11110092COV E RS H E ET
11110092-D
10191JUDYAVE
i
PERMIT #
PROJECT �FQ lU�w iific
DATE
ADDRESS
APPLICANT
OWNERt
LA,Mlp
WA 8
rd OR
IM
WN M
It SRO
W
w I �M- M
10
US. (LVNG) ��y G (OMAGE)
9"s1 7c
COMM. SQ. FT. (NEW) T.I. SQ.FT. . REMODEi,
CONTACT PHONES 7LS--6 31 / VAX "� �{s 02Z
VALUATION (Cost of Project) /--
READ. PAID
NOTES: 5 // /iY l CONSTRUCTION TAX (Y) (N)
SCHOOL FEES (Y) 0)
HOUSING NMG (Y) (N)
HEART OF THE CITY (Y) (N)
ISSUED BY DATE 2rl �,-l- -
TOTAL FEES
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10191 JUDY AVE
CONTRACTOR: MING-FU LIU
PERMIT NO: 11110092
OWNER'S NAME: MING-FU LIU
10191 JUDY AVE
DATE ISSUED: 02/15/2012
OWNER'S PHONE: 4085120360
CUPERTINO, CA 95014
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
r r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
r r
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: NEW 546 SQFT 2ND UNIT AND ATTACHED 441 SQFT
(commencing with Section 7000) of Division 3 of the Business & Professions
GARAGE (SCOPE OF WORK CHANGED ON ORIG
Code and that my license is in full force and effect.
# 10010123-PRMT CLOSED OUT & NEW PERMIT ASSIGNED).
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.
I have and will maintain Worker's Compensation Insurance, as provided for by
Sq. Ft Floor Area:
Valuation: $60000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 37507057.2ND UNIT
Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances 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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Issued by: //��� - Date: Z771
Signature Date
OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
1, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should 1 use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Health & Safety Code, Sections 25505, 25533, and 25534.
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
forthwith
O ner thorized agent:
Date: t Z
comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby aff irm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non -poi source regul ions per the Cupertino Municipal Code, Section
9.18.
I understand my plans shall be used as public records.
/
Signature (� '
Date
Licensed Professional
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(_@cupertino.org
CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 101 L / �J 11 f�
APN U S
OWNER NAME _ PIN I - -
� I 0
PHONE / LOX� S///���I �Z /_ „
E-MAIL
`FV
STREET ADDRESS r b a I J /l ��r )u �/
/
CITY. STATE. ZIP C . C a-vo Q' C _j,
/
(FAX
CONTACT NAME P J
PHONE 4 Qg_•f
G 3,3,J
E-Mall (/' �� �O CS �/v�� `o ��' �✓IS
STREET ADDRESS + 2 L's� �,� 1
CITY, STATE, ZIPv
❑ OWNER WNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHrrECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME .Y 2
l C7
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
I
CHTCE GINEERNAME S �
VZ, '1��-14G
LICENSE NUMBER C 1 L 7I�
l
BUS. LIC 11
COMPANY NAME S l Q �../1 kft .
"Am�s { � l! � R&(I `9 V" t' d i-
FAX
STREET ADDRESS z, ��►ZS/„ I )
„'N
CITY, STATE ZIP"IJ ✓44 �+. d r / p �
i/J� 7
PHONE (� �/� 7�y Q j
� m I
DESCRIPTION OF WORK ,16 W N �" V I,t N
a �
EXISTING USE
PROPOSED USE CONSTR.
TYPE
0 STORIES
USE
TYPE
OTC.
SQFT.
VALUATION (S)
EXOS-rG
AREA
NEW FLOOR_ °
AREA .l �
DEMO
ARIA
TOTAL
/
REMO L
REMODEL AREA �
KI1 Ft DE
REMODEL AREA �
OTHER
REMODEL AREA
\
PORCH AREA
IN6
DECK AREA
X1
�X
TOTAL DECK/PORCH AREA
&
GE AREA— ETACH
` ❑ ATTACH
N DWELLING UNITS:
IS A SECOND UNIT YES
SEC`OONDTSTI ORY []YES
BEIIYGADDED? ❑NO
ADDITION? []NO
PRE -APPLICATION [DYES IF YES, PROVIDE COPY OF
PI NNING APPL # []NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
RECEIVED BY:
TO VALUATION:
D �I
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the prpperty owners behalf. I bave read this
application and the information I have provided is correct I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws g to building construction. I authorize tatives of Cupertino to enter the above -identified for inspection purposes.
