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15120201i CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: : PERMIT NO: 15120201 805 ROSE BLOSSOM R CUPERTINO, CA 95014-4213 (359 03 052) L N INC LFREMONT, 4539OWNER'S NAME: M & Mrs THOMAS N AND DOLORES CTRUSTEE SOSODATE ISSUED: 04/07/2016 OWNER'S PHONE: PHONE NO: (408) 883-8668 LICENSED CONTRA CTORIS DECLARATION RAMIC AND MOSAIC Lic. #948867 BUILDING PERMIT INFO: License Class TILE C Contractor TITAN GENERAL C N TR TI N INCDate 06/30/2016 —BLDG —ELECT —PLUMB MECH RESIDENTIAL _ COMMERCIAL I hereby affirm that I a a licensed under the provisions of Chapter 9 (commencing _ with Section 7000) of D vision 3 of the Business & Professions Code and that my license is in full force ai d effect. JOB DESCRIPTION: CONSTRUCT (N) 2 STORY SFD (3339 S.F.); FRONT PORCH I hereby affirm under I enalty of perjury one of the following two declarations: (83 S.F.) WITH ATTACHED GARAGE (484 S.F.) 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 REV It 1 - RELOCATE SUB PANEL, FIREPLACE & MODIFY BATH it 2 performance 2. I have and will of the work for which this permit is issued. maintain Worker's Compensation Insurance, as provided for by, LAYOUT - ISSUED 8/18/2016 e S;7- Lp - j l.97" L r1n 6'-//S;7- f� Section 3700 of the Labor Code, for the performance of the work for which this 9M�726_0 permit is issu d. APPLICANT CERTIFICATION Sq' Ft Floor Area: Valuation: $650000.00 I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct, I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 359 03 052 representatives of this city to enter upon the above mentioned property for inspection purposes. e) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which EXPIRES IF WORK IS NOT STARTED may accrue against s id City in consequence of the granting of this permit. PERMIT Additionally, the applicant understands and will comply with all non -point. WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations pet the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date Issued by: Le ac Date: 04/07/2016 OWNER -BUILDER D CLARATION 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 inspected prior to any being installed. If a roof is 1. I, as owner o the property, or my employees with wages as their sole troofing ,Iagreteto r Installed without first obtaining an inspection, I agree to remove all new materials for t compensation, will do the work, and the stricture is not intended or offered for inspection. sale (See.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors t construct the project (See.7044, Business & Professions Code). Signature ofApplicant: Date; 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 2. I have and ill maintain Worker's Compensation Insurance, as provided for by I have. read the hazardous materials requirements under Chapter of the Section 370 of the Labor Code, for the performance of the work for which this California Health &Safety Code, Sections 25505, 25533,. and 25534.34. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. 1 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 Worker's Cc mpensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area ,Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Labor Code, I must forthwith comply with such provisions or this permit shall the Health & Safety Code, Sections 25505, 25533, and 25534. be deemed r voked. Owner or authorised agent: APPLICANT CERTIFICATION Date: I certify that I have red 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 cc nstruction, 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 an 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 DECLARATION Code, Section 9.18. _ARCHITECT'S I understand my plans shall be used as public records. Signature Date Licensed Professional i CITY OF CUPERTINO BUILDING: PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO; 15120201 211 S2.MGr_1,ELL-AN RD=G : ERTENO-CA-950--14(359-03-052}---- Mr & Mrs THOMAS N AND, TRUSTEESOSO DOLORES C DOLACANTIA 5630 PYRD DR CUPERTIhIO, CA 95014-4265 OWNER'S INANE: Ivlr & s TKOMAS N AND DOLORES C TRUSTEE SOSO DATE ISSUED: 04/0712016 OWNER'S PRONE; 831-419-5941 PONE NO: (831) 419-5941 License Class Lic. # Contractor Mr & Mrs THOMAS N AND DOLORES C TRUSTEE SOSO Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Divif ion 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 r iaintain a certificate of consent to self -insure for Worker's Compensation, s 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 I have read ihis application and stats thatthe above informationis correct. I ree to comply with all city, and county ordinances and state laws relating to building construction, and hereby authorize representatives of this ci y to enter upon the above mentioned property for inspection purposes.( e) 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-applica t understands and will comply with all non -point source regulations pert e Cupertino Municipal Code, Section 9.18. Signature - Date 41711 I hereby affirm that I an following two reasons: 1. I, as owner of 1 compensation, sale (Sec.7042 2. I, as owner of -contractors to I hereby affirm under- p 1. 1 have and wi performance, 2_. 1 have and wi Section 3700 permit is issu 3, 1certifythat; shall not em1 Worker's Co: exemption, I Labor Code, be deemed n I certify that. I have n correct. I agree to cc relating to building c to .enter upon the ab to save indemnify ar judgments, costs, er consequence of the and will comply with Code. Seciipo - 18. PERMIT INFO: —BLDG —ELECT —PLUMB _ MECH _ RESIDENTIAL _ COMMER.CL.L JOB DESCRIPTION: CONSTRUCT (N) 2 STORY SFD (3339 S,R); FRONT PORCH ($3S,F.) WITH ATTACHED GARAGE (484' S.P,) Sq: Ft Floor Area: I Valuation: $650000:00 APN Number; Occupancy Type; 35903-052 exempt from the Contractor's License Law for one of the ie property, :or my employees with wages as their sole vill do the work, and the structure is not intended or offered for Business & Professions Code) �r icproperty, am exclusively. contracting with licensed onstruct the project (Scc.7044, Business & Professions Code),:' ` nalty of perjury one of the following three declarations. maintain a Certificate of Consent to self -insure -for Worker's as provided forby Section 3700 of the Labor Code, for the 'the work for which this permit is issued. maintain Worker's Compensation Insurance, as provided for by f the Labor Code, for the performance of the work for which this the performance of the Work for which this permit is issued, I sy any person in any manner so as to become subject to the pensation laws of California. If, after makingthis certificate of ecome subject to the Worker's. Compensation provisions of the must forthwith comply with such provisions or this permit shall PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180,DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INNSPECTION. Issued by: SEAN HATCH APPLICANT CERTIFICATION J this application and state thatthe above information is ply with all city and county ordinances and state laws struction, and hereby authorize representatives of this city e mentioned property for inspection purposes. (We.) agree keep harmless the City of Cupertino against liabilities, expenses which may accrue against said City in anting of this permit. Additionally, the applicant understands I non -point source regulations per the Cupertino Municipal �+-ROOFS- All roofs shall be inspectedprior to any roofing material being installed. if a roof is installed without first obtaining :an inspection, I agree to remove ail new materials for inspection, tune of Applicant: 4/7/1 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 8i Safety Code, Sections 25505, 25533, and 25534. 1 will maintain Compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & SafetyCode, 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,. Sections 25505, 25$33, and 25534, Owner or authorized a Date: 417/1 TIO I ENDIN gAGEN CY I hereby affirm that there is a construction fending agency for the performance of work's for which this permit, is [$sued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARC ECT' DECLARATION 1 understand my plans shall be used as public records,. 'PERMIT TYPI PRIMARY USE: $F WORK Cons — SCOPE OCCUPAIN R-3 (Gustorn) CITY OF CUPERTINO 15 CGO I FEE ESTIMATOR - BUILDING DIVISION 0. E: 1212 W PAUL R44 �5�-�A �12015 REVIEWED "y. s ION - 35903052 BP#-. *VALUATION' $650,000 Building Permit PLAN CHECK TYPE: New Construction 2nd Unit? U 1, No PYes P ENTAMATION or Duplex PERMIT TYPE: 1 R3SFDW ct (N) 2 StoU 8FD (3 0 339 Sj.), Front Porch (83 8.Q. with Attached G,arage (484 S -f) , TYPE 0 . F .. FRAREA CFEL __S PC FEE IDBP FEES BP FEE ID /h 3,906 $5 1R3 pLNCK $3,,488A5 3,273.1 TOTALS: 1 3,906 1 $3,273.15 Alech. Nora Cheek ,flej _rni�f Ve,�, $687-10 he;, . -,14ech.' 11 psr} OIhew ee: Tr o is est mate does not include fees due I to other Departments Oe' Planning' District, eta ). .7 �ese fees are based on the prelimin24 information available andareFEE,ITEMS 'Fee Res.olation TI -Q.:53 Efff 7111131 FEE QTY/FEE Plan Cheek. Fe 11: $3,273,15 Suppl, PC Fee � Reg. 0 OT 0.0 hrS $0,-E $ PME Plan Ch- c�: $0.00 Permit Fee. $3,488.45 Suppl. Insp.. F e -E) Reg. 0 OT 0.0 hfs $aGQ PME Unit Fee: 10,00 PME Permit Fee: $0v00 Construction 1BC0jVSTAXR twits $687-10 Work Witho-utPermit? 0 Yes (F)_ No Advanced. -nnini-F.'em IPLLONGR- $546.84 D,avel Doczaqentafi&;rt P9MS: Strojig Motion Fee: IBSEISMCR $84.5Q Bldg Stds Q irunission Fee: 1J3CBSC_. $26.00 0 7' 777, $8,106.Q4 $Q.00 $3,488.45 Vii{ eT E71ec, lyvs. Worts, Fire, Sanitary Sewer District, Seft0l Fles"ate, Contact the Dept for addn� UR MISC ITEMS Select a Misc Bldg/Structure 1 or Element of a Building 22 Select a Non-Pesidentilal Building. Or Structure ,Select a,if-Administrative Item ,8,106.04 1Q101/20J0 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15120201 ,2 42 AdGG r:r r AN RD rtm/FERT/INO CA 9 U4 359 03 052) TITAN GENERAL &5 /J/US�SI/%7 CONSTRUCTION O CLQ_ FREMONT, CA 94539 OWNER'S NAME: Mr & Mrs THOMAS N AND DOLORES C TRUSTEE SOSO DATE ISSUED: 04/07/2016 OWNER'S PHONE: 408-464-5030 PHONE NO: (408) 883-8668 LICENSED C'ONTRACTOR'S DECLARATION BUILDING PERNHT INFO: License Class @ Lic. #948867 Contractor TITAN GENERAL CONSTRUCTION INC Date 06/30/2016 —BLDG _ELECT _ PLUMB MECH 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: CONSTRUCT (I) 2 STORY SFD (3339 S.F.); FRONT PORCH I hereby affirm under penalty of perjury one of the following two declarations: (83 S.F.) WITH ATTACHED GARAGE (484 S.F.) 1. 1 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 REV # 1 - RELOCATE SUB PANEL, FIREPLACE & MODIFY BATH # 2 performance of the work for which this permit is issued. LAYOUT - ISSUED 8/18/2016 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. Sq. Ft Floor Area: Valuation: $650000.00 APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 359 03 052 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. PERMIT EXPIRES IF WORK IS NOT STARTED Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature, -Date. 18/2016 Issued by: ABBY AYENDE OWNER -BUILDER DECLARATION Date: 04/07/2016 1 hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: 1. I, as owner of the property, or my employees with wages as their sole All roofs shall inspected prior to any roofing material being installed if roof is rials for installed withoutt first obtaining an inspection, I agree to remove all new materials f compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Sec.7044, Business & Professions Code). Signature of Applicant: Date: 8/18/2016 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE 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 a. 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 Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cu ertino Municipal Code, Chapter 9.12 and Labor Code, I must forthwith comply with such provisions or this permit shall the Health & Safety C e, Sectioes B 25533, and 25534. be deemed revoked. APPLICANT CERTIFICATION Owner or authorized agen I certify that I have read this application and state that the above information is Date: 8/18/2016 CONSTRUC 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 9.18. 1 understand my plans shall be used as public records. Signature Date 8/18/2016 Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISI 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 1, #6 (408) 777-3228 • FAX (408) 777-3333 • building(c1cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI 9 REVISION / DEFERRED ORIGINAL PERMIT # 1 5 f Z U Z-0 PROJECT .ADDRESS �.J�% %d .APN ', OWNER NAME PHONE a1 / '1,30 E-MAIL 0 _ � \ L F� [ STREET ADDRESS � 2 3 _ L raA� TY, STATE, ZIP �µ� ' �^ ry, j FAA— I -0 ` 1 -(C CONTACT NAME �r I 1 1v �(� PHO e 8 �T �d E-fA'f��lL, 1' .� t l Gl �l oL1 . STREET ADDRESS l (� CITY, STATE, ZIP FAXCAO, 1�41 . 2 ov� Pk,,,dA �❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER DEVELOPER ❑ IENANT CONTRACTOR NAME r - I4CENSE NUMBER LICENSE TYPE BUS. LIC �// 67 ry COMPANY NAME E- L FAX STREET ADDRESS CITY, STATE, ZIP PHONE {rte' ARCHITECT/ENGINEER NAME 1 ` LICENSE NUMBER BUS. LIC # COMPANY NAME /� J� �_„ Q ��e C E-MAIL FAX -- STREET ADDRES ,_ Zo •, CITY, STATE, ZIP S�,J���� HONE�gI� � O9� D L DESCRIPTION OF AVORK J Ol/VL 1 G, I A C - C I S LV DIA I `- I EXISTING USE PROPOSED USE CONSTR. TYPE p STORIES USE TYPE OCC. SQ.FT VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL T AREA AREA AREA NET AREA BATHROOM KITCHEN —7 OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: LJ DETACH 13 ATTACH ;= DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ By my signature below, I certify to each of the following: I am the property owner or authori�agmt�to�prty owner's behalf. I have read this application and the information I have provided is correct. I have read the Dgscription of Work and v r rs accurate. I agree to comply with all applicable local ordinances and state laws relating to building ns n. I authorize re fives of Cupertino to enter the above-iden 'fled property for inspection purposes. A Signature of ApplicanUAgent: _ Date: SUPPLEMENTAL INFORMATION REACIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multifamily 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 WORKS _ form if any Hazardous Materials are being used as part of this project. ❑ ' ❑ LARGE FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ NI AJOR ❑ SANITARY SE\VER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 I CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: PERMIT # ZO Z© OWNER'S NAME: PHONE # GENERAL CONTRACTOR: 41 SINESS LICENSE # M2, 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 V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork�'� C" 3 C f Z -- Cement Cement Finishing /4"UZ k, 3 v Electrical Excavation 0 Fencing 304-30 Flooring / Carpeting 3Z` Linoleum / Wood 3 "L Glass / Glazing146('6k- Im"not aydy t Cl Heating Le keOJ7 Atole �� 4 0 Insulation V Landscaping �-yt 5-��'l.