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14030067 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10640 MORENGO DR CONTRACTOR:EDDY MAYORAZ PERMIT NO: 14030067 OWNER'S NAME: EDDY MAYORAZ 10640 MORENGO DR DATE ISSUED:03/11/2014 OWNER'S PHONE: 4088651557 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL REMOVE(E) KITCHEN WALL&REPLACE WITH(N) License Class Lic.# BEAM, REMOVE FP IN LIVING ROOM AREA AND MOVE TO Contractor Date EXTERIOR hereby affirm that I am licensed under the provisions of Chapter 9 WALL FOR INDOOR/OUTDOOR USE,GAS ONLY. MOVE (commencing with Section 7000)of Division 3 of the Business&Professions (E) 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:$15000 1 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:37534060.00 Occupancy Type: 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 L LLED INSPE TION. 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 applicant understands and will co s Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ROOFS: `Signature Date All roofs shall be inspected 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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) 1,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 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 compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Workers Compensation Insurance,as provided for by the Health&Safety Code,Sections 2_5 5;-25_533,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 Ni 4 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,1 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 CERTIFICATION Lender's Address I certify that 1 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION 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 non-point source regulatious per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10640 MORENGO DR CONTRACTOR:EDDY MAYORAZ PERMIT NO: 14030067 OWNER'S NAME: EDDY MAYORAZ 10640 MORENGO DR DATE ISSUED:03/11/2014 OWNER'S PHONE: 4088651557 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL REMOVE(E) KITCHEN WALL& REPLACE WITH (N) License Class Lic.# BEAM, REMOVE FP IN LIVING ROOM AREA AND MOVE TO Contractor Date EXTERIOR I hereby affirm that I am licensed under the provisions of Chapter 9 WALL FOR INDOOR/OUTDOOR USE,GAS ONLY. MOVE (commencing with Section 7000)of Division 3 of the Business&Professions (E) Code and that my license is in full force and effect. REVISION 41-KEEP REMAINING KITCHEN WALL, ADJUSTS' I hereby affirm under penalty of perjury one of the following two declarations: DIAMETER CIRUCLAR WINDOW AND RELOCATE.FIREPLACE-1SSD I have and will maintain a certificate of consent to self-insure for Worker's 6/11/2014 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:$15000 1 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:37534060.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 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 ERMIT 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 FRO AST 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 granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: 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. op OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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 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 compliance with the Cupertino Municipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this , o `� Owner or authorized agent: �',��/�'�'� Date: 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 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION 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 non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. / Signature ` Date �, l� CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228• FAX(408)777-3333• building(c1cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERnATION/TI NE REVISION/DEFERRED ORIGINAL PERMIT 9- PROJECT ADDRESS / / l'IO(ei'I a j\r `v LVLO APN N OWNERNAME _1 l� PHONE 6:0 '�(��/ /� E-MAIL STREET ADDRESS CITY, STATE,ZIP b FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑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 LICENSE NUMBER BUS LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP ' / �0 PHONE DESCRIPTION/OF WORKI✓(,QIIL TLv � O✓Q WC�.�K �L ��h QVtI Ul,/(Ztl'vt room tv J51' 144emefj'.e'' c.l'(cE)fci.,,- W iv>O�vt✓ 14�So r cveoL 9QS �!e place A0-1 I k,de-6 I n Ct.,Idoor. EXISTING USE PROPOSED USE CONSTR.TYPE I #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH IAREAECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY E]YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOTAL VAL ION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO By my signature below,I certify to each of the following: I am the property owner or authorize ent to act on th Ry owner's behalf. I have read this (/ V application and the information I have provided i rect. I have read the Description of W and ver I'S accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin ction. I authorize representatives of Cupe mo to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: �`�� ll ZO! SUPPLEMENTAL INFORMATION REQUIRED CHECK TYPE ROUTING SLIP New SFD Or Multifamily dwellings: Apply for demolition permit for OVER-THE-COUNTER BUILDING PLAN REVIEW 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 ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BtdgApp_2011.doc revised 06/21/11 CONSTRUCTION PERMIT APPLICATION O00' COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINCl (408)777-3228 •FAX(408)777-3333• build ing(a)cupertino.org v ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS I i, MnAPN# D �` l.y c. U �`� v OWNER NAME E(�Ck N I C G L Q 5 NC` o rcupt PHONE to Q 5 J IS r 7 E-MAIL n I � � C f,✓r1 STREET ADDRESS CITY, STATE,ZIP I C 7FAX i o61tf0 I�I�ten�c �r C�F��r �� J.�� ►4 CONTACT NAME rut 140` S M('�G Ca� PHONE I;V(? 