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11080183 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1673 GALWAY DR CONTRACTOR:THE GROUT KING PERMIT NO: 11080183 OWNER'S NAME: TONY KO 287 GREENDALE WAY APT 1 DATE ISSUED:08/24/2011 OWNER'S PHONE: 4087716541 SAN JOSE,CA 95129 PHONE NO:(408)821-9058 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB r License Class C—S'J Li,.# u t� 5 Y GJf— MECH RESIDENTIAL COMMERCIAL Contractor C k ' n Date 2Y AQ b 1 I I hereby affirm that I am licensed under thi provisions of Chapter 9 JOB DESCRIPTION:TO CLEAR CODE ENFORCEMENT CASE:ADD TUB (commencing with Section 7000)of Division 3 of the Business&Professions SURROUND Code and that my license is in full force and effect. CHANGE OUT VALVE 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:$2900 permit is issued. APPLICANT CERTIFICATION APN Number:36624028.00 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. Si grat A�� Date 2 yAj 6 ( Issued by: --- Date:OC L %,-" 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. 1 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 Own e a horized agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date:.0 CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I 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%ork's correct.1 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 upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address c-- z,and expenses which may accrue against said City in consequence of the ng of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION %,v_all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333• building(c.cuoertino.org MISC LUMBING ❑MECHANICAL []ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS ! ��G�. APN �.. L O� Lal VV St%14- OWNER NAS ��N f�u PHONE fOj��q? C[�.( E-MAIL STREET ADDRESS C/� GCt 11r CITY, STATE,ZIP l G/ V �J / �naj (/ r) l FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICEN ERG LICENSE TYPE BUS.LIC# COMPANY NAME �I ( lc[ &,sT �"\"rt E S STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF 9 FD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK TOTAL VALUATION: v J RECEIVED BY: 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.}have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating o bu' ag construction. I authorize representatives of Cupertino to enter the above-identified property for inspection pudposes. Signature of Applicant/Agent: Date: 2HMy Ca PLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY ` W 1--OVER-THE-COUNTER ❑ EXPRESS U W ❑ STANDARD U ❑ LARGE ❑ MAJOR AEPMzsa4pp_201 1.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 1673 galway dr. DATE: 08/24/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$2,900 PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 RPFIX USE: PERMIT TYPE: WORK To Clear Code Enforcement Case: add tub surround change out valve. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Fixture or Trap 1 BPFIXTURE 1 # $9 TOTALS: $9.00 Plumb.Plan Check 0.0 hrs $0.00 - Plumb.Permit Fee: 1PPERMIT Other Plumb Insp. 1.0 hrs $44.0 Plumb.Insp.Fee: 1PLMBINSP Li $130.00 . NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh7 info, FEE ITEMS (Fee Resolution 11-053]ff. T'1,"]]I FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $9.00 PME Permit Fee: $174.00 Work Without Permit? 0 Yes 0 No $183.00 Travel Documentation Fee: ITRA VDOC $44.0 Strong Motion Fee: IBSEISMICR $0.50 0.5 hrs Admin./Clerical Fee Bldg Stds Commission Fee: IBCBSC $1.00 $41.00 1ADMIN SUBTOTALS: $411.50 $41.00 TOTAL FEE: $452.50 Revised: 07/04/2011 RECORDING REQUESTED BY: DOCUMENT: 21 248909 Pages; 2 Chicago Title Company Fees 18.00 Escrow No.: 11-99901881 Taxes. 