13050077 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10881 MAXINE AVE CONTRACTOR:ENRIQUE TAN PERMIT NO:13050077
OWNER'S NAME: ENRIQUE TAN 10881 MAXINE AVE DATE ISSUED:05/09/2013
OWNER'S PHONE: 9094680936 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALD
License Class Lid.# REPLACE 13(E)WINDOWS.REMODEL(E)KITCHEN&
BATH
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. Sq.Ft Floor Area: Valuation:$20000
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 APN Number:32602014.00 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 DAYS FRO LED 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 Date:
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.
�-RWFS-:
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)
I,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. 1 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
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, c'ons 25505,25533,and 25 p 2
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent ,^ """""L Date• O S / [7
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 CONSTRUCTION LENDING AGENCY
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 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,
osts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
ting of this permit.Additionally,the applicant understands and will comply
alI non- int source regulations per the Cupertino Municipal Code,Section Licensed Professional
R"`'Dat
�0 (3
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
CUPERTtNO (408)777-3228•FAX(408)777-3333•buildinolaDcupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS N V ��s 6/ 4G APN 41 # 3 Z'6 -
OWNER NAME Pxo D { T/ gb � / E-MAIL
b G
STREET ADDRESS I n 2*U'ik V,�fk pn CITY,STATE,ZIP FAX
CONTACT NAME / j �J f,C.e� v rO PHO
6f ye4 F4�0 E-MAIL L ArN (6$ @ MAtt,,com
STREET ADDRESS 52 M1 n14 Z � CITY,STATE,ZIP ,,117p FAX
OWNER M OWNER_BUDAER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT /S❑ ARCHITECT 7❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER FICENSETYPE, BUS.LIC#
COMPANY NAME E-MAIL
FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL
FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK ZUr LP Cf (3 tX`c Tl�ti, WINV
DOWS , 1/ N(EW DDUB LE Fl` ,',Je W lWpo�
PATt4RooM ( ?mMbftL �
KI TC H EIJ 'IZ=MW DIF L
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODELAREA REMODELAREA REMODELAREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA; DETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? ❑NO ADDITION? []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YESVED BY: T TAL
PLANNING APPL# E]NO PLANNING APPROVAL LETTER EICHLER HOME? N VALUATION:
^V / ^
L vVLJ �s
By my signature below,I certify to eachof the following: I am the property owner or autho' gent on the property er's behalf. I have read this
application and the information I have provided is correct. I have read the Description of ork and verify it is accurate. I to comply with all applicable local
ordinances and state laws relating to bu c nstmction. I authorize representatives:EH
he above-i led prope for inspection purposes.
Signature of Applicant/Agent: 015-
SUPPLEMENTAL
,j �� 3
SUPPLEMENTAL INFORMATION REQUIRED ECK TYPE ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for VER-THE-COUNTER ❑ BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ 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 ❑ FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR El SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10881 MAXINE AVE DATE: 05/09/2013 REVIEWED BY: MELISSA
APN: 326 02 014 BP#: *VALUATION: $20,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION 1GENRES
USE: SFD or Duplex PERMIT TYPE:
WORK REPLACE 13 E WINDOWS. REMODEL E KITCHEN & BATH
SCOPE
- '
VIA-
r
l fech.Plan Check Plumb.Plan Check Elec.Plan{:;hack
Wech.Permit Fee: Plumb.Permit Fee: Elec.Permit IW:
C)ther ;19ech.In.sr�.
Other Plumb Insp. Other Glee.Insp.
[3
=i ech. Insp.fee: Plumb. fial). Fee:: Elec,Insp.Fee:
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 prelimina information available and are only an estimate. Contact the Dept for addn'1 info,
FEE ITEMS(Fee Resolution 11-053 E . 7ff /1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 13 # Window/Sliding Glass Door
Supp/.PC Fee: Q Reg: Q OT 0.0 hrs $0.00 $533.00 1 WINREP Replacement
PME Plan Check: $0.00 F20071 s.f Remodel,Kitchen(<=300 sf)
Permit Fee: $0.00 $600.00 IREMRESKIT
Suppl. Insp.Fee.0 Reg. 0 OT 0,0 hrs $0.00 1001 s.f. Remodel,Other
PME Unit Fee: $0.00 $400.00 IREMRESOTH
PME Permit Fee: $0.00
Conslruction :Tczr:.
0
Arltninistrative.Pec:
Work Without Permit? ®Yes No $0.00
Advanced Planning;Fee: $0.00 Select a Non-Residential 0
Building or Structure 0
71-0vel Documentation Fees: �
Strong Motion,Fee: IBSEISMICR $2.00 Select an Administrative Item
Bldg_Stds Commission Fee: 1BCBSC $1.00
$3.00 $1,533.00 _ ATFE $1,536.00
A\ Revised: 04/29/2013
OWNER-BUILDER DISCLOSURE FORM
•, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildina(dt wertino.orn
Dear Property Owner(s):
An application for a building permit has been submitted in your name fisting yourself as the builder of the property
improvements specified at:
SITEADDRESS DI APN —D l BPS
PkXrl��" V�. ut �tzTrNa 3zr; `�
OWNER NAI E,51y�l Q(l T T OWNER ADD fid A LNu e A q t-79
DESCRIPTIONOPWORK: REPLAC6 I3 J�)(15fIN& WINDVWS Vy MEW Wt ELF, PAt45 WINDOWS.
15grtiRoorA piFmv0t1, rTrOUO nWKI
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 it building permit until you have read,Initialed your understanding of each provision,signed,and
returned this forth 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.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.1,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 overage for injuries to workers on my property.
2.1 understand building permits are not required to be signed by property owners unless they are responsible for
e construction and are not hiring a licensed Contractor to assume this responsibility.
A3.1 understand as an.'Owner-Builder'I am the responsible party of record on the permit.I understand that r may
eect 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 Naw 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
to 1 value of my construction is at least five hundred dollars($500), including labor and materials, I may be
co idared an'employer'under state and federal law.
6.1 understandif 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
1to7.serious financial risk.
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
ir8.
rformed under contract with a licensed general building Contractor.
I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for
I ny: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
,
,9.1 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. l also understand I may contact the California Contractors'State
License Board(CSLB)at 14800-321-CSLB(2752)or www.csib.ca.gov for more information about licensed
tractors.
10.1 am aware of and consent to an Owner-Builder budding 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 fisted 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.
12:I agree to notify the issuer of this Conn immediately of any additions,deletions,or changes to any of the.
in ation l have provided on.this form.Licensed contractors are regulated by laws designed to protect the public. If
you contract with-someone who dares 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 property 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 CM).
Lender Name: LenderAddress:
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 owners drivees license,
form notarization,or other verification acceptable to the city may be required to be presented when the permit is issued
to veft the pTggfk owner's si nature.
Property Owner's Signature. M.E. Date:
------------------
---------------------------------- ----------------------------------------------------------------------------------------
(NOTE. The following Authorization Form is required to be completed by the property owner orgy 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)-t6 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): �tEpi,�r.E W I OOwS . BArTH ROOM � �Ei—�j KIDEL.
Project Location or Address: I ogfir JttkK10& 446 L'uewitz Glj�7-6i q
Name of Authorized Agent: LAr0"_?3G* t/` A111 Tel No
Address of Authorized Agent 5A r 5 UU,
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 owners drivel's license,fonn notarization,or other
verficadon acceptable to the city may be required to be presented when the permit is issued to verify the property owner's
signature. e: r3
Property Owner's Signature. Dat '
OwnerBuilderForn 2010.doc revised 04/14110
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST..:
<.,.
JOB ADDRESS: 105ff( jJl pt,>CI Kte PERMIT#
OWNER'S NAME: V9KlaVE EVl%U &vA #kJ PHONE# V%'6 ,
S6
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: CITY/ZIPCOD:E::
*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 Date
Please check applicable subcontractors and complete the following information
SUBCONTRACTOR BUSINESS NAME BIT;SINESS 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
SCOPE OF WORK:
0
l6 `n 1.^REPLACE 13 EXISTING WINDOWS WITH NEW DOUBLE
nr rr
PANE WINDOW .
O c� . 21 E34T AROOM RE
BEDROOM 30 �� °�2i `>'r 3 F1SA0�/E AND NITY,WATER CLOSET,BATH
Tl�$j'T1L�S A p
MASTER BEDROOM °. ,,; % � TCktNRE _ �• ���`
sty`."N� REMO iy OUNTERTOP,�AEfit E S,A No
G� UTLETS,S VITC PPLI jiS IK,FI �$/�$R,
p` n ° �G�� �iFviE�,�p uU 2013
E 00P
C,% � °�BAT o0 edley.-
e� � ANCF
OFFICE
W10
a
BEDROOM 2 0O WINDOW SCHEDULE:
w4 w11
00
W1 24"W x 35"H Wg 35"W x 47"H
KITCHEN
W2 30"W x 47"H Wg 24"W x 35"H,tempered
OO 29"W x 47"H W10 47"W x 35"H
W4 74"W x 47"H W11 35"W x 35"H
LIVING ROOM
otw p_ W5 35"W x 47"H W12 35"W x 47"H
DINING ROOM
By 35"W x 47"H W1 0"W x 71"H,tempered
O L)ATF
3 �►7 35"W x 47"H
W13 W12 �'
PORCH + OWNER'S NAME: ENRIQUE TAN
ADDRESS: 10881 MAXINE AVE. 1
jU CUPERTINO, CA 95014
W1
SCOPE OF WORK:
1.REPLACE 13 EXISTING WINDOWS WITH NEW DOUBLE
PANE WINDOWS.
2.BATHROOM REMODEL:
BAT REMOVE AND REPLACE VANITY,WATER CLOSET,BATH
TUB,TILES AND FIXTURES.
3.KITCHEN REMODEL:
REMOVE AND REPLACE COUNTERTOP,CABINETS,TILES,
OUTLETS,SWITCHES,APPLIANCES,SINK,FIXTURES.
E�jo
--------------- -
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KITCHEN
I
OWNER'SNAME: ENRIQUE TAN
ADDRESS: 101981 MAXINE AVE. 2
CUPERTINO, CA 95014