B-2017-2048 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2048
22647 OAKCREST CT CUPERTINO,CA 95014-0830(342 48 039) HOMEOWNER
BUILDER
OWNER'S NAME: Yang Li And Haining Yu DATE ISSUED: 11/30/2017
OWNER'S PHONE:408-429-0566 PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor HOMEOWNER BUILDER Date X BLDG _ELECT _PLUMB
MECH X RESIDENTIAL COMMERCIAL
Ihereby 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. JOB DESCRIPTION:
GARAGE REMODEL-DRYWALL CEILING AND WALL;INSTALL(2)
I hereby affirm under penalty of perjury one of the following two declarations: CEILING FANS;INSTALL 9 RECESSED LIGHTS;CONSTRUCT
1. I have and will maintain a certificate of consent to self-insure for Worker's WATER HEATER ENCLOSURE ,
,Compensation,as provided for by Section 3700 of the Labor Code,for the
40 eperformance of the work for which this permit is issued.
2. 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. Sq.Ft Floor Area: Valuation:$2400.00
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 APN Number: Occupancy Type:
and state laws relating to building,construction,and hereby authorize 342 48 039
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue,against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED'INSPECTION.
S. ature Date 11/30/2017 Issued by:Abby Ayende •
Date: 11/30/2017
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofmg material being installed.If a roof is
1. I,asowner of the,property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
ale(Sec.7044,Business&Professions Code)
,,as,owner of the property,am exclusively contracting with licensed Signature of Applicant:
/j contractors td construct the project(Sec.7044,Business&Professions Code). Date:11/30/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
' 1. 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
erformance'of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
I'have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall'not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
• air contaminants as defined by the Bay Area Air Quality Management District I
Worker's;Corhpensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked.
ner or authorized ag
'' APPLICANT CERTIFICATION W s ate:11/30/2017
I certify that I have,read,this.application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree. o comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name .
to save indemnify and keep harmless the City of Cupertino against liabilities, '
judgments,costs,and;expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
a' al
tur- 0 Date 11/30/2017 Professional
CONSTRUCTION PERMIT APPLICATION
�`1 / COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255 '^/
5T:t 9s`
s (408) 777-3228 • building@cupertino.org PEMIT#B- aot_�
L
CUPERTINO ' REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑X ALTERATION ❑T.I. ❑MEP
'' ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS APN# 1 (1%,03q
22647 OAKCREST CT,CUPERTINO,CA
OWNER NAME PHONE E-MAIL
YANG LI 408-429-0566 ' YANG.LIY@GMAIL.COM
STREET ADDRESS CITY, STATE,ZIP
22647 OAKCREST CT CUPERTINO,CA 95014
❑CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
ISTREET ADDRESS CITY,STATE,ZIP I
E-MAIL PHONE BUS.LIC# .
, ❑ARCHITECT 0 OWNER,0 OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER❑TENANT '
CONTACT NAME E-MAIL
YANG,LI YANG.LIY@GMAIL.COM
STREET ADDRESS CITY,STATE,Zn' PHONE
22647 OAKCREST,CT CUPERTINO,CA 95014 408-429-0566 DESCRIPTON ,
Garage project,578 sOff.1)Put dry wall on walls and ceilings to finish:the inner surface to make the looking better. ' '
2)Install 2 ceiling fans to iinprove.air venting and cooling during summer.
3)Install 8 to 10 recessed.LED lights on ceiling.
