12030041CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10384 PARADISE DR
OWNER'S NAME: LEE NGUYEN
OWNER'S PHONE: 4084826830
❑ 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:
1 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.
Signature Date
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
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.
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 -p int source regulations per the Cupertino Municipal Code, Section
9.18. L(2-- SignatureME1 ` Date 4 g
CONTRACTOR: LEE NGUYEN
10384 PARADISE DR
CUPERTINO, CA 95014-2914
PERMIT NO: 12030047
DATE ISSUED: 0628/2012
PHONE NO:
BUILDING PERMIT INFO: BLDG r— ELECT r PLUMB r
MECH r RESIDENTIAL r COMMERCIAL F
JOB DESCRIPTION: KITCHEN REMODEL(490SQFT) AND INSTALL NEW
WINDOW
AND CHANGE EXISTING WINDOW TO FRENCH DOOR
Sq. Ft Floor Area: I Valuation: $40000
APN Number: 35916030.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS F M LAST CALLED INSPECTION.
Is u bv:ll Date:
Jr
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(x) 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.
r or authorized agent: j I
o
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 Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Lee Nguyen
10384 Paradise Dr
Cupertino, C
December 5, 2012
Permit No: 12030047
Building Permit Inspection
City of Cupertino
Dear City of Cupertino Building Permit Inspection:
I am writing to ask for a 180 days extension on my building permit number 12030047.
We have not started our remodel yet, but have decided to make major changes to our
remodel plan. The current plan is to move the existing kitchen to the family room. But we
have decided to expand our kitchen into the laundry room instead of moving the kitchen
to the family room. We are in the process of redrawing the plan and will submit the new
plan for approval shortly.
Thank you for your support.
Sincerely,
Lee Nguyen
CFE�L L�D$— 49Z��b3�
(ttrn► � � c.wg -- 3�6 - �.� 7 2--
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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: Y-ei ol i se F�Y— .
PERMIT # 12,03(X)q-7
OWNER'S NAME: („ i t -erl
PHONE #
GENERAL CONTRACTOR:
BUSINESS LICENSE #
ADDRESS:
CITY/ZIPCODE:
*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
Please check applicable subcontractors and complete the following information:
Date
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
CITY OF CUPERTINO
NFOW FEE ESTIMATOR — BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public fforks, Fire, Sanitary Sewer District, School
Dixtriet- e1r.). These fees are based on the nrelininart, information available and are only an estimate. Contact lite Dent foraddnl info.
FEE ITEMS Resolution 11-053 1
10384 Paradise Drive
DATE: 03/09/2012
REVIEWED BY: Sean
JimADDRESS:
APN:��-q. 16,6 3,0
BP#: ' 71�7
$0.00
VALUATION: [$40,000
'PERMIT TYPE: Building Permit
PLAN CHECK TYPE:
Alteration / Repair
PRIMARY SFD or Duplex
USE:
$0.00
PME Plan Check:
PENTANIATION 1R3SFDREM
I PERMIT TYPE:
WORK
Kitchen remodel (490 sq ft)
and install new window and change
existing window to french door.
SCOPE
Permit Fee:
$0.00
Supp[. Insp. Fee -.G Reg.
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public fforks, Fire, Sanitary Sewer District, School
Dixtriet- e1r.). These fees are based on the nrelininart, information available and are only an estimate. Contact lite Dent foraddnl info.
FEE ITEMS Resolution 11-053 1
FEE
QTY/FEE
I MISC ITEMS
Platt Check Fee:
$0.00
F-490 s. f
$457.001
Remodel, Other
IREAfRESOTH
Suppl. PC Fee: 0 Reg. Q OT
F6,61
hrs
$0.00
PME Plan Check:
$0.00
2 l#
$392.001
Window Sliding Glass Door
1 WINREP Replacement
Permit Fee:
$0.00
Supp[. Insp. Fee -.G Reg.
Q OT
10.0
1 firs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? 0 Yes e No
$0.00
A�
...... . ...
......... . ..
$0.00
Select a Non -Residential
Building or Structure
I
A
0
................................ .............. ............ .......... .................. ..
S _
........... . .. ............. . . .. . . ........ . .......
IBSE1,5HICR
.......... . ....... ...... .
$4.00
. ........
