIVISION 10300 TORRE AVENUE.CUPERTINO,CA 95014-3255 (408)777-3228*FM(408)777-3333*buildinqAcupertino.orq r,— 0311'• - • 2064 3 -nos ibipilm Aviyhiv-4 t „ix . 1)4 -,-1:1; , 1.,pmpcdfrillgii*reatitti atft. I olooNiaaji:Vwgf 4' ;t4...$ • - • • Ptil POSE Th's affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for co pliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for ins e ections are required. G INERAL 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 $11100.00,CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Merioxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the X X bedroomN On every level of a dwelling unit includirt:basements X Within each sleeping room X C.Tbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that de not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with C C Section 420.6 and shall be approved by the Office of the State Fire Marshal. P ewer Supply.In dwelling units with no commercial power supply, alarm(s)may be solely battery operated. irclwellingunits,al tsarepermitt.ed-to-hcsaelyrbattery-Operated-where-repairs-or alteratiOirgtki— — not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl s ace.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. s owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been stalled in accordance with the manufacturer's instructions and in compliance with the California Building d California Residential Codes.The alarms have been tested and are operational, as of the date signed blow t.toy&read(and a,offee to con* with:the terms and conditions of this statement (41:Titiiiiie tf V's5 41 _ f ggiibtair6: . aii19.Z5/110 - 1 L Y2-76?37 flDa6.: 167/Z6.../47 ••-h