•
4)Install wall to isolate;the water heater and furnace to reduce noise. '
OSINGLE-FAMILY/DUPLEX 10MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I
, EXISTING USE EXISTING SF; NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. • VALUATION($)
•I
REMODEL , REMODEL KITCHEN REMODEL OTHR GARAGE 0 ATTACHED
BATHROOM SF . SF ' SF SF 578 0 DETACHED
EXISING 0 YES EICHLER ❑YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS❑NO 0 NO ❑NO
' DWELLING SECOND DWELLING ❑YES 0 ATTACHED 0 DETACHED OTHER ' 1 '
UNITS# UNIT ADDITON:, ❑NO S F
POOLS' ❑FIBERGLASS,❑VINYL-LINED ❑GUNITE ❑PREFABRICATED
POOL-SF. SPA-SF I SPA ATTACHED❑YES 0 NO I TOTAL-SF sir
R IVEDBY: //(/// 1 y py9 is
Commercial or Multi-Family Buildingsi with PublicSwimming Pools requires Department ofEnviranmental Heath approval n Q,4�Q n
RE-ROOF)EXISTING ROOF TYPE ❑BUILT-UP ROOF Q ASPHALT SHINGLES El WOOD SHAKES❑WOOD SHING ES❑TILE OTHER(SPECIFY) ,
REMOVE/REPLACE I]NOI IF NO PLYWOOD ❑w CI 3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
0 ygS #OF LAYERS THICKNESS❑5/8"'OTHER ❑OSB ❑CDX OTHER :12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF #of SQUARES
• By my signature below I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I
have read this application';and the information I have provided is correct. I have read the Description of Work andcverify 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. I acknowledge and authorize all information•contained on this application form
I
' to be made available for .ublic record. _ '
Signature tiitiii a. 211041"-:, P57,,,e. /007 17
• SUPPLEMENTAL.INFORMATION RE D
*New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA-Provide a letter of approval from the Home Owner's Association
BldgApp_2017.doc revised 08/01/17
•
I
\ OWNER-BUILDER DISCLOSURE FORM
- 00/ COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
4s,r s 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•buildinq(a cupertino.orq
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 .Zn q 7 04KC, f . ,L, el 6-9�4 APN o #
Ld! v Cif 311-2 ��- 3� -2h1-4--2 z
OWNER NAME !A� h�(/� OWNER ADDREI�SSd vim} / n [ p C
yl •"_• �i 'Lzt 7 %Gtjz& e', Ori CiL•.Aper -i1 o; Vfr 'V oI / "�
DESCRIPTION OF WORK: Pk+ drq („Ipf 4,9 ki,k,ln' iNMee cufGd Wa1I evAel cei II>�. t4 Aar"; ,1q-(4 2
Ceik.,. � % ih yule-: 4�io�,rt- q rete d L400 in gAr , /XS- wJ( 0 Iso afeJ- iWitir��uaNat@
u f
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.)
i1. 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 injuriessustained 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 thelimits of my
insurance boveragefor injuries to workers on my'property.
V 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 Contractor to assume this responsibility.
j3. 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.
V 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license.
numbers/ on permits and contracts.
�/ 5. 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 federal law. . ,
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
mILa to serious financial risk.
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 ii8f
ormed under contract with a licensed general building Contractor.
8. I 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 04/14/10
/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.
10. 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.
11. I 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 12. 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 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: ,',/i/5-0/17
(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:
Owne7BuildelForm 2010.doc revised 04/14/10
CUPERTINO
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • build inaCo?cuoertino.oro
W T CANi1T BFyIl�IALED ill\?TIL.THIS CEItTIFIGATE.HAS BEEN
C£31M£ �;ETEi�9 Sf ftTm &
T1C3 THE B1.IlLj) G i3IUISI{aN
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2016 CRC Section R314, R315, 2016 CBC Sections 420 6 and 907.2.11.2 where no interior access
for inspections are required.
GENERAL INFORMATION
Existing single-family and multi -family dwellings shall be -provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000 00, CRC Section R314, R315, and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or
Carbon Monoxide Alarms be installed in the following locations.
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s) — (Smoke alarms shall not be located within 3 feet of bathroom door)
X
X
On every level of a dwelling unit including basements and habitable attics
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burring appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420 6 and shall be approved by the Office of the State Fire Marshal.
Power Supply In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.114 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below
Address- 12W tlrie ke (g�,+ Cf, CLAmrj j , C 11-U l L _ Permit No.6-2 V1 ? Cly
Specify Number of Alarms - # Smoke Alanns # Carbon Monoxide Detectors 177771
f
l have read and aoree to romnfv with tha tArm„ - and nnnrlrirnnc of Phio oinfn nv
Owner (or Owner Agent's) Name:
p
Si nature.... — Date:
Contractor Name:
aO
Signature Lic.# Date:
S727oke and COfonmdoc revised 0111012017
Abby Ayende
11/30/17
11/30/17
B-2017-2048
Abby Ayende