13050217 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20211 LYNTON CT CONTRACTOR:TSENG WEN KUNG PERMIT NO: 13050217
OWNER'S NAME: TSENG WEN KUNG 20211 LYNTON CT DATE ISSUED:07/05/2013
OWNER'S PHONE: 4085934085 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL
License Class Lic.# CONSTRUCT A 956 SQ FT ONE STORY ADDITION WITH A
16
Contractor Date SQ FT BAY WINDOW,A 41 SQ FT COVERED PORCH,AND
I hereby affirm that I am licensed under the provisions of Chapter 9 A
(commencing with Section 7000)of Division 3 of the Business&Professions 51 SQ FT COVERED PATIO;REMOVE ROOF STRUCTURE
Code and that my license is in full force and effect. AT
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:$140000
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:36935018.00 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 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 D YS F T 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 S !
granting of this permit. Additionally,the applicant understands and will comply Issued 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.
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. 1 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
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 505,25533,a d 25534.
Section 3700 of the Labor Code,for the performance of the work for which this ` 7
permit is issued. Owner or authorized agent: Date:.
I certify that in the performance of the work for which this permit is issued,I shall 61
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 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
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION J
ADDRESS: 20211 Lynton Ct. DATE: 05/31/2013 REVIEWED BY: gs
APN: BP#: / *VALUATION: Isije,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY 2nd Unit? Yes !) No PENTAMATION
SFD or Duplex OTC? Yes 1 R3SFDADD
USE:
�No PERMIT TYPE: �
WORK
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. sJ.
R-3 (Custom) II-B,111-BjV,v-B 1,327 $2,544.72 IR3PLNCK $1,823.92 IR3INSP
TOTALS: 1,327 $2,544.72 $1,823.92
MECH,HOURLY Q Yes 0 No PLUMB, HOURLY Q Yes Q No F.,LEC,HOURLY Q Yes Q No
Mech.Plan Check 0-.01hrs $0.00 Plro,rn. Nail Urc A IileL. Plufr Check
Mech. Permit Fee: IMPERMIT Plumb.Permit Fee Elec, Permit Fel
Other Mech.Insp. 0.0 �hrs $45.00 Other Plumb Insp Other Elec. Insp
Alech. Insp. Fec Plumb. hisp.Fee: Elec.Insp.Fee:
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on the preliminary information available and are only an estimate. Contact the Dept-for addn'l info,
FEE ITEMS (Fee Resolution 11-053 Eff 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,544.72 1 1 # Mechanical
Suppl.PC Fee: Reg. Q OT 0.0 hrs $0.00 $133.00 IMFR=<loo Furnace,Forced-Air
PME Plan Check: $0.00 1 2 1 # Skylight
Permit Fee: $1,823.92 $800.00 1 ISKxL<10SF <= 10 s.f.
Suppl. Insp. Fee-.0 Reg. Q OT 0,0 hrs $0.00 0 # Covered Porch
PME Unit Fee: $0.00 $933.00 ICOVPORCH
PME Permit Fee: $45.00
Construction Tux:
Administrative Fee:
Work Without Permit? 0 Yes 0 No $0.00 0
Advanced Planning Fee: IPLLONGR $172.51 Select a Non-Residential
Travel Documentation Fee: ITRA VDOC $45.00 Building or Structure 0
Strong Motion Fee: IBSEISMICR Select an Administrative Item 1
Bldg Stds Commission Fee: IBCBSCUV
` S
SUBTOTALS: $4,645.15 $1,866.00 TOTAL FEE: $6,511.15
Revised: 04/29/2013
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(40.8).777-3228• FAX(408)777-3333•buildin4 okupertino.org
.CUPERTINO
❑NEW CONSTRUCTION ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMFF#
PROJECT ADDRESS APN O a r G I G
OWNER NAME PHONE /`r
(�{J M��R /f
STREET ADDRESS. CITY, STATE,ZIP FAX
CONTACT NAME PHONE E-MAJI `
STREET ADDRESS CITY,STATE, ZIP FAX
❑OWNER ❑ OWNER-B=ER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC 0
COMPANY NAME EMAIL 4 In ( tl® FAX
STREET ADDRESS CITY,STATE,ZIP r PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME EMAIL FAX
STREET ADDRESS 2/� _CITY,STATE,ZIP PHW.
