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B-2016-2159
CITY OF CUPERTINO BUILDING PERMIT BUH.DING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2159 10704 MARTINWOOD WAY CUPERTINO,CA 95014-4422(369 35033) OWNER-BUILDER OWNER'S NAME: YIN MARK TAND WONG CECI SHU-WAH TAL DATE ISSUED:06/17/2016 OWNER'S PHONE:408-829-4010 PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lie.# Contractor OWNER-BUILDER Date 2[BLDG —ELECT _PLUMB MECH X RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: KITCHEN REMODEL(300 S.F.) I hereby affirm under penalty of perjury one of the following two eclarations: 1. I have and will maintain a certificate of consent to self-insrue for Worker's Compensation,as provided for by Section 3700 of the LabTas Code,for the performance of the work for which this permit is issued.2. I have and will maintain Worker's Compensation Insuranc 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:$35000.00 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 rdinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby aut onze 369.35 033 representatives of this city to enter upon the above mentioned pJroperty 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 on-point source regulations per the Cupertino Municipal Code,Section 918. 180 DAYS FROM LAS D SPECTION. Signature Date 6/1t2016 Issued by:Alex Vallclunga Date:06/17/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License L w for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages a 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. sale(Sec.7044,Business&Professions Code) 2. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&professions Code). Date:6/17/2016 I hereby affirm under penalty of perjury one of the following threg declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER r. I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Lab rr Code,for the performance of the work for which this permit is issued. I HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insuranc ,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 a. 1 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 bee 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 Compensation laws of California. If,after in this certificatc 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. Owner or authorized agent: APPLICANT CERTIFICATION Dater 6/17/2016 I certify that I have read this application and state that the above information is CO NSTRUCIONLENDINGA correct.I agree to comply with all city and county ordinances anIstate laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize represen atives 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 agai st 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 'h all non-point source regulations per the Cu•ertino Municipal ARCHITECT'S DECLARATION Code,Section .1 I understand my plans shall be used as public records. Signature Date 1 2 1 Licensed g Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPME T DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•C PERTINO, CA 95014-3255 CUPERTIN� (408)777-3228•FAX(408) 77-3333•building(a-cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ AL-flERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS0� „^W. 1 w�A Q1 1}I0 lA-1"IJ 14,N# h ! o3 2 OWNER NAME PHONE E-MAIL IUlcv k Z e Cc, u� 409 8�� 4o I o movk ; � +Mai I GtiYI STREET ADDRESS CITY, STATE,ZIP FAX I o t MW o01A '' sz�-t\m CA 9 go 4 CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CO CTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# AH T QgTnStftAc 68 13 COMPANY NAM ( EMAIL [fr C5 fg nj c�hc't7 C t1vJ► FAX STREET Alp%Sv �Y V\ (y, CITY,STATE,ZIP P� 0) ARCHITECT/ENGINEER NAME L CENSE NUMBER BUS.ILIC# COMPA14Y NAME E-MAIL • FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK -- � - VA3� G EXISTING US - PROPOS USE - CONSTR TYPE STORIES ' rT�PE USE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO WAL AREA AREA AREA AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA RFMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND.UNIT ❑YES SECOND STORY []YES BEING ADDED? ONO ADDITIO ? []NO I i PRE-APPLICATION FI YES IF YES,PROVIDE COPY OF IS THE BI,DG AN ❑YES RECEIVED+ ' TOT/L/y^gLUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLEJ HOME? ❑NO /JV ©o By my signature below,I certify to each of the following: I am the ' pe owner or authorized a ent t act o e property owner's behalf. I have read this application and the information I have providecolrect. 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 building on traction. aut i e r� resentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: ' Date: SUPPLEMENTAL INFO ATIONREQ P,hANCHECKTIPE, $ `ROUTINGSLIP , _New SFD or Multifamily dwellings: Apply for demoliti n permit for ❑'OVERTHE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building eE � permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Ma erials Disclosure ❑;STANDARD \ ❑ PUBLIC woRxs form if any Hazardous Materials are being used as part of thi project. ❑-'i IRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ 1vLa�oR ❑ SANITARY`scwERDISTRICT submittal of Building Permit application. ❑%ENVIRONAIEP T-HEALTH BldgApp_2011.doc I-evised 06/21/11 OWNER-BUILDE� DISCLOSURE FORM 12, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION Im 114 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228• FAX�(408)777-3333•building cDcupertino.org CUPERTINO 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 a4 APN 3 1 —z�— 03 BP# G��f(a— Vs- OWNER NAME ,A A v WNER ADDRESS, / �J U/CA -o I`rI �VI p I1V1 ( l Y DESCRIPTION OF WORK: GvvL&I Lam � r ��vv�sucl�yl� 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 b having this permit issued in our 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 appro�,al 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.) A1. I understand a frequent practice ofLi-cenied persons is to have the property owner obtain an "Owner- der"building 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 f 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 n my property. y 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 licens �d Contractor to assume this responsibility. 