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11060219CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7765 ORION LN
CONTRACTOR: BAY AREA CUSTOM
PERMIT NO: 11060219
BUILDERS INC
OWNER'S NAME: GEORGE CUAN
1002 S DE ANZA BLVD STE Al
DATE ISSUED: 06/29/2011
OWNER'S PHONE: 4083660976
SAN JOSE, CA 95129
PHONE NO: (408) 446-1200
❑ LICENSED CONTRACTOR'S DECLARATIONF
r
License Class Lie. N 2 U L/ `/ / 6 7
BUILDING PERMIT INFO: BLDG ELECT PLUMB
r�'° "
-A
C,� �t� r�
Contractor %j R S 4 re ra „ - _ Date
MECH RESIDENTIAL COMMERCIAL
1 hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: BATHROOMS REMODELtNG(210SQFT), 1ST FLR POWDER
(commencing with Section 7000) of Division 3 of the Business & Professions
ROOM,2ND FLR HALL BATH & 2TH FLOOR MASTER BATH
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 CI_
Compensation, as provided for by Section 3700 of the Labor Code, for the ►'I
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $25000
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
permit is issued.
APN Number: 36218043.00
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
PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs, and expenses which may accrue against said City in consequence of the
180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18•
Issued by: Date:
Signature Date r,:� V�11 %
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
All roofs shall be inspected prior to any roofing material berg installed. If a roof is
1 hereby affirm that I am exempt from the Contractor's License Law for one of
installed without first obtaining an inspection, I agree to remove all new materials for
the following two reasons:
inspection.
I, 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,
Signature of Applicant: Date:
Business & Professions Code)
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:
HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self -insure for Worker's
I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation, as provided for by Section 3700 of the Labor Code, for the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
performance of the work for which this permit is issued.
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
I have and will maintain Worker's Compensation Insurance, as provided for by
Safety Code, Section 25532(x) should I store or handle hazardous material.
Section 3700 of the Labor Code, for the performance of the work for which this
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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued, I shall
Health & Safety Code, Sections 25505, 25533, and 25534.
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, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
Owner or au hgrized agent:
—Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is
for which this permit is issued (Sec. 3097, Civ C.)
correct. I agree to comply with all city and county ordinances and state laws relating
Lender's Name
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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 ,
I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
� (b �p 02_(q
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingla-�cupertino.orq
I
C^NUPERTINO r-� � IFW rOMITR t ICTION I I AIIIITTVIN P4—A—TTFR ATI()N/TT I I RFVI1,i0N/IIFFFRRPn (1RUIINAT PPRMIT#
PROTECT; 6D ; r, A
APN� O
OWNER NAME
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PHONE
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E-MAIL
C_ AA Li)�mdLnWA
STREET ADDRESS
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CE STATE, ZIPy�
FAX
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CONTACT NAME
PHONE E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
ElOWNER El OWNER -BUILDER 11OWNER AGENT CONT CTOR ElCONTRACTOR AGENT El ARCHITECT 11 ENGINEER 11DEVELOPER 11TENANT
CON'TRACTO AME J
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
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COMPANY NAME
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FAX �O 11LI&O 2 4
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PHONE Y o
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ARCHITECTIENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
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EXISTING USE —
PROPOSED USE C0NSTIL
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TYPE
p S RIES /`l^
�
USE
TYPE
. OCC.
SQ.FT.
VALUATION (5)
EXISTG
AREA
NEW FLOORS
AREA
DEMO
AREA
TOTAL
NET AREA
V
BATHROOM
CHEN
OTHER
REMODEL AREA 4210
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA
GARAGE AREA: DETACH
[]ATTACH
N DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ❑NO
ADDITION? ❑NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
1S THE BLDG AN ❑ YES
RECEIVED BY:
TOTAL VALUATION:
PLANNING ADPL N []NO PLANNPIG APPROVAL LETTER .
EICHLER HOME? []NO
21So 0o
By my signature below, I certify to each of the following: I am the property owner or authorized4gent 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 buildingconstruc o, I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of ApplicanUAgent: �Date: O Ei 2 7 I I
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
ER-THE-COUNTERBL'i
UILDING PLAN REVIEW
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑
❑ LARGE
FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_201 Ldoc revised 06/21/11
J
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO I (408) 777-3228 • FAX (408) 777-3333 • building aDcupertino.org
ElNEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
C RESS APN
6X%
OWNER NAME E-MAIL
STREET ADDRESS
d
C ST TE, ZIP
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FAX
s' C r-1 t-/ r
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CONTACT NAMEL`
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ ONRNER-BUILDER ❑ OWNER AGENT 14 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMELICENSE BER O
A 36
LIC E TYPE
BUS. ICS #
COMPA�'Y NA E J9
E-MAIL ,�
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FAX
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CITY, STATE, ZIP c�
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PHONE
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DE�CRIP ON OF WORK
C; b'z dc) ti %✓i
&I aAJ ,-i eul%� c tib
v
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA !l
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNIT [-]YES
SECOND STORY ❑ YES
BEING ADDED? []NO
ADDITION? []NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPL # []NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
RECEIVED BY:
TOTAL VALUATION:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to acct on the przJnperty 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 Mth all applicable local
roperty for inspection purposes.
