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11030053 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22816 POPLAR GROVE SQ CONTRACTOR:DAVID CHOI PERMIT NO: 11030053 OWNER'S NAME: DAVID CHOI 22816 POPLAR GROVE SQ DATE ISSUED:03/11/2011 OWNER'S PHONE: 4083359060 CUPERTINO,CA 95014-2653 PHONE NO: L LICENSED CONTRACTOR'S DECLARATION r- r F_ BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH r— RESIDENTIAL[_ COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:KITCHEN REMODEL(143SQFT)NEW GAS PIPELINE,ADD (commencing with Section 7000)of Division 3 of the Business&Professions ELECTRIC SWITCHES,RELOCATE POWER RECEPTACLES,NO Code and that my license is in full force and effect. NEW;LIGHTING,NEW CABINET,HOME 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:$1000 permit is issued. APPLICANT CERTIFICATION APN Number:34233024.00 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. Issued by: Date: Signature Date / 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 I,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: 1,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 P C 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 authorized agent: forthwith comply with such provisions or this permit shall be deemed revoked. f'-��r� Date: OQ 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 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 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 costs_and expenses which may accrue against said City in consequence of the I g of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION w. .il non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature `'�_\� Date 3/ (� �G Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228-FAX(408)777-3333-building gjcupertino.orq ❑NEW CONSTRUCTION ADDITION/ALTERATION ❑ REVISION/DEFERRED SUBMITTAL PROJECT ADDRESS a;a O (1R G Ro VE SO cu eR #� � ` OWNER NAME DAV( D Cloi PHO +q)33s_ / E-MAIL tr-'CItO I® KSO-J` CO STREET AD_ s O R V CITY, STATE,ZIP f l�•r1 NQ a APPLICANT NAME ©� PHO E fl E-MAIL STREET ADD ESS CITY,STATE, ZIP FAX b LAS OVESQ::�: I�0WNER IV OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME DAVID AV[D LICENSE NUMBER LICENSE TYPE 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 �,IQ 0 � 1 I X11 fir ' DeM EXISTING USE PROPOSED USE CONSTR_TYPE #STORIES FFICE U E' '�/i3 DESCCkIPTIQNe EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN 1,)�, 1� OTHER 5 REMODEL AREA ..� REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: ❑ DETACH ❑ ATTACH 0, N DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES } - ; • / BEING ADDED? NO ADDITION7 NO PRE-APPLICATION ❑ YES IF YES,PROVIDE COPY OF PLANNEER'S NAME: C H 1 RECEIVED gY; TOTAL\?ALU:4TIGN •, PLANNING APPL N NO PLANNING APPROVAL LETTER P AQ \0; `G ` c L 066 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 and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin1g construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: 3� I L / �) SUPPLEMENTAL INFORMATION REQUIRED aiaFlC ustu&pN>��. . : ,s _New SFD or Multifamily dwellings: Apply for demolition permit for PLAN CHECK TYPE. •�.tt� rEksz�r existing building(s). Demolition permit is required prior to issuance of building �k SOD— permit for new building, t�v R-T. E-COVN'Likx: 1 PIaIvI E t _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ExPizEss "PANt41NC PLAN CtEYIEr' form if any Hazardous Materials are being used as part of this project. Cl: TAxn�tixn LJ,PvsLxC;woluts; _Copy of Planning Approval Letter or Meeting with Planning prior to ❑;!LARGE 1771 > nEl'1 submittal of Building Permit application. MAJOR. �,EMONMENNIAL HEALTA, BldgApp_2011.doc revised 03103/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 22816 poplar grove sq. DATE: 03/11/2011 REVIEWED BY: bobs. APN: BP#: VALUATION: 1$1,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: p PERMIT TYPE: WORK To Clear Code Enforcement Case: sfd kitchen remodel non structural include elect mechplumb, no SCOPE new lighting. Lj Lj NOTE: Theseees 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 I ff. 7-1.70) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel,Kitchen(<=300 sf) Suppl.PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 $570.00 IREMRESKIT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee ' Reg. OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes 0 No $0.00 0 Work Without Permit? 0 Yes 0 No $570.00 0 P(annin Fee: $0.00 Select a Non-Residential 0 Building or Structure Strong_Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 -7-1 SUBTOTALS: $571.50 $570.00 TOTAL FEE: $1,141.50 Revised: 01/15/2011 OWNER-BUILDER DISCLOSURE FORM 1-91 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333 • building cupertino.org 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 Cc./��: CTI D1!G APN BP# C �c I OWNER NAME OWNER ADDRESS l 0 T � JQ CtAO1. �t�c 9-1D qz DESCRIPTION OF WORK: t�e vS C c- W E 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.) QC - X 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 property. PCL�,_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. DQ_2�__3. 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. 7C K 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. lam' ( 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. ga_6. 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 me to serious financial risk. DC_)�_7. 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 is performed under contract with a licensed general building Contractor. PC< 8. 1 understand as an Owner-Builder if 1 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. O ,nerBuilderForm 2010.doc revised 04114/10 PROJECT DATA - RESIDENTIAL COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228 • FAX(408)777-3333 • building cDcupertino.orq .UPERTINO PROJECT ADDRESS O cu �6 N o� 7 APN OWNER NAME `, n� (�� uA AV l D -1 I O'1 PHONE "C1 _���O b(7 E MA c>111,C`iaa MSN •C0" STREET ADDRESS '�aaI6 LAQ �V VIE ,{1 CITY, STATE,Z� �l'`O A ` FAX _ APPLICANT NAME D A`1 r 11 O= PHONES•�-' L E-MAIL 1 I` CAO M�N STREET ADDRESS C) Lh� 4A�h U E ({1 CITY,STATE, ZIP ^�� , FAX L7 OWNER LJ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 13CONTRACTOR AGENT 11ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑TENANT DESCRIPT.IONOFWORK r *' 1 �r a; '0 u pry r fy „x_ r NR ro kv EXISTING USE(S): -+ p� PROPOSED USE(S): OCCUPANCY(S): TYPE OFCONSTRUCTION Parcel Area: - square feet Existin Proposed Floor Area: First Floor: s.f. s.f. Second Floor: f. s.f. 4 Garage s.f. -s.f. TOTAL: s.L s.f. Are there at least two 10 feet by 20 feet clear spaces inside the garage? Y ® � Is privacy protection planting required for the project? Y `N - Governing Codes: 010 California Building Code(based on the 2009 International Building Code) 2010 California Residential Code (based on the 2009 International Residential Code) X2010 California Plumbing Code(based on the 2009 Uniform Plumbing Code) C��pl�egbl� j( 2010 California Mechanical Code(based on the 2009 Uniform Mechanical Code)— y.2010 California Electrical Code(based on the 2009 International Electrical Code) — CA -L 2010 California Energy Code no 2010 California Green Building Standards Code Cupertino Municipal Code ProjectData.doc revised 02/23/11 3 Qlp G+ `lot D-W Q- ro N rorill a + � N � .� V) M T� r o T v n ro e, I `• I � � S I � G 1 5/ 5P rb �i G G a- rD a G - o ��a