3. 1 understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may pro ect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. lers 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license on permits and contracts. 45. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the toI 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. 46. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and feera[ 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. 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. 8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for an financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OwnrerBuilderForm 2010.doc revised 04/14/10 9. 1 understand I may obtain more info mation regarding my obligations as an "employer"from the Internal Re enue Service,the United States Small usiness Administration, the California Department of Benefit Payments, an 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.csib.ca.gov for more information about licensed contractors. q10. I am aware of and consent to an OI ner-Builder building permit applied for in my name, and understand that I amhe 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 4by I applicable laws and requirements tha govern Owner-Builders as well as employers. 12. 1 agree to notify the issuer of this f 9 rm immediately of any additions, deletions, or changes to any of the inf rmation 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 vyish 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 onstruction lending agency information.) I hereby affirm that there is a construction lend�ng 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 issue g the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification accept e 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: �- ------------------------------------------------------- -------------------------------- --------------------------------------------------- (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 roperty 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 maybe required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: Owne1Builde7Forin 2010.doe revised 04/14/10 Assessor's Parcel Number: Plumbing Notes: 1. Faucets in kitchens,wet bars,lavatories,laundry sinks,etc shall have a water flow not to exceed 1.8 gallons per minute @ 60 psi.(CPC 403.6) Electrical Nates: Name of Owner: 2. The Installation of smoke alarms In all of the following areas shall be provided: (R814.3) i a. On the telling or wall outside of each separate sleeping area in the immediate vicinity of bedrooms. i Contact Person: phone: b. In each room used for sleeping purposes. C. in each story within a dwelling unit,including basements but not Including crawl spaces and uninhabitable attics. 3. 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 Project Address: basements in dwelling units that have fuel-fired appliances or attached garages.(CRC R315A) 4. 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.(GEC Scope of Work: 210.11(C)(1)) 5. At least one 20 amp branch circuit shall be provided to supply bathroom receptacle outlets.Such circuits shall have no other outlets.(CEC 210.11(C)(3)). 6. In every dwelling unit,fixed appliances such as food waste grinders,dishwashers,washing machines,dryers,laundry tray locations,built-in refrigerators or freezers, Code Editions: 2013 California Residential Code 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: I 7. All receptacles in bathrooms,garages,accessory buildings,outdoors,crawl spaces,unfinished basements,kitchens(where receptacles serve countertop surfaces), 2013 California Plumbing Code 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(A)) 2013 California Mechanical Code 8. In all areas specified In 210.52,all non-locking type 125-volt,15-and 20-ampere receptacles shall be listed tamper-resistant receptacles.(CEC 406.12) 2013 California Electrical Code _PY 2013 California Energy Code Energy Code mandatory lighting measures: 1. All permanently installed high efficacy luminaires shall be switched separately from low efficacy luminaires.(150(k)(7)) f 2. Permanents Installed- in Kitchens shall be high efficacy luminaires.U to 50%of the wattage of ermanentl installed lighting In kitchens may be in lights that > I Y 9 9 Y P 9 P Y 9 9 Y are not high efficacy.(I 60(k)(8)) cl t I I I a Z rDEPARTMENT CUPER_ E � 1 l/1 S ( I ' l j h;rat c �. �s-;ld , ^i.,.. :t a;,a IMIUST by kept at the 1 ^'r` i`:s,Ot3.'It!.3 unlawful to make any 7n ::c rne,Or to devlute l app oval from the Building GfFiI I. i � — ? 1_ ✓ } Sf G�f it f �pz :, o€t,,; plan,' �r� uitioations SHALL arJf s/ ..!to pCi nllt C? 7 ..i)i Veil Of the Violatlfln I S 1 ) s `` .y prcv,Sio .y r ar yrdinu-^e or State Law. i €f u ---t BY DATA It `I PERMIT NO. !✓' ,AZI-1 , rill , ► I t ��t oLhA I 7 ! r I RECEIVED 4 i i I I 1 tV 13Y JUN i. I= EXISTING KITCHEN FLOOR PLAN PROPOSED KITCHEN FLOOR PLAN f: