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14080081I I C CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10241 JOHNSON AVE CONTRACTOR: BULL FAMILY PERMIT NO: 14080081 OWNER'S NAME: BULL FAMILY 724 LAUREL ST DATE ISSUED: 12/08/2014 OWNER'S PHONE: 5419447815 SAN JOSE, CA 97526 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] ADD 244 SQ FT TO SIDE OF SFDWL FOR STORAGE SPACE, License Class Lie. 4 REMODEL (E) CARPORT CONVERT TO GARAGE 500 SQ FT Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 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. Sq. Ft Floor Area: Valuation: $10000 1 have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 37518027.00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WIT F PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DA CALLED INSPE TION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, 7LAST costs, and expenses which may accrue against said City in consequence of the Issued by: Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE ict the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compli, ee vith the Cupertino M icipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safet , Co , See io s 25505, 255 d 2553. Section 3700 of the Labor Code, for the performance of the work for which this Owner or author zed . t poll s issued. that in the performance of the work for which this permit is issued, I shall loy any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all n -point source re ulati per the Cupertino Municipal Code, Section Licensed Professional L9.18.4�� ` DatA U / Si nat w�ta'C9D�: CONSTRUCTION PERMHT APPLICATION COMMUNITY DEVELOPMENT. DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildino(d)cupertino.org f-1 1-1 ., — ATinm /TT n p1=171cinN InE;77TZP7n • ,mss.. Y ORIGINAL PERMIT n LJ NEW CONS 1 KUC 11UN u �Lr l iuiv LJ-- ----- PROJECTADDRESS �f L�L� ��/ �® n 0 �N" �7� OWNERNP.I4E PHONE,. E-MAIL STREET ADDRE 3 Cj I •, TATE, ZIP I FAX, ./ Y 11'd� CONTACT NAME PHONE. -- �y E JJJ ��� STREET ADDRESS � CITY, STATE, ZIP . i FAX Z2 OgT'ER ❑ O1X NER BTILDER ❑ OVPubR AGTZ ❑ CONTIuC OR ❑ CONTRACTOR AGENT ❑ ARCHn ^ CT ENGL TER ❑ DEVELOPER ❑ TENANT CONTRACTOR I LICENSE "Lwa LICENSE TYPE I BUS. LIC R COMPANY NAME E-MAIL I FAX STREET ADDRESS TY, STATE, ZIP L� a I PHONE ARCHiTECTIENGINTEER NA.M I LICENSE NUMBER BUS. LIC I' COMPANY NAME E-MAIL I FAX STREET ADDRESS A CITY, STATE, ZIP (Ww I PHONE i DESCRIPTION OF WORK (N PROPOSED USE CONSTR 'PE STORIES USE TYPE OCC. SQ.FT. VALUATION (S) _� j11INGU/SF NEW FLOOR DEMO � AREA %> TOTAL NErAR-A iC AREA l/ BATHROOM KITCHEN OTHER REMODEL AREA M40DEL AREA D REMODEL AREA PORCHAREA DECK AREA TOTALDECKTORCHAREA GARAGEDF�FACH 00 l TTACH m DR LLING UNITS: ISA SECOND UNIT ❑ YES SEC D STORI' ❑ TES BEING ADDED? WO ADDITION? -P-r1PPL-IC-A�iON-01'-ES--ir 1'ES.3-ROYIDELOPL' OE _J E BLDG AN M YES 'RECEII'EDB3' TOTAL VA .4TION: PLANR�4NGA?PLR ❑NO PLANNING APPROVAL IEREICHLERHOR4E? ❑NO By my signature below, I certify to eac e following: I am the property owner or authorized agent to ct on the property vner's behalf. I have read this application and the informztion I ha e prov ded is corzect. I have read the Description of Work znd verify -u Zrcurate I a to comply with all applicable local ordinances and state lzws relative o buil g construction. I ize representatives of Cupertino to enter the above -identified pro ty for inspection purposes. (Q� ( (� / Signature ofApplicanUAgent: i Date: Signature w , '5E SUPPLE?IEN I�IFORMATIO\ REQUIRED HECK Y .J - 1\7ew SFD or 1\1 dwellings: Apply for demolition permit for Q Dl\GPLT RE��ii OVERTA)rCOURT]?R �BTJII existing building(s). Demolition permit is required prior to issuance of building �—A}" , 2 � r IF �- :. for building. EaPR�sswF 7 ANr`G�LnRE;�z�'�y� a permit new '' �ar'J"k1'1$ `�5_ � �lS �� r-�2'� �' I l� � '� M "�. T�•y. "�'�LYf � .�.SS''Ss4• ,: sT Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �•DA R��5 F�F74 Ii _ ".MN� 01 form if any Hazardous Maferials are being used as part of this project. �, • _ 4 , zs=, Da1r `z��T Copy of Planning Approval Letter or Meeting with Planningrior to P ❑ ,��0 - 'x- � © SATIT�RI SEIi�R,DIST.RICT� �' _ submittal of Building Permit application.' � t - ��Eli'3'SR07h➢iEI\TALHEa:35'fA `i ., � . ,_= Bldgflpp-2011.doc revised 06/21/11 /S Y, �—�, CITY OF CUPERTINO � � I FEE ESTIMATOR — BUILDING DIVISION 19 ADDRESS: 10241 johnson ave DATE: 08/11/2014 REVIEWED BY: Mendez A,Icc:h. Permit Fee: APN: BP#: &OWVALUATION: Other, tech. Insp.E:F-L- $10,000 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: P l;iec. Insp. hoe: PENTAMATION 1GENRES PERMIT TYPE: WORK add 244 sq ft to side of sfdwl for storage space, remodel e carport convert to garage 500 