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11110148 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20559 RODRIGUES AVE CONTRACTOR:CHEN TSU KUANG AND PERMIT NO: 11110148 LIAO YU TING OWNER'S NAME: CHEN TSU KUANG AND LIAO YU TING 20559 RODRIGUES AVE DATE ISSUED: 11/28/2011 R'S PHONE: CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class Lie.# r MECH RESIDENTIAL r COMMERCIAL Contractor Date hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMODEL(I 19SQFT)NON-STRUCTURAL TO CLEAR CODE ENFORCEMENT CASE:2 BATHROOM (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license Is In full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,w provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$2000 permit is issued. APPLICANT CERTIFICATION APN Number:35910047.00 Occupancy Type: 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 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:�� Signature Date Ask IFOWNER-BUILDER DECLARATION RE-ROOFS: 1 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 bring installed.If a roof is the following two reasons: installed without first obtaining an inspection,1 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, Signature of Applicant: Date: Business&Professions Code) 1,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: HAZARDOUS MATERIALS DISCLOSURE 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 1 have read the hazardous materiels tions 25505, under Chapter 6.95 of the performance of the work for which this permit is issued. compliance California Health&Safety Coda Sections 25505,Chapter and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by Safety o e with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should t store or handle hazardous materiel. Section 3700 of the Labor Code,for the performance of the work for which this 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,l 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 most Owner or authorized age tt: C Date: forthwith comply with such provisions or this permit shall be deemed revoked. V(o V. / J CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm 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 u on the above mentioned property for inspection purposes.(We)agree to save mfy and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address 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-point source regulations per the Cupertino Municipal Code,Section 9 18 1 understand my plans shall be used as public records. Signature AIAP, Date 1'2( J,I Licensed Professional • CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35910047.00 DATE ISSUED. . . . . . . : 11/28/2011 RECEIPT #. . . . . . . . . : BS000015413 REFERENCE ID # . . . : 11110148 SITE ADDRESS . . . . . : 20559 RODRIGUES AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CHEN TSU KUANG AND LIAO YU TIN ADDRESS . . . . . . . . . . : 20559 RODRIGUES AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : YUTING LIAO CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : CHEN TSU KUANG AND LIAO YU TIN ADDRESS . . . . . . . . . . : 20559 RODRIGUES AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCSSC VALUATION 2, 000.00 2 .00 0.00 2.00 0. 00 1BSEISMICR VALUATION 2, 000.00 1. 00 0.00 1.00 0. 00 1REMRESBAT SQ FEET 119 .00 1176 . 00 0 . 00 1176 .00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 1179.00 0. 00 1179.00 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 1, 179. 00 MC --------------- TOTAL RECEIPT 1, 179. 00 • CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 • CUPERTINO (408)777-3228• FAX(408)777-3333• buildinG(Mcuoertino ora ❑NEW CONSTRUCTION ❑ ADDITION 7lTERATI10N/Ti Q REVISION/D(EFEM= '^ORIGINAL PERRNUTT..# PROJECT ADDRESSCA OWNERNAME 3V ,l PHO SO� E � n " 1 CITY, ATE ZIP CA V)I FAX AIleCONTACT NAMLN\ PHOO E- n O� STREET ADD S - ,STATE ZIP —� FAX / ✓ I ILt t.,WWNER ❑ OWNER-a11n.0 ❑ OWNER AGENT 13 CONTRA= 13 CONTRACTOR AGENT 13ARCHnELT 13 ENGINEER El DEVELOPER 11 TENANT CONTRACTOR NAME® LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STAT$ZIP PHONE ARCHITECl/ENGINEEI NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE ZIP PHONE t;'0F'!T 1yy� PROPOSED pUSE CONSTR.TYPE #STORIES '7f1 r USE TYPE OCC. SQ.FT. VALUATION(S) EXLSTO `/ NEW FLOOR 1� DEMO ��,, �`3 3 ( � 00 CHEM OTHER REMODELA / REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTALDECR/PORCHAREA GARAGEAREA DETACH ATTACH #DWELLING UNITS: IS A SECOND UNITYFS SECOND STORY YES BRING ADDED? fTNO� ADOrIION! r,-IN4 PRE-APPLICATION ❑YES IF YBS,PROVIDE COPY OF [S TIE BLDG AN L]YES RECEIVED BY' TOTAL VALUATION' PLlNNINGAPPL# ❑NO PLR E ANNINGAPPROVALLETTECHLER HOME ❑ y /-` ? y\ By my signature below,I certify to each of the following: i am the property owner or authorized agent to act on the pnlpeM owner's behalf. i have read this application and the information I have provided is comm I have read the Desorption of Work and verify it is accurate. I agree to comply With all applicable local ordinances and state laws relating to 'Idingc nstrucdo . I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. 