13060168 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10159 RICHWOOD DR CONTRACTOR:KI LEE PERMIT NO: 13060168
OWNER'S NAME: KIWOOK KIM 7064 PELICAN RIDGE DR DATE ISSUED:06/20/2013
OWNER'S PHONE: 4088630225 SAN JOSE,CA 95120 PHONE NO:(408)857-9999
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class_ Lic.# .�J INSTALL TEMPORARY POWER
Contractoro a�o�a Date
I hereby affirm that I am licensed under the provisions f 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:S�iiii
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 kl,N Number:36908038.00 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 O? SSUANCE OR
to building construction,and hereby authorize representatives of this city to enter ED INSPECTION.
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY
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: 3
granting of this pe . Additionally,the applicant understands and will comply by:
all ll non-point o ce Meretions per the Cupertino Municipal Code,Section
9.18. I
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:
1 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)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.1044,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 Ba rea Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the p rtino Municipal Code,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Section 25 5,2 33,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:
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,l
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby afPurn 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
i
GENERAL PERMIT APPLICATION M E P
ILI] COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION �O
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 O
MISCCUPERTINO
(408)777-3228• FAX(408)777-3333•building(a1cupertino.orq
❑PLUMBING ❑MECHANICAL ❑ELECTRICAL MISCELLANEOUS
PROJECT ADDRESS! r n 'I APN# / t? _ /ti i _ 4
OWNER NAME PHONE (MAJIL
STREET ADDRESS CITY,STATE,ZIP FAX
CONTACT NAME t PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP IFAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME i ` e LICENSE NUMBER LICENSE TYPE e BUS.LIC#
COMPANY NAME I�) �� (—
E-MAIL, �. e e FAX
i
STREET ADDRESS CITY,STATE,ZIP V PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAH. FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD 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
U Q
TOTAL VALUATION: �U RECEI
By my signature below,I certify to each of the f Jawing: I am th roperty owner or authorized age ac on the owner's behalf. I have read this
application and the information I have provide is corT I. I hav ead the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildin ctio . an orize representatives of Cupertino to enter the above-id tified prope for inspection purposes.
Signature of Applicant/Agent: Date: 6
SUPPLE"INFORMATION REQUIRED OFFICE USE ONLY
w ❑ OVER-THE-COUNTER
a
F^ ❑ EXPRESS
U
U
❑ STANDARD
U
❑ LARGE
a
❑ MAJOR
MEPMiscApp_2011.doc revised 06121/11
I
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10159 RICHWOOD DR DATE: 06/20/2013 REVIEWED BY: MELISSA
APN: 369 08 038 BP#: *VALUATION: $500
WxPERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION 1REAP14
USE: SFD or Duplex PERMIT TYPE: i
WORK INSTALL TEMPORARY POWER
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Temporary Power 1 ERT<200 100 Amps $45
TOTALS: $45.00
Nfech. PlanC7:< Plarrnb. Plan(heck Elee.PlanCheck 0.0 1 hrs $0.00
Phrmh. ; Elec.Permit Fee: IEPERMIT
Other AIecrh.Insp Odder Plumb Insp. Other Elea Insp. 0.0 hrs $45.00
Plumb. Insp. Fee: Elec.I
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,Sehool
District,eta). These fees are based on the prelimina information available and are only an estimate Contact the Dept-for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl.PC Fee L �
PME Plan Check: $0.00
Permit Fee:
Suppl. Insp Fee
PME Unit Fee: $45.00
$
PME Permit Fee: 45.00
Consiruction Tax:
Administrative Fee: IADMIN $42.00
Work Without Permit? ® Yes (F) No $0.00
Adtianced Planning Fees:
Travel Documentation Fee: ITRAVDOC $45.00 i
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldiz Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $178.50 $0.00 TOTAL FEE: $178.50
Revised: 04/29/2013
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 13 L,)60 16.?
JOB ADDRESS: /-p PERMIT#
OWNER'S NAME: PHONE# — S
GENERAL CONTRACTOR: 1 L BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE:
*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 BUSINESS 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
0
tr Contractor Signature Date