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B-2016-2976CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20668 SCOFIELD DR CUPERTINO, CA 95014-2962 (359 10 006) CONTRACTOR: PERMIT NO: B-2016-2976 OWNER BUILDER OWNER'S NAME: WU YE -MING TRUSTEE & ET AL DATE ISSUED: 10/24/2016 OWNER'S PHONE: 510-604-2696 PHONE NO: LICENSED COMRACTOR's DECLARATION BUII,DING PERMIT INFO: License Class Lia # Contractor OWNER B l nFR Date X BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH X RESIDENTIAL _ COMMERCIAL 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: PG&E REQUIRED INSPECTION FOR ROOF MASK 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. Sq. Ft Floor Area: Valuation: $0.00 APPLICANT CERTIFICATION 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 10 006 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 this permit. may accrue against said City in consequence l the granting all 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 10/24/2016 Issued by: Kim Dunbar Date: 10/24/2016 OWNER--BURMERDECLARATION 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 i. 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 (Sec.7044, Business & Professions Code) z I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 10/24/2016 I hereby affirm under penalty of perjury one of the following three declarations:ALL 1. I have and will maintain a Certificate of Consent to self -insure for Worker's 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. 1 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 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 Cupertino Municipal Code, Chapter 9.12 and 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. Owner or authorized agent: APPLICANT CERTIFICATION Date: 10/24/2016 1 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 9.18. 1 understand my plans shall be used as public records. '' SignattiieDate 10/24/2016 Licensed professional CONSTRUCTION PERMIT APPLICATION .� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 T ORRE AVENUE • CUPERTINO, CA 95014-3255 r (408) 777-3228 FAX (408) 777-3333 • bulldlno(5�cupertino.or cul=l E tea n —.C? -201 f� n V-1 W (-) 'cT-PIIrT7n?t A7l1 1T 1-i.T I n r u;:raxlc.tt) UEUGiNA- PERMIT PROJECT ADDRESS / C / �i V I I C► LJ �• 63 v r [ 10 - C) 0 (. r- yl sB Ylf nPHO?\-- //9�� / �p L�IL t� ` STREET ADDRESS CITY; ST TE, ZILPl1 FAQ 66 � � �� sV/56 CONTACT NAME F Ai .// /� J ! I Pri0\E� STREET ADDRESS �" f � ��( J1\� e I CIi ST",TE, ZiP f �1 Pym �/ F3 ONR r -it ❑ 04, It -3L DER ❑ 0,,�-N-Et kGE`\T ❑ CO?.TR 4CTOR ❑ CONTR4CTOR AGENT ❑ -RCHIrECT❑ D G7BER ❑ Dt\YELOnER ❑ 4�T CONTRACTOR At E I LI CEN SE?TL'1V,BER I LICENSE TYPE I BUS. LIC COI,'2A2vYI AME E-?ei=SL I I FAX STREET ADDRESS I CITY, STATE, ZiP I PHO\E =:RCh-ITECT/FN DNEER?T:U,'E I LICENSEE IL7,3'cR BUS. LIC= COATAWY N'A1v E — �E.I L,.SL _ FAX STREETADDRESS I CITY, STATE, ZIP -- PriO XE DESCP,IPTIONOF\\ L fils0e- it C7 r �ry EXISTEM USE. PROPOSED USE CONS -1R- TYPE _ STORIES i USE TYPE OCC. SQ.FT. I VALUATION (S) EXISTG NEW FLOOR DE1,40 - TOTAL AREA AP.EA I AREA N= AREA BA.TI-LP00h4I I:A'CHE7\ OTHER REM REMODEL EA I R:T: EMARDELAREA PORC'r,.AREA DECKAREA TOTALDECKPORCH-AREA GARAGEA.REfi: ❑DETACH ❑ ATTACH I I DIAILLLkG T -'QTS: IS A SECOND L-\ IT ❑ -M SECOND STORY ❑-ITS BEING A.DDED? ONO I ADDMOIQ NO " PR= q LiCATION ❑T -S I rS PROVIDE COPY OF PL.4.\N"\G.A�?PL40 (�PT t'.":�L�G_kPPR0'•ALLETTER I IS THEBLDGA.i ❑1 S EICHLERHOME? ED]N0 ',RE Ei)1. u. ` ��C,.,%/J�/ By my Signature below, I certi--^ to each of the following: I am the property owner or zuthonzed went to act on he Property owner's behalf. I have rend this application and the iafon7iation I have provided is correct. I have read the Description of \1,Torh and verify it is accurate. I aP-ee to coz7ply with all applicable local crdin2nces and state la\v s relating to building c0nSsncQ0 \I authorize representatives of Cume Lino to enter the above -identified property pin-poses._or inspectionpin-poses.Si- wreofApplicant/Agent: /i Dat': �� 6 - s SUPPLE?\ZENTAL INFORMATIOINI REQUIRED TIPS:.' .... .PL'i\,CFECh 1� Nvw SFD Or 14ul ifamily d x,ellings Apply for de_,7olition pe nnit for e.` -.:l �lii?� 1JL.l O�D��S�. D�i?7011 X10'1 p i1711t 1� reQL�_,.d D:tOr i0 i551'.2n Ce O bLi1Ci^Q 0\ ER TI E COL TER BL,2IiIiG PLA'1 RE\TE�i 1DeITnit for e\ ! lJ gilding. V ? 1PRESS PLfi \L GPL4t RE\ IE\\ _ Co .imElc_al Bldgs: Provide a completed hazardous h4aterials DiSCI-osure L�LIC \;ORDS _ for_'J711 am Hazardous TviC«-ilals are being L=vd L� part GI this l.�i c�l.i. t.. r - _ - ❑ 7 +RGI � � FIRE DEPT Copy of Planning Approval Letter or fleeting \with Planning prior to _ AL�JOR ?� Submittal of Building Pennit application. Sfi �IT�RI SEZ�ERDI�TRICTf EhlII20T�'�SE;�TSLFESLTI3 ..-: Eldg1'pp_2011.dec revised 0621!11 �s OWNED? -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CLJPERTINti (408) 777-3228 • FAX (408) 777-3333 • building(d.