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12020113 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10424 VISTA DR CONTRACTOR:OU CHIN LEE AND SUSAN PERMIT NO: 12020113 TSUN MEI TRUS OWNER'S NAME: OU CHIN LEE AND SUSAN TSUN MEI TRUS 10424 VISTA DR DATE ISSUED:02/27/2012 OWNER'S PHONE: 4083981089 CUPERTINO,CA 95014 PHONE NO: ❑ L:I<_'ENSED CONTRAC'TOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT ' PLUMB ' License Claus Lie.# MECH, RESIDENTIAL ' COMMERCIAL Contractor Date 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:UNIT A-TO CLEAR CODE ENFORCEMENT CASE-RENEW (corurnencing with Section 7000)of Division 3 of the Business&Professions WINDOW&BATH,10 WINDOWS TOTAL&(INCLUDES 2 FRONT Code and that my license is in full force and effect. WINDOWS IN UNIT B)&REPLACING ELECTRICAL I hereby affrrru under penalty of perjury one of the following two declarations: I have and will maintain a certificate ofconsent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for tite performance of the work for which this permit is issued. I 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 Sq.Ft Floor Area: Valuation:$6000 permit is issued. APPLICANT CERTIFICATION APN Number:31633130.00 Occupancy Type: I certify that[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-print source regulations per the Cupertino Municipal Code,Section 9.18. 2 2-7— L Issued by: Date: 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 rernove all new materials for €,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and(tie structure is not intended or offered t6r 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 I hereby affirm tinder penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have anis 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 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 3 700 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 I 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 tare performance of ttre work for which this perrnit 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 W'orker'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 Owner authorize agent: forthwith comply with such provisions or this permit shall be deemed revoked. -- Date' 1 ' 1 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 at(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 indemnity 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-point source regulations per the Cupertino Municipal Code,Section Q.18. I understand my plans shall be used as public records. Signature 04, Date i'7/1t L Licensed Professional CITY OF CUPERTINO 10 ITEMS OF 10 PERMIT RECEIPT OPERATOR: patg COPY # Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31633130 . 00 DATE ISSUED. . . . . . . : 02/27/2012 RECEIPT #. . . . . . . . . : BS000016110 REFERENCE ID # . . . : 12020113 SITE ADDRESS . . . . . : 10424 VISTA DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : OU CHIN LEE AND SUSAN TSUN MEI ADDRESS . . . . . . . . . . : 10424 VISTA DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : CHIN LEE OU CONTRACTOR . . . . . . . . LIC # *OWNER* COMPANY . . . . . . . . . . : OU CHIN LEE AND SUSAN TSUN MEI ADDRESS . . . . . . . . . . : 10424 VISTA DR CITY//STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1ADMIN HOURS 1.00 82 . 00 0 .00 82 .00 0 . 00 1BCBSC VALUATION 6, 000 .00 2 . 00 0 . 00 2 .00 0 .00 1BSEISMICR VALUATION 6, 000 . 00 1.20 0 . 00 1.20 0 . 00 1EPERMITFE FLAT RATE 1.00 88 . 00 0 .00 88 .00 0 . 00 1ERT<200 UNITS 1 .00 88 . 00 0 . 00 88 .00 0 .00 1P(GASRES OUTLETS 1 .00 130 . 00 0. 00 130 .00 0. 00 1PPERMITFE FLAT RATE 1.00 88 . 00 0 . 00 88 .00 0. 00 1STINSP UNITS 1.00 260. 00 0 .00 260 . 00 0. 00 1TRAVDOC FLAT RATE 1 .00 88 . 00 0 . 00 88 .00 0 . 00 1WINREP EACH 8 11 .00 1044 .00 0 . 00 1044 .00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 1871 .20 0 . 00 1871 .20 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 1, 871.20 #411 --------------- TOTAL RECEIPT 1, 871.20 20 12102i26 14:20:44 046856 02/26/2012 13:19 FAX 14083828008 TSMC MAILROOM 7-1 9 001 2012/02/2 ]4:16:E1 Mi6xi6 02/26/2012 13:12 FAX 141083828008 TSMC MAILROOM 7-1 001 OWNER-BUILDER DISCLOSURE FORM Cr:►MMUNITY DEVELOPMENT DEPARTMENT•BUILDING DMSION 1 C300 TORRE AVENUE-CUPERTINO,CA 95014-3255 CUPERTINQ (4)8)777.3228-FAX(4(38)777.3333 s�?!�lZgi2gid Qa1[tB,4L1 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 APN BP# 1c7 a -- Or, Ckar iw C S 6 t ,j u.o OWNER NAME OWNER ADDRESS C I ioTree 4;c/ DESCRIPTION OF WORK: 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. OW ERIJACKNOWLEIZsM1!JTANDVERIFICaTI ORMATION (DIRECTIONS:Please reed and Initlal each statement below to slgnity you understand or verify this Information.) I understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner- Builder"building permit that erroneously implies that the property owner Is providing his or her own labor and material personally. 