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10070055 - .* ` CITY OF CUPERTIT O BUILDING PERMIT BUILDING ADDRESS: 10802 GASCOIGNE DR CONTRACTOR:THE 2000 TSENG FAMILY PERMIT NO: 10070055 TRUST "NER'S NAME: THE 2000 TSENG FAMILY TRUST 10802 GASCOIGNE DR DATE ISSUED:07/07/2010 tyvVNER'S PHONE: 4088289077 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH r RESIDENTIAL r- COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:BATH REMODEL;REPLC TILE,BATHTUB,SHOWER VAULT (commencing with Section 7000)of Division 3 of the Business&Professions @SAME LOCATION SHEET ROCK&INSULATION THROUGHOUT Code and that my license is in full force and effect. THE HOUSE(NO ELECTRICAL&NO MECHANICAL 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 Sq.Ft Floor Area: Valuation:$20000 permit is issued. APPLICANT CERTIFICATION APN Number:37529042.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. °'-nature Date Issued by- ��r Date:` W� OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 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 I 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 Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. 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 I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. 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 a�thorized agent: forthwith comply with such provisions or this permit shall be deemed revoked,A j �� G� Date: —ft712Z i O APPLICANT CERTIFICATION C/+ ' CONSTRUCTION LENDING AGENCY I certify that 1 have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name the above mentioned property for inspection purposes.(We)agree to save aify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address 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 9.18. �/ I understand my plans shall be used as public records. Signature L "�f' J Date I1 w�I�l Licensed Professional r CITY OF CUPERTINO FEE ESTIMATOR-- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: 1$20,000 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY '�' a . APPLICATION USE: SFD or Duplex . , TYPE: � a 3c APPLIANCE/EQUIP TYPE CAPACITY FE E ID QTY BP FEES Fixture or Trap 1BPFIXTURE 1 $8 TOTALS: $8.00 -T Plumb.Plan Checc 0.0 hrs $0.00 - - r- _ �.;� _ Plun_b.Permit Fee: IPPERMIT Other Plumb Insp. F1.0Fhrs $168.00 NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Pee Resolution 09-051 Eff ''l%I)91 FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $8.00 PME Permit Fee: $168.00 Travel Documentation Fee: ITIM VDOC $42.00 hrs Standard Hourly Rate Bldg Stds Commission Fee: IBCBSC $1.00 $252.00 SUBTOTALS: $219.00 $252.00 TOTAL FEE: $471.00 Revised: 6/30/2010 CITY OF CUPERTINO 6 ITEMS OF 6 PERMIZ RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN . . . . . . . . : 37E29042 . 00 DATE ISSUED. . . . . . . : 07/07/2010 RECEIPT #. . . . . . . . . : BSC00010801 REFERENCE ID # . . . : 1OC70055 SITE ADDRESS . . . . . : 10802 GASCOIGNE DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . : THE 2000 TSENG FAMILY TRUST ADDRESS . . . . . . . . . . : 10802 GASCOIGNE DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : CHIAOHSIN J WANG CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : THE 2000 TSENG FAMILY TRUST ADDRESS . . . . . . . . . . : 10802 GASCOIGNE DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 20, 000. 00 2 . 00 0. 00 2 . 00 0 .00 1BPFIXTURE NO OF FIXTURE 1 .00 16 . 00 0. 00 16. 00 0 .00 1PLMBINSP HOURS 1 . 00 252 . 00 0.00 252 . 00 0 . 00 1PPERMITFE FLAT RATE 1. 00 84 .00 0 .00 84 . 00 0 . 00 1STPLNCK HOURS 2 . 00 504 .00 0 . 00 504 . 00 0 . 00 1TRAVDOC FLAT RATE 1. 00 84 . 00 0. 00 84 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 942 . 00 0 . 00 942 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 942 . 00 VISA --------------- TOTAL RECEIPT 942 . 00 7Z> CITY OF C,UPERTINO CITY OF CUPEkT1NO GENERAL BUILDING PERMIT APPLICATION FORM APN# Date: Building Address: _ 10?r 2 :C.scoi nee 1� Raves I CAV LYIO s l y Mailing Address (if different from building address): lL3� M (I a c Cit T ��—� Are Hazardous Materials being used as part of this project? Yes No HOA: Exterior work only) Yes ❑ No �T If 'es, provide letter from HOA Owner's Name: Phone#: ,, 2ub 77 Contractor: ®� Phone: Fax: Contractor License#: Cupertino Business License#: Contact: Phone: Fax: Residential Commercial Job Description: P) � c� I Q���� (e , b��f tub s o wa r 'J" Ott Sew (v Batt/1'�-i S1�2efi ro�� ci�v�c g,)a,4�fi_b� ikrDV_ hamort fele housQ 1 l c0,► 06 k6(A Building Permit Info: Bldg Elect ❑ Plumb Mech ❑ Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-E V^-__7 - - Valuation: Square Footage: t20, coo Project Size: Express ©Standard ❑ Large [] Major ❑ Green Building: Please complete relevant portion c f the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set& the sheet index. Points Achieved: For help, contact Build it Green at www.builditgre-n.or Revised 07/14/09 M.Indoor Air Quality and Finishes INPUT Resoumes Energy IADZHeadb 1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes p 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.Seal all Exposed Particleboard or MDF 4 IAQ/Health. pts y=yes 0 B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes D 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 6mimmmi N.Flooring I= 1.Select FSC Certified Wood Flooring 3 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials f Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles t Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor I Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs f Resource pts y=yes 0 Total Points Available: 1 1401 1301 57 Total Points Project Received: 1 01 0 0 G:data/progs/gres ibuildngguidelines/remodelers/greenpointsfinal2.12.D4protected.xis RESIDENTIAL PRO�fECT COVER SHEET Assessor's Parcel Number: ��r7' Z� ' 142- Name 4ZName of owner. JOLT -Te nGA Projectaddress. » _ UZ- Cwscol !! Oe (,ufej±inU; 6/11 Contact person. rie Pho se. 40 -'i-7 Fax Net square footage of lot. -- Existing Proposed Square footage: First floor: Second oor: ------� Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? Is privacy protection planting required for the project?'