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12110107 CITY OF CUPERTINO BUILDING PERMIbA- BUILDING,ADDRESS: 10302.TERRY WAY CONTRACTOR:LIAO CHUM I HAND BEI PERMIT NO:'12I 10101 W OWNER'S"NAME: LIAO�CHUNQKAND BEI W' 143 TERESITA.WAY DATE ISSUED: I f/19/2012 OWNER'SPHONE: 4082526179 LOS,G'ATOS,`CA 95030, PHONE'NO` (]e LIC ENSEDiCONTRACTOR'S DECLARATION BUILDING'PERMIT°INFO: BLDG ELECT f7i PLCj UMB License Class Lic.#. -..._ .-. ��. MECH' . RESIDENTIAL` .COMMERCIAL Contractor Date hereby r with Sect onr7000)of oder the',provisions otChapier 9 JOB DESCRIPTION .APT 1 REMODEL KITCHEN 209 SQ FT Y DOUBLE FEES STARTED WORK WITH NO PERMIT' ( ivisind 3 ofahe Business&Professions I2/6/1'27REV42 ADD HALFQBATH UNDER STAIRS(]8 12/6/12-REV#2-ADD HALF Codetand that:my license is;rn full force,nil effect. BATH UNDER-STAIRS(] S F.T)-REV#2 ISS'D 12/6%12 I hereby affirm`under penalty,of perjury one of t-he following tvv6Acclarations: l'haye,and'will maintain a•.certificate-ofconsentto self-insure.for Worker's, Corripedsation;as provided for`by Section 3700 of the LaborCode;;fof the. performance,ofthe workfor which'thi's permit is-issued. Lhave and will maintain Worker's°Compensation_Insurance,as;p_rovided•for'by Section 3700 of the Labor Code;for the performance of the-work°for which this, permitlis issued. Sq.Ft.Floor Area: Valuation:$20900 APPLICANT CERTIFICATION J certify thaLl h'ave:read this application and state ihat,the above information is APN Number:359],7012.00 Occupancy Type: correct.I,"agree to corriply with all city.;and•county ordinances and state3aws,relating to-building construdion;;and hereby authorize representatives-.of this city to`enter upon the above mentioned property,forinspection purposes. (We);agree:to.save indemnify,and keep harm less:the City of.Cupertinoagainstliabilities„judgments, ” PERMIT EXPIRES`IF WORK IS NOT STARTED 'costs and expenses which may.accrue;agamst.said,,City,inconsequence of;the gra1 ting�oftfiis permit: Additionally,the,appIicant`understands�and'will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all,non-poinfsource regulations per the Cupertino.Mun'icipal Code'Section 180 DAYS FROM LAST CALLED INSPECTION. ,9.18. Signature Date Issued by- o� %� �1TG Dater ❑ OWNER"BUILDER"DECLARATION Lhereby affirm that l am exempt from the.Con.t-racto_r'sLicerise Law for one;of RE-ROOFS: the_followiog two,-reasons: All roofs shall be insoectedcorior to any roofing mateiial'beng installed If a roofis I,as owner of the property;or my�employees with wages as their`sole compensation, installed without first obtaining.an inspection,l':agree toremove all;new materials for wilfdo-the work;;ah&the"structure1s nouintended or offered.for,sale(S;ec:7044; 'inspection., Business&_ProfessionspCode) L;as owner of the.property,,arirlexclusivelycontracting with licensed_contractors to Signature of Applicant: bate: construct the,project.(Sec.7044,Business&Professions'Code). , 1 hereby,aftirm under penaltyof perjury one ofahe.followiog threeALL ROOF COVERINGS TO BE':CLASS"AA"OR BETTER declarations:.- I haveand•will,maintain a Certificate`of Consent to _ self-insure:forWoker' Worker's HAZARDOUS MATERIALS DISCLOSURE, Compensation as rovidedfor bYSection3700 oftheLabor;Codejorthe' ;06fforrhance)of theTWoik for.which this permit is.issued. I;have°read the.hazardous materials requirernents'under Chapter 6 95 of the �,I'have_and wilf maintain Worker.s Compensation Insurance;as provided for by California Health&�SafetyCode,Sections 25505,25533,�and`25534 I will maintain c""ompliance`with'the,Cupertino:Muni6pal Code,Chapter 9 11and the health&c Section 3700+of the1abior,Code,for the performance�of the•woiklfor'which this Safety Code,Section.25532(a).,sfiould 1 store or handle hazardous,material., permitis issued: Additionally,should 1'-use.equipmentor devices which emit hazardousair `,I certify thabin:the performance of the°work for which thisp&mit is issued,Fshall contaminants as defined by.the Bay,Area.Air Quality•Managemenf istrict l will not employEany,person irran`y,'manner,swas t-o becomesubiect tothe Worker's maintain win plianee with theCupertino Mu.nicipal�Cod- e,Chapter 9a2,and.the - Cornpensation Iawsof CAlifornia. If after rriaking;this-certificate of exemption,I Health&SafetyCode,Sections;25505,25533,aod;25534. 'become,.subiectto the Worker:'s Compensation provisions.ofthe,Labor Code,I_must _ O�wneror,authorized fortliwith con IY withsuch rovisions;or this erriit shall be deemedrevoked. agent- � Date., r'Z -d6 '-/Z T- - APPLICANYCERTIFICATION CONSTRUCTIONLENDING AGENCY' fcertifythat°I have read this application and state;that the above information:is correcC I agree to,coinply with:all city and county,ordgranc&and state laws relating y onstructionlending agency for the performance"of Ao&s, I hereby affirm'that;there is a c to.btuldiiiglconstruction,and hereby,authorize representatives ofthis'cityto enter for which,this permitis issued(Sec.3097 Civ C) upon;the"aboye?mentioned;property_forinspection`purposes:(We),agree to save Lender's Name indemnify°and'keep harmless the City of Cupertino agiinsdiabilities;judgments; costs;.and expenses which may accrue against said City in consequimce�of the Lender's Address grangng;ofthis permit.Additionally,'the applicant:'nderstands and-will comply with all non-pointsource regulations per the.Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. - understandmy,plans-shall.kused as public records. `Signature, ��_-- Date: iZ,- 061 1 2- Ticerised Professional CITY OF CUPERTINO FEE E°ST�IMATOR.— BUILDING DIVISION a-i,,APN- ADORESS;, 10302TERRY WAY'UNIT"#1' DATE:, 12/06%2012REVIEWED BY: SEAN BP#. `VALUATION: 1,$5,000 *PERMIT TY-PE: Building Permit PLAN CRECICTY.PE- Alteration/ Repair PRIMARY MulBuildind is' PENTAMATION ti-Family Dwelling F 1 R2REIVI FQ USE: 3'Stoties �. Yes ,�No PERMITTYPE: WORK . REVISION#2: ADD 172 BATH UNDER STAIRS 18 SQ FT SCOPE �- �n l 10 IL-fec%r. Plan.Check` Alar"C Fr Plan(:he;k F, ,1ltrch.7nsl�. ;)tlierf'lrsmh In.rp: Utlri>r LIt'c.lns�, 1lecii.