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B-2016-2338 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:13-2016-2338 22288 BELLEVUE AVE CUPERTINO,CA 95014-2703(357 01 027) HOMEOWNER BUILDER OWNER'S NAME: KUO GENE KAND RITAY DATE ISSUED:07/18/2016 OWNER'S PHONE:408-623-0454 PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 'Lic.# Contractor HOMEOWNER BUILDER Date X BLDG _MECH X RESIDENTIAL_COMMERCIAL ELECT —PLUMB 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: I hereby affirm under penalty of perjury one of the following two.declarations: REPAIR STUCCO AND SIDING(425 S.F.) L 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. 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. Sq.Ft Floor Area: Valuation:$5000.00 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 357 01 027 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,.the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 7/1812016 Issued by:AbbyAyende Date:07/18/2016 14L", OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection.. ,sale(See'7044,Business&Professions Code) - I,as owner of the propert3;am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project(Sec.7044,Business&Professions Code).. Date:7/18/2016 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 _,-'performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall / be deemed revoked. O ner or authorized agent: _ APPLICANT CERTIFICATION dDate:7/18/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.), to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.1 1 understand my plans shall be used as public records. Signature Date 7/18/201Licensed Professional n CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228 FAX(408)777-3333•buildingCakupertino.org El NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/Ti ❑ REVISION 1 DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS APN OWNER NAME y9 PY p �ZN EA`Mauk �3 C1 p STREET ADD S CITY,STATE,ZIP FAX Z y�- 3Z A— o `rl CONTACT NAME PHONE E-MAIL STjTG CG-(SES vTW� U CITY,STATE,ZIP FAX OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTORNAME LICENSENUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK 14c-e-o e v . • Cn�l t),(Am (41S 5.A EXISTING USE PROPOSED USE - CONSTR TYPE #STORIES - USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM - KITCHEN OTHER' - - - - REMODEL AREA REMODEL AREA REMODEL AREA' PORCH AREA DECK AREA TOTAL DECK/PORCH AREA - GARAGE AREA[ CIDETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND-STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION DYES IF YES,PROVIDE COPY OF IS.THE BLDG AN ❑YES RE IVEDBYC '' TO AL LUATION:. PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO ' - By ray signature below,I certify to each of the following: I am the property owner or authorized agent to act onlhe property owner's behalf. I have read this application and the information I have provided is cpirect. 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 buildin cons ction. I authorize representatives of Cupertino to enter the above/-iden'fie property for inspection purposes. Signature of Applicant/Agent: Date: j SUPPLEMENTAL FORMATIONREQUIRED LA cHEC TYe roll csi _New SFD or Multifamily dwellings: Apply for demolition permit for OVER TIitE COUNTElk a�UILDING'Pi An*itkvr v existing building(s). Demolition permit is required prior to issuance of building permit for new building. Cl`ErREss J, Cl I'L.4NNINGZ*t ANI2EVLEw _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure CL.S ;D TANAIZP Q P LlIMURxs form if any Hazardous Materials are being used as part of this project. `LARGE 0 FIREDEPT. _Copy of Planning Approval Letter or Meeting with Planning prior to MAJ'O'RS4iSITARX SEttERDISTRICT submittal of Building Pennit application. CI Elite'IRON='4T-N7ALREALT,H S1dgApp 2011.doc revised 06121111 s x OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228>FAX(408)777-3333 o building(a)-cupertino.org CUPER.TIN 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 D" �f��i'' APN + 0' 01 BP# ElBi 233 OWNER ER ADDRESS9 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.) lP 'i. 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. _2. 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. ft4i3- 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. 5. 1 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. g6. 1 understand if I am considered an"employer"'under state and federal law, I must register with the state and al 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. 7. t 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 Ve.fformed under contract with a licensed general building Contractor. tL8. 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. OwnerBuilderForrn 2010.doc revised 04/14/10 . 1 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 mare information about licensed contractors. 10. 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. 