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identifi7/,
Signature of Applicant/Agent: / / �( kc., (0dvt c_O Date: �� ©�
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
_ New SFD or Multifamily dwellings: Apply for demolition permit for
- OVER-T'HE-COUNTER
ES BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
SANITARY SE��'ER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_201 1. doc revised 06121111
CUPERTINO
OWNER -BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building5cupertino.org
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 W I 10S (,60 APN BP /
ow C. a A G O
DESC�RRIIpT ON W WORK:
I (O
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.)
k/1. 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 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.
I 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 responsibility.
kyl 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
iGermits
of my own.
rstand Contractors are required by law to be licensed and bonded in California and to list their license
and contracts.
kK5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be
considered an "employer" under state and federaldaw.
�D/16. 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
Ky7l
rious financial risk.
understand under California Contractors' State License Law, an Owner -Builder who builds single-family
9 Y
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 pert rmed under contract with a licensed general building Contractor.
8. 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.
OwnerBuilderForns 2010.doc revised 04/14/10
k-9. I 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 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.
—1 — 0. I 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.
�Q
//11. 1 agree that, as 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.
�1. I 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. 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 a able to the city may be required to be presented when the permit is issued
to verify the property owner's sionatur /
Property Owner's Signature: 4 — Date: le/ -11 r '
-
--------------------------------------------------------------------------------------------------------------------------------------------
(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:
OwnelBuildelForm 2010.doc revised 04114110
CITY OF CUPERTINO
W -M FEE ESTIMATOR - BUILDING DIVISION
Mech. Plan Check 10.0 1 hrs $0.00
Mech. Permit Fee: 1MPERMIT
Other Mech. Insp. 1 0.0 1 hrs 1 $42.00 1 _ ,
NOTF. - These fees are hated an the nroliminary infnrinatinn availahlo and are nn1v an ostimato_ Cantart tho Dont fnr addn'1 info_
FEE ITEMS (h'ee Resolution 09-05I I:�f.' 7/f,"10�
ADDRESS: 10657 rosewood # D
DATE: 06/30/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION: 1$15,000
r°PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
0.0
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
WORK
multy-family mutt-familykitchen and bath remodel new w/d hook-up.
SCOPE
30 s.f.
$570.00
Mech. Plan Check 10.0 1 hrs $0.00
Mech. Permit Fee: 1MPERMIT
Other Mech. Insp. 1 0.0 1 hrs 1 $42.00 1 _ ,
NOTF. - These fees are hated an the nroliminary infnrinatinn availahlo and are nn1v an ostimato_ Cantart tho Dont fnr addn'1 info_
FEE ITEMS (h'ee Resolution 09-05I I:�f.' 7/f,"10�
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= s.f.
$570.00
Remodel, Kitchen (<=300 sf)
IREMRESKIT
Suppl. PC Fee: G Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
30 s.f.
$570.00
Remodel, Bath (<=300 sf)
1REMRESBAT
Permit Fee:
$0.00
Suppl. Insp. Fee -0 Reg. 0 OT
1 0.0
hrs
$0.00
= # Mechanical
$126.00 IBAPPLOT Other Appliance/Equip
PME Unit Fee:
$0.00
PME Permit Fee:
$42.00
Acoustical Fee: 0 Yes (F) No
$0.00
Q
Work Without Permit? 0 Yes 0 No
$0.00
Punning Fee:
$0.00
Select a Non -Residential
Building or Structure
A
Travel Documentation Fee: ITRA VDOC
$42.00
Stronjz Motion Fee: IBSEISMICR
$1.50
Select an Administrative Item
Bld€'Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$86.501$1,266.001
TOTAL FEE.T
$1,352.50
Revised: 04/29/2011
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: 776,5 Ort -O" Lh PERMIT # D'Z / z7
OWNER'S NAME: Ge o q e C Ltaih PHONE # 11,0 1-1 4/6 — 12 O o
GENERAL CONTRACTOR: %T� f}reti G++ Ufa+, i��.,` <,►V BUSINESS LICENSE # X12 p 6 y �(
ADDRESS: ,p c h CITY/ZIPCODE: !�a n Jo 1 e S-01
*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:
Signature Date
Please check applicable subcontractors and complete the following information:
Owner / Contractor Signature
Date
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