- sp,f i-:e: Numb, • NOTE:;This estimate;does3not indlude fees;dtieF tooth-er°Deparimenis(i:e..Pknning;.Public,Works,Fire,Sanitary Sewer District,School. District,etc Ttiesef ees�are'based,owthe, relimina in ormation"dvaildhioe and d-e oril an,estimate. Contact'the,Pe t`or addn4 info, FEE ITEMS,(Fee:Resolutiona l-053 Ef. Zil.712)- FEE Q,TY%FEE MISC ITEMS Plan Check.Fee: $0:00 1'8 s.f: Remodel,Bath(<=3,0Q 9f.)Suppl.PC Fee: E Reg. 'Q OT 0.0 'hrs '$0.00 $600'.00 IREMRESBAT PME Plan Check: '$0.00 Permit Feer $0.00 Sup-'01! lnsp: Fee: .Reg. () OT 0;0 hrs. $0..00 PME Unit Fed: $.0.00 PME:Permit Fee: $0.00' Consirxrcaion Fax- Adinini's trati ve.Fee: � Work`V✓ithou"t Permit? 0,Yes' ,E) No $0.00 Advanced Planning Fee: $0.00 Select allon-Residential` Travel Docuinentotion F'ecs: Building or=Structure 0. A Strong Motion Fee: I.BSEISMICR $0.50 Select an,Admimstrative.Item B1dp,.Stds.Cominission Fee: 1B,CBSC' $1..00 suBT�®TALs. x$1.50 $600.00 TOTAL FEE: $601.50 Revised: 10101/2012 uON# .` CITY:OF CUPERTINO'-BUILDING PERI we BUILDING ADDRESS: 10302 TERRY WAY CONTRACTOR:-LIAO CHUNG;H.AND.:BEI PERMIT NO: 12 1'O 107 W OWNER(S.NAME: LIAO-CHUNG H AND BEIW .1 ISTERESITA WAY DATE ISSUED: HA-9/2012 OW_NER'S;PHONE: 4082526,179 LOS`GATOS„CA,95030 PHONE NO: ❑, LICENSED CONTRACTOR'SMECLARATION BUILDING PERMIT INFO: BLDG - .ELECT PLUMB License Class tic.# 1 MECH'- RESIDENTIAL ”"` COMMERCIAL Contractor Date I Hereby affirinahat`I am licensed under the provisions ot.Chap[er 9 JOB DESCRIP,TION:�APT I-REMODEL-KITCHEN 209;SQ,FT (commencing with Section 7000)of Division 3 of the;Business.&,Professions DOUBLE FEES'-STrcARTED WORK WITH NO PERMIT Code,and,thatm license isan.ful,lJorce_;and effect. 12/3/1,2=REV#I m TO CL;EAR,CODE ENFORCEMENT CASE REMOVE ANDREPLAGE-(7)WINDOWS;REMOVE AND REPLACE UPSTAIRS- I hereb affirm under enal_ of erjur one ofahe foliowin two,declarations- 12/3/12 REV#-1 ISS'D J -� v,�, �Y-.. _ - P_ tY perjury Y g` S/j.Gr�C/vc 1`,,'tiave,and'will maintain a,certificate'of consent to self-insure for'W,orker's Cr ompensation;,as provided for Section-3700 of the:Labor Code ;:forthe, perf4mance"of the wo k;for+which'this permit is issued. 1;have:and'will maintain Worker's,Compensationlrisurance,as�provided'for'by Section 3700,'6f the C`abor Code ,for the performance ofihe'work.'forwhich.this Sq.FtFloor Area: Valuation:$15900 permit:is issued.. APPLICANT CERTIFICATION APN Number:3591`701.2.00 Occupancy Type: certify'thai[haveireadthistapplication.andsiate than the�aboveilinforrnation is correct.I agree.fo.complywith,all city-and.countyordinances and statelaws relating to;huilding construction„andihereby;authorize•representatives;of this city to°enter I pon the above meet oned.property forainspection`purposes: (We),agree[o;save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify'and.keep`,harmless,thei@ity'of Cupertino aga.insi liabdrties;judgments, costs,and expenses which.mayaccrue against-.said Cityinconsequence of the WITHIN 180 DAYS;OF PERMIT ISSUANCE OR gran-tmg.of this permit. Addrtionally theapplicantunderstands and�wiII comply 180 DAYS FROM LAST CALLED INSPECTION'. with all non�pomt_so urce.regulatrons per the Cupeitmo,Munrcipal,Code,Section .9..18. Issued by: -,-. Date: 3 %" ;Signature. Date OWNER-BUILDER.DECLARATION RE-ROOFS: 'I hereby affirm that.I am�ezempffrom the Contractor's License:Law'for one of All roofs shall be.irispected;prior"to any r6ofing.materiah6eng:installed.af a roof,is 'the following two reasons: installed.without first obtaining:an_inspection;11 agree to',remove all new,maierials'for 1,8`owner of the property;or my employees with wages€as•their sole-compensation, inspection. will do',the work,,and,;tlie,str'ucture'is notintended:oroffered for sale(Sec..7044; Businessi&Professions.Code) Signature ofApplirant Date: 1,,asI.owriero`f the property,'am-exclusi"velycontractingrwith'licensed,contractors.to coALL ROOF COVERINGS TO BE C nstrict°the; ro Sec:7044,Business"&Professions Code)'.,P Ject( ) .l� �.f; LASS"A":OR BETPER l Hereby affirm under penal.ty,of perjury:one of the following three declarations: HAZARDOUSiMATERIALS DISCLOSURE have and.willmaintainia.Certificate ofCoosent taself-insure for�Worker's Compensation for 6y5ection3700�of the Labor Code,for the I have read.,thehazardous,materials requirements under Chapter 6`95 of the performance ofthe work for,wfiich this;permit'isissued. California Health&Safety'Code,Sections 25505,25533,and'-2+5534 '1 Will.ma main I have,and will maintain Worker's-Compensation;Insurance;.as provided for by SafecomPliCode,Sect on""25532 aance'-with*thi n should Istore oreh ndlethazardou mat l3a'lth,&a Section:3700 ofthe;Labort6de;,tot the erformance of the work for which this ty, ( ) P- Additionally;should,l use equipment-or devices,which emit:hazardoris alr permit is issued. contaminant-Was defined by.th6Bay Area AW96ality_Manageibent District'l,Will' I`certify that in the perform ance;of the workforwhich this permit'istissued,I shall maintain c6mpliance4ith ttfe.Cupertino Municipal Code,Chapter 9.12 and the not,employ any person in:any>manner'so asfto become:subject;to"the Worker's, Health,&;Safety Code,Sections 255051,25533,and,,25534. Compensation laws of.Cahfomi'a If,,after makinwthis certificate�of,ekernption„1 become subject to_the`Worker'.s Compensati6mpro"visions ofthe Labor Code,]must O ner�.authoriz d a ent: ate /2 —03 —/Z forthwith.comp]y'with,such provisions or this_permit.shall be+.deemed revoked., CONSTRUCTION LENDING-AGENCY APPLICANT CERTIFICATION I.,certifythat I have�rgad tfits application and state that the>above information is I hereby affirm that there.is.a construction lenduig;agency for the performance,of-uork's correct.I,agree.t 1 comply wrth.a11 6ty�ah&county,ordinances and stateElaws relating for whrchlthis p'emiit4s issued(Sec.3097,Civ,C.) tabuildinglconstruction,and.hereby'authorize representatives,of this city io;enter. Lender's Name. upon,the above menti' propertoy for_inspect-ion;purp_oses: Wa indemnifY`and.kee harmless;the.CitY of Cupertino ainst liabilitiegsr;eeudto rsriaevnet s, Lender's;- Address costs;,and expenses which_may,accrue,agairkt said City in,consequence,of,the- grangng;ofthis perni t.Additionally,'the applioantunderstandsand_will comply ARCH ITECT'S,DECLARATION. with all non-poinbsource,regulations'per the Cupertino Municipal Code;Siecfi'on 9:1'8. 