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13080187i� ��J CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10661 CARVER DR CONTRACTOR: RICCARDO FORLEO & PERMIT NO: 13080187 DOROTHY LIN OWNER'S NAME: RICCARDO FORLEO & DOROTHY LIN 10661 CARVER DR DATE ISSUED: 09/23/2014 OWNER'S PHONE: 4088288426 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CONSTRUCT 2 STORY SFDWL TO 1ST FLOOR 2019 License Class Lic. # SQFT,2ND FLR 717 SQFT TO INCLUDE ATTACHED CAR GARAGE 427 SQFT Contractor Date REV # 1 - SHORTEN GARAGE ADDITION BY APPROX. 1 I hereby affirm that I am licensed under the provisions of Chapter 9 S.F. TO MEET SIDE YARD SET BACK - ISSUED 2/9/15 (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: $250000 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 37534050.00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I 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 WITHIN 180 DAYS OF 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 DAYS D INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 2— granting of this permit. Additionally, the applicant understands and will comply v: a e: 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 construct 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 Muni Code, Chapter 9.12 and the declarations: Health &Safety Code, Section 25532(a) shoal I st re or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I e equipme t or evices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by h Bay Area it ality Management District I performance of the work for which this permit is issued. will maintain compliance wit he Cupertin Mu cipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health &Safety Code, Se 'o s 25505, 2 3 and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Dater � permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ 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 an ounty ordinances and state laws relating to building construction, and hereby au ri representatives of this city to enter upon the above mentioned property for nspe tion purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City f Cu ertino against liabilities, judgments, costs, and expe which may accru agai t said City in consequence of the I understand my plans shall be used as public records. granting of thi pe it. Additionally thea licant understands and will comply with all non- int ource reg tion a Cupertino Municipal Code, Section Licensed Professional 9.18. Signature DateW_- 5%' " �J - -, I g ( , ( - ( (, ",4 a Q- w z 1) 0? - - P5 (74 0 � -( 0- -, 2 a c) 16 � � I tg,? rieqyunt A L4 a/L P&-4 fix-� 4- 1-30 16--� �ec?vw- u l 0�2 lit p ,9� xr C�j f L �p c.1e 017 J//, 3 //, 5 - - &OZ7 � qj,a/Js i��v CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, rubuc wortcs, pore, sanirary,3ewer tirsrrncr, acnoot .. r.,...ed , " fhanrotiminani irJnrmatinn aVailahlP and are only an estimate. Contact the Dept for addn 7 info. [/{J!/161, CLI.. . �/f GJG Gcu uiG �uuvu v.• ..... .......»..». FEE ITEMS (Fee Resolution t 1-053 Eff 7/1/132 DDRESS: 10661 CARVER DR DATE: 02 9/2015 REVIEWED BY: MELISSA W PN: 375 34 050 BP#: -VALUATION: $0 PE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: p 0.0 PENTAMATION 1GENRES PERMIT TYPE: WORK REV # 1 - SHORTEN GARAGE ADDITION BY APPROX. 1 S.F. TO MEET SIDE YARD SET BACK - SCOPE ISSUED 2/9/15 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, rubuc wortcs, pore, sanirary,3ewer tirsrrncr, acnoot .. r.,...ed , " fhanrotiminani irJnrmatinn aVailahlP and are only an estimate. Contact the Dept for addn 7 info. [/{J!/161, CLI.. . �/f GJG Gcu uiG �uuvu v.• ..... .......»..». FEE ITEMS (Fee Resolution t 1-053 Eff 7/1/132 h a r. Niue t >!cc Ptnrnb. Plan Check Check heck .ltech. Peruta 1 mumb. Permit mit Fire: Othcr a/ec h. Insp. Other Plumb Insp )rhet. P1ec. Inst ED �Wech. Insp. Fee: 0.0 hrs NOTE: This estimate does not include fees due to other Departments (i.e. Planning, rubuc wortcs, pore, sanirary,3ewer tirsrrncr, acnoot .. r.,...ed , " fhanrotiminani irJnrmatinn aVailahlP and are only an estimate. Contact the Dept for addn 7 info. [/{J!/161, CLI.. . �/f GJG Gcu uiG �uuvu v.• ..... .......»..». FEE ITEMS (Fee Resolution t 1-053 Eff 7/1/132 -_1_...____ .- __. FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Yes Q No $0.00 2 hours Plan Check, Hourly $286.00 ISTPLNCK Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? ()Yes Q No $0.00 Suppl. Insp. Fee -0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax. Administrative Fee: Work Without Permit? Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure A T''mwel Documentation Fees: Strong Motion Fee: $0.00 0.0 hrs $0.00Inspection, Inspections Hourly Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $286.00 TOTAL FEE: 1 $286.00 Revised: 01/06/2015 Rf 1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10661 CARVER DR CONTRACTOR: RICCARDO FORLEO & PERMIT NO: 13080187 DOROTHY LIN OWNER'S NAME: RICCARDO FORLEO & DOROTHY LIN 10661 CARVER DR DATE ISSUED: 09/23/2014 OWNER'S PHONE: 4088288426 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ CONSTRUCT 2 STORY SFDWL TO IST FLOOR 2019 License Class Lic. # SQFT,2ND FLR 717 SQFT TO INCLUDE ATTACHED CAR GARAGE 427 Contractor Date SQFT 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 Sq. Ft Floor Area: Valuation: $250000 performance of the work for which this permit is issued. 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 APN Number: 37534050.00 OCC upancy "I'ypc: permit is issued. APPLICANT CERTIFICATION I 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 WITHIN 180 DAYS OF 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 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the ^ / ni f a j Issued by: ��! V T/ % /� 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. 14 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 1, 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 construct 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 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Muni ' a ode, Chapter 9.12 and the declarations: Health &Safety Code, Section 25 a) shoal I stor or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should use quipm t or vices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the y Are Air ality Management District I performance of the work for which this permit is issued. will maintain compliance wit he perti Mu cipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, S ons 5505, nd 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date:19424DJ permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY 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"RTI Lender's Address I certify that I have read this app"catio and sta that the above information is correct. I agree to comply with all city d co ty ordinances and state laws relating to building construction, and hereby thoriz representatives of this city to enter Zp upon the above me Toned property r ction purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and p armless the,City of pertino against liabilities, judgments, costs, and exp ses hich ma cc e a Inst said City in consequence of the l understand my plans shall be used as public records. granting of th pe t. Addi applicant understands and will comply with all non- nt s rce re ti s r the Cupertino Municipal Code, Section Licensed Professional 9.18. gyp Signature Date N CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 \�V (408) 777-3228 • FAX (408) 777-3333 • building a0cupertino.org J CUPERTINO NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS(06G t t' APN # '31.5 -/ 2q 05V , C1a2�� �2i U OWNER NAME n E-MAIL ��/ �\C� A62UO �� (2 L SU PHONEE��_� /' C 1 V&Al STREET ADDRESS CITY, STATE, ZIP �{{_uC _ I • f"1 n�� •/ CONTACT NAME PHONE � n _<, G�l �a ���-� - �SL—�I STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUDDER ❑ OWNER AGENT ❑ coN RACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME _ LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME COMPANY NAME STREET ADDRESS DESCRIPTION OF WORK EXISTG NEW FLOOR DEMO AREA AREA 2 AREA BATHROOM KITCHEN REMODEL AREA REMODEL AREA LICENSE NUMBER E-MAIL CITY, STATE, ZIP VSTR TYPE # 5 TOTAL e NET AREA OTHER REMODEL AREA ATTACH BUS. LIC # FAX PHONE USE I TYPE I OCC I SQ -FT VALUATION ($) #DWELLING UNITS: IS A SECOND UNIT LJ SECUry �v LJ ina BEING ADDED? ❑NO ADDIT N? []NO PRE -APPLICATION S IF YES, PROVIDE COPY OF ISTH BLD AN ❑YES NO PLANNING APP AL LEITER ER H M E? ❑ NO RE 1 BY: OTALVALUATION: G S O� G O J PLANNING APPL ❑ By my signature below, I certify o c f e follo ng: I he roperty owner or authorized agent to act on the property owner's beha f I have read this it is I agree to comply with all applicable local application and the information I av rovi ed is c rrect. I h e ad the Description of Work and verify accurate. of Cupertino to enter the above- dentified property for inspection purposes. ordinances and state laws relating to uildi o t epresen 21:2 1 31 Signature of Applicant/Agent: Date: SUPPLEMENT L INFORMA RE D PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ING PLAN REVIEW _ existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRE ANNING 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 In FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR SANITARY SEWER DISTRICT _ Submittal ofBuilding Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_MLdoc revised 06/21/11 CITY OF CUPERTINO IlY"_Y/1J1 FFF. F4T1MATnR - BUILDING DIVISION 0 ADDRESS: 10661 carver dr DATE: 08/22/2013 REVIEWED BY: Mendez PC FEE ID APN: BP#: ,' Mt1,) & "VALUATION: 1$250,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: 2nd Unit? 0 Yes No I PENTAMATION 1 R3SFDW I PERMIT TYPE: WORK construct 2 story sfdwl to 1 st floor 2019 sq ft 2nd floor 717 sq ft include attached car garage 427 sq ft SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 2,964 $2,977.05 1R3PLNCK $2,924.20 1R3INSP $0.00 PME Plan Check: $0.00 Permit Fee: $2,924.20 Suppl. Insp. Fee -0 Reg. Q OT f 0,07 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 2,964 $2,977.05 Construction Tax: 1BC0NSTAXR $2,924.20 # new units NOTE: This estimate does not include fees due to other Departments (i.e. rtammng, ruouc worKs, rise, ounuury 5ewc, "lauiu, -- L bd #1.1' 'na in ormation available and are onl an estimate. Contact the Dept or addn7 info. District, etcj. These Lees are ase on a re imt FEE ITEMS (Fee Resolution 11-053 Ej': 7f 1;"L2j ;tt. Plan C h"rk PhunE Plan C'hec'k Elee..Plan ("heck Meeh. Pennif Fee: Plumb. Pc Elec, Permit Fee Other Alech. Insp. tNher Plumb Insp. Lj Other Elec, Insp. Hech. Insp. fee: !-cv" E%c'c. Incf,Fco NOTE: This estimate does not include fees due to other Departments (i.e. rtammng, ruouc worKs, rise, ounuury 5ewc, "lauiu, -- L bd #1.1' 'na in ormation available and are onl an estimate. Contact the Dept or addn7 info. District, etcj. These Lees are ase on a re imt FEE ITEMS (Fee Resolution 11-053 Ej': 7f 1;"L2j FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,977.05 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $2,924.20 Suppl. Insp. Fee -0 Reg. Q OT f 0,07 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 1BC0NSTAXR 1 # new units $ 647.24 ,ldminisirutiveFee: 0 E) Work Without Permit? © Yes (F) No $0.00 Advanced Planning Fee: IPLLONGR $414.96 Select a Non -Residential Building or Structure 0 Travel Documentation Fees: Strong Motion Fee: IBSEISAKCR $25.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $10.00 SUBTOTALS: $6,998.451 $0.001 TOTAL FEE: $6,998.45 Revised: 07/01/2013 Cupertino Union School District 10301 Vista Drive, Cupertino, CA 95014 Tel (408) 252-3000 • Fax (408) 865-0326 I f>e)r-'l Developer Impact Fee Compliance The Cupertino Union School District has adopted Resolution Nos. 1403 and 1404, imposing developer impact fee pursuant to Government Code 53080. Building Permit Request The City of has received a request for a Building Permit described as follows: ❑ Residential Development Project ❑ Commercial/Industrial Development Project Name of Developer: 4 Project Address: Description: Square Footage: v242GeL Lot/Parcel#:��7--`���L Permit#.' �3�/i!,7 �d7 Date: /''� BL:�N Y: City Authorized Representative Square footage will be verified by the city prior to issuance of a building permit; fees may be adjusted accordingly. Important Notice: Cupertino Union School District gives no credit for total demolition of existing square footage area, which makes way for new construction as mandated in the Government Code Sections 53080, 53080.6 and 65995. SCHOOL DISTRICT DEVELOPER IMPACT FEE CERTIFICATE OF COMPLIANCE The authorized representative of the Cupertino Union School District has reviewed the City of C uP,p k3T llv U Building Permit Request described above and hereby certifies that the developer or authorized representative has met the requirements of the District's Developer Impact Fee requirements. Dated: �—• 2 Z By: Authorized Representative Cupertino Union School District Certificate not valid without District seal, initial, and date. Facilities Planning - White City - Yellow Fee: $ Check No.: 2 Z Requestor - Pink Accounting - Gold FREMONT UNION HIGH SCHOOL DISTRICT 589 WEST FREMONT AVENUE SUNNYVALE, CALIFORNIA 94087 408-522-2200 Developer Impact Fee Compliance Building permits will not be issued without a completed Certificate of Compliance Building Permit Application The City of has received a request for a Building Permit described as follows: New Residential Development _ Residential Addition (501) sq. ft. or more _ Commercial Development Name of Owner / Developer: Project Address: Lot/Parcel # j7^5 Square Footage: f Description: '" �/�o / ) 5��7 L1 L11? J ;��''� r77 /1&'/r1 Permit / Plan Check # %` `�, ✓�' Date By: City Building Inspector Square footage verified by the city prior to issuance of a building permit; fees may be adjusted accordingly. Feeder Elementary District (t;(.4 C, .................................................... _............. SCHOOL DISTRICT DEVELOPER IMPACT FEE CERTIFICATE OF COMPLIANCE The authorized representative of the Fremont Union High School District has reviewed the City of Building Permit Request described above and hereby certifies that the developer or authorized representative has met the requirements of the District's Developer Impact Fee requirements. Dated: By: Fremont Union High School District Authorized Representative Certificate not valid without District Seal, Initial, and Date Fee $ Distribution: Facilities Planning —White City — Yellow Requestor — Pink Accounting — Gold Dev. Impact Fee Compliance (Rev. 11/22/05) [12/08 — 1000] JP' o►.... OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINC) (408) 777-3228 • FAX (408) 777-3333 • building(@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: 10,66 R - r (Zrlu0 e,-,APN BP# -77 OWNER NAME r—, _ I f� ; OWNER ADDRESS 6262 ,-' DESCRIPTION OF WORK: We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) QF 1. 1 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. R2. 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. Y3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. eE_4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. QL5. 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. r6. 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. 1RE7. 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 performed under contract with a licensed general building Contractor. �r 1 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwneYBuilderForm 2010.doc revised 04/14/10 6 9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. OL -11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. �12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not Je 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 Before a building permit can be issued,'s form st b co pleted and signed by the property owner and returned to the agency responsible for ing t erm' . te: A copy of the property owner's driver's license, form notarization, or other verification a ep a ere uired to be presented when the permit is issued to verify the property owner's si natur Property Owner's Signature: I Date: -(NOTE-:--T--h-e---fo--ll-o-w--i-n-g--A--u--th--o-r-i-z-a-t-i-o-n--F--o-r-m---i-s--r-e-q--u-i-re--d--t-o- -b-e-- 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: OwnerBuilderForm 2010.doc revised 04/14/10 CUPERTINO March 16, 2017 BUILDING PERMIT / APPLICATION EXPIRATION LETTER COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-7606 • building(d)cupertino.org RICCARDO FORLEO & DOROTHY LIN 10661 CARVER DR. CUPERTINO CA, 95014-4120 SUBJECT: BUILDING PERMIT EXPIRATION LETTER Site Address: 10661 Carver Dr. Building Permit Application #: 13080187 Expiration Date: 03/27/2017 Per Section 105.5 of the California Building Code, ... "every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 180 days after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period of 180 days after the time the work is commenced. " Your Building Permit 13080187 will expire 03/27/2017. There have been no inspections since 09/27/2016. If a valid inspection is not completed by the expiration date of 3/27/2017, the building permit will expire. Once a permit expires all fees paid to date will be relinquished. You will need to submit a new application & new plans (electronically) that are in compliance with the new Building Codes and local ordinances. New fees and plan reviews will be required. We are not able to grant you any further extensions. Discretionary Planning Approvals are also subject to expiration. Please refer to the Planning Department to determine if anew planning review process is required A code enforcement case will result if a construction site is left abandoned and unsafe. Please call 408-777-3228 to schedule your inspection. Let me know if you have any questions. Sincerely, 1 Susan Winslow Administrative Assistant City of Cupertino Building Department 408-777-3246 suew@cupertino.org 1 'V� IDV21J -U9Mo -11-9 'Il rols(,&-7cw nom' )C. V5 b ryo�'iv