/property
Signature & � —
ofApplican Agent: ('/ Date:I /
SUPP AL INFORMATION REQ D
PLAN CHECK TYPE
ROUTING SLIP
El OVER-THE-COUNTER
0-B ING FLAN REVIEW
New SFD or Multifamily dwellings: Apply for demob 'on permit for
eusting bullding(s). Demolition permit is required prior to nuance of building
permit for new building.
❑ EXPRESS
/
0 P G PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
®/STANDARD
L'l PUBUC.WORKs
form if any Hazardous Materials are being used as part of this project
El LARGE
.
0/ZSAN7TARY
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑MAJOR
L� sEwER DISTRICT
submittal of Building Permit application.
❑ vrvmoNMENTAL HEALTH.
BldgApp_2011.doc revised 06121111
` OWNER -BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
{ (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org
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 I
/�\kaj
v�
TPN
BP#
CJ
OWNER N E
�142
OWNER ADDRESS
4 vaaf�l.
DESCRIPTI N OF
ORK:
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
A(DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.)
1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
/ 'Ider" 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.
PA 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for
e construction and are not hiring a licensed Contractor to assume this responsibility.
3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may
ect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
Ibners
instead of my own.
4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license
on permits and contracts.
5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
t I value of my construction is at least five hundred dollars ($500), including labor and materials, I may be
co sidered an "employer" under state and federal law.
6. 1 understand if I am considered an "employer.
under state and federal law, I must register with the state and
4fe eral government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject
4m to serious financial risk.
7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family
r Idential 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.
48. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for
Iainancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction
ts in the workmanship or materials.
OwnerBuilderForm 2010.doc revised 04114110
R
9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal
venue 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.csib.ca.gov for more information about licensed
coGoctors.
6a10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that
he party legally and financially responsible for proposed construction activity at the site address listed above.
11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
b applicable laws and requirements that govern Owner -Builders as well as employers.
. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
nfor Zation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If
you contract with someone who does not have a license, the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed
Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while working on your property, you may be held liable for damages. If
you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not
those Contractors are properly licensed and the status of their workers' compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECTIONS: Please complete the following construction lending agency information.)
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name:
Lender Address:
Before a building permit can be issued, this form must be completed and signed by the property owner and
returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license,
form notarization, or other 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: L� i" Date: :�.l I f— j 1 7i 1
--------------------------------------------------------------------------------------------------------------------------------------------
(NOTE: The following Authorization Form is required to be completed by the property owner only when designating an
agent of the property owner to apply for a construction pen -nit 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: D'i(, f,
OwnerBuilderForm 2010.doc revised 04/14110
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10191 Judy Ave. - 2nd Unit
DATE: 11/16/2011
REVIEWED BY: A. Salvador
APN: 375-07-057
BP#: 11110092
*VALUATION: $60,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: New Construction
PRIMARY SFD or Duplex
USE:
2nd Unit? ' Yes No
PENTAMATION 1 R3SFD2ND
PERMIT TYPE:
WORK
NEW 2ND UNIT 546 S.F. AND ATTACHED GARAGE 441 S.F.. REFER TO OLD BP#10010123
SCOPE
FOR SOME OF THE PLAN REVIEWS. (E) 2ND UNIT AND GARAGE DEMOLISHED W/O PERMIT.
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,III-B,IV,V-B
987
$2,420.00
IR3PLNCK
$1,519.00
IR3INSP
TOTALS:
987
$2,420.00
''?"' '''''' " `'
$1,519.00
:%%:..
r>.
•: .•,:::::. ... , .,., �, .. ..,:;•,:•-•......•...:;;:::<.�::w?^:?';.:; •.oT C: yy,>c�l ;.
�. �r. �...� .. .... .. ... .. ..r.r.....; ... .. �...: r...,. ...../....