sq ft SCOPE Remodel, Other IREMRESOTH NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Worcs, Fire, Sanitary Sewer District, School I Lm --int etc 1 Tlrncn fooc aro hacod im thw nndhninary information available and are only an estimate. Contact the Dept for addn'I info. FEE ITEMS (Fee Resolution 11-053 Eff 711/13) itlech. Plan Check Phunh. Plan Chccl, PI/ec:. Plan Cn.:ck A,Icc:h. Permit Fee: PhImb. I'urmil Fec. Glee, Permit Foe: Other, tech. Insp.E:F-L- 01111,1. Plumb Insp. a,her Elec. Insp. Li ,14cc h. hasp. l c:e: 11111mb. hisp. Fce: l;iec. Insp. hoe: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Worcs, Fire, Sanitary Sewer District, School I Lm --int etc 1 Tlrncn fooc aro hacod im thw nndhninary information available and are only an estimate. Contact the Dept for addn'I info. FEE ITEMS (Fee Resolution 11-053 Eff 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes Q No $0.00 hours $143.00 Plan Check, Hourly ISTPLNCK A Suppl. PC Fee: 0 Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 500 S.£ $503.00 Remodel, Other IREMRESOTH Permit Fee: Hourly Only? Q Yes Q No $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consl1'dwtion7 1Ox: ,d�rrtfrisir��ri::e Pee: 0 E) Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 I i Trym el Doollinentalion 1,ees: Strong Motion Fee: IBSEISMICR $1.30 1.0 hrs $143.00 Inspections 1STINSP Inspection, Hourly Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.30 $789.00 TOTAL FEE: 1 $791.30 Revised: 07/10/2014 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 specified at: SITE ADDRESS i 0 -, /��� C.�AI ,, �j f c� APN BP# OWNER �T 6V N'ER ADDRESS DESCRIPTION OF WORK: .Qr 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.) 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. �. 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. /M-3. 1 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 nameeinstead of my own. 01-45AI,- I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. anA. I 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. I understand if I am considered an "employer" under state and federal law, I must register with the state and fe eral 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. /2&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 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. 5B. 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. 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.cslb.ca.gov for more information about licensed contractors. Og10. 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. ft11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by allapplicable laws and requirements that govern Owner -Builders as well as employers. O12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the inormation 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 verifica bn acceptable to e city may be required to be presented when the permit is issued to verifv the property owner's si n ture. -, If O , d Z__ / -------------------------------------------------------------------------------------------------------------------------------------------- (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: 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: 01vneiBzd1derFbon 2010.doc revised 04/19/10 , * SUVA. November 26, 2014 City of Cupertino Building Department 10300 Torre Avenue Cupertino, CA 95014-3202 Subject: Residential Addition @ 10241 Johnson Avenue, Cupertino, CA 95014 To Whom It May Concern: Please be advised that the proposed residential addition as referenced above will not have any adverse impact on the City of Sunnyvale's sewer system. According to City of Sunnyvale's record, the existing sewer lateral is at 30' North of South property line. Please call me if you have any questions at (408) 730-7609. Very truly yours, Manuel Pineda, PE Director of Public Works Vu Tran Engineering Assistant II cc: The Bull Family 724 Laurel St. San Tose, CA 95126. r l I'A. Cra.' S1 Si.nlw 1 i' February, 13, 2015 Building Inspector -Z;Ly of Cupertino Re: Special Inspection Re Applicant: George actor Project: Jim Bull' ew Garage and Storage Project Locatio : 10241 Johnson Avenue, Cu rtino Ca Permit No: 14 80081 Dear Building �[ c - I + 0 7 C�) (T� DAVID HUM RAVENA iii 301 On Friday, February •13th, 2015, 1 inspected the drilled hole between House and Garage at the west edge of man door for the above referenced construction project. I inspected the location, size and depth of the drilled hole for installation of Simpson Htt4 holdown. I approve the drilled hole for holdown installation. Sincerely,./-' 1 David Huboi Architect (83 1) 536-0949 H M31 ! (-336-8843 FAX ( °!-0811 3.6,4-'.)-11 7 `t,!:'Jw.hub,Oi.CG''.?'•