1 understand,my,plans;shall,be�used as,public records. SignatureDate; �Z ��r 1 Licensed.Professiooal CITY OF CUPERTINO FEE ESTIMATOR-,BUILDING DIVISION :ADDRESS: 10302 Terry DATE': 11'11.9/2012 . REVIEWED.BY: Sean, A'PN: �'BP#': �.. ''VALUATION: $10;000 �' PERMIT TYPE: Building Permit PLAN'CHECKTYPE; Alteration /,Repair USEMARY Multi Family Dwelling B31Stones. Q_Yes; _Q No PENTAMATION T TYPE: 1,R2REM woRK. -Kitchen:cemodel 209 stl ft . 'SCOPE a As IP� Mm x r. • NOTE This estimate does,not include fees due to dtlier-Deparimenis(ire.PlanningPublic,Works;Fire,Sanitary Sewer District,School District;eic) These•ees are^based,on the relimina in ormation,availa5leand dre�bnly ah estinzata Contact?the De t oraddn"I info. PKEATENIS h e'e Resolution 11-053 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 209_ s._f; Remodel,Kitchen(<=300 sf $up 'L PC,Fee:, � Reg. C)�OT Q„Q his $0.00' $600.00' IREMRESKII' ,.PMETlan Check: $0.00 Permit Fee: $0.00 ;Suppl: Insp..Fee: ,Reg. Q OT 0'.0' firs $0..00 PME Unit Fee.- $0;00 ggPME'Permit Fee:; $0:00- , Work:Wi'thout Permit? �es '0-N6 Advanced Pl'annin� $0.00 'Select a Non-Residential E) Building or Structure SL< 3}?coa1 Eii ltd # '',Si Siron g._Motion Ttc. I'BSEISMIC'R $1.00 Select,an Administrative Item Btdg.Stds�Cominission.Pee: IBCBSC $1.00 K SUBTOTALS _ 600 00' ` TOTAL FEE 02.00' $200. $ _ F Revised: 10/0112012 CITY OF CUPERTINO BUILDING PE'RlyIIT 'BUILDING ADDRESS: 10302 TERRYVAAY CONTRACTOR:LIAO CHUNG H AND'BEI ,PERMIT•NO: 121,101:0,7 W OWNER'S NAMLUL O CHUNG HAND%BEI W 113 TERESITA WAY DATE ISSUED': l(/19/2012 OWNER'S PHONE:40825261,79 LOS.GATOS,CA 95030 PHONE NO: L'10ENSEWCONTRACTOWS DECLARATION BUILDING PERMIT`INFO:: BLDG ELECT `" PLUMB License•Class. L'ic.# rl MECH RESIDENTIAL,' COMMERCIAL Contractor Date 9,herebya'Mrm that°l,arn licensedunderthe provisionco-f Chapter4 JOB DESCRIPTION:AP.TI-,REMODEL KITCHEN 209SQ•FT (corrimencing'wiih Section'7000)'ofDiyision;3,of ilie,Business&'Professions ,Code and that my license is-in'full°force an&effect. herebyjaff rm under,penalty,of perjury one;of thelfollowiog two declarations: 6 have and'will,maintain.a:certificate of.consenf:to;self-insure for•Worker's Compensation;as provided for by Section 3700 of Labor Code,'forthe ,performance,oftheworkforwhich,thispermit is issued. S FGFIoorArea: valuation:'$10000 ;I have and will4maintain-Worker s,Compensation Insurance,as provided for'.by q' Section-37005of:the`Labor,Code,for the performance of,the work'forwhich°this permit is;issued: APN,Number:3591701=2-00 Occupancy Type: APPLICANTCERTIFICA7lON; , I certify ihatl,have read this applicatiom�and,§tatedhafthe above i'riforniation1s correct f agree to comply with•all,city•and county o7dinances and state laws.relatin& Co building construction„and'hereby authonze,representatives,of,thisicity'to enter PERMIT EXPIRES;IF WORK IS NOT STARTED upon the"above mentioned property for inspeWon,p6rposes. (We).agree to save VWITHIN 180'DAYS.OF PERMIT ISSUANCE OR ;i'ndemnify and keep harmless the City of Cupertino,.against,liabilitics;judgments; costs,.and,expenses which°may:accrue.agamst'said City in conseguence'rifthe 180 DAYS FROM LAST CALLED INSPECTION. granting of.tbis permit: Addlitionally the;applicant understands and,willcomply with all.non-point'source regulations per the Cupertino Mur ici d Code Section Issued by:. _o5 rvl ¢ / :9 ezz Date: .l Signature Date RE-ROOFS: ❑ OWNER-BUILDER_ .DECLARATION All.roofs shall beiinspected prior to:any roofing material being installed.If a roof is, instal led'without,first obtaining an inspection,I agree to.remove al1'.new materials for (:.hereby'aflirin thaci-ain exempt from,the&ontractor's,License.Law:for one-of inspection. the4following;two;reasons: 1,;8 owner'of the propedy,,or;my employees with wages astheir,sol'e��corriperisation, 'Signature of Applicant: Date: will do,the work,aiid'di&str icturet'is-not,intended or"offered:forssale(Sec.7044, Business&:Professions;Code) I„-as ownerof the property;--Am exclusivel'yscontracting,wrth licensedcontractors to ALL ROOFICOVERINGS TO BE CLASS"A”OR BETTER constructthe�,project,(Sec.7044,Business&Professions;Code). I hereby of irm:under'penalty.:of perjupyrone of the following three HAZARDOUS MATERIALS DISCLOSURE declarations:, I have read the-hazardous materials requirements'under Chapter..6.95•of the Lhave<and will maintain a Certificate of.Consent to self insuie for Worker's, .California,Health&`Safety':Code,Sections 25505,25533,and,25534. Lwill maintain Compensation;as provided for by Section 3700 of,the1abor Code,for the compliance with the VtirwrtinoMui icipal Code,Chapter 9.12,and the Health&- performancelof the,work!foc which this permit isIssued. Safety,Code,Section 25532(a)should I store or handle hazardousma"terial:, 1'have and°will maintain Worker s,Compen§ tion`lnsufance,as�provided.for,by Additionally,should Luse„equipment,or devices which emifhazardous air con tam in ants'as,defined b the Ba Area Air'Qua M. errient District Pwill Section 3700 of the Labor Code,for,the performance of the-work for which,this y - y` - Q, ty, g. maintain,complianee with=the Cupertino Municipal Codi,Chapter 9:12 and;the „ permitis issued.: Health&Safety Code,'Sec tions,25505;,25533,,and 25534. I"certrfytbat imthe performance of the-work for which this permit is issued]shall not,employ-any person4n anymamierso.as to become subject to the Worker's Ow or,authori ed ent Compensationilaws'ofCalifomia. if,,after making this certificate of exemption,1 _ : moi, Dat-e; become°subject 16�the'Worker's Compensation provisions of the.Labor Code,I.must forthwith coinply�with'ucfi provisions or:this permit shall.be deemed'revoked: CONSTRUCTION`LENDING AGENCY hereby affirm that-atiere is,a coristmctionlending agency`for the`performance of work's APPLICANT CERTIFICATION. for-which this permitisissued,(Sec.3097,Civ C.) I certify that l have;read thi"s,ap01icationiandMate at theiabove-information.is Lender,'s Naine correct l,agree to comp( with all ci and coup ordinances,and•siate laws:relatin Comply ty �' g to buildiri"g,constructiorr and'hereby authorize.representatives:ofthis;city;to^enter Lender's.Address_ upon the above mentioned property for,inspection purposes:(,We),agree to save indemnify,and keep harmless the City,of Cupertino againstliabilities;judgments„ costs;and expenses,which may,accrue!api hs tt§aid:Cityimconsequence of,the ARCHITECT'S`.DECLARATION granting=ofttirs permit:Additionally,ttie applicant understands,and will comply. 