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15020083FR CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6354 BLACKWOOD DR CONTRACTOR:. PERMIT NO: 15020083 OWNER'S NAME: MYOUNG KANG &IAN OGLESBY � 1 f��l�© /l�f DATE ISSUED: 05/05/2015 OWNER'S PHONE: 6508671551 PHONE NO: �8.1 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] 9 �C� As W,6 CW�C 2ND STORY ADDITION OF 637 S.F TO CREATE (1) License -'=� Li.. # 1 %' EXTENDED MASTER SUITE /`/,4/I iii Date �51d 9 3� Contractor f9/7 I hereby affirm 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: $180000 ormance of the work for which this permit is issued. ave 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: 36917052.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 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 WITIIIINN 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 FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City to consequence of the 7- granting of this permit. Additionally, the applic t and will comply Issued by: % ri/7� �l�i Date: Issued la£ions the Cu ifio Municipal Code, Section with all non-po' ource reg per RE -ROOFS: 9 18. S Signatur Date P 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) I, 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 handlehazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices whi mit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality M 'gement District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal C e, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Secti fi 25505 25533 n 259 4. 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, I 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 918. Signature Date CUPERTINO COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 ^ building(aD-cupertino.org ❑ NEW CONSTRUCTION i :`I. ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT - DSS (/L�!%L� ((] G APN # 2�7 r �1 I 1 / I- J �C/ OWNER NAME PHONE- '� �' 7'� �Jt" � � - 1L IGT '), I�Sl��j� lG}� 1t1c 1 f Gi C l "� (•ul' CCr{`jG t V l P C��.r I is ca C''� S EET ADDRES p :5 , L./}CK �I-'<7�' D J� f2 (Ufa%` CITY,STATE, ZIP r FAX lti,l c % 5p CO ACT NP �'/� G: SLE le sp— S CF^ -(v PHONE HONE ' ��oy -MAIL �� I 1 '[ 54�4•C �1�4 1•I/l�_ '�C &—� STRE T ADDRESS C TY, STATE, ZI t3 IZ`� j7� �1`� Z l �(�n FAX 10 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT WMA R NAME S/ LICENSE 2NUiIBER LICENSE TYPE BUS. LIC # Iti �Gi COMPAIJY NAME � E-MAIL FAX 4 ET S i CITY, STATE, ZIP PHONE I ARCM TEC /ENGINEER _ACME VVOMPA LICENSE NUMBER BUS. LIC H C1 NAE E-MAIL FAX STIZIP /ET ADD SS' "Lr 1 TEG -Z , "'1'51 lel C ONS 13 ^ tl>Lrt� i \j` i%SiI� 1 O D CRIPTION OF WWonJveQ Aredc1 Ma cv; 1YA46 lbe' t nnvm lutt ( ems Bc-1 5=r��=� �> N � �� t-��-�i �-� ��t��- � •�1��.. � � �.s tit �?��� � �! ��� �'� ��r �-� EXISTINGGUSE PROPOSED USE CONSTR. � #STO$jES . _ f � USE Y TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA I NEW FLOOR• DEMO AREA 0 3 AREA TOTAL NET EQ , ' BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARACa� AREA: DETACH ATTACH #DWELLING UNITS: IS A SECOND UNrr ❑ YES BEING ADDED? �-SNo SE N STORY YES ADDITION? O PRE-APPLICATIONYES IF YES, PROVIDE COPY OF PLANNING ADPL# ❑No PLANNING APPROVAL LETTER IS THE BLDG AN El YES ED BY: EICHLER HOME? TOTAL VALUATION: lalo®o By my signature below, I certify to each of the following: I am the property owner or authoriz e propeowner's behalf. I have read this and the information I have provided is correct. I have read the Description o ve ura�e_/I.,�gre- application to comply With all applicable local ordinances and state laws relating tobuilding const . I authorize representatives of Cuperti o enter the abo2v-iifierty for inspection purposes. Signature of Applicant/Agent: ( Date: SUPPLEMENTAL INFORMATION REQUIRED PLNC HECK TYPE ROUTING. SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ 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. ❑. EMPRESS : ❑ .PLANNING PLAN REVIENN' _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD 0 PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE;' ❑FIRE DEPT _ Copy Of Planning Approval Letter Or Meeting with Planning prior t0 ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL IiEALTA BldgApp_201 Ldoe revised 06/21/11 ill PIN CITY OF CUPERTINO l�I FEE ESTIMATOR — BUILDING DIVISION ialADDRESS: 6354 BLACKWOOD DR DATE: 02/13/2015 REVIEWED BY: MELISSA PC FEE ID APN: 36917 052 BP#: Q9 " *VALUATION: 1$180,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY USE: SFD or Duplex 2nd Unit? Yes No OTC? 0 Yes )No PENTAMATION PERMIT TYPE: 1 R3SFDADD WORK 2ND STORY ADDITION OF 637 S.F TO CREATE N EXTENDED MASTER SUITE SCOPE Suppl. Insp. Fee:Q Reg. 0 OT OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 637 $2,654.00 IR3PLNCK $1,666.00 IR3INSP Elec. Insp. Fee: $1,666.00 Suppl. Insp. Fee:Q Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tar: Aclininistrative Fee: 0 0 Work Without Permit? 0 Yes Q No $0.00 TOTALS: 637 $2,654.00 Travel Documentation Fees: $1,666.00 !Y MECH, HOURLY Yes :{ DyNo PL>(7MB, HOURLY 0 EYes Q No C.HOURLY Q` Yes Q No t tllech. llkwn Check Phtwb. Plcaa ('heck Elec. Plan (..`heck ;L1ec1, Per110 Fcw: Plumb. Permit Fee: Isles. Pennir Fee: Ch'her a/ech. Inrp. C)rl:er Plumb Insp. Urizer 1 "lec. Insp, 0 tilech. h sp. Fee: N nrb. hrsp. Fee: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District etc). These ees are based on the Drelimina information available and are onlv an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,654.00 Select a Misc Bldg/Structure or Element of a Building A Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,666.00 Suppl. Insp. Fee:Q Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tar: Aclininistrative Fee: 0 0 Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fee: IPLLONGR $89.18 Select a Non -Residential Building or Structure 0 I i Travel Documentation Fees: Strong Motion Fee: IBSEISMICR $23.40 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $8.00 `, 1SUBTOTALS : $4,440.58 $0.00 z ' ". TOTAL FEET $4,440.58 Revised: 01/06/2015 A N k , � 1 1ST aj r