�ch TVA C ' LL 3 a Lathing Masonry G-3 LE4p Painting / Wallpaper 4 Paving Plastering6e4ACYAk C-t�SkyucW"- Plumbing -�-,QX- 3 j -3 Roofing CD F p Septic Tank Sheet Metal - ` �� Sheet Rockl' Z Tile vwC 3 er / 4�1 o (( -1 Date M �� CUPERTINO OWNER -BUILDER NOTICE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildino(o)cupertino.orq Effective January, 1, 2009, Assembly Bill 2335 amends California Health and Safety Code, Section 19825, regarding disclosures and verifications required for all applicants seeking Owner - Builder construction permits. These new application requirements provide an enhanced level of consumer awareness and protection for property owners accepting the risks associated with Owner -Builder construction permits. "The Legislature hereby finds and declares that there is an urgent and statewide public interest in assuring that building contractors comply with the Contractors License Law ... and provisions of law relating to Workers' Compensation Insurance for building construction, that property owners are informed about, and protected from, fraudulent representations, liability for worker's injuries, liability for material and labor costs unpaid by contractors, licensing requirements, and employer's tax liabilities when improving their property as owner -builders" Important information you need to know BEFORE pulling your permit! The term "Owner -Builder" can mean three different things: "Owner as Worker", "Owner as Contractor" or "Owner as Employee" Understand each has Benefits or Risk, and it is possible to combine them! Hiring a California Licensed Contractor means you do not personally perform any of the construction work, the permit is not taken out in your name, you are not personally responsible for the construction and you are not an Owner -Builder. Instead, you become a "Customer" and California law provides you the benefit of protection from poor workmanship, failure to finish the job and financial risk due to worker injury. Benefit/Risk: Highest Benefits and the Least amount of Risk Owner -as -Worker is a type of Owner -Builder where you personally perform the construction work, the permit is taken out in your name and you are personally responsible for the construction management, knowledge, workmanship, and completion of the job. You benefit by not paying others to perform this work for you and your risk depends on your own ability to complete the job successfully. Benefit/Risk: Possible Benefit with Low Financial Risk Owner -as -Contractor is a type of Owner -Builder where you personally act as your own General Contractor, the permit is taken out in your name and you hire California licensed sub -contractors to perform portions of the construction work. WARNING: The benefit of protection provided by law when you hire only California licensed sub -contractors can turn to serious financial risk if you hire unlicensed contractors to perform any of the work. Benefit/Risk: Possible Benefit and Sienificant Financial Risk Owner -as -Employer is a type of Owner -Builder where you pay any individual to perform any construction work valued at more than $500.00, the permit is taken out in your name and you are personally responsible for their employment requirements, supervision, performance, safety and welfare while on your property. WARNING: Cost savings benefit can turn to serious financial risk if you fail to deduct payroll taxes or provide workers compensation insurance for each worker. Benefit/Risk: Possible Benefit with Significant Financial Risk Over 20,000 consumer complaints are filed each year. Many complaints relate to owner/builder projects and include workmanship and workers' compensation issues Homeowners suffer financial harm due to defective workmanship and injured employees. OwnerBuilder 2010.doc revised 06/08/10 Following are alarming examples of what has occurred with Owner -Builder permits: Example 1: Homeowner received insurance money to rebuild burned -down home. • Owner/Builder permit pulled to rebuild structure. ■ Unlicensed contractor built substandard structure — must be torn down and replaced. ■ Estimated financial injury is $225,000. ■ Additional financial injury - IRS threatened to tax insurance payout if house not completed by the end of the year. Example 2: Brother-in-law had active license but