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 specified at: SITE ADDRESS>01/ 6 ��J'�G�t�S� Ybr< r �r�N ! i,® l✓� �? ®�A , # 1�"`. OWNER NAME , OW E ADD`PRESS DESCRIPTION OF WORK: POE WK h 'd N P720i 116 1 - 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.) (lam- 1. I understand a frequent practice of unlicensed persons is to have the property ownerobtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and Kis 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 construction and are not hiring a licensed Contractor to assume this responsibility. 43. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may otect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license umbers on permits and contracts. A5A5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. ' 6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. tsidrential 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. t.i 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for ahy financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. - OwnerBuildeYForm 2010.doc revised 04/14110 r 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Re enue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.. 0 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I the party legally and financially responsible for proposed construction activity at the site address listed above. a11. 1 agree that, as the party legally and financially responsible for this proposed' construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information l have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. if you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) �"r s Lender Name: ( Lender Address: 2010 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 propeyZ owners signature_,, Property Owner's Signature: Dater 10%2- (f�//�, [ f --------------------------------------------------------------------------------------------------------------------------------------------- (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 1 understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuildeYFonn 2010.doc revised 04/14/10 SMOKE] CARBON MONOXIDE ALARMS�- ism, OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPERTIN40 10300 TORREAVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cugertino.org ' PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN , COMPLETED, SIVMD- AND RF N; +�D TO THE BUILDING DIVISION PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013. CRC Section 8314, 2013 CBC Sections. 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL 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 $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 42.0.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM. CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. 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.. As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms specified below have been tested and are operational, as of the date signed below. Address: `� � ��y 1`�1 �teF-e(yfio C��g1 !�® 14 Permit No. Specify Number of Alarms: # Smoke Alanns: Y ' # Carbon Monoxide Detectors: `1 2 I have read and aaree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name:- - _. ......................................................... ._._ e... at —t Signature .. D e' Ni .... ._. — _ - .:. ,::: .- ................ Contractor ame: _ Signature.................................................................. Lie.# ......................................Date: Smoke and CO form.doc remised 09127116 WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPERTtNO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 yr , (408)77773228, -FAX (408) 777-3333 buiidingCa-cupertino-om Owner Name W(A ! �= , - T6'I I !r 7 A L" Permit No. � � � 01 � m2q i Address 3o 4t Sc;�-t iQ'IN .- :.DY -Cw �i ►� , .e�.:, �Sol(G 1. 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. No 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 plutnber's certification has been provided to the Building Division. Skip the rest ofthe form and sign bottom of form. 17No Go to Question 3. ` 3. Is water service permanently discomiected.for your building? ❑ Yes Civil Code Sections 1101.1 through 1.101.8 do:not apply. Skip the rest of the form and sign bottom of form. .. 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. z 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 Iuse 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... 5.- Please check ONE of the following: ' ®' My property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014,:buildmg 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 - 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 'T, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). I, as the owner of 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 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 following pate. - . _ r AP i Owner or Owner Agent's Signature: —4u�zj_N 12." Date: Upon completing and signing this Certificate, please return it to the t3utWing llivision in oroer to anal your ouiiomg permit. SB40 7 2015. doe revised 08/26115