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 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 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 accepta a to the city may be required to be presented when the permit is issued to verify the propeLty owners si nature. Property Owner's Signature: Date: 1 ------- ------------------------ ----------------------------------------------------------------------------------------- -------------- (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: Tel No Address of Authorized Agent: 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: ONnzerBuildetForm 2010.doc revised 04114110 E/ r` FlSMOKE 1' A ft V XXII IE ALARMS R ' 16 COMMUNITY DEVELOPMENT aEPARTMENT A BUILDING DIV1S10'N � 10300 TO.RRE AVENUE,,CUPERTINO,,!CA 95014-3255 (408)777-31228 a FAX"(408)777-8333. buillirrg&cpertino oro ri r twURcl' s llhis affidavit is a erf-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2:13 CRC Section R314,2013 CBC Sections 40.6 and 907.2.11.2 where no interior access.for inspec'ttM5 are rec aired: TION Existing Am farhl ily aztd multi-family dwellings shall be provided with Smoke Alarms and Carbo-t MOnoxide alarms When the valuation of additions,alterations,or repairs to existing d.well ug units exceeds $°Ia©0�©0 CIBC Sec�,ioru 1314 and CSC Sections 907 211.5 and 42Q.6 require that Smoke Alan s and/o'r Carbon MUM e Ala ns be insta,led in the fallowirtg locations: ARS 9-MMM, A,ARM CO'ALAR Outside of each separate sleeping area in the immediate vicinity of the beds`®©rm(s)k Orr wer fevellof a dwellin unit tndudin_ basements _ j WRhin"each glee;in{ roo m Carbon Mommilde alarms are nowt re ,aired in dwellin a which,do mat,contai ,f tell-bu,t �,- �, q g uining ap liances and tfLiat, 7 do not lm�a,,,e as anti c11ed ga=range Carfro nlonox de a arrm� coixlbir ed with scoot e ala�rrms sll�aill com ly wiih ` CBC Sec .oi 42A61 and sTmIllbe azppxoved by the-Office of the State Fire Marshal. Power S z <L. d=weell`u1 u- is wi�l na,coam,;ereia p, poly alar, ,,,(�.I, + y "b. e-ry ayerated.. Y g T ower`su t> s,tapy,be solely b ?tt Itn exisfix g (I�c?e11'i tg uiiit5, alarm are permitted to be solely battery operated wrhere repaks or al i,aitoilts,doe ii tat resuilt ins the removal of wall,and celligtig finishes or. Ther e is iso)access.by m eamms oaf antic;,Uas:err e,ml ar aawll space..Refer toe C;,C Sect on R3,14 and CDC Sections 9�0'7.2..TT.4 and 42�t5>..2-An electricatl pex t t t ss required fog alar-mss wlird��rnu t be coi�uR.ected to> � je bunldng wa�ritLng;. As owner of:the owe refexei�ce:d p>ioperty,f her=eby certify thatthen',alarin(s)referenced abo-ve has/fiave b.eeI% iiistall'ed = actor ai ce wit tl e ailufacturer`s iris:t eLctlons>adds.in corrnsplante with the Cafill'a taia)Builth tig axed CaUbm, R.sidendal Codes,. f e alat ms have been tested=and are operatro aal,as of the date sipied below., I�have=read,'and a-,pec to card,l=j with the;harms),and condition,s of, bis;staternentt { 5[' afu�e L 1 _. .....4 .�)c. D to i i WATER-CONSERVING PLUMBING FIXTURES F1 OWNER CERTIFICATE OF COMPLIANCE - COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTIN0 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)77-,3228•FAX(408)777-3333•building(a)cupertino:orq° 01 o �1 . Owner Name Permit N o. r� �t Address 1. Is your real)roperty 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. No Go to Question 2. 2. Does your r;al property have a licensed plumber certifying that,due to the age or configuration of the property or its plumbing,'j stallation of water-conserving plumbing fixtures is not technically feasible? ❑ Yes til 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. No Go to Question 3. 3. Is water sen ice permanently disconnected for your building? Q Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. No Cao 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. es My real property is built and available for use or occupancy on or before January 1, 1994. ivil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign b ttom of form.. 5. Pel jase,check ONE of the following: My property is a single-family residential real property. See Civil Code Section 1101.4. r NOn and after January 1,2014,building alterations or improvements shall require all non-compliant plumbing fixtures to be rep Faced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017,all non- complian plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether property dergoes alterations or improvements). Myproprty is a multifamily residential real property. See Civil Code Section 1101.5. On and aler January,1,2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or be ore January 1,2019,all non-compliant plumbing fixtures shall be replaced with water- cone ' g plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements). ❑ Myproperty is a commercial real property. See Civil Code Section 1101.5. On and a:.1er January,1, 2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or b6fore January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbinn 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 110.8,the current California 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 table on the rollowing page. Owner or Ow er Agent's Signature: Date: Upon conpieting and signing this Certific e,please return it to the Building Division in order to final your building permit. i SB407 2015.doe revised 08/26115