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13050085 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10280 PARK GREEN LN UNIT 843 CONTRACTOR: SOON yIJ PERMIT NO:13050085 C o N s-rrc-u�-re o ry cd. OWNER'S NAME: SEI YOUNG LEE DATE ISSUED:05/10/2013 OWNER'S PHONE: 4082029874 PHONE NO: ❑ LICENSED CONTRAC*TOR's DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL E] License Class_ Lic.# V 6 7 9 REPAIR WATER DAMAGE IN KITCHEN(CABINETS LIKE FOR Contractor-,C-00 �V (.0100( ate LIKE,SHEETROCK&COUNTERS)&DINING ROOM I hereby affirm that I am licensed under the provisions of Chapter 9 (SHEETROCK ONLY)&DAMAGE IN DOWNSTAIR (commencing with Section 7000)of Division 3.of the Business&Professions GARAGE.ADD 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:$38000 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:36954043.00 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 FROW.L D 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 granting of this permit. Additionally,the applicant understands and will comply e b with all non-point sourc ; ulations per the Cupertino Municipal Code,Section 9.18. � RE-ROOFS: 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 I,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) 1,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: I 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,Sections 25505,25533,and 2//55I534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: �O)✓ lel 'V F Date:S *"3 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 Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY 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, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date r^V CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �O 10300 TORRE.AVENUE•CUPERTINO, CA 95014-3255 \ (408).777-3228•FAX(408)777-3333•buildin9 cupertino.ora GUI EIRT INO NEW CONSTRUCTION . ❑ ADDmoI ❑ALTERATION�'[/TI ❑ REVISION/D/EFEQRRED ORIGINAL PERMIT# PROJECT ADDRESS/E,,2Q Por K e e a hq�1a !� APNe 3 ' ` ' 0 ` PHONEf.Q6 EMAILOWNERNAME ALD l/ L / 9 STREET ADDRESS/0).g Q ra 1 0 r n h�I n 'STATE ZTP 1 JP� rtAPU C� /,S O 1� FAX CONTACT NAME E . �' I B �? PHONE y./C, _6 6 .573Z EMAIL CITY,STATE ZIP S F CA / / /)-2. FAX STREET ADDRESS, ,( ❑OWNER ❑ OWNER-BUILDER ❑OWNERAGENr p CONTRACTOR ❑CONfRACTORAGENT 13 ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME SQ O I O #UCENSEBER 661764LICENSETYPEBUS.LICI, y,I� / IL S OOA(PO14W4�1409 AIL .CQIr FAX COMPANYNAMES'oQy` IU �6hS I v`t�1j✓I�� +`,iG7STATE,ZIP SC f A 9 f�2 Z PHONE STREET ADDRESS j� v ARCHa?Zr/ENGDMER NAME FAX LICENSE NUMBER BUS.LIC k COMPANY NAME E-MAIL STREET ADDRESS CITY,STATE,ZIP PHONE j rr I j j ,�J DESCRTPTIONOFWORK Rp��Ia:�� '� e w+�l Er aJ44. @ �' C�1�J�. (Al�iq�T S . A slaC�1 �p�l ;n ]��,, ate :�ciJh; ro6r, a� jni Roos, �1qr woo doer; I�° �vc� ie tuo��er da Ma lei be1C ;y� . 4 A/c�u Req . X213 1,430 ia�t ;k Gra a Cei�in ak ` E dT_ G USE PROPOSFp USE CONSTR TYPE iJ STORIES USE TYPE OCC. SQ.FT. VALUATION(S). EXISTG NEW FLOOR DEMO TOTAL AREA, -. �.AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODFL AREA REMODEL AREA .PORCH AREA ..DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑ATTACH ifDWELLINGUNTTS: ISA'SECONDUNIT ❑YES SECOND STORY OYES BEING ADDED? ONO ADDITION? ONO .PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF. IS THE BLDG AN ❑YES - - TAT.VALUATION: PLANNING APPL#_ [-]NO PLANNING APPROVAL LETTER EICHLER H ME? 11 NO 3!V`a,,0 0 C By my signature below,I certify to each of the following: I am the property owner or autho' agent to act on th r rty.owner's behalf. I have read this application and the information I have pr , ed is correct I have read the Description of Work and verify itis accurate. I agree to comply with all applicable local ordinances and state laws relating to buil '' construction I authorizer resentatives of Cupertino to enter the above-identified property for inspection purposes. CON Date: 5- Signature of Applicant/Agent: At SUPPLEMENTAL INFO TION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s):.Demolition permit is required prior to issuance of building permit for new building. _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure To—rm.if any Hazardous Materials are being used as part of this project. _Copy of Planning Approval Letter or Meeting with Planning prior to Submittal of Building Permit application. BldgApp_2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION {' ADDRESS: 10280 PARK GREEN LN#843 DATE: 05/10/2013 REVIEWED BY: MELISSA APN: 369 54 043 BP#: *VALUATION: 1$38,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION 1 R3SFDREM USE: SFD or Duplex PERMIT TYPE: i WORK REPAIR WATER DAMAGE IN KITCHEN CABINETS LIKE FOR LIKE SHEETROCK& COUNTERS SCOPE & DINING ROOM (SHEETROCK ONLY) & DAMAGE IN DOWNSTAIR GARAGE.ADD INSULATION o ai Nog MAI Xlech.Plan Check, Phrrrrb.Plan Check Elec. Plan(:;heck ,Meeh. Perrrrit Fee: Plumb.Permit Fee: L'lec. Pr<rmit Fee: C)ther !Meeh.Inch. Other Plumb Insp. Li Other Elec.Insp. 11ech, Insp.Fee: Plumb. Irish.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 on! an estimate Contact the De t or addn7 info. FEE ITEMS (Fee Resolution 11-053 E . 7ff 11/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.£ Remodel,Other Suppl. PC Fee: Q Reg. ® OT 0.0 hrs $0.00 $467.00 1REMRESOTH PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Feer Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 CConviruction Tax: Adininlstrative.l'ee: Work Without Permit? 0 Yes No $0.00 G Advanced Planning Fee: $0.00 Select a Non-Residential G Building or Structure Travel Documentation Fees: Strong Motion Fee: IBSEISMICR $3.80 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 7g7t ., - $5.80 $467.00 TE $472.80 Revised: 04/29/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C O P E RT 1 N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS:/ 0 a C,-eQA 'QnC PERMIT# OWNER'S NAME: Ste' Le e, PHONE# 1-y-6 - -:5 GENERAL CONTRACTOR: SDPAI �'(! W C/cv? N BUSINESS LICENSE#: ADDRESS;),c) CA CITY/ZIPCODE: .,�A 9VIL *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 SUBCO CTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signre Date Please check applicable subcontractors and complete e.following information: 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 JJV Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date