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10070131CITY OF CUPERTIP O BUILDING PERMIT BUILDING ADDRESS: 7595 NEWCASTLE DR OWNER'S NAME: HUAI DING VER'S PHONE: 4084061417 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 (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. 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. 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 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the stricture is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ( le I 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 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall 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 forthwith comply with such provisions or this permit shall be deemed revoked. I I 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 inify and keep harmless the City of Cupertino against liabilities, judgments, and expenses which may accrue against said City in consequence of the 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. , Date V D CONTRACTOR: HUAI DING PERMIT NO: 10070131 7595 NEWCASTLE DR DATE ISSUED: 07/19/2010 CUPERTINO, CA 95014 PHONE NO: BUILDING PERMIT INFO: BLDG ELECT I— PLUMB F MECH I— RESIDENTIAL r— COMMERCIAL r JOB DESCRIPTION: REPLACEMENT OF AC CONDENSOR WHICH CAME WITH THE PROPERTY BOUGHT IN 2000 Sq. Ft Floor Area: APN Number: 36617079.00 Valuation: $2500 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: /- RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air 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 Health & Safety Code, Sections 25505, 25533, and 25534. Owner or th ized nt• —�/��,,��L��, Date:_ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 4 ITEMS OF 4 CITY OF CUPERTINO PERMIT' RECEIPT Sec: Twp: Rng: Sub: Blh: Lot: APN ........: 36617079.00 DATE ISSUED.......: 07,19/2010 RECEIPT #......... BS000010904 REFERENCE ID # .•.: 10070131 SITE ADDRESS .....: 7505 NEWCASTLE DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER HUAI DING ADDRESS 7595 NEWCASTLE DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: HUAI DING CONTRACTOR .......: LIC # *OWNER* COMPANY ..........: HUM DING ADDRESS 7595 NEWCASTLE DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 TELEPHONE ......... OPERATOR: patg COPY # : 1 FEE ID UNIT QUANTITY AMOUNTPD-TO-DT THIS REC NEW BAL ---------- ---------- 1BCBSC ------------- VALUATION ---------- 2,500.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 0.00 1BREMAIRHA NO.UNITS 1.00 63.00 0.00 63.00 0.00 1MPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1TRAVDOC FLAT RATE 1.00 42.00 0.00 42.00 0.00 ---------- TOTAL PERMIT ---------- 148.00 ---------- 0.00 ---------- 148.00 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT AMOUNT --------------- 148.00 --------------- 148.00 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING CITY OF 1^UPERTINO ffim FEE ESTIMATOR BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: DATE: QTY REVIEWED BY: BP FEES APN: BP#: *VALUATION: 1$2,500 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: = �� �r? , APPLICATION PME Unit Fee: � a O� PME Permit Fee: $42.00 3� APPLIANCE / EQUIP TYPE CAPACITY FEE ID QTY BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 PME Plan Check: $63 PME Unit Fee: $63.00 PME Permit Fee: $42.00 3{ TOTALS: Travel Documentation Fee: I TRAVDOC $63.00 Mech. Plan Check 0.0 hrs 1 $0.00 Mech. Permit Fee: 1MPERM T FotheMech. Insp. 0.0 hrs $42.00 rr` - r �:. ::'7 IV"TF. - Thovo fees are ha.ced on the nreliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (1-ee Resolution 09-051 F.t ' ,7`1 Q9) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $63.00 PME Permit Fee: $42.00 3{ Travel Documentation Fee: I TRAVDOC $412.00 Select an Administrative Item Bldg, Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $14E.00 $0.00i-- TOTAL FEE: $148.00 Revised: 6/30/2010 CITY OF CUPERTINO FUWiACE/AC CUPEkTINO PERMIT APP]JICATION FORM APN # Date: .7161 -�v r 0 Building Address: Owner's Name: 01, Phone #: Contractor: Phone #: / Fax#: Contractor License #: Cupertino Business License M Contact: " t JA 1 t �( v Phone #: Fax #: Building Permit Info: Elect B" Plumb Mech [----- Residential P Commercial ❑ Job Description: 0akVJen( Uf b,V,dem JUY wA�Gh cc,� e w� tL, , / )?FiHJ 6v ,JJ b E '�,V U U For Residential Installations: Attic ❑ 1st floor DI 2nd floor ❑ Adhere to minimum setback requirement For Commercial Installations: ❑ Replacement same weight ❑ Additional weight (structural calcs) Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): �Isv0 � Strapped On Platform Bonded New Location a Replacement Project Size: Expressizi Standard E]Large [] Major ❑ Valuation: Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Revisea uiiu iiuy CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333-,uiidina5cuDertino.oro Dear Property Owner(s): en submitted in �7our name listing yourself as the builder of the property An application for a building permit has be improvements specified at: SITE ADDRESS APN OWNER NAME OWNER ADDRESS HId(A1 n5_. 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 he ving 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 DF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) HD-1. I understand a frequent practice of unlicensec persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that 1 he property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held Iiablo 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. ]Ak_2. 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 Contra Aor to assume this responsibility. kL3. I understand as an "Owner -Builder" I am the -esponsible 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. UIL4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. AL5. I understand if I employ or otherwise ve hu ndreel dollars any r($500),ther than including Clabo� rnia andlmaterals, I may bed Contractors, and the total value of my construction is at least considered an "employer" under state and federal laN. "k6. I understand if I am considered an "employe" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide Norkers' compensation disability insurance, and contribute to unemployment compensation for each "employee." also understand my failure to abide by these laws may subject me to serious financial risk. JA_�7. I 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. 8. I understand as an Owner -Builder if I sell thi; property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any : ubsequent owner(s) that result from any latent construction defects in the workmanship or materials. ,,,77erBui1derFo7•17: 2010.doc revised 04/14/10 H 1)-9. 1 understand I may obtain more information reg 3rding 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 als ) understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or wvvw.cslb.ca.gov for more information about licensed contractors. H 0 10. 1 am aware of and consent to an Owner-Buildor 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. }IL11. 1 agree that, as the party legally and financiall 1 responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. P 12. 1 agree to notify the issuer of this form immed ately 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 fcr you to understand thpt 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 ole 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: Lend ar Address: Before a building permit can be issued, this form must be completed and s,gned by the property owner and returned to the agency responsible for issuing the per mit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the ci y may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: 7-21 ( 9 - - - 9completed--y p ----------------------------------------------- NOTE: The followin Authonzation Form ►s re uired to bs b the roperty owner only when designating an agent of the property owner to apply for a construction pe mit 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 o,,vner 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. p _ Property Owner's Signature:' Date: OwnaerBuilderForm 1010.docrevised04114/10