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15110011CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15110011 10208 RICHWOOD DR CUPERTINO, CA 95014-3361 (369 08 028) OWNER-BUILDER 10210 RICHWOOD DR CUPERTINO, CA 95014-3361 OWNER'S NAME: CHOI HENRY AND JACQUELIN DATE ISSUED: 02/18/2016 OWNER'S PHONE: 650-450-3363 PHONE NO: (650) 450-2363 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor OWNER-BUILDER Date —BLDG _ELECT _ PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing _ MECH _ RESIDENTIAL _ COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: ADD (1) ATTACHED 2ND UNIT (639 S.F.). I hereby affirm under penalty of perjury one of the following two declarations: 1. 1 have and will maintain a certificate of consent to self-insure for Worker's REV#1 - RECONFIGURE KITCHEN LAYOUT IN SECOND UNIT; Compensation, as provided for by Section 3700 of the Labor Code, for the RECONFIGURE BATHROOM #2; CHANGE FRON r WINDOW AT performance of the work for which this permit is issued. HOME STUDIO AT MASTER BEDROOM #l; INS L (N) PENDANT 2. I have and will maintain Worker's Compensation Insurance, as provided for by LIGHT IN ROME STUDIO AND INSTALL 2 (N) FR ONT EXT. LIGHTS Section 3700 ofthe Labor Code, for the performance of the work for which this - ISSUED 3/10/2016 permit is issued. APPLICANT CERTIFICATION DEF #1 - TRUSS CALCS I certify that 1 have read this application and state that the above ISSUED - 6/29/2016 information is correct. l agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize Sq. Ft Floor Area: Valuation: $120000.00 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, costs, and expenses which APN Number: Occupancy Type: may accrue against said City in consequence of the granting of this permit. 369 08 028 Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. PERMIT EXPIRES IF WORK IS NOT STARTED /29 Signature Date 6/2015 WITHIN 180 DAYS OF PERMIT IS UA CE OR 180 DAYS FROM LAST CALL. S CTION. t OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the Issued by: ALEX VALLELUNGA followingtwo reasons: Date: 02/18/2016 1. 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 RE-ROOFS: sale (Sec.7044, Business & Professions Code) All roofs shall be inspected prior to any roofing material be' ag installed. If a roof is I, as owner of the property, am exclusively contracting with licensed installed without first obtaining an inspection, I agree to remove all new materials for contractors to construct the project (Sec.7044, Business & Professions Code). inspection. I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self-insure for Worker's Signature of Applicant: Compensation, as provided for by Section 3700 of the Labor Code, for the Date: 6/29/2016 performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLO URE ,a. I certify that in the performance of the work for which this permit is issued, I I have read the hazardous materials requirements undor Chapter 6.95 of the 1i shall not employ any person in any manner so as to become subject to the Ill` H/ California Health & Safety Code, Sections 25505, 255 3, and 25534. I will Worker's Compensation laws of California. If, after making this certificate of maintain compliance with the Cupertino Municipal Cod , Chapter 9.12 and the exemption, I become subject to the Worker's Compensation provisions of the Health & Safety Code, Section 25532(a) should I store r handle hazardous Labor Code, I must forthwith comply with such provisions or this permit shall material. Additionally, should I use equipment or devices which emit hazardous be deemed revoked, air contaminants as defined by the Bay Area Air Quality Uanagement District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and APPLICANT CERTIFICATION the Health & Safety Code, c ' ns 25505, 2553 ,and 25 1 certify that I have read this application and state that the above information is ?k\ correct. I agree to comply with all city and county ordinances and state laws �---- --�--� -- �_., Owner orauth -or-1 u01 or zzed-agent:D relating to building construction, and hereby authorize representatives of this ci ty 9 g y p Date: 6 6111 to enter upon the above mentioned property for inspection purposes. (We) agree CON TR TIO E A N i to save indemnify and keep harmless the City of Cupertino against liabilities, I hereby affirm that there T a construction tending agency lending for the performance judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands of work's for which this permit is issued (Sec. Civ c.) and will comply with all non-point source regulations per the