—Y 3uild it Green Total Points On what floor(s) is work being done? Brief description of work. MWe� }-i,,b, -Vile e g LA.ul-f- � '�' fi��i►YL-1 Sa w�¢� �0�a��Yl �1nE ttl7�r i hs�1�Ci117� tb In 6u f t )cam e(�C�ani Code editions: 2007 CBC RN)2007 CFC (Y -N)2007 CMC (Y-N) 2007 CPC -N)2007 NEC (Y -N) APPROVED IN ACCOPDAN(J VVITH THE CITY OF Effective 1/1/08 CUPFRTINO CODJ 5 AND ORDINANCES DATE__"?" SIGN -- This set of pans and specifications MUST be kept on the lob at all times and it is unlawful to make any changes or alterations on same without written permission from the Building Department,City of Cupertino. The stamping of this plan and specifications SHALL NOT be held to permit or to be an `F � approval of the wolar,on f ar,y provisions of any City i)r,1rr:jnrc-;,r ,,!,ire I aw Plan Review Process Work Book Page-8-Revised 8/05/08 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPAR WENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•.»i�in�i c� ain �- Dear Property Owner(s): An application for a building permit has been submitted in Stour name listing yourself as the builder of the property improvements specified at: SITE ADDRESS APNBP# 110002 co e D - -7 5-21J 2 OWNER NAME OWNER AE DRESS DESCRIPTION OF WORK: 11(t L 1 - We are providing you with an Owner-Builder Acknowledgrr ent 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, inil ialed 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 PE rmitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) 14, 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 propEirty. _TG 2. I understand building permits are not required t:) be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. _TL_3. 1 understand as an"Owner-Builder" I am the re 3ponsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a lii;ensed Contractor and having the permit filed in his or her name instead of my own. TL 4. 1 understand Contractors are required by law tc be licensed and bonded in California and to list their license numbers on permits and contracts. Xjf�t_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 d:)Ilars ($500), including labor and materials, I may be considered an "employer"under state and federal law. 'C(-6. 1 understand if I am considered an "employer"L rider state and federal law, I must register with the state and federal government, withhold payroll taxes, provide wo-kers'compensation disability insurance, and contribute to unemployment compensation for each "employee." I alio understand my failure to abide by these laws may subject me to serious financial risk. TL 7. I understand under California Contractors'Stat, 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 sloes not exceed four within any calendar year, or all of the work is performed under contract with a licensed general bu Iding Contractor. _T_C- 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. Oii,neTBuildel'Foi-i7i 2010.doc revised 04114110 _9. 1 understand I may obtain more information n:garding 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 E Iso understand I may contact the California Contractors'State License Board (CSLB)at 1-800-321-CSLB (2752)or www.csib.ca.gov for more information about licensed contractors. X10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that am the party legally and financially responsible for pioposed construction activity at the site address listed above. _T(, 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 Dwner-Builders as well as employers. T(_ 12. 1 agree to notify the issuer of this form immE!diately 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 states of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) hereby affirm that there is a construction lending agen,-y 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 pormit. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the :ity may be required to be presented when the permit is issued to verify the property owner's signature. 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 p E=it 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)::�o�}b� rP YV�o�Q I , 5 �� ✓y c-(L , Project Location or Address: 10002 As Go i AYIe >tuy,,e, r CW %D R510 1!q Name of Authorized Agent: CH I ft ISS 1/V T Tel No 40t-$9,$-610T7 Address of Authorized Agent: 15-ql MiltCQ Ale , San glOSe- CA 4.5-149 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,)resented when the permit is issued to verify the property owner's signature. Property Owner's Signature: -744LA A4 (4-0-0- Date: &(2 (O 0)4,77e-BuilderForm 2010.doe revised 04/14/10 To City of Cupertino, I recently purchased a house located at 10802 Gascoigne Drive, Cupertino. The house is under the name of our family trust. I (Tsai-Chih Chao) am the trustee would like at thorize Chiao-Hsin Julie Wang to apply my house remodeling permit. Sincerely, --05 A- � Tsai-Chih Chao R � f