Select an Administrative Item
........... .......... _ ................ . ..... . ............. _._ . . . ...........
131c :Jrid:, .. ........... ......................... j"eC. IBCBk
$2.00
SUBTOTALS:
$6.00
$849.001
TOTAL FEE:
$855.00
Revised: 1/19/2012
CUPERTINO
OWNER -BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • build ing(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 ADDRESS 16'691�
Y. 7
APN
BP#
OWNER NAME 1�-cEJ.rr�--T
OWNER ADDRESS
DESCRIPTION OF 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.)
I
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.
l_tJ 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.
LN 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.
Lti 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.
��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.
(_�J 6. 1 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.
L 0 7. 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.
l�J%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.
Oli'nel'Buildei"Foi-i?i 2010.docrevised 04/14/10
Lu/ -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.
L.L�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.
L01 1. 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.
LK,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 verif ati n acceptable to the city may be required to be presented when the permit is issued
to vert the property owner's si ure.
Property Owner's Signature: Date: Z
---------------------------------------------------------------------- ----------------------------------------------------------------------
(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:
Oii71e1"Buildei-Foi-i7i 2010.doc revised 04114110
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org
1a03v0V7
❑ NEW CONSTRUCTION ❑ ADDITION 21 ALTERATION/II ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 1033LPA"PTS X
/
APN # a / / O O
OWNER NAME LSC %JV �yf fv
PHONE b`gZ �-6��/ '
E-MAILr/Lalf��Yt�l3cS�e'yyNm.c.
STREET ADDRESS 10394 P6,J)E 5E v J7.
CITY, STATE, ZIP f L f� , � ySZ I(/
_(
FAX
CONTACT NAME LOt- NJ 60>4C^
PHONE 410V_ g2 - 6 0 307
E -MAA �(Yt% �� L�� q yIY�v • C
STREET ADDRESS Q
CITY, STATE ZIP v 7 )e�,' /
OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX .
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHTTECT/ENGINEER NAME,
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRPON OF WORK nM D'AA�7 A -/ T7 ' (CQ
1 ( f
O j?✓ 7
EXISTING USE„
31
PROPOSED CONSTR
g 3 1
TYPE
0
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTO
AR-EAdDD D
NEW
AREA FLOOR
AREADEMO
TOTALA
�/, /F
L
41,1,,
BATHROOM
REMODEL AREA
KITCHEN
REMODEL AREA l&9il
(CH
OTHER
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKIP/ O<<R
AREA
GARAGE AREA. DETACH
,
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNIT []YES
SECOND STORY ❑ YES
BEING ADDED? FTNO
ADDITION? NNO
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? ❑ NO
�,1914
/ O GQ zq
By my signature below, I certify to each of the following: I am the property owner or authorized anent to act on the prrperty 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 relator uilding costrucauthorize representatives of Cupertino to enter the aboy'idgntifed property for inspection purposes.
Signature of Applicant/Agent: K Date: If SCJ �Z—
SUPPLEMENTAL INFOR TION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
perfor new building.
��/
U 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
❑ ME DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIIZONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
RESIDENTIAL PROJECT COVER SHEET
As >essor's Parcel Number: /6 -,::2 _3e,-)
Na.:ne of owner. L.E E iJC,U �'G ►v
Project address. 1035��- FLS 9" _DT5F DR.
Coritact person. LES M(,L)YFAJ Phone. lI-dg — 4-g Z - Q3a
Fax.
Net: square footage of lot. 56.6t
Existing Proposed
Square. footage: First floor: lire
Second floor:
Garage: 30"P" P S6z E=
TOTAL: 2-300 5-6,PT 2-30 Sa=t -
Are there at least two 10 foot by 20 foot clear spaces inside the garage? N
Is p;-ivacy protection planting required for the project? Y
Build it Green Total Points
On what floor(s) is work being done? 151
Brief description of work. WI Kl k LbC1i1--F �K T7 Z �i i*r�
Coci.e editions: 2010 CBC (Y - N)2010 CFC (Y - N)2010 CMC (Y- N)
2010 CPC (Y - N) 2010 NEC (Y - N)
California Green Building Standards Code 2010
Effective 1/01/11
Plan 1<:eview Process Work Book Page -8- Revised 12/21/10