1265 00 Locate No.: CACT17743-7743-2999.0099901881 i Tide No.: 11-99901881 KMB Copies. . AMT PAID 1283 00 When Recorded Mail Document and Tax Statement To: REGINA ALCOMENDRAS RDE # 001 Mr. and Mrs.Tony Ko SANTA CLARA COUNTY RECORDER 7/20/2011 1673 Galway Drive Recorded at the request of 800 AM Cupertino, CA 95014 Chicago Title APN: 366-24-028 SPACE ABOVE THIS LINE FOR RECORDERS USE GRANT DEED The undersigned grantor(s) declare(s) Documentary transfer tax is$1,265.00 / Richard R. Keenly [ x ] computed on full value of property conveyed, or [ ] computed on full value less value of liens or encumbrances remaining at time of sale, [ ] Unincorporated Area City of Cupertino, FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Richard R. Keenly, Trustee of The Keenly Family Living Trust dated December 13, 1999 hereby GRANTsurvivorship shi many H. Ko and Amy Lee, husband and wife as community property with right of survivorship the following described real property in the City of Cupertino, County of Santa Clara, State of California: SEE EXHIBIT"A"ATTACHED HERETO AND MADE A PART HEREOF DATED: July 11, 1 State of Californi ) The Keenly Family Living Trust dated December 13, county f 1999 On ; before me, y Notary Public R chard R. Keenl rust (h a insert name an title of the offs er , personal) a ared Y� who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s)is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized ca city(ies), and that by his/her/their signature(s) on the in ment &Iq person(s), or the entity upon DAWN MCCANAN behalf of which rson(s)act , executed the instrument. ;,. Commission# 1834201 Z o< Notary Public-California z I certify un r PEA OF PERJURY�under the laws of State of z ,� Santa Clara County California at th egoing raph is true and orrect. My Comm.Expires Feb 26,2013 WITNES my h off, ial ! Signatur 7 (Seal) MAIL TAX STATEMENTS AS DIRECTED ABOVE FD-213(Rev 12/07) GRANT DEED (grantsc)(06.09) PROJECT DATA - RESIDENTIAL COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 <:Ui'BRIN (408)777-3228 • FAX(408)777-3333 • buiidina(d)cupertino.org T' C� PROJECT ADDRESS APN# t(,-II Ghlw�� fir. OWNER NAMEPHONE E-MAIL on k l(.5 �- STREET ADDRESSCITY, STATE,ZIP FAX i D( q v I APPLICANT NAME P�H�6N4 �S E-NIAIL STREET ADDRESS CITY,STATE, ZIP q FAX R ❑ OWNER-13=ER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT DE CRIF'IIa�ala�CRI� EXISTING USE(S): PROPOSED USE(S): OCCUPANCY(S): TYPE OF �=%PARCEL CONSTRUCTION: �� AREA: FIRE Y NWUI AREA: Y N FLOOD AREA: Y N SIESNIIC AREA: Y N SPRINKLERS: Existing Proposed Floor Area: First Floor: s.f. s.f. Second Floor: s.f. S.f. Garage TOTAL: s.f. s.f. Are there at least two 10 feet by 20 feet clear spaces inside the garage? Y N Is privacy protection planting required for the project? Y N Governing Codes: 2010 California Building Code (based on the 2009 International Building Code) 2010 California Residential Code (based on the 2009 International Residential Code) 2010 California Plumbing Code(based on the 2009 Unif6WM%W-. MENT DEPARTMENT 2010 California Mechanical Code(based on the 2009 Uniform � 11g Ae f UPERTINO 2010 California Electrical Code(based on the 2009 International ElAf?PFQWD 2010 California Energy Code This set of plans and specifications MUST be kF 2010 California Green Building Standards Code )ob site during construction. It is unlawful to n Cupertino Municipal Code r;--roes or alterations on same,or to dev! ttrere ruin, vj;'hout approval from the Buildin,.; The stamping of this p'an and sperTcAtions` !a ;!^T be held,to permit or to be an approlaal cf t e of any provi--ons of any City Ordinance or BY tlr't • % r vise 7— DATE PERMIT NO. 7 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: (.�� c� PERMIT# OWNER'S NAME: PHONE # q o ZI._q 3a -- q -t S`3 GENERAL CONTRACTOR: ArJ GAt( BUSINESS LICENSE# 3 221v ADDRESS: 2 (-7 G ti CITY/ZIPCODE: =+- 9 `I *Our municipal code requires all busines es 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 subcontractor - Signature Date Please check applicable subconi(iractors and complete the following information: V 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 X Plumbing /b Roofing Septic Tank Sheet Metal Sheet Rock Tile (-. T,�t Aii v42-- V 2( v 'Owner ractor Signature Date