filed an exemption from Workers Comp. ■ Owner -Builder hires brother-in-law to install a new roof. ■ Employee falls and sustains multiple spinal and extremity fractures as well as a head injury and remains in a coma to this day. ■ The Owner -Builder, who has sold the home, is now a defendant in a lawsuit for reimbursement for benefits paid to the injured worker. Example 3: Employee of contractor without Workers Comp is hired by Owner -Builder to install septic system and suffers injury that results in permanent disability. ■ The Owner -Builder did not have a homeowner's insurance policy on the house against which to submit a claim. ■ The Owner -Builder is now a defendant in a lawsuit for reimbursement for benefits paid to the injured worker. Did you know — unlicensed persons frequently have the property owner obtain an "Owner - Builder" building permit which erroneously implies that the property owner is providing his or her own labor and material personally? Did you know — your homeowner's insurance may not provide coverage for injuries sustained on your property by an unlicensed contractor and his/her employees? Did you know — if you are considered an "employer" under state and federal law, you must register with the state and federal government, withhold payroll taxes, provide workers compensation and disability insurance and contribute to unemployment compensation for each "employee"? Did you know — that if you fail to abide by these laws you may be subjected to serious financial risk? OWNERS BEWARE AND CONSIDER THE RISK BEFORE ACCEPTING FULL RESPONSIBILITY FOR YOUR CONSTRUCTION PERMIT OwnerBuilder 2010.doc revised 04/12/10 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(a)-cupertino.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 specifig at: perttno, Ca. APN359-03-052-00 BP# oWNE� NAMEn 4"rr'sD racantha Dr Shingle Springs, Ca 95 DESCRIPTION OF WORK: Uonstruct a two story singe family house 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.) -a-b 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 msusce coverage for injuries to workers on my property. r' ,(22. 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. Aunderstand 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 rTaZ 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. rl .4. 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 conside ed an "employer" under state and federal law. rl6.Wriderstand 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. n A I 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 perf m under contract with a licensed general building Contractor. ri 8. I understand as an Owner -Builder if I sell the property for which thisma ermit is issued, I be held liable for P Y 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 " 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.csib.ca.gov for more information about licensed contractors. .x191 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the arty legally and financially responsible for proposed construction activity at the site address listed above. —111 � agree that, as the party legally and financially responsible for this proposed construction activity, I will abide �1by�all applicable laws and requirements that govern Owner -Builders as well as employers. J ti 41 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.) None Lender Name: LenNonderess: 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: n . Date: C"711 6 --------------------------------------------------------------------------------------------------------------------------------------------- (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. :story single family home to be constructed Scope of Construction Project ect ( (or Description of Wo Project Location or Address:52WC_Ge'lan ,Cupertino Ca. � Name of Authorized Agent: 9+ a rLa -D Tel No 408-374-4241 Address of Authorized Agent: 1090 Florence AV., Campbell, Ca. 95008 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 owners drivers 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: _94, -yyAAA ri _ AAAdzr Date: 04/07/16 OwnerBuildeYForm 2010.doc revised 04/14/10 P CALGREEN RESIDENTIAL CHECKLIST — MANDATORY ITEMS COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION CUPERTINO ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingftcupertino.org GiPE TINO ent PURPOSE: gu;lding Dep3rIll The 2013 CalGreen Code applies to additions or alterations of existing residential buildings where the addition or alteration increases the building's conditioned area, volume, or size and also applies to all new low-rise ., residential buildings, high-rise residential buildings, or both. Existing site and landscaping improvements that are not otherwise disturbed are not subject to the requirements of CALGreen. A By' Project Name: Project Address: Project Description Instructions: New Residence aw-- 1 . 