..{.:,rr::<.,..>4,?n..::r•::•:>....x.,r�;::.... .,:t.,,;..; ...s.sr ,. ;, .,i. ).�.-i
.......;:.. /1'-. -:
,r :f.
r. r.,;. •.,:.::•:uv p:;. ::A: r;Y;;9(;i q: •::Z•iA
.,... [...<..�...>..2r:..... ..... it ......,. ., ... ... ,.... .f r .. .: •.. .....;r..•. •:•::��: �':.'�': �r �r'.�:••,.; �::
...0 .-..s,i.:.:•::..,..,r..:.., :, :•,irk r f 'y'•rf .'- :M1 ti��:
.. ..�.I .:....:..: :fit:':: �'•i. i ti r ?. r. • •./i r �r.'M1 �.'r
;��C'f"i 1r��+'.'I.'��i';
ls�r;J:B�a+. ix:: c`t;d (..,e•{.:r
r,. .-. ,
ftlfrr`, .'t°r•lattt ('crc`:
if"i.�s.�+' 1•.a F'i.:, Pi i�4'j�,
.1L'.l_h ir'h r! f-..
a''i is it U. P: 'p. Fee
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 ff. 7/1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? Q Yes (F) No
$2,420.00
4 hours Plan Check, Hourly
—]
$520.00 ISTPLNCK
Suppl. PC Fee: Q Reg. 0 OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,519.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Constr. Tax: IBCONSTAXR
1
1 new
units
$582.00
0
Work Without Permit? C) Yes (F) No
$0.00
Advanced Planning Fee: PLLONGRNGR
$128.31
Select a Non -Residential Q
Building or Structure 0
i
Strong Motion Fee: IBSEISMICR
$6.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$3.00
;Isi'•r ,:�:s'i':S rUliYa's.:�tc>!.;�s(;i�;:5:'s;'.,sr.;ss'Fx,:r;Nt�t;r.;.:q[::.�: n;_::: r.;:;i::.;:r:-: `i::.
:. fi � ! ✓4: •:v;='r `<a:,•r ::i: Z ;ss•„os::>? xa�;::3, f<:> . .•`,z -!'
`d[y1r�f,;•.% �:_'•iti:•'„'�:$Gist'� 3`:C4:c:. •s.:ieyiS ;;'< t�,>[i
,'._:..> :..,:..,.,.:., c �.-.,.,. ' '`
r.»..........�....�..s.,...�r.:.t.,:::1�;.fr.,�..r.:::::..11fr•::�:.ar�_ : i�r.•:;::::r�r.
$ 4 658 31
,
•,f,_
,; f•. •':i �:'i
': /%�1• �.
.....r..........._..........r..__
$520.00 '
$5 178.31
r
Revised: 10/01 /2011
CITY OF SUNNYVALE
Department of Public -Works
Engineering Division
PERMIT FOR ENCROACHMENT
Use: Construction - Public Facilities
APPLICANT:
Name, Phone: Liu Minh Fu, 408-512-0360
Mailing Address: 10191 Judy Ave., Cupertino, CA 95014
LOCATION: 829 SHETLAND PL 10191 Judy Avenue Cupehwo, CA 95014
CONTRACTOR:
Name, Phone: Liu Minh Fu, 408-512-0360
Address: 10191 Judy Ave. Cu rtino .CA 95014
Plans: Attached ( )
Contractor shall have a ,
DESCRIPTION OF WORK:
Subgrade Fonm
license to do permitted work.
Place FINAL
Permit Number.
2012-9036
Receive Date:
11 / 23 / 2011
Issue Date:
1/ 19/2012
Expiration Date:
4 / 19 / 2012
fo`��lc
ec 003
UNE S SON E���r�` �• ✓ .
Trench Install B ckfill FINAL
Sidewalk
Storm
Driveway
X
Sewer
Curb
Gas
Paying
Water
Other: Sanitary sewer impact fee only for the address Telephone
10191 Judy Avenue, Cupertino,. CA 95014. Electric
Fire Serv.
Fiber Opt
All Public
Completion: l Year:
PERMISSION IS HEREBY GRANTED to the above -named .applicant for ENCROACHMENT specified at the
location on or between designated dates in the above application, subject to the conditions of this application,
SMC Ch. 13.08, plus the following SPECIAL CONDITIONS:
I have read the general requirements for this application and shall comply with them, any
all provisions of SMC Ch. # 13.08, if a permit for this application is granted.
Applicant Understands License Requirement ' A
CONTRACTOR SHALL CALL (408) 730-7605 Liu Minh Fu BY:
BEFORE 4.-00 PI![, 24 HOURS PRIOR TO Name of Applicant/Agent
STARTING ANY WORK
INSPECTION REQUEST, HE
FINAL INSPECTION.
Uninspected work will be rejected I
SignatW Applicant/Agent
FEE TOTAL DUE: i$ $2,015.00 Insurance Certificate: Waived
Bond: Warve
Copies: FW Inspector, PW File, Applicant, and Revenue Sunnyvale Public Works Official