Cupertino Municipal Lender's Name Code, Section18. Lender's Address Signatd e i Date 6/29/201 understand my plans shall be used as public records. CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (✓ (408) 777=322£ -FAX (40$) 777-3333 e building(a.cupertino.org j S f' CUPERTINO ❑ NEW CONSTRUCTION ADDITION ❑ALTERATION / TI ElREVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS ., Z C.J � � � � �r APN OWNER NAMEf� 6 C � PHONE i /T -D `, /� L STREET ADDRESS C) �y d CITY, 5 ATE, }PIJ -�1A� E FAX 12k CONTACT NAME ' PHONE o Q' TQ a 1 E-MAIL STREET ADD7% `%' `W� CITY, STATE, ZIP '-® PA ❑ OWNER ❑ owNER-BUH.DER T❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINLER (T❑ D(f EVEL DPFR ❑ TENANT CONTRACTOR NAME �,� LICENSE NUMBER LICENSE TYPE BUS. LIC # i COMPANYNAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME ? ` LICENSE NUMBER S '7 � I BUS. LIC n COMPANY NA E-MAIL f 3 / . / FAX STREET DRESS / r� CITY TATh, ZIP v PHON (� DESCRIPTION OF WORK0� USE I TYPE 1 OCC. j, SQ.FT. i I VALUATION ($) BldgApp_2011.doc ifevised 06/21/11 EXISTG NEW FLOOR - DEMO TOTAL AREA AREA AREA NETAREA BATHROOM - KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGEAREA: EIDETACH []ATTACH I I �l .. DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES • BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION ❑.YES IF YES, PROVIDE COPY OF IS THE BLDG AN El YES REC£iVED;$- 'i. TOT :TION: . PLANNING APPL# ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO { I t` By my signature below, I certify. to each of the following: I am the property owner or.authorized agent to aV on theproperty 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 relabudding constructi orize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature o-Appiicant/Ag =Date:Crcyelg SUPPLEM TAL INFO ATION REQUIRED PLAICHECii1iPE izairri GSLIP.,.< p\jEB THE CounTER Q BIIiLDINGrL '>zEVIEw 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. ExPR> ss r ❑ PLA JNING PL N RE�nI t� Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sTANDnRD ;uBLlcaoRx x _ form if any Hazardous Materials are being usedas part of this project.' F LARGE ,EIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to i] ��A7oR D < SAnrrAlu sENiER DIST RICT submittal ofBuilding Permit application. BldgApp_2011.doc ifevised 06/21/11 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDINGON 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 ANSION (408) 777-3228 - FAX (408) 777-3333 • buildingC@cupertino.org CUPERT11t4 ❑NEWCONSTRUCTION ❑ ADDITION F- ALTERATION/TT IFI RFVTSTnN/nFFFRRF.T) nRTr;TNAT_PPPTXiT:Y PROJECT ADDREf i h r APN # -36 ►YI OWNER NAME � Q V1 ckc, PHONE / 5b-Arp. �"` 3tFCMAIL2 nr ,drn w�. c� ^j�(J b STREET DDRES� aim.. UU • - CITY, STT , IP LA V-eWxo FAX CONTACT NAME s o Qu' PHO ' E - -$ as E-MAIL ; �n arkdesi o s lobi, STREET ADDRESS sC4 v �(_ ,{ CITY, STATE, ZIP o4q F t -2,q6 OWNER ❑. OWNER -BUILDER ❑OWNER AGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT 0 /ENGINEER ❑ DE OPER ❑ TENANT CONTRACTORNAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGINEER NAMEr_ e �� j (�r u L t LR ICENSE NUMBER BUS. LIC # COMPANY NAME / •R. ;n&yiK3 E-MAIL aren . w.qktg @5�c Cb n" FAX STREET ADDRESS �{- [ CITY, ST TE, Z 24C• SIR < �f 14 01"A 9 U� - 7 DESCRIPTION OF WORK ,vyt L' � � � Jtr� t.� I• � � .� 'dt y moo EXISTING USE _ OSEDUSE CONSTR. TYPE ,: STO IES ` s 1 l4L�J e ode li c f I EXISTG AREA NEW FLOOR AREA DEMO AREA TOTALQ' NET AREA -A i - BATHROOM REMODEL AREA KITCHEN - REMODEL AREA. OTHER REMODEL AREA % •y D_ PORCH AREA -. DECKAREA- TOTAL DECK/PORCH ARE GARAGE AREA: DETACH ❑,ATTACH I # DWELLING UNITS: IS A SECOND UNIT SECOND STORY YES BEING ADDED? ❑NO ADDITION? PRE -APPLICATION ❑.YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YESDBI' .. '� '•,' TOTAL V UATION. PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER. EICHLER HOME? 4Lk<O By my signature below, I certify to each of the following: I am the property owner or authorizect agent to act on the property owner's behalf. I hav read this application and the information I hav ovided is correct. I have read t e Description of Work and verify it is accurate. I agree to comply with all pplicable local ordinances and state laws relating d' construction. I au iz epreseintatives of Cupertino to enter the above -identified property for inspec Lion purposes. Signature of Applicant/Agent: Date: O 72U SUPPLEMENTAL INFORMATIOt4 REQUIREIJ17PI art eFlEek•T ,_,r : io.. IvcsLl>x _ ;'. Q ovi%TTI� cotTVTER C7 .:sFJIIT3I�G..� Text IE�� 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.r.Ess ❑":T'T