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 1trose injuries. t am willfully acting as an Owner-Bulkier and am aware of the limits of my Insurance coverage for,Injuries to workers on my property, Cill?. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and erre not hiring a licensed Contractor to assume this responsibility, Lr&.I 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 flied in his or her name instead of my ovo-n. r jA4. 1 understand Contractors are required by law to be licensed and bonded In California and to list their iicense numbers on permits and contracts. CLL5. 1 understand if i employ or otherwise engage any persons, other than California licensed Contractors,and the total value of my consi.Tuctlon is at least five hundred dollars($600), Including labor and materials, I may be considered an"employer"under state and federal law. "6. 1 understand If 1 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 taws may subject me to serious financial risk, �7. 1 understand under Callfomla Contractors'State License Law,an Owner-Bulider 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. C:M8.11 understand as Nn 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. O»w7elBuilderFoint_2010.doc revised 04/!d/10 201L02i26 14:20:49 04.656 02/26/2012 13:19 FAX 14083828008 TSMC MAILROOM 7-1 IN02 1011102x6 lt:lwsi n+west 02/26/2012 13:13 FAX 141083828008 TSMC MAILROOM 7-1 002 g 9.1 understand I may obtain more Information regarding my obligations as an"employer"from the Internal Revenue Service,tho United States Small Business Administration,the California Department of Benefit Payments, and the California Divislon of Industrial Accidents. t also understand I may contact the California Contractors'State License Board(CSLI3)at 1-BOO-321-CSLB (2752)or www.csib.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 I am the party legally and financially responsible for proposed construction activity at the site address listed above. j=11,1 agree that,iss the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. !_Ml 2.l agree to noi:ify the issuer of this form Immediately of any additions,deletions,or changes to any of the Information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public.If you contract with someone who does not have a license,the Contractors'State Lloense 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-Bullder and wish to hire Contractors,you will be responsible for verifying whether or not those Contractors ani properly licensed and the status of their workers'compensation Insurance coverage. CONSTRUCTION LENU(JML&QENCY (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 3087 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!!cense, form notarization, or other verification acceptable to the city may be required to be presented when the permit is Issued to ve[V the property owrier's signature. _ Property Owner's Signature ` _ tate; ? 2 . .....................................---...............................----................................._....... ....... (NOTE: The following Authorization Form is requlmd 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). AUTHOI"r_;IZATION OF AGENT TO ACT ONS OPER OWNER'S,BEHALF Excluding the Notice to Property O.,. •. •. -- .. ..... . . .. _ caner,the executionw of which I understand is my personal responsibility, Thereby 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): Unaef batL 0 rzmaee ?6rT GWA- S.forso+.e Protect Location or Address: 044 0c}r_ Or Name of Authodzed Agent: Loi•:s _Tel No .409 3 t V fa$9 Address of Authorized Agent: ?off eea er Trr e L., CCwud, -a q 2 io q- 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. Date: Properly Owner's Signature: OwrrerBuilderForm 2010.doe revised 04114110 RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number: 6 l? _c O Name of owner. C(1:0 Project address. OlCU Contact person. (—Lmoi<`S (p,A Phone. 47(-)2 3`r� V P,5 Fax. Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? YY Is privacy protection planting required for the project? Build it Green Total Points On what floor(s) is work being done? S f Brief description of work. rku t,,�TC(,,J c yst fat 1 ^r" �h C kA 6' u i<<,' ' ne C � ces �r{ Code editions: 2010 CBC �- N)2010 CFC N)2010 CMC ON) 2010 CPC �Y -N)2010 NEC ON) California Green Building ;� n�,.ds Code 2010 DEVELOPMENT DE �T1�It" COMMUNITY TING �■� BUILDING DIVISiot`I�ED Effective 1/O1/11 APPRO tat the C"> set of plans and Spec' MUST be kep b site during construct is it is on same,o unlawful to deviate any j° es or aiteratio Offic changes rovai from the Building , C"> therefrom without app O planand specifications SHALL NOT -rne stamping of this p rovai of the violation be held to permit or to be an app rovisions of any City Orrdiilarl or State haw• of any P 6Y � "7. 