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13080108G CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20337 SILVERADO AVE CONTRACTOR: WANG CHUNG S AND PERMIT NO: 13080108 GRACE T OWNER'S NAME: WANG CHUNG S AND GRACE T 20337 SILVER -ADO AVE DATE ISSUED: 08/14/2013 OWNER'S PHONE: 4082531280 CUPERTINO, CA 95014-4437 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lic. # KITCHEN REMODEL 200 SQFT,& FAMILY ROOM REMODEL 250 Contractor Date SQFT Vii) I hereby affirm that I am licensed under the provisions of Chapter 9 REVISION #1- REMOVE FAMILYA000 Z REMODEL (commencing with Section 7000) of Division 3 of the Business & Professions FROM SCOPE OF WORK-ISSD OTC 9/23/2013 Code and that my license is in full force and effect. 1 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 Cod Sq. Ft Floor Area: Valuation: $15000 performance of the work for which this permit is issued. l have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 36939008.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES I6' WORK IS NOT STARTED correct. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DA FR01vI LAST CALLED INSPE$DT19N. 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 Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. C/J7 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 I Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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, Business & Professions Code) as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE onstruct the project (Sec.7044, Business & Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I 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(x) should 1 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, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this11 Owner or authorized agegt: Date: 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 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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. r" SignatureDate CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinq(aDcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI 15 REVISION / DEFERRED ORIGINAL PERMIT # 1362(5fo ' PROIECrADDRESS `3 �I I,/pAQ _e ! }_j ��A- V �(J i Nb __ .L� j l V L (NE 1 OWNER NAME P � " 67 >� � [� 0 - 3 -I E- IL 6 % uhaa, C STREET ADDRESS CITY STATE, ZIP FAX ry CONTACT E PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX E OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ COMRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME — LICENSE BER LICENSE TYPE BUS. LIC 9 µ T Jr COMPANY NAME r Z0 G G(C7GUY G< G'j7 E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT NGT, fER NAME LICENSE NUMBER BUS. LIC k r/ ey COMPANY NA E-MAIL /�f P U " SIRE& ADDASS CITY, TATE, ZIP '� �/� PHONE Voc'-'? p - a -a t o % DESC T70N OF RK EXISTING USE PROPOSED USE CONSTR. TYPE N STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH NDWELLINGUNITS: IS ASECOND UNIT DYES SECOND STORY OYES BEING ADDED? ON.ADDrT10N? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPLH ONO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOM E? ANO IyEo j�'' /moi „//ail, /� ' ��/ ��� �G �/� TOTAL V TION: �' By my signature below, 1 certify to each of the following: I am the property owner or authorized agent to act on the property o er's behalf. I have read this,,,, application and the information I have provided is collect. I have readthe scription of Work and verify it is accurate. I agree to 'v - `—E =PPIi� local ordinances and state laws relating to building construction. I authorize repr sentahves of Cupertino to enter t e above -identified property for inspection purposes. g p , "f Signature of A IicanUA �-�z Dat 'Z. 1; PP SUP LEMEN AL INFORMATION REQUIRED' //%% / _ 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. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure L' sr n/Di'!,/i !' ;/ % J ►t i if �/ /% ' %< Form if any Hazardous Materials are being used as part of this project. k7%Ii/ir; Copy of Planning Approval Letter or Meeting with Planning prior to��%�yi��/' submittal of Buildma Permit application. BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20337 SILVERADO AVE CONTRACTOR: WANG CHUNG S AND PERMIT NO: 13080108 GRACE T OWNER'S NAME: WANG CHUNG S AND GRACE T 20337 SILVERADO AVE DATE ISSUED: 08/14/2013 OWNER'S PHONE: 4082531280 CUPERTINO, CA 95014-4437 PHONE NO: ❑ JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALE] LICENSED CONTRACTOR'S DECLARATION License Class Lic. # KITCHEN REMODEL 200 SQFT,& FAMILY ROOM_ REMODEL 250 Contractor Date SQFT I hereby affirm that I aro 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 Sq. Ft Floor Area: Valuation: $15000 performance of the work for which this permit is issued. 