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the California Green Building Standards Codes to verify and assure that all required work described herein'j5"j�c�e�ly planned and implemented in the project. ` n& 2. The licensed professional, in collaboration with the owner and the design professional shall initial Column 2 of this checklist, sign and date Section 1 - Design Verification at the end of this checklist and have the checklist printed on the approved plans for the project. 3. Prior to final inspection by the Building Department, the licensed professional shall complete Column 3 and sign and date Section 2 - Implementation Verification at the end of this checklist and submit the completed form to the Building Inspector. Page 1 of 5 TKJF-CEIVIED DEC 2 3 2015 CalGreen 2014.doc revised 11104114 Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Re uirements ., .1 PLANNING AND DESIGN Planning and Design - Site Development 4.106.2 Storm water drainage and retention during construction. A plan is developed and implemented to manage storm water drainage during construction. 4.106.3 Grading and paving. The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how site grading or a drainage system will manage all surface water flows. Page 1 of 5 TKJF-CEIVIED DEC 2 3 2015 CalGreen 2014.doc revised 11104114 A4.2 General 4.201.1 Low-rise residential buildings shall meet or exceed the minimum ® ❑ standard design required by the California Energy Standards. .. .3 WATER EFFICIENCY AND CONSERVATION Indoor Water Use 4.303.1 Water conserving plumbing fixtures and fittings. Plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads) shall comply with the following: ❑ 4.303.1.3.2 Water Closets. The effective flush volume of all water closets shall not exceed 1.28 gallons per flush. Tank -type water closets shall be certified to the performance criteria of the U.S. EPA WaterSense Specifications for Tank -type Toilets. ❑ 4.303.1.3.2 Urinals. The effective flush volume of urinals shall not exceed 0.5 gallons per flush. ❑ 4.303.1.3.1 Single Showerheads. Showerheads shall have a maximum flow rate of not more than 2.0 gallons per minute at 80 psi. Showerheads shall be certified to the performance criteria of the U.S. EPA WaterSense Specification for showerheads. ❑ 4.303.1.3.2 Multiple Showerheads serving one shower. When a shower is served by more than one showerhead, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute at 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. ❑ 4.303.1.4.1 Residential lavatory faucets. The maximum flow rate of residential lavatory faucets shall not exceed 1.5 gallons per minute at 60 psi. The minimum flow rate of residential lavatory faucets shall not be less than 0.8 gallons per minute at 20 psi. ❑ 4.303.1.3.2 Lavatory faucets in common and public use areas. The maximum flow rate of lavatory faucets installed in common and public use areas (outside of dwellings or sleeping units) in residential buildings shall not exceed 0.5 gallons per minute at 60 psi. ❑ 4.303.1.4.3 Metering faucets. Metering faucets when installed in residential buildings shall not deliver more than 0.25 gallons per cycle. ❑ 4.303.1.4.4 Kitchen Faucets. The maximum flow rate of kitchen faucets shall not exceed 1.8 gallons per minute at 60 psi. Kitchen faucets may temporarily increase the flow above the maximum rate, but not to exceed 2.2 gallons per minute at 60 psi, and must default to a maximum flow rate of 1.8 gallons per minute at 60 psi. 4.303.2 Standards for plumbing fixtures and fittings. Plumbing fixtures and fittings shall be installed in accordance with the California Plumbing Code, and shall meet the applicable standards referenced in Table 1401.1 of the California Plumbing Code. Page 2 of 5 CalGreen 2014.doc revised 11/04//4 V Outdoor Water Use 4.304.1 Irrigation controllers. Automatic irrigation systems installed at the time of final inspection shall be weather -based. ❑ 4.304.1.1 Controllers shall be weather- or soil moisture -based controllers that automatically adjust irrigation in response to changes in plants' needs as weather conditions change. ❑X ❑ 4.304.1.2 Weather -based controllers without integral rain sensors or communication systems that account for local rainfall shall have a separate wired or wireless rain sensor which connects or communicated with the controller(s). Soil moisture -based controllers are not required to have rain sensor input. A4.4 MATERIAL- RESOURCE Enhanced Durability and Reduced Maintenance 4.406.1 Rodent proofing. Annular spaces around pipes, electric cables, conduits, or other openings in plates at exterior walls shall be protected against the passage of rodents by closing such openings with cement mortar, concrete masonry or similar