0� PERMIT No. Plan Review Process Work Book Page-8- Revised 12/21/10 Q Gtr� 4- E (fCfr(*cG� S,AC p<Kd dvoi 424 38-8 ❑° Oo rPW ��s 4 00 00 N c%f O_ (3�droaCrccldor m o elpc+r.�G( subp�hP� Smoke A(arr+/ COcn detector smoke ala•r� CD defec4o( �fit _ 40 rezo N 9 bei u� door_ (eMovt A'Al( S�orr, N O N N � t Q O L � 3 0 0 � s N N ° $w+okC AIRvr� N T2 Ca dpteefor- o ° v it) lK�YDQ M - in f�Io�.0 (D over +LAb is wa+e r Prom cemeN+ board + SC( JL4+er Kerd; w,eM6ra�,E T ba4k ltgl45 are 0, 4 1m4r✓ Swr+-cG awl Iry A- 49-4 19-10 18-7 341 Ln 00 00 0 N (9 O rvoM '4 p I M heir 4 46' zOx76' (sable ;� u.N 8 0 v v o m N f0 O N 4/xi/ N n O N N D O O 0 tea / p ¢XL L o l3edYDOV� ..•_ '.,� v tY N p O 4 r to —c 61)(4-1 (same hi 19-4 WL IC IA VV t, ir^�:�E un�'I d kn sawn w-"llcw G�Gw�f� iYt �rOk+ WrooM Gv(I �rD,+ WtW. y CITY OF CUPERTINO F E ESTIMATOR- BUILDING DIVISION ADDRESS: 10 vista dr. DATE: REVIEWED BY: bobs. APN: I BP#: -VALUATION: 1$6,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration i Repair PRII�IARY FD Or Duplex PENTAM.ATION 1GENRES SPERMIT TYPE: USE; WORK To Clear Code Enforcement Case: SCOPE Plumb.Plan Check 0.01 hrs $0,00 Elec.Plan Check 0.0 hrs $0.00 Plumb. Permit Fee: IPPERMIT Elec.Permit Fee: IEPERMIT Other Plumb Insp. 0.0 hrs $44.00 Other Elec. Insp. E hrs $44.00 NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,.Sanitary Sewer District,School District,etc.). These _ees are based on the prelimina in ormation available and are only an estimate. Contact the Det Lr addn 7 info, FEE ITEMS (Fee Resolution 11-053 La. 711%.11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 LLJ # Window/Sliding Glass Door Suppl. PC Fee: Reg. OT ®.0 hrs $0.00 $522.00 1WIAIREP Replacement PME.Plan Check: $0.00 200 amps Electrical Permit Fee: Hourly Only? 0 Yes (F) No $0.00 $44.00 1ERT<200 I Services Suppl. Insp. Fee-0 Reg. d OT 0,0 hrs $0.00 ;= # Plumbing PME Unit Fee: $0.00 $65.00 IPGASRES Piping,Gas<;4 Outlets PME Permit Fee: $88.00 Administrative Fee: ]ADMIN $41.00 0 Work Without Permit'? Ices () No $719.00 Advanced Planmiw,Fee: $0.00 LaLi hours Inspections Travel Documentation Fee: I TR4 Y"L70C $44.00 $130.00 I STINSP Inspection,Hourly Strong Motion Fee: 1 BSEISMICR $0.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS': 1 $893.60 $761.00 TOTAL FEE:` $W4.60 Revised: 1/19/2012 Iac� � a � l3 CONSTRUCTION PERMIT APPLICATION ELI COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408) 777-3333• building(&-cupertino.org CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITIONALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS APN# a G4 V. ��; OWNER NAME PHONE E-MAIL STREET ADDRESS I L,� CITY. r, STATE,ZIP FAX >�r 5 j�e (4 CONTACT NAJ, PHONE/ E-MAII Lot�� 4u 3�( (C OLA, ._C`cic- UI.CC STREET ADDRESS CITY,STATE,ZIP_ FAX f LLc'(4- ❑.OWNER Ip OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME O /�f LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHTTECTIENGINEERNAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK / RrKe lnJly)efovJ A,4 66il 10 P t �•c � . � r . .• ,, .;�" it r��� -r bµ,'1• -�� cook . EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQFT. VALUATION(S) yes e��1c- S � EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA HM NET AREA lr) l/1 / r-3 BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODELAREA -•I ter:• .�1 PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREALJ DETACH 1A(A 1 01 A I� ®ATTACH #DWELLING UNITS: t` IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ©NO ADDITION? MNO PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY; TOTAL VALUATION: PLANNING APPL# ®NO PLANNING APPROVAL LETTER EICHLER HOME? R1 NO By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prpperty owner's behalf.•I have 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 relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant(Agent L-,(- t21 _ Date: 1 b 4- 2-1(� SUPPLEMENTAL INFORMATION REQ=D PLAN CHECK TYPE _ �-ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ®ovER,-.T.M-COUN= tsBUnXiNG PLAN Raw existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EM-RESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 13 STANDARD ❑ MLIC WORES form if any Hazardous Materials are being used as part of this project. ❑ r.euGE ❑ FIRED'= _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_201 Ldoc revised 06/21/11