1 understand_my plans shall be used as publiarecords. with all pon;point source regulations perthe,Cupertino:Municipal Code;Section 9.:18. Licensed_"Professional Signature 2 .,ate, f l—1 j Z CITY OF CUPERTINO FEE ESTIMATOR BUILDING,DIVISION ADDRESS: 1A302.Terry Way DATE:. 42%02/2012 REVIEWED BY:. ;Sean APN:. BP#: 1211-0107 *VALUATION: $5,900 xPER1VIIT TYPE: Building Permit PLAN CHECK TYPE; Alteration;/ Repair 'PRIMARY. PENTAMATION' S.FD'or Duplex 1GENRES USE:', PERMIT TYPE': WORK To.Clear. Code'Enforcement'Case: Remove and replace 7 windows; remove and replace upstairs SCOPE, shower. `` _ _ c!l:Nan(7Fic-,:k , Plumb.Plan Check FO.7 hrs $0.00 !'3oc:.,P/W1,1('h(ck fc,`ch,. Perirril•f"ee.; Plumb.Permit Fee: IPPERMIT Ii�iec:Perttrtt.l cr4; �r>ic; iileci"ra.Ins��. 'Other Plumb Insp. 0.0 h_rs $45.00 Urhej f 1cr, •Inas Li I-- 11Ie�h:.fn""sfr Fee". k'lurnb.d;r�u 'F[�i;: • flee:InSf,; T?r�e: ROTE This,esiimaierdoesknot`include fees due,to ottier Departments(i.e.Planning;,Public.Wo"rks,.Fire,Sanitary Sewer District,School 'District"ete.). 'Th`es"e ees are;bksed;onthe" relim`ina information availab'le.and`are,onl an>estimate Contact the Deptor addn'Cin o. FEE ITEMS&,(Fee Resolution jl-,'053 LM'711YP2) .FEE QT`Y/FEE MISC,ITEMS Plan Check,Fee: $0.00 # Window./Sliding Glass.Door Suppl.PG.Fee: Q Reg: Q OT 0.0 hrs $0:00 $4;00..00 .IWINREP Replacement PN1E.Plan Check: $:0.00 1 # Phmibing Permit Feel $0:00 $1,O.Q0 JBP._FJXTURE Fixture or Trap Suppl:,Insp' Fee.Q Reg: OT Q Q hrs F $0:00 . PME Unit Fee:- '$0.00' PME:.Permit Fee: C;onslrarction l,4a Administrative_Fee: IADMIN' $42.00 0 Work Without.Permit? E) Yes! ,o _No $455.00 E) Advanced Planning Fee: x$0:00 Selecta Non-Residential :01 or.Structure, '. Travel Documentati`on_Fee: ITR,4,�VpOC �$`4"5.00 Building � Strong Motion Fee:, IBSEISMICR- $0:59 Selectan Administrative Item l31dg;S'tds'Cornmiss16n Fee: IBCBSC $1.00 �` A $588.59; $'41'0.00 '' TOT`ALFEEt $998_.59 SUBTOTAIS ,:. , Revised: '10/01/2012 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEUELOPMENT'DEPARTMENT-BUILDINGwN ,a , f030 TORRE'AVENUE•CUPERTINO., CA 95014-3255 (408)'777-3228 e FAX'(408)7,77-3333:- building0cupertino.org GUOERT'INO F ❑ NEW CONSTRUCTION'_ ❑ ADDITION ❑,ALTERATION/TI'. REVISIONI"DEFERRED ORIGINAL PERMIT'# PROJECT,ADDRESSN / APN4' OWNEKNAME e 1 '/I/n I 0 PHONE(4 8\ 15-_q q b( E=MAIL: ,STREET ADDRESS' UV'C: CITY, STATE;ZIP �J �(�( FAX CONTACT NAME PHONE E-MAIL; STREET'ADDRESS CITY„STATE, ZIP FAX, , ❑ OWNER ,OWNER-BUILDER ❑ OWNERI'AGENT ❑ CONTRACTOR El CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER._ ❑ DEVELOPER ❑TENANT CONTRACTORNAME LICENSE NUMBER LICENSE TYPE BUS.LIC.#, /V .A OWhey- l:� w CoMMN.Y;NAME E-MAIL FAX;. STREET ADDRESS CITY„STAT@,ZIP PHONE ARCHITECT ENGINEER NAILIEr\J /4 LICENSE NUMBER BUS:LIC!# COMPANY NAME �/ /( E-MAIL FAX STREET ADDRESS CITY,-STATE,'ZIP PHONE DESCRIPTION OF,WORK A Ry 5 EXISTING'U_SE_' - PROPOSED USE CONSTR.:TYPE #STORIES _ USE TYPE OCC. SQ'TT: VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA• AREA AREA NETAREA. .,.1 ye BATHROOM: KITCHEN OTHER "• 7�� �I REMODEL-AREA REMODEL AREA ;REMODEL AREA _ PORCH AREA .DECK AREA TOTAL DECK/PORCH AREA 'GAR'AGEARER: DETACH , ❑ATTACK - .. ' #,DWELLING_UNITS 'I6A'SECOND`UNIT ❑YES: `SECOND STORY ❑YES .BEINGADDED? IDNO ADDITION? []NO PRE'�PPCICATION ❑ _ DG'AN ❑`YE RECEIVED,` Y2 e A"K, TOTAL VALUATION;, ❑YES IF YES PROVIDE'COPYOF'' IS THE BL PLANNING APPU# NO PLANNCNG'APPROVAL'I.ETTER EICHLER'HOME? ❑:NO <: - ADD By my signature below,t certify to each of the following: I am the property owner or authorized agent.to act on�the propeity,owner's.behalf. I'have;read this application' nd.the-information.l.have provided is'correc[ I_have,read the Description of Work and verify it is accurate. I,agree;to complywith all applicable-local ordinances and state)Iaws;relating:to'bililding construction._I.authorizeresenfatives.of Cupertino.to enterthe above-identified property O,inspection;purposes: ,,- �PLAN CHECKsTYPE �r r, Obi ianature of nUAgentDate: l?. R • 1� SVPPLEMENTALNFORMATIONREQUIRED OUTING'SLIP. ng buildings) Deinolifiompermlt is req red prior to Issuance of bu oV R�'rH> eouivTER�- ' Iry vlEw r _New SFD or Multifamil dwellings- A 1 for'demolition ermit�for exlstl building, peklW rmit'�for Clew building. ❑EXPRESS f o' PLANNIN PLAivRE�IEw WRR "A Commercial,Bldgs: Provide acompleted HazardouS'Materials Disclosure O STANDARD ❑ PUBL1C WORKS fonn ifany Hazardous.Materialsare being used as partlofthis:project: - X.Y` � a ❑ LARGE k FIRE DEPT _Copy of,Pl`anningg ApprovppLefter or Meeting with,Plammng.prior to DivtAaoR � � ❑` SANiTARYSEwERDtsTRICT � x subm,Ittal of,Bu'Ildin Permit a h'cation. ,._[D-- EWIRONMENTAL HEALTH , BldgApp_2017.doc revised 06/21/11 CON;STRU'CTI.ON PERMIT'APP'LICATIO;N COMMUNITY DEVELOPMENT DEPARTMENT• BUILDIN NGSJ, � [ 10300 TORRE AVENUE•CUPERI ONO-, CX95014-3255 ('408)-777=3228• FAX, (408)77773333• budding(a)cupertino.org. CU.PERTIN'p ❑NEW°CONSTRUCTION ❑ ADDITION: [:1 ALTERATION./TI REVISION'IbEFERREEi ORIGINAL.PERMIT n. �� Q PRO]ECT.ADDRESS ��O�. l eV V A` © 2— OWNERNAME- I��p e0 1 � � ON �0� - 61�q E'MAIL, STREET ADDRESS 119j CIT.Y,'STATE,ZIP_ FAX 1 � 3 l eves +aW CONTACT NAME PHONE E-MAIL tee. as a6ov: STREET'ADDRESS CITY;STATE, ZIPFAX ❑I OWNER' t] OWNER'-BUHLDEA ❑ O�ANER-,AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ -DEVELOPER ❑ TENANT C6NT-RACTO,R'NPtv(E ( lW 0V �oI-1G�C LICENSE NUMBER LICENSETYPE BUS.LIC,# COMP,ANY�NAME' `E-MAIL FAX, ;STREET ADDRESS' CIT];'STATE,ZIP ,PHONE ARCHITECTIENGINEER NAME' ,/1/ LICENSE NUMBER :BUS:LIC 4 COMPANY NAME / ( E-MAIL FAX STREETADDRESS CITY,`STATE,ZIP. PHONE DESCRIPTION OF WORK: 17 EXISTINGUS_E PR_OPO_S q USE CONSTR.'TYPE. :STORIES USE, TYPE; OCC: SQ:FT. VALUATION(S) EXISTG- NEWTLOOR DEMO TOTAL, - AREA AREA AREA NET'AREA _ BATHROOM KITCHENOTHER< REMODEL AREA 'REMODEL-AREA REMODEL.AREA PORCH'AREA 'DECK AREA TOTAL DECKIPORCH AREA G.AR.4G_E AREA: DETACH -- .