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: 36939008.00 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 OF 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 S OM LAST 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 �i���'3 granting of this permit. Additionally, the applicant understands and will comply Issued by: 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 Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of 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. I 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 1 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, fdr 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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sections 25505, 25533, d 25534. (� Owner or authorized agent: Date: 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 anymanner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, 1 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 1 certify that l 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 �� 3 CITY OF CUPERTINO Fr—A-70 FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the vreliminary information available and are onlv an estimate. Contact the Dept for addh7 info. FEE ITEMS (Fee Resolution 11-053 Ef 711/12) FEE t,( /c . Mon (7,", ' Plumb ('tram (:7w(A I ADDRESS: 20337 Silverado Ave roc r art F,V: DATE: 0811412013 REVIEWED BY: Sean Jim1 APN: BP#:��(��a A'If' VALUATION: 1$15,000 *PERMIT TYPE: Building Permit %E,)kC/v1In") 1,cc, PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex Remodel, Other IREMRESOTH PENTAMATION 1 R3SFDREM USE: $0.00 PERMIT TYPE: WORKKitchen remodel 200 s ftfamily room remodel 250 s ft . SCOPE PME Unit Fee: $0.00 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the vreliminary information available and are onlv an estimate. Contact the Dept for addh7 info. FEE ITEMS (Fee Resolution 11-053 Ef 711/12) FEE t,( /c . Mon (7,", ' Plumb ('tram (:7w(A �t°<'. ('Gain Ch"ck roc r art F,V: $0.00 =s.f. $626.00 o(/wr l(C'("(. I'iJ, IK'w A'If' bop. "lwrPjmvb I'l!ob, III,"o. fvc %E,)kC/v1In") 1,cc, NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the vreliminary information available and are onlv an estimate. Contact the Dept for addh7 info. FEE ITEMS (Fee Resolution 11-053 Ef 711/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =s.f. $626.00 Remodel, Kitchen (<=300 sf) IREMRESKIT Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 250 1 s.f. $418.00 Remodel, Other IREMRESOTH Permit Fee: $0.00 Suppl. Insp. Fee: E, Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? C) Yes (2) No $0.00 Advanced Planning, Fee: $0.00 Select a Non -Residential Building or Structure E) i /rvl lr`ces. Strong Motion Fee: IBSEISMICR $1.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 03 7 �"�"'�`�,�: 7., $2.50 $1,044.00 ►,`�° $1,046.50 Revised: 07/01/2013 CUPER"TINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingPcupettino.org ❑ NEW CONSTRUCTION ❑ ADDITION ZIALTERATION / Tl ❑ REVISION / DEFERRED ORIGINAL PERMIT N PROJECT ADDRESS APN M ` OWNER NAME F\ �4zf _ r�, P -)Q & PHONE( , e7o E-MAIL STREET ADDRESS �a �7 5kL vE-Rn(>o fl CITY, STATE, ZIP FAX C.C7 (KJC, (7A Gj4 CONTACT NAME PHONE E-MAIL STREET ADDRESS rO � �(O � CITY, STATE, � �41• � FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT 9 ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME .� LICENSE NUMBER LICENSE TYPE BUS. LIC M COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCMTECTIENOrNEER NAME LICENSE NUMBER BUS. LIC 0 COMPANY NAME S r'J �p �CC(C , E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK `1'cGde1 EXISTING USE PROPOSED USE CONSTR H STORS STORIES S 5 © V_ K d �� USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA �--y i� -'{' AREA O AREA NET AREA Z BATHR00 KITCHEN EMODE L�1 REMODEL OTHER REMODEL AREA 4 .. REh40DElAREA AREA 2 QG . PORCH AREA DECK AREA,TOTAL DECK/PORCH AREAGARAGE AREA: DETACH ,fJCKATTACH 9 DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY []YES BEING ADDED? ' Wo (OF�' ADDITION? ANO rte—❑�_ P" -APPLICATION YES 1F' YES, PROVIDE COPY IS THE BLDG AN YES RECEIVE TOTAL VALUATION: PLANNING APPL. N O PLADaNJNG �4PPROVAL LETTER EICHLER HOME? �'NO By my signature below, I certify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information i hgve 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 Jrconstructi I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent Date: SUPPLEMENTAL INFORMATION D ' a' rl �rfclarc�hE, %� r'�' „.'QtITNs[iJ"u,'� New SFD or Multifamily dwellings: Apply for demolition permit for 3r' o�R rxl�-COUNTER � �s�tv��i� t.,�v vlrv✓ ��� existing building(s). Demolition permit is required prior to Issuance of building ermit for new but din P g• Ex PRE ss ❑ PI AN1>w PLAN REYLEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD /% ❑ PUBLtC WdRKS form if any Hazardous Materials are being used as part of this project. 0 LARGE - ; ❑ -FIiiE DEI!T , Copy of Planning Approval Letter or Meeting with Planning prior to ` ` ❑ ❑ SEtiVER submittal of Building Permit application..;:: 14IAJOR SANITARY DISTRICT © EN ON HEALTH BldgApp_2011.doe revised 06/21/11 Building Department City Of Cupertino 10300 Torre Avenue i Cupertino, CA 95014-3255 C O P E RT I N© Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR CTOR / SUBCONTRACTOR LIST JOB AI7DRI_�,SS: ; -rr/L o PERMIT # /4,7 "o AME: NONTRACT BUSINESS LICENSE # GENERAL R: , BUSINESS LICENSE # ADDRESS: Z ._ - CITY/ZIPCODE: *Our municipal code requires all businesVes 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 SUB TRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: ............ -, Signature to Please check applicable subcontractors and complete the following information: V 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 ... er / Contractor Signature D to CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 90300 TORRE AVENUE • CUPERTINO, CA 95094-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a.cupertino.