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B-2017-0271CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMITNO: B-2017-0271 20975 VALLEY GREEN DRAPT 225 CUPERTINO, CA 95014-1855 (326 09 041) SANCHEZ & SONS CONSTRUCTION SAN JOSE, CA 95127 OWNER'S NAME: KORET VC I LP DATE ISSUED: 02/16/2017 OWNER'S PHONE: 408-253-0200 PHONE NO: (408) 896-0974 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #747898 Contractor SANCHEZ & SONS CONSTRUCTION Date 04/30/2018 X BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing X 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: WASHER DRYER HOOIKUP Ihereb affirm under penalty of perjury one of the following two declarations: 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: $500.00 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 326 09 041 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 a d will comply with all non -point source regulations per the Cupertino M icipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signatu -.1 Date 02/16/2017 Issued by: Kim Dunbar OWNER -BUILDER DECLARATION Date: 02/16/2017 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 (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Scc.7044, Business & Professions Code). Date: 02/16/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER r. 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 2. 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. Owner or authorized agen: ,' ? % APPLICANT CERTIFICATION Date: 02/16/2017 / , I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws CONSTRUCTION LENDWG AGENCY 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. Licensed Signature Date 02/16/2017 Professional GENERAL PERMIT APPLICAT ION T MEP rigA COMMUNI i Y DEVELOPMEN i DEFAR. IIALEN i - SUIDINIG DIVISION] 10300 -1 ORr E AVF-l\'UE - CUPEKIFIN0, CA 9501 3255 EL -vk (408) 777-3228 - FAX (408) 777-3333 • buiLdinaftuDerfino.ora CUPERTINO 3-201* -02-V L-p—Tbnm.NL-,c, ikr�WIICKL I =- T -q I MT lz Z, c E L L Aa Tz- 0 T.; S 2:15- au e p ,�VfjA 'mill I.. I , Goo li rur) D.? m 5 CONV= Xkvzz� reovimd 06i -Jill ol BUS. i1c 9 colveVvy OCA 0 13 D ri a am 0c 13 D coil, USS w [3smpr:x,-x =,---?.0 VMS MY LBI.V D r_- —=RzA C--- A. -M A. NO c 3,m OM: I ratou-km-k4 and 5,onm reovimd 06i -Jill ol BUS. i1c 9 colveVvy USS w [3smpr:x,-x =,---?.0 VMS MY LBI.V D r_- —=RzA C--- A. -M A. NO m=, -r -w 3,m m c a m- reovimd 06i -Jill CUPERTINO SANITARY DISTRICT 20863 Stevens Creek Blvd #100, Cupertino, CA 95014 Tel (408) 253-7071 • Fax (408) 253-5173 r r� � ,.h� cupenrmo SANITARY DISTRICT PERMIT LEITER Cupertino Sanitary District has adopted Resolution No. 1263. Building Permit Request (Over -the -Counter) ❑ Single Family, Project [Multi -Family Project ❑ Commercial Project Project Address: Permit Number: Scope of Work: Gtr Owner/Applicant Name: � i "`(j�/,�_6i� %/ d Phone: &ad 0 Address: 70e— Arees? Dr. 611,2e,_11-17170 r Date: Prepared By: City Authorized Representative I, as property owner or authorized agent, acknowledge that all Cupertino Sanitary District requirements will be met and all required fees will be paid prior to the approval of final inspection for proposed project. Date: 2°-41'-1 Signature: Owner Authorized Agent CUPERTINO SANITARY DISTRICT OFFICE USE ONLY [� Pre -inspection Required ❑ Final Inspection Required Date Scheduled: r Date: — '1 Conditional Approval By: AulhorizeRepresentative Cupertir6 Sanitary District District will notify owner of the required fee within 5 days after Pre -Inspection has been completed and cc City of Cupertino. ❑ Inspection Fee Paid Date Paid: Inspection Fees: $250/unit - Single Family Residential already connected, but new cleanout is required °$150/unit - Single Family Residential already connected with existing cleanout in working order $350 Minimum - Commercial and Retail Actual Amount: $200/each - Disconnect and/or abandon lateral service Connection Permit Fees: $350/unit - Single Family Residential connecting to existing lateral $650/unit - Single Family Residential connecting with new lateral $100/unit - Multi, Hotel, Living Units, etc. Actual Amount: O $500/connection - Commercial and Retail Actual Amount: Connection Use Fees (See Attached Calculation Sheet): Date: Iia -[`� Final Approval By: %%t A14—i Authoriz • d Representative Cupertin Sanitary District Area and Frontage Fees Amount: Residential Excess Fees over 3.5 unit/acre Amount: Commercial and Retail Connection Fees Amount: D Commercial and Retail Change in Use Fees Amount: Date: Iia -[`� Final Approval By: %%t A14—i Authoriz • d Representative Cupertin Sanitary District CUPERTI[Na 0 WNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - bul Ildinaacunerfino.ora Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the improvements specified at: builder of the property vvt: di u proviaing you witn an Ownet-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 notici unless you, the property owner, obtain the prior approval of the permitting authority. rl 1-UKIVIAHUN 'ONS -NRECTI Please read and initial each statement below to signify you understand or verify this Inforri7ation 2 _t/t i -I understand a freqVen't 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. 1, 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. M homeowner's insurancem y n willfully acting as an Owner -Builder and am aware of the limits of rrW provide coverage for those injuries. I am wl Y a ot insurance coverage for injuries to workers on my property. 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to -assume this responsibility. ,/.L_3. I understand as an aOwner-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. s I V 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. 117 J ,)_fl 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 4employer under state and federal law. -5 ) S.1 understand if I am considered an "employer" under state and -federal law, I must register with the state and federal government, withhold payroll taxes, provide workers! compensation disability insurance, and contribute to unemployment compensation for each "employee-" I also understand my failure to abide by these laws may subject me to serious financial risk. �7.1 understand under California Contractors! State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless alfwork 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. a. I 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. 0ivnerBuiA*rF6rm_2010.d6c revised 04114110 Lander Name, LenderAddress: ------------ Ch I JrOdfng-pe�rQf�—­�— Per= can be Issued t -WA a -Mf N0115 -- FA . ............. ;AMM.M. MAMA 71*1=; 117&TQ110Hft1gAFfn0i1Zaff0nFi equir----------------------------- — J�Iwiw orm is, red to be domplated by the proSw T�fiiTR) R -gent ofthe property owner to apply for a Comfmcgon, permit for the Owner-BuIroer). AUTHORIZATION OF AGENT To An -r eva not EHALF ExClUdIng the NoUce to Property Owner,the execution .of,which 'i understand Is MY *Sonai ;psponsibility I - I if authorize the fbf(oWfn4 PEiig6h(s) to acf as my agent(s) f.6 apply for, sign, and file the documents:nebes4a Owner Builder Permit for my project Scope of doW, 6X66, n PTP*ct (Pr Description, 04 i Netma ofAuftrized Agent Addr .eo!§ cifAutho&dd Agei --n I dec! lam