- -. - - .. ❑ATTACH - #.D}VELLINGUNTrS:- ISA SECOND,UNIT E]YES - SECONDR§TO_RY ❑YES, BEING'ADDED? ❑NO ADDITION?' ❑NO PRE=APPCICATION [3.m IF YPS,:PRO VHJ,E'COPY OF IS THE BLDG AN ❑YES RECEIVE BY y , ;. TOTAL'UALUATION PLANNINGAPP,L# ❑NO PLANNINGAPPPovAL.LETTEA EICHLER�90N[E? NO: s �,; } � ._ - _ . 3' lion By_rnwsignature,below T certify to each,,oftlie following: I armthe,,propeity owner"orauthor`ized'agent'to,acton tPie property•:owner's behalf. I liaveuead'this application'and'the-information,I h'a've provided is correct, I have read the:Description of Work and vefify,it;.is,accu aafe:.'I agree to'comply wiih all applicable local PP •� o }". .f �� P P �D J �r 2-- SUPPLEMENTAL for inspecfiom urposes. ordinances arid,state laws,relatin,to bulldin construction. I authorize re resentatnes ofCu ertino to,enter the above-identified r p Sl&nature of A IicanUA2ent., l/ �a Date:- �Z SUPPLEMENTAL 11 FORM[ATIOK REQUIRED " E New SF,D or Multifamily dwellings: Apply for demolition permit for OVER THE COL\TER BUILDIIvGPLAN REVIE]] eKistina`buildi_ng(S) .Demolition permit-is requiied prior t0'issuance of building � 4 permit for new building. ❑ EXPRESS ❑ PLAI�1VInGPLA\RE]IE]v a J Commercial,Bld s: Prbvidc.acorr leted�Hazardous`Material'sDisclosure ❑ �sT�>rnARD ❑ PUBLIcAVO RRs�`�� �. P form'ifaiiy,Hazardous.Materials are beinguse_d as part of this project: ❑ LARGE ❑ FIRE DEPT z subm opy of Planning,Approval Letter or'Aleeting with Pla"nriin�prior to z Y C ❑ DL4JOR ❑ S 1NITARY SERER DISTRICT x ittal of Building Permltiapplication.. i a. ENVIRO1vAfENTALHEAUH B1dg.4pp_j01'l.doc reyised 06/11/1,1 CONSTRUCTION PERMIT APPLICATION now& COMMUNITY DEVELOPMENT DEPARTMENT cBUILDING DIVISION ' 10300 TORRE AVENUE-CUPERTIN0, CA 95014--3255 08) 777.322&o�FAX (408)777-:3333 - building(C-)-cupertirio.org C-U Pit RT I N'a (4 ❑14EWCONSTRUC-T1014 [:]_ADDITION, IR kLTERATION/T1 [:1 REVISION/DEFERRED ORIGINAL tt PROJECT ADDRESS 02 /1 J1 APNig C-- 0121 r 03 re v Wa C42 oeyw 6�1 '76 2­ —OWIERNAM_E. HONI�.og E-MAIL 8ei kh Li6to STREET ADDRESS FAX -e5i CITY, STATE21P V"j CONTACT'.NAME PHONE E-MAIL. STREET ADDRESS CITY,STATE,,Z1P _7F -XIOW"KER - El 01AINTER-1BUILDER 11 ,OWNER"AGENT ❑'-CONMI ACTOR [IiCONTRACTORAGENT 11 ARC=CV 11 ENGINEER El DEVELOPER El TENANT CO14TRACTOR'NAME LICENSE NUMBER UtENSE,TYPE BUS.11C-g -Q0M_PANY,NAME E-MOIL FAX ;STREET,ADDR-ESS CITY,STATE,ZIP PHONE. kRG_1jfTE&1ENGINEER!NAMEVLICENSE NUMBER BU LIC'# " 1 COMPANY N;WE E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP -DESCRIPTION OF WORK .EXISTMG.USE:.'* 'PROPOS USE CONSTR.TYPE 'STORIES V1USE TYPE 'OCC: SQFT. 'VALUATION'(S) 2 'EXISTG NEW FLOOR AREA AREA NET AREA V6 62�p /L BATHROOM 22 REMODEL AREA REMODEL AREA REMODELARFA PqRCI-�ARkk :[DECKARE 'TOTAL DECK/PORCH,AREA � GARAGE7J�EA� DETACH. ATTACH DWELLINGUtgTS: 11A'-CON-D UNIT. ❑YE -0,NDSTORv El 0 �Vi)ftfONf SEC QOS PRE-,A_Pnic,ATm El;'i:ES, IF.'(FS,PRqVIok EIVFP,;B TOTAL VALTJATION: ,- , El��7 , P PLANNING APPL, UK40 PLANNINGAPPROVAL LETTER E'RfEILERHO.1111? 0 ET' j &C20 By1Tny,siqnature;be1oNv,-1 ccrtify toleach:of the f6116Wing- l,amthe'ptcperty6N,n6rorabthorized,.aReitt64ctonAheoproperty lhave'read-this ap,p,!i'c�tion,afidtheiihfor-m�ti6-n,lhavi�orbVidedis,co�rcct. I have read,the'Description of V. and veriQ'it is�ac�curate. 1,agree to comply with'all applicable local ordi6ances and state laws rclatinsz;to bu'lldin-construction. I authorize representatives of Cupertino,to enter tht�,abov-.,ident'ified property for,inspection.purposes. Sianaffrea Applicant/Agent: -4 Date: SURPLENENTAL INFORMATION REQUIRED New-SFD or Multifamily p dWellincs- A p�y for dblitiermit for 4 V, 637 T exis't,ino,bui ITIO na laing�(s).. Der lition�ermit is'.regemonq)6ired prior to issuance of '71" perrriii for new building. Commercial Bldgs: Pro-_,;,ide,a completed Hazardous'Materials DiSclbsure ARD forTn'ifanyHazardbus,"Materials are being used as part ofthis project; E" U "FFTf ARCE + FIRE DEPT CoRrof P anning.Appr1qval Letter or Meeting with-Plahniha prior to ER_DI�ST submittal of BuildingPerrriit application. _0 NTALUEAL B14�App_-201 1.doc revised 06127111 SCOPE OF WORK: HALF BATH REMODEL. Project shall comply"with the,201,0 California Building(Base code 2009 IBC.); 2010 Residential (2009 IRC); Plumbing(2009 IJPC), Mechanical (2009 UMC); Electrical (2008 NEC.),,Firew(200.9 IFC) and,Energy, Codes (2Q08 Building Energy Efficiency Standards) Energy code mandatory lighting measures: 1.. All permanently installed high efficacy luminaires,shall be switched separately from,low efficacy,. - luminaires. 2. .Permanently installed luminaires in bathrooms, garages, laundry rooms and utility rooms shall'b'e high efficacy luminaires OR are controlled by an,occupant'sensor(s)certified to'comioly'wiih' Section 119 that does not turn on automatically or have an always on option. (1'50(k)(10.)) Plunibing plan notes: 3: Water closets shall have an average water consumption of not more than 1,-.28 gallons per-flush. �(CPC.402.2) , 4. Faucets in..kitchens, wet.bars,.lavatories, laundry sinks, etc"shall have,a water'flow not td,exceed 2,2 gallons per minute. (CP.0 402.1.2) 5. A,30-inch clearwidth for`water closet--compartment and 24 inch clearance in fronof'water`closet'. (CPC'407..5) Electrical,Plan Notes: 6. The installation of'smoke`alarms in all of the following areas shall be.provided:`(R31.4.3), a. On the ceiling or°wall outside of e.ach,separate sleepi-ng area in the,immediate.vicinity,of bedrooms-. ° b. In each room.used for sleeping purposes. T The installation of carbon monoxide alarms in the following areas shall be provided: (R315.1) a. Approved carbon monoxide alarms shall 6&installed outside of each separate sleeping area in the immediate:vicinityof-the bedrooms and,on every.level including basements in dwelling units that havefuel-fired appliances or attached garages. 