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 ADDRESSj / _ V l/` -C% APN ' f 3�?o6) OWN NAME r� OWNER ADDRE �, DESCRIPTION OF WORK: v,_, i 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. 1 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. r 1' 2.1 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. ,�3. 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 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 numbers on permits and contracts. it 5. 1 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 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 to serious financial risk. (N 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. 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. OWnerBuilderForm 2010.doc revised 04114/10 0 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. 69V, 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. 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. 12. 1 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 acceptable to the city may be required to be presented when the permit is issued to verify the property owner's si natur Property Owner's Signature: - 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: Address of Authorized Agent: Tel No 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. doe revised 04/14/10 CA PEX EN GINEERING IN C. 110 Ho'14198, i-ki MOM LA 945;9 k:1'(5101('08-1815 [ax 010)490 -MW 13o�a(v8' Projcct No. 8554 October 151 2013 Building Department City of Cupertino 10100 Torre Ave. Cupertino. CA 95014 Sub 4- N ject. Wan -'s Interior Aitcration at 20337 Silverado Ave. Cupcilino. CA (Permit No. 13080108) SPECIAL INSPECTION SERVICES FINAL AFFIDAVIT .FOR ALL THREADED ROD BOLTS INSTALLATION WITH EPDXY Dear Sir: CAPEENGINEERING PVC. has provided testing and special inspection services at I the sub -sect site in accordance with. section 1704A of the California Building Code (2010 Edition) as listed below: (1) Inspections of (2) 5/8-'fi x 121- rein. cnibcd. all threaded rod bolts installation filled with Epoxy and embedded into existing concrete for holdown placement at specific .locations, (2) All drilled holes for reccivingall threaded rod bolts instaU,,:ition -,-vere cleaned of dust and debris and adequate in depth to embed into existing concrete. Personnel under the gerioral supervision of registered Civi.1 ['Agincer, performed these inspections. Based on the inspections performed and upon our substantiate reports that the inspected work was performed, to the best of our f nov,,-ledge, in conformance with the approved plans <md spccifitcations and the applicableworkmanshipprovisions of the California Building Code, Sincerelv, C 1� APFX FIGIN]"ERING1 fNC:.. (iarvjIsh. I)J�, Principal C4PFX1-N(,'1NFFRJ.,VG INC, CUPERTINO COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION CITY HALL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 SCOPE OF WORK: Kitchen Remodel. Project shall comply with the 2010 California Building (Base code 2009 IBC), 2010 Residential (2009 IRC), Plumbing (2009 UPC), Mechanical (2009 UMC), Electrical (2008 NEC), Fire (2009 IFC) and Energy Codes (2008 Building Energy Efficiency Standards) EnergV code mandatory lighting measures: 1. All permanently installed high efficacy luminaires shall be switched separately from low efficacy luminaires. (150(k)(7)) 2. Permanently installed lighting in Kitchens shall be high efficacy luminaires. Up to 50% of the wattage of permanently installed lighting in kitchens may be in lights that are not high efficacy. (150(k)(8)) Plumbing plan notes: 3. Faucets in kitchens, wet bars, lavatories, laundry sinks, etc shall have a water flow not to exceed 2.2 gallons per minute. (CPC 402.1.2) Electrical Plan Notes: 4. The installation of smoke alarms in all of the following areas shall be provided: (R314.3) a. On the ceiling or wall outside of each separate sleeping area in the immediate vicinity of bedrooms. b. In each room used for sleeping purposes. 5. The installation of carbon monoxide alarms in the following areas shall be provided: (R315.1) a. Approved carbon monoxide alarms shall be installed outside of each separate sleeping area in the immediate vicinity of the bedrooms and on every level including basements in dwelling units that have fuel -fired appliances or attached garages. 6. A minimum of two 20 amp small appliance branch circuits shall be provided for all receptacle outlets in the kitchen, dining room, pantry, or other similar areas. (CEC 210.11(C)(1)) 7. In every dwelling unit, fixed appliances such as food waste grinders, dishwashers, washing machines, dryers, laundry tray locations, built-in refrigerators or freezers, furnaces, AC units, built-in heaters or any other fixed appliance with a motor of'/ h.p. or larger shall be on a separate 20 amp. branch circuit. 8. All receptacles in bathrooms, garages, accessory buildings, outdoors, crawl spaces, unfinished basements, kitchens (where receptacles serve counter top surfaces), laundry, utility, wet bar sinks (within 6 feet of the edge of the sink), shall have ground -fault circuit interrupter (GFCI) protection. (CEC 210.8) 9. In all areas specified in 210.52, all 125 -volt, 15- and 20- ampere receptacles shall be listed tamper-resistant receptacles. (CEC 406.11)