method acceptable to the enforcing agency. Construction Waste Reduction, Disposal and Recycling 4.408.2 Construction waste management plan. Where a local jurisdiction does not have a construction and demolition waste management ordinance, a construction waste management plan shall be submitted for approval to the enforcing agency. Building Maintenance and Operation 4.410.1 Operation and maintenance manual. At the time of final inspection, an operation and maintenance manual shall be provided to the building occupant or owner. A4.5 ENVIRONMENTAL Fireplaces 4.503.1 General. Install only a direct -vent sealed -combustion gas or sealed wood -burning fireplace, or a sealed woodstove. Pollutant Control 4.504.1 Covering of duct openings and protection of mechanical equipment during construction. Duct openings and other related air distribution component openings shall be covered during construction. 4.504.2.1 Adhesives, sealants and caulks. Adhesives, sealants and caulks shall be compliant with VOC and other toxic compound limits. 4.504.2.2 Paints and coatings. Paints, stains and other coatings shall be compliant with VOC limits. 4.504.2.3 Aerosol paints and coatings. Aerosol paints and other coatings shall be compliant with product weighted MIR Limits for ROC and other toxic compounds. Page 3 of 5 CalGreen_2014.doc revised 11104/14 4.504.2.4 Verification. Documentation shall be provided to verify that ® El VOC limit finish materials have been used. 4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with ® ❑ VOC limits. 4.504.4 Resilient flooring systems. Eighty (80) percent of floor area receiving resilient flooring shall comply with the VOC-emission limits defined in the Collaborative for High Performance Schools (CHPS) Low -emitting ® ❑ Materials List or be certified under the Resilient Floor Covering Institute (RCFI) FloorScore program. 4.504.5 Composite wood products. Particleboard, medium density fiberboard (MDF), and hardwood plywood used in interior finish systems shall Q ❑ comply with low formaldehyde emission standards. Interior Moisture Control 4.505.2 Concrete slab foundation. Required vapor retarders and capillary ® ❑ breaks are also required to comply with CalGreen Section 4.505.2.1. 4.505.3 Moisture content of building materials. Moisture content of building © ❑ materials used in wall and floor framing is checked before enclosure. Indoor Air Quality and Exhaust 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the ® ❑ building are provided in every bathroom. Environmental Comfort 4.507.2. Duct systems are sized and designed and equipment is selected using the following methods: 1. Establish heat loss and heat gain values according to ACCA Manual J or equivalent. ® ❑ 2. Size duct systems according to ACCA 29-D (Manual D) or equivalent. 3. Select heating and cooling equipment according to ACCA 36-S (Manual S) or equivalent. INSTALLER AND SPECIAL INSPECTOR QUALIFICATIONS Qualifications 702.1 Installer training. HVAC system installers are trained and certified in ® ❑ the proper installation of HVAC systems. 702.2 Special inspection. The Licensed Professional responsible to verify CALGreen compliance is qualified and able to demonstrate competence in the ® ❑ discipline they inspect and verify. Verifications 703.1 Documentation. Verification of compliance with CALGreen may include construction documents, plans, specifications, builder or installer certification, inspection reports, or other methods acceptable to the enforcing ® ❑ agency which show substantial conformance. Implementation verification shall be submitted to the Building Department after implementation of all required measures and prior to final inspection approval. Page 4 of 5 CalGreen_2014.doc revised 11/04/14 Project Name: Project Address: Project Description CALGREEN SIGNATURE DECLARATIONS New Residence 21152 McClellan Road New single family home SECTION 1 - DESIGN VERIFICATION Complete all lines of Section 1 — "Design Verification" and submit the completed checklist (Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Owners Signature Owner's Name (Please Print) Design Pe6fessional's Signature Date Designr ris Na{ne (Please Print)tt ��+" 12/13/2015 Signature of License Professional responsible for CalGreen compliance Date Michael Chau 650-799-7100 Name of License Professional responsible for CalGreen compliance (Please Print) Phone michael@msjconstruction.com Email Address for License Professional responsible for CalGreen compliance SECTION 2 - IMPLEMENTATION VERIFICATION Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Signature of License Professional responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance (Please Print) Phone Email Address for License Professional responsible for CalGreen compliance Page 5 of 5 CalGreen 2014.doc revised 11104114