8. At least one,20 amp branch c'itcuit-shall be.prouided to supply,bathroom.,receptacle outlets.Such circuits shall have no other outlets. (CEC 210.11(0)(3)) 9. All receptacles in bathrooms, garages,,a.ccessory buildings,.outdoors, crawl spaces,,unfinished basements, kitchens (where,receptacles,se,rve counter°top surfaces), laundry, utility,wet bar. sinks,'(w.ithin 6 feet.of'the edge of the sink), shall have ground-fault,circuit-in_terrupfe-r(GFCI) protection: (CEC'210.8) .. „ 10. In all areas specified in 210:52, all 125-volt, .15-,and 20-amp--ere,receptacle_s shall be;-listed _ tamper-resistant receptacles. (CEC 406.1.1)» SCOPE OF WOW HALF BATH REMODEL. Project'shall comply;with,the;201A California Building (Bas.e':code2009 IBC); 2010.Residential (2009, ,IRC); Plum bing(2009 UPC), Mechanical (20.09 UMC.), Electrical. (2008 NEC), Fire (206.0. IFC) and Energy Codes (2008 Building Energy Efficiency Standards) Energy code mandatory lighting measures: 1. All permanently installed high efficacy"luminaires:shall be switched separately from low efficacy luminaires. (150(;k)(7)) 2. Permanently installed-luminaires in bathrooms, garages; laundry-rooms and,utility'rooms shall be .high efficacy luminaires OR are controlled by an occupant se.nsor"(s) certified to'compiy with Section,119 that does notturn on,auto.maticall,y:or have an always on.option. (150(oo 0)) Plurrnbing plan notes: Water-cl'osets shall have an average water consumption of'not more than T.28,gallons per,flush. (CPC 402:2) 4- Faucets,in kitchens, wet bars, lavatories,laundry sinks, etc shall have a Ovate°#low not to exceed. 2.2'gallons per minute. (CPC.402.1..2) 5., A 30;inch clear width for water closet compartment;and 24 inch.clearance in front of'water closet., (CPC 407.5) :Electrical Plan Notes: 6. The..installation of,smoke alarms in all of'the following areas shall be provided: '(8314:3), a. On the ceiling or wall outside of each separate sleeping area in'the,immediate.vicinity,of' bedrooms. b.. In each room used for sleeping purposes. 7. Thet installation of carbon monoxide:alarms in the following areas shall be pro.vided.; (R31;5.1), a. Approved carbon monoxide alarms shall be inst`a'lled outside of'each"separate sleeping area in the immediate vicinity of,thebedrooms and,on every level;including basemen'ts'ih. dwelling unitsthat.have,fuel=fired appliances or attached garages, - p p pp y A . circuits shall have,no other outlets. (C,EC 210.11(C)(3))su I abathroom race"tacle outlets.,S'u.ch 8. At-least one 20 am branch circuit. be provided 9.. All'receptacles.in bathrooms, garages, accessory buildings, outdoors, crawl spaces,;unfinished basements, kitchens(,where receptacles serve.counter°top surfaces), laundry, utility, wet bar sipks.(wthin 6 feetof the edge of the.sink),.shallhave;ground-fault circuit interrupter(GFCI) protection. (CEC-210..8) 1.0. In all areas specified in 210.52, all 1`25-volt, 15.-,and 20=ampere:receptacles shall b`e listed . " tamper-resistant receptacles. (CEC 406:11) -- OWNER-BUILDER NOTICE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING�DIVISION 10300 TORRE AVENUE CUPERT-NO,CA,0501443255 (408,)`777=3228rAX(4 n'd(a-)cobLi �ino.ora 771 33�3, bdildi .CUPERTINO Effective fanuary, 1, 2009, Assembly Bill, 233'5 amends Cafifornia Health and Safety Code, -Section 1982551 regarding discl6§tffes and verifications required for all applicants seeking Owner- 'Builder construction permits. These new ap ,plication requirements provide an enhanced level of consumer awareness and prdtec1ibn for property owners, accepting the risks associated with ,Owner-Builder construction permits., "The Legislature hereby finds,and,declares that there is an urgent and statewide public interest in assuringjhat building contractors,.,comply with the Contractors License Law.,.and provisions of 'law.relating to Workers' for building construction, that property owners 0 -a ,are informed.about, and protected from, fraudulent_representations, liability for worker's iniuries, liability;for material I and':labor costs unpaid by contractors, li'cens'ing requirements, and. employer's tax fiaWfties when improving 1heir,prop eftywas owner-builders" Important information you need:to k.now,BEF6)?E,,,pulling your permit! The term,"Own en.-Bufider" can.mean threeAffferent things: 4�Owner-as Worker% "Owner as Contractor" orOwner as Employer" Understand each ha-stBeiefits or 18.sk,and it is possible to combine them!, jiieiq 'nfrattorifteansyou.do not personally perform an ,f the construction Work, the ,g a CaliforniaCdliforiiia Li�ehse# 0 y o pennit:is riot taken out iriyour-name'! you°are,noi personally responsible for the,construction.and,you are;not an. Owner-Builder. Instead, you become z",Cusiomer"and California law provides,you the benefit of,protection,,from -poor workmanship;failure to finish the job and financial injury: -al risk,due to worker inju , Seineflt/Msk':; Highest Benefits and the,teast amount 6URisk. Ownerras-W,orker'is,a type,of Owner-Builder where you personally perforin'the construction on work,the permit is taken out, in your name and you are personally responsible f6r the construction management, knowledge, workmanship, and.icomoletioia,,of theJoh., 'Ybu'benefit by not,.paying others,to°,p erformth is work f6r-you,and your risk depends on,your own abili'typto cornpleteAhe job successfully: Benefit/RBenefit/Benefit/RiskPossible Benefit With.Low Financial Rick Owner.