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14060154CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10850 BROOKWELL DR CONTRACTOR: PETER KANG PERMIT NO: 14060154 OWNER'S NAME: CHANG JENNIFER Y 690 E PERSIAN DR #3 DATE ISSUED: 09/15/2014 OWNER'S PHONE: 4082522115 SUNNYVALE, CA 94089 PHONE NO: (650) 906-8788 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CONSTRUCT ONE STORY ADDITIONS AT FRONT AND Q License Class Lie, # �� REAR OF Contractors Aate - '�� 5 �C,,,S,f, EXISTING RESIDENCE (704 SQ FT); RE -ROOF (E) SFD r ,s� Ct,� AND GARAGE (1874 SQ FT). 1 hereby firm tha�I am licensed/ under the provisions of Chapter 9 REV # 1 - REMODEL 2 (E) BATHROOMS (100 SQ FT) - ISSUED 5/20/15 (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: $110600 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 36921025.00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRE I OT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN F PE ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 18 ROM ALLED INSPECTION. upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Issued by. Date: J �d granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9 18. r S 1 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 1, 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. 1 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 25505,2 and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Dater permit is issued. I certify that in the performance of the work for which this permit is issued, l 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, 1 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 ^ building(cDcupertino.org lC-�UPERTINO I I NFW C(-)NSTRI1CTi(�N n ADDTTION n ALTERATION / TI �/ DEFERRED ORIGINAL PERMIT 9 PROJECT ADDRESS �/ (I G� /✓ 1� ley y OWNER NAME`� PHO �'-�z� � � E-MAIL ' rc �%'��', STREET ADDRESS �0 �l CITY 3�T$ ZIP FAX CONTACT NAME ( PHONE E-MAIL �)7 STREET ADDRESS o o `tea AD CITY, STATE, ZIP FAX OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME _ �,J� G� (/ LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/F.NGINEER NAM �� O� /, - l—/]� LICENSE NUMBER BUS. LIC M COMPANY NAME {� L E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK�m _ /� pct y //--7 EXISTING USE PROPOSED USE CONSTR TYPE I STORIES I USE TYPE OCC. SQ.FT. VALUATION (S) EMSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH []ATTACH d DWELLING UNITS: ISA SECOND UNrr ❑YES SECOND STORY DYES BEING ADDED? E) NO ADDITION? ❑NO PRE -APPLICATION ❑YES IF YES, PROVME COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS TlIE BLDG AN ❑ YES EICHLER HOTIE? ❑ NO RECEIVED X t s ? - t TOT VALUATION: r G/ •._MF 4 r. �$ii �v r.dr-i .y+"` f' 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 bu' ing struc� I aut e r resentatives of Cupertino to enter the above- iden 'feed property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED u.r ` ^y " 1 sty h g h P..L'AN,CHECKT]PE, 3 e&G SLIP _ I g I\ew SFD or Multifamily dwellings: Apply for demolition permit for I z C� � L � � {, OVER THE COU)rTER x� r f g& i. 7 I BUII DING PLAREVIE➢� - existing building(s). Demolition permit is required prior to issuance of buildingUK r �a�x, "tf]IryS^' permit for new building. EkPRE5S+4>�' t �'rkry0 pinlvTZNGPiANREpI1 w _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ©F STANDARD ���� � , � UQ�PUB�-iewoRTCC =,s'f'T'1 form if any Hazardous Materials are being used as part ofthis project. . _ Copy of Planning Approval Letter or Meeting with Planning prior to b submittal of Building Permit application. ���� `� �j'-' � ,�Et't-z•,,�jyc','� ,."Q ENY,ISiO�NMENTAlHE'A1yiTFI fa � B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO WIPW imerrTtvR A rr"iD RTTTT T1TWC DlfVFC'F(-) T ADDRESS: 10850 BROOKWELL DR DATE: 05/20/2015 REVIEWED BY: SEAN 121 BP#: �� *VALUATION:0 APN: *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM PERMIT TYPE: i USE: WORK REVISION 1: REMODEL 2 BATHROOMS 100 SQ FT SCOPE CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10850 BROOKWELL DR CONTRACTOR: PETER WANG PERMIT NO: 14060154 OWNER'S NAME: CHANG JENNIFER Y 100 CONCORD CIR DATE ISSUED: 09/15/2014 OWNER'S PHONE: 4082522115 MOUNTAIN VIEW, CA 94040 PHONE NO: (650) 906-8788 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CONSTRUCT ONE STORY ADDITIONS AT FRONT AND �y / License Class—Z_____..__ Lic. #t L5 T REAR OF --� t ContractorDae " "7"_ �" �_� EXISTING RESIDENCE (704 SQ FT); RE -ROOF (E) SFD - — AND GARAGE (1874 SQ FT). I hereby a firm 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. 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 Sq. Ft Floor Area: Valuation: $102600 performance of the work for which this permit is issued. 1 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: 3692! 025.00 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"P IT 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 F�3A ' CALLED 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 �•" I� Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Is RE -ROOFS: Signature— d Date All roofs shall be inspected prior to any roofing material being installed. if a roof is installed without first obtaining an inspection, 1 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) 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. 1 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(x) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should 1 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 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 Compensation laws of California. if, after making this certificate of exemption, l 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinggc cupertino.orq ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT R PROJECT ADDRESS 9 r /� _7APN # OWNER NAME �%7%7✓1 �! PHOIJE� E-MAIL S1 G ..-- d2nll// STREET ADDRESS CITY, ST�ATEZIP l� L � �,y � Jam/ � /f G C FAX CONTACT NAME PHONE 71-47 �� 40t f STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGEN-r❑ CONTRACTOR ❑ CONTR-ACTORAGEI'r VAIC=CT ❑ ENGIINTER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME J'� (/ LICENSE NUMBER LICENSETYPE BUS, LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITE /ENGINEER NAME LICENSE NUMBER O� J (�7 Com( Y BUS. LIC d COMPANY NAME E-MAIL (, A -c STREET ADDRESS I CITY, STATE ZIP PHONE 7i� �4l f DESCRIPTION OF WORK B a 1 f`dY` EXIST'fi USE 7 ED USE CONST T1TE PROPO191_� { a # STORIES USE TYPE OCC. SQ,FT. VALUATION (i) ` MSTG 114 4V - NEW FLOOR DET10 TOT "I AREA AREA AREA NET y _ 'yam �+ © < < 010 01 Y i 1't V v BATHROOM*UNIITS:IS E OTHER L REMODEL ADEL AREA `'� REMODEL AREA PORCH��TOTALrDE.rCK/K/PORCH AREA GARAGE AREA: DETACH tb `�tV ` �� `j�ATTACH k DWELLINECOND UNIT ❑TBS SECOND STORY [] YES ADDED? �JO ADDITION? UKO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF 1S THE BLDG AN ❑ YES TOTPJ., VALUATION: PLANNING APPL k 0 PLANNING APPROVAL LETTER EICHLER HONIE? NO 11[J " � ,�� d✓� ' Q � By my signature below, I certify to each of the following! I am the property owner or authorized agent to act on t perry 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 building cons ruction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. IIA— Signature of Applicant/Agent IL Date: SUPPLEMENTTkL INFORMATION REQUIRED clEcxnmE pili - 29t1TINGSTLP, w q�iRT HIfOOUJvTER cUlLDIAG A PLAN REVIEW � r 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. Q;�asapzzr s ❑ r�nNNTt G PI �rrRE�rr � Commercial Bldogs: Provide a completed Hazardous Materials Disclosure �� �� m ' �r� ❑ sTAT`DARD � ❑ UBL WORI.S��" F�� �r�� P I� _�� form if any Hazardous Materials are being used as part of this project. � — Copy of Planning Approval Letter or Meeting With Planning prior to 5 T SR 1�1STRICT submittal of Buildin Permit application. R PP ��T��07 sr t� I� r �+ iGsn�'f, t T i� q �( ❑�Evilzl .� .� s,��wti YvIENTA�L�HEALTH'; r. , BldgApp_2 0 11. do c revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ` ADDRESS: 10850 BROOKWELL DR DATE: 0612512014 REVIEWED BY: MELISSA APN: 36921 025 BP#: l °VALUATION: 1$102,600 '`PERMITTYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex 2nd Unit? Yes '. No PENTAMATION 1R3SFDADD USE: OTC. Yes (F) No PERMIT TYPE: WORK FRONT & REAR ADDITION TO ADD N LIVING RM GUEST RM &BATH &EXPAND E FAMILY SCOPE RM (704 S.F.). RE -ROOF (E) SFD (17 SQ'S) OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B1111-B,IV,V-B 704 $2,577.00 IR3PLNCK $1,617.00 IR3INSP $0.00 PME Plan Check: $0.00 Permit Fee: $1,617.00 Suppl. Insp. Fee:,• Reg. Q OT 0.0 F $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 704 $2,577.00 1 $1,617.00 MECH, HOURLY 0 Yes 0 No PLUMB, HOURLY ® Yes E) No ELEC, HOURLY ® Yes 0 No Suppl. PC Fee: Q Reg. Q OT Q.Q hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,617.00 Suppl. Insp. Fee:,• Reg. Q OT 0.0 F $0.00 PME Unit Fee: $0.00 PME Permit Fee: E $0.00 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School nidrirl. etr )_ Thnco fovc ary hacad an lhv nroliminary infnrmalinn availahlo and ara nnly an oclimnln_ Cnnlart lha nnnt fnr addn'1 infa_ FEE ITEMS (Fee Resolution 11-053 Eff 7/1.'1n FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,577.001,700 s.f. $272.00 Re -roof IREROOFRES Suppl. PC Fee: Q Reg. Q OT Q.Q hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,617.00 Suppl. Insp. Fee:,• Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 E) Work Without Permit? 0 Yes (F) No $0.00 Advanced Plannin, Fee: IPLLOA'GR $98.56 Select a Non -Residential Building or Structure (D Strong Motion Fee: 1BSE1SN11CR $10.26 Select an Administrative Item Bldg Stds Commission Fee; IBCBSC $5.00 SUBTOTALS; $4,307.82 $272.00 TOTAL FEE. $4,579.82 Revised: 04/0112014 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: /Vg5o Yba j^ PERMIT # D S OWNER'S NAME: <-' - PHONE # GENERAL, CONTRACTOR: BUSINESS LICENSE # ADDRESS: p -- CITY/ZIPCODE: *Our municipal code requites all businesses working in the city to have a City of Cupertino dusiness 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: Signator Date Please check applicable subcontractors 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 Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 "Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) 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: / Contractor Suture Date SUBCONTRACTOR Cabinets & Millwork BUSINESS NAME BUSINESS LICENSE # 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 / Contractor Suture Date