9 5 f SS 7 E-MAIL STREET ADDRESS I I I 1 I CITY,STATE, a / FAX IoEc�v Nlcrevt9� Jr Cv e,(Awa CA 9SZ)14 la OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESSii 6r CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME ;fah 41 Vey'k I C LICENSE NUMBER I Z E BUS LIC# COMPANY NAME 1 1 n E-MAIL V G FAX !,D3 C 77_ /, $3J STREET ADDRESS j7t4'5, 5 C /l r n tq p. CITY,STATE,ZIP -Sav) Tme ) CA PHONE`ff/(�9 464-3,311 TO DESCRIPTION OF WORK `1 JJ C r 1 V T Removiriq Chtmevi asci old anct re la c n1ij J w x gas li nacre r - 't4ot r /uWV1iG EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC, SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA�DECKAREA TOTAL DECK/PORCH AREA GARAGE AREA DETACH ❑ATTACH a DWELLING A SECOND UNIT []YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? []NO PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED$ - 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 authorized a ner's behalf. I have rea application and the information I have provided is correct. I have read the Description of Work and veri It is accurate. I agree to comply with all applicable local ordinances and state laws relating to building constructiocay— a representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: I`7e2/C ti l t/ SUPPLEMENTAL INFORMATION QUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ RUiLDING PLAN REVIEW 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 ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp 2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10640 MORENGO DR DATE: 03/11/2014 REVIEWED BY: MELISSA APN: 375 34 060 BP#: L' TIV `VALUATION: 1$15,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: PERMIT TYPE: WORK REMOVE E KITCHEN WALL & REPLACE WITH N BEAM REMOVE FP IN LIVING ROOM AREA SCOPE AND MOVE TO EXTERIOR WALL FOR INDOOR/OUTDOOR USE, GAS ONLY. MOVE (E) GAS LINK NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc. . Theseees are based on the preliminar information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution I1-053 El 7j ;1.131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F-4-207 s.f. Remodel, Other Suppl. PC Fee: Q Reg. Q OT0.0 hrs $0.00 $488.00 IREMRESOTH PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? 0 Yes Q No $0.00 0 Advanced Planninu) Fee: $0.00 Select a Non-Residential Building or Structure 4 A Strom Motion Fee: IBSEISMICR $1.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.50 $488.00 TOTAL FEE: $490.50 Revised: 01/15/2014 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 1 CJr p mofe'ng o br PERMIT# U G OWNER'S NAME: E N �o( 1J1'ya 1-vL� PHONE# 409 9ES (.S,S7 GENERAL CONTRACTOR: O WA BUSINESS LICENSE# 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 INSPECTIONS) 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 Date Please check applicable subcontractors and complete the following information: e,WCyLn /V6 V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 1111201 Owne /Qontractor Signature Date OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• buildina(5)cuoerlino.org CUPERTINO 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 �J 6 40 M y rem q o J r APN 3 " 3 _ o 6 b BP# �YV3006jL- OWNER NAMEE M IV ``vl u s ]�^ &(�� OwADDRESS jam e DESCRIPTION OF WORK: re.M G V1 J t `,1 re ('Zi-C i/i 4t_. W i✓ow In a .i g ;re UaL_ ii— rev,c i i vLej k+�c.k en LIVIVI1 raovn 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.) 1w1. 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. 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. 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. A4W 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. X13. 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 name instead of my own. W 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. A5. 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 ive hundred dollars ($500), including labor and materials, I may be considered an "employer'under state and federal law. M"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. 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 fourwithin any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 8. 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. 011177er3ui?derForm 2010.doc revised 04/19/10 0M 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 v✓ww,cslb.ca.gov for more information about licensed contractors. MOM10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the parry legally and financially responsible for proposed construction activity at the site address listed above. MN11. 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 covern Owner-Builders as well as employers. (V PM12. I 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.) 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 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: 3 '%r Zo --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE. The 'olloi4ing 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). AUTHOiRIZAT[ON 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: Tel No Address of Authorized Agent: [ 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 properly 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: Oi%,7ie7BuildeiFon7i2010.doc revised 04/14/10 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION CUPERI-INO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408)777-3228 •FAX(408)777-3333 •buildinga(�cupertino.org Permit No. Address ,14 d I/ #of Alarms Smoke: 7 Carbon Monoxide: I/ PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN SIGNED AND RETURNED 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 R314, 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 420.6 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 X X bedroom(s) 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 w ere,repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by m ns of attic,basenient or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2.0Anlectrical per t is re ired for alarms which must be connected to the building wiring. z � `IL «lAs owner of the above-referenced property, I hereby cerhat eaarmferenced abo h /have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. I have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agent's) Name: Si nature............ .. ..!va .............I......................... pa�: ........ Contractor Name: q ��—FC i li ha STf� i� Si nature..... ........Licl .....9..7I 3 1.....Date: �S Smoke and COform.doc revised 03/18/14