-as-Contractor is a,type of Owner-Builder where you personally act.as your own Generdl Contractor; the permitis taken,out in your name. and. you hire California licens&& sub-0ritracI.off, to perform portions of the, constructionwork. WARNING:The betiefit.,ofgrotectibri provided by law when you hire only California licensed canfurn'to'serious financial risk.if you hire=unlicensed contractom to,perform any:of the work. Blenerit/Risk:, Possible Benefit apd.Siarflficanffirfancial Risk, Owner.as-Employer is la:type;of Owner-Builder where you`pay anj, individual Ao perform any construction work valued=at more than $500.00,the'permit is taken out in your,name and'you are,personally-responsible for their employmentrequirements; supervision,,performance,safety and welfare while on your property. WARNING-Cost savings-benefit can turn'to serious financial risk if.y.qu fail,to deductpyroll.taxes-es-orpr,ovidd,woi-kers;cml) .oe_hscition insurance for eachworker; Berfeflt/lki§k'­ Possible Benefit With Siuiifi'&`an1_Financial Risk Ovef 20,60 consumer complaints- are filed each year: Many complaints relate to Owner/builder 0(ojects, and inclUde Workmanship and workers' compensation. issues 'Homeowners suffer fi'nanciefl harm due tol,defective woIrkman-shlip and injured. employees. OvoierBuilder-21010.doc revised"06/08/10 4 Following,w Owner'-Builder permits: ollo ing,are alarrnling�examoles ofWh'athas bcdurr6dVith ' EkairftpW T. Homeowner received-insurance!money'tot rebUild burned-down home. Owner/Bui,Id-er permit pq[led to rebuild structure. Unlicensed contractor built substandard structure must IJ&torn down and replaced. E-§timated,fihahc,ial linjury Is f$2, 25,000. Additional financip]'Jinjur- IRS threatened tolax insurance payout if,house,not completed by the.end of the year. ExArn-ple,2- Brbth&-in-laW had;active license butfiled an.exemptionfrom Workers"Comp. 0 Owner-Builde'r, hires:brother-in,-1,aw to install ia new roof. a Em ploYeeJalls,'and sustains.m'ultiole,spin-alkand 6xfrern,ity,fract-uresas well as a head injury,and remains;in,a coma a to,this day. n he ,01W er'Builder, who has,sb1dthe home, is now'a deferidant1irib lawsuit for reimbursement for benefifts.paid to the injured worker. Ekarnolle,3. Ernoloyobbf'cohttacfdr Wiihb6f Workers:Como is hired by Owner-Builder to In-st,611�septic,systern:la,n,ql,suffers.injurythat results in permarfent disability,:, The bwher�;Builder � did noi,ha[Vel a.hor-heowhEirls insurance 1 001-icy on.'t I he,house against which to,submit a.claim. The;Owner-Builder i&ri.ow'8 defendant in a lawsuit-for reirribursementfor benefits,paid to the injured Worker. Did you know-unlicensed persons frequently have,the pro,pertyowner obtain an"'Owner- Builder" building perirnitWhich.6rrbhebusly I iniplies ihahh&property owner is providing his or he-r-own.labor and Material personally? Did you know-your homeowner's.insurance may not,provid&coverage for injuries sustained on your property'by an unlicensed contractor and hisffier employees? Did know.-if'yqu.are considered an "employer under state and federal law, you must, register with lhe,sl�I state,and f6d&,al;government,. :withhold-thhold payroll I taxes, -provide workerg compensationd-- and isabili'ty'insura'nce'and contribute- to unemployment pompensa-tiolfl,for each "employee"? Did'you,know—that if you fail'to,abide by these laws'you maybe subjected to serious financial risk? OWNERS BEWARE-�'AND CONSIDER THE RISK,113EFOREACCEPTING FULL REsP`ONsiBiL11TY FOR,YQUIR,CONSTRUCTION PEIRrviff OwnerAudder 20110.doc revised'04112110 ti OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE CUPER.TINO;CA 9501;4=3255 L U P E RT I N O (408)777=3228-.FAX(4018)777=3333• buildina(5cuberino.ora Dear Property:Owner(s): An application for a building permit has been,submitted in°your name listing'yourselfas the builder of the property improvements!specified at: SITE ADDRESSAPN, BP# 10302- 7ew WAV cupekmo O_WNERNAMEOWNER ADDRESS t Sl yt `Gro DESCRIPTION.OF'WORK: kl_ Ch 6,111 4 We are providing you with an Owner-Builder Acknowledgment and Information V",6rification Form to make you aware of your responslbilities'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- t 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 VEWMATION OF INFORMATION (DIRECTIONS:Please read land initial each statement below(o signify you understand or verify'this_information!) riV1. I understand a_frequent practice^of unlicensed persons is to have the property owner obtain an "OWner- Builder'"building perrnit°that.erroneously impliesthat.the property ownerJs,providing his orher 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.h&r employees while working on my property. 'My homeowner's insurance may not. provide coVe,rage for those inturies:'I am willfu-llyacting as an Owner-Builder'andiam aware:of;the limits of my `insurance:coverage for.injuries'to workers.on my property,:. WIL 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 r."esponsibility. \v8L 3. I.understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself.from potentialfinancial risk by hiring a licensed Contractor and`having,'the permit filed in his or her name instead of my own. 1AY L 4. I understand Contractorsare requl�ed by law to be licensed and bonded in California and to lisfith_eir license numbers on permits and contracts., W,j L'5. I understand,if] erriployorotheMise engage any persons; other than California licensed Contractors,.and the total',yalue,of'my consttuction is-at lbastfive hundred dollars`($500),,includi,ng'labor and materials, I may be considered'an '`employer”understate and`federal law. p -y _. . 11V L 6. I understand if l am considered:an"em lbyer under state and federal law, f rriust'register with the state and federal government'vithh'old payroll taxes,provide workers'compensation'disability insurance, and contribute to une.mployment.cornpensation for each "employee,.I.also understand my failure to abide by these laws may subject me 10 serious financial risk. WALT I understand under California Contractors''S_tafe,License Law;fan Owner'Build'er who builds single=family residential structures cannof legally build4thern'`with the;inte_nt fo offer them'for sale, unless all'work,is performed by licensed subcontractors'and`the_number of structures-does note'need four within any calendar year, or`all'ofahe,work is performed under contractwith a licensed general building Contractor. �L-8. I understand as.an Owner-Builder if I sell'the property forwhich-this,permit is issued, I may be held liable for any°financial or,personal4injuries sustained by any subsequent owner(sthat,result from any latent construction ,defects in the workmanship or mat. rial`s:: OwnerBuilderForm1 2010.doc.,revised 04114110 hy$l 9.t 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'Dioartment of Benefit, �Ii and,1h. California;Division of Industrial Accidents. I also understand.I may contact the California Contractors'State License,Board (.CSLB)at 1. -321=CSL13,(2752)or'www.cslb.ca.gov for more information about licensed contractors. 