CRIPTION OF WOR K
L
c G�9 GGA e c71� cG
62"4d wLAl-orti 17
C'G a/d Z97A
EXISTING USED USE CO STR TYPE 9 ORIES
t /J USE TYPE OCC. SQ.FT. VALUATION(S).
CGUC
VATIRFMODEL
G NEW FLOOR DEMO TOTAL
ET
l� .AREA � AREA NAREA
ROOM KITCHEN OTHER
AREA REMODEL AREA REMODEL AREA '
.PORCH DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
❑ATTACH
H DWELLING UNITS:, IS A SECOND UNIT ❑YES SECOND STORY []YES
BEING ADDED? NO ADDITION? NO
.PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF. IS THE BLDG AN El YES RECEIVED BY:. TOTAL VALUATION:
PLANNING APPLA ONO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO '
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read/this
application and the information I have ovided 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 relating ildin s c ion. I u r�entatives of Cupertino to enter the a Ove-`dentified operty for inspection purposes.
S i&nature of ApplicanUAgent: Date:
SUPPLEmoplrAL ORMATl - REQUIRED FLAN CHECK TYPE ROUTING SLIP
New SFD or Multifamily dw mgs: App for demolition permit for ElOVER-TRE—COUNTER El BUILDINGPLANREVIEW
existing building(s)."Demolition ermit is required prior to issuance of building
permit for new building. ❑ EXPRESS - ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD ❑ PUBLICWORKS
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE KEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ ivLAaoR ❑ snNrrAxY SEWER DISTRICT
submittal of Building Permit application.
::: ..❑!-ENVIRONMENTAL HEALTH.
BldgAPP_2011.doc revised 06/21/11
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RTI N O Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: V h PERMIT#
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: V, 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 INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors. v /
elete
ature Date
Please check applicable subcontractors /dcom the following information:
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
Owner/Contractor 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•building d( 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,,,2C�� j� ^A , APN 5 6 Gi 9ro /d, BP#
OWNER NAME / OWNER ADDRESS ? / / C a
DESCRIPTION OF WORK: 1WE4 GW' Gf/
A
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.)
1. I.understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner-
. Wilder" 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.
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.
Wotect
I understand as an."Owner-Builder" I am the responsible party of record on the permit. I understand that I may
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
na instead of my own.
I/w`; . understand Contractors are required by law to be licensed and bonded in California and to list their license
bers on permits and contracts.
Z 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
tal value of my construction is at least five hundred dollars ($500), including labor and materials, I may be
considered.an "employer" under state and federal law.
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 serious financial risk.
7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family
ential 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
ormed under contract with a licensed general building Contractor.
W8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for
financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction
efects in the workmanship or materials.
OwnerBuilderForm 2010.doc revised 04114110
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.cslb.ca.gov for more information about licensed
CoAtpctors.
Ja
am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I
rty legally and financially responsible for proposed construction activity at the site address listed above.
agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
licable laws and requirements that govern Owner-Builders as well as employers.
agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
n I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If
act with someone who does not have a license, the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed
Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while working on your property, you may be held liable for damages. If
you obtain a permit as Owner-Builder and wish to hire Contractors,you will be responsible for verifying whether or not
those Contractors are properly licensed and the status of their workers' compensation insurance coverage.
CONSTRUCTION LENDING AGENCY.
(DIRECTIONS:Please complete the following construction lending agency information.)
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name: Lender Address:
Before a building permit can be issued,this form must be completed and signed by the property owner and _
returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license;
form notarization, or other verifica io accep le to the c' may be required to be presented when the permit is issued
to veri the property owner's si t re.
Property Owner's Signature: If Z,4Date:
----------------------------------------- --------------------------------------------------------------------------------------------------
(NOTE: The following Authorization Form is required to be completed by the property owner only when designating an
agent of the property owner to apply for a construction permit for the Owner-Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an
Owner-Builder Permit for my project.
Scope of Construction Project(or Description of Work):
Project Location or Address:
Name of Authorized Agent: Tel No
Address of Authorized Agent:
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, orother
verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's
signature.
Property Owner's Signature: Date:
OwnerBuilderForm 2010.doc revised 04/14/10