1 Signature ofAppEcandAgent: Date: SUPPLEMENTAL INFORMATIONREQUIRED PLANCHECKTYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for 0Q—UVER-.TH[F COUNTER 'BUMDUqG PLAN REVIEW existing building(s). Demolition permit is requited prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WOm6S form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ Fina DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT bmittal of Building Permit application. ❑ ENVIRONNONTAL BEALTH. BldgApp_2011.doc revised 06121111 it CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION • ADDRESS: 20559 rodriques ave. DATE: 11/28/2011 REVIEWED BY: bob s. APN: BP#: "VALUATION: $2,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1R3SFDREM USE: PERMIT TYPE: WORK To Clear Code Enforcement Case: 2 bathroom remodel non structural. SCOPE ;If",gib. Man ChdJ: Plalnb. Plan Check Iilec.Plnu Ch;:ck Mech. Per+wn Fce: Plumb.Persia fee: f:Ie:. Permii Fce: ;i Olber oek?ap, Other Phrnrb 1j:7P. Omer Elec. Imp. Li ilfach Inco. Far,: J'lwnb. loyp. l°"rr; Eley.Iny. Pee: NOTE:This estimate does not lncludefees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). These fees are based on the prefindna information available and are only an estimate. Contact the De ! or addn7 info. FEE ITEMS (Fee Resolution 11-058 Eff 7/71I1) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 1-9-1 s.£ Remodel,Bath(<=300 s0 Suppl. PC Fee: Q Reg. 0 OT FO.0 hrs $0.00 $588.001 IREMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. lnsp. Feele Reg. 0 OT F0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cojlslrrl(•Itun l71,r Administrative Pee: 0 Work Without Permit? (F) Yes 0 No $0.00 0 Advanced Planning Fee: $0.00 Select Non-Residential E) Travel Docninenfation Fei'S: Building or Structure SlrongMotion Fee: IBSEIShBCR $0.50 Select an Administrative Item\\' ` • Bldg Stds Commission Fee: IBCBSC $1.00 u SUBTOTALS: $1.50 $588.001 TOTAL FEE: 1 $589.50 Revised: 10/01/2011 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION • 10300 TORRE AVENUE -CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228-FAX (408)777-3333- buildinor5cuoertino.ora 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 ADDRES WDe N IL� BP# OW RNF�M OWN RAD ESS DESCRIPTION CQ WORK: We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, Initialed your understanding of each provision, signed, and returned this form to us at our official address Indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- er" 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 bliFconstruction and are not hiring a licensed Contractor to assume this responsibility. JV-3. 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. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license umbers on permits and contracts. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the 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 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 me to serious financial risk. ,�L7. 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 four within any calendar year, or all of the work • is performed under contract with a licensed general building Contractor. _L8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. _ Oi+9fe'BuilderFoW'n] 1010.doc revised 04/14/10 49. I understand I may obtain more information regarding my obligations as an "employer"from the Internal e—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 contractors. 10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that 1 p am the arty 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 kR:wl applicable laws and requirements that govern Owner-Builders as well as employers. 412. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the n rmation 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 verity the property owner's signature. Property Owner's Signature: A Date: ----------------------------------------------------------------------------------------------------------------------- (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, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. • Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04114110 RESIDENTIAL PROJECT COVER SHEET Assor's Parcel\N/umber: Name of owner. 1 U--r I nq LT b u j� Project address. 10 S S q Rl� Y 1 Q, I t P� k P , Contact person. 'r I - CA Phone. Uo<�( GS-U Fax. Net square footage of lot. y., due -oo Existing ', Proposed Square footage: First floor: Second flo Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the gar Y N Is privacy protection planting required for the pry Y 10 it Green Total Points On what floor(s) is work being done? � _ Brief description of work. 1 h CAkYT50 ln.t )�kn&0 e— C_00lA- 2,n T2E:C— GC(S'z Code editions: 2010 CBC N)2010 CFCN)2010 CMC C(�y N) 'tl 2010 CPC N)d200o10�NEC S(-9-N) California Green&W � bandards Code 2010 > BUILDING EVELOPMDIVISION E UPERTINO NT DEPARTMENT Effective 1/01/11 APPROVED ) This set of plans and specifications MUST be kept at the Job site during construction. it Is unlawful to make any ., changes or alterations on same,or to deviate RBCEIVED therefrom,without approval from the Building official. NOV 28 2011 The stamping of this plan and speolflcadone SHALL NOT be held to permit or to be an approval of the violation BY: of any provisions of any City Ordinance or State Law. BY-- DATE Y—_DATE • PERMIT N0. Plan Review Process Work Book Page-8- Revised 12/21/10 N N N W N rq �� 1� al o o w EF 1d Cll a ® x A i rD N —hr 0 ^ t ,�f(A r> 1 v� 0� (A ` �CEIVE�.j ` 0 C l�7 F- � � ` NOV 29 G) BY. n cn O M 3 ncrO O m �n OoQ- d co co 0 m 3� M d C N Q m ° :3K my 0 (p 7r 1 N Q" X N O r+ Owl n� O ® O ° Q' fD � (D O aCL m 0 0 d H WOOD RUTAIJ