0L 10.,1 am aware of and consent to an Owner-Builder building'permit a"pplied for in my°name;and understand that am the party le"g"ally and financially°responsible for-proposed construction activity atthe site address listed above. ,\dZ !i t I agree that; as the party legally`and financially responsible for this proposed construction'activity, I will abide by all,applicablelaws and eequirements'that:govern Owner-Builders as,well as employers. VV&L!. 2,:T 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. Lice nsedtcontractorsfare're9u,lated bylaws 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 assis'tyou with any financial loss you maysustain as a result of.a complaint. Your only remedyagainstunlicensed Contractors maybe in civil 'court. It;js' ,also'important for'you,to'uriderstand that if an unlicensed Contractor°or employee of`that individual o-firm isi injured,while"working,on your'property,you may 6e held liable for damages. If you obtain a permit.as Owner=Builderand,wish'to hire,Contractors, you will be,responsiblefor verifying whether or not those,Contractors)are prope rlylicensed sand the status of'their workers'compensation insurance coverage. CONSTRUCTION LENDING AGENCY' (DIRECTIONS: Please complete tlie,,followin"g'cohstruction,,lending agency information.) ; f 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,'thisi'form must be-completed°anti's gned 6y the property owner,and returned toAhe 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 si nature: Property Owner's,Signature: Date: 0— /I—/Z ------------------------------------ ------------ = --- = ---- :---- ---------------- --------- (NOTE The following Authorization Form is required to_be completed by the property owner only when designating an agent ofthe property owner;to applyfor.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 l understand is my personal responsibility;, I.hereby iauthorize'the following person(s)to act as my agent(s)to apply for; sign,and ,file the documents necessary°fo obtain an Owner=Builder Permit for'my project. Scope of Construction Project,,(or D'escnption of Work,), Project Location or Address: Narrie of Authorized Agent: Tel No Address of Authorized.Agent: 1 declare,under penalty�of perjury that;f'am the;property owner for'the address listed above and I personally filled out the above I_nformat and certify its accuracy Note A copy of the propertyowhers driver's license, form notarization, or other verification acre table to the city maybe,required to",be presented'when^the permit is issued to verify the property owner's Signature. Property Owner's Signature: Date: Oivi�erBiiilderForni 2619,doc revised`04/1.:4/10 c V � REVISIONSY: r- Ow 3 _ E 2. Eli - l (0Oo• o r � ,. 7 7 �=silding Department DEC 0 6� 2012M1 yay, o Wh _ .FFIC 9 {� _C ^ E -C P PLI (Reviewed Sy: &dn�° DEC 0 6 2012 77 REVIS i _ IO � F ,til ,�- • -� SCOPE OF WORK: Kitchen Remodel Project shall comply with the'2010 California Building (Base code 2.009 IBC), 2010 Residential (2009 IRC,), Plumbing (2009 UPC), Mechanical (2009 UMC), Electrical (2008 NEC), Fire (2009 IFC)and Energy Codes (2008 Building Energy Efficiency Standards) Energy code.mandatory lighting measures: 1. All permanently installed high efficacy luminaires shall be switched separately from low efficacy luminaires. (150(k)(7)) 2. Permanently installed lighting in Kitchens shall be high efficacy luminaires. Up to 50% of the wattage of permanently installed lighting in kitchens maybe in lights that are not high efficacy. (150(k)(8)) Plumbing plan notes: 3. Faucets in kitchens, wet bars, lavatories, laundry sinks, etc shall have a water flow not to exceed 2.2 gallons per minute._ (CPC 402.1.2)_ Electrical Plan Notes: 4, The installation of smoke alarms in,all of the following areas shall be provided: (R314.3) a. On the ceiling or wall outside of each separate sleeping area in the. immediate vicinity of bedrooms. b. In each room used for sleeping purposes. 5. The installation of carbon monoxide alarms in.the following areas shall be provided: (R315.1,) a. Approved carbon r0noxide.alarms shall be installed outside of each separate.sleeping area in the immediate vicinity of the bedrooms and on every level including basements in dwelling units that have fuel-fired appliances or attached garages. 6. A minimum of two 20 amp small appliance branch circuits shall be provided for all receptacle outlets in the kitchen, dining room, pantry, or other-similar areas. (CEC 210.11(C)(1)) 7. In every dwelling unit, fixed appliances such as food waste grinders;, dishwashers, washing machines, dryers, laundry tray locations, built-in refrigerators or freezers, furnaces, AC units, built-in heaters or any other fixed appliance with a motor of'/ h.p. or larger shall be on a separate 20 amp. branch circuit. 8.. All receptacles in bathrooms, garages, accessory buildings, outdoors, crawl spaces, unfinished basements, kitchens,(where receptacles serve counter top surfaces), laundry, utility, wet bar sinks (within 6 feet.of the edge of the•sink), shall have ground-fault circuit interrupter (GFCI) protection. (CEC 210.8) 9. In all areas specified in 210.52, all 1.25-volt, 1,5-and 20-ampere receptacles shall be listed tamper-resistant receptacles. (CEC 406.11) i c,r A, NOV 19 2011 i Jr 1 i 6l i l , 4D30 ?.03 P54 z�3� 2o3n ° D a ow ow 14 i 040 oo 0 COPz i '/Xf Q ® COMMUNITY MBUILDNG uiVl DIVISION CUELOPMENT DERT NO ENT � f Oma. I ED This set of plans and specifications MUST be kept a the jots site during construction. it is unlawful to make y changes or alterations on same,or to deviato therefrom,without approval from the Building Offic f. The stamping of this plan and specifications SHALL l0T r be Heid to permit or to be an approval of the viola<ii •n of any provisions of any City ordinance or State L BY SAN G� DATE PER,i,IT N0. - !J / 11 APPROVED BY: SCALE: DRAWN BY DATE: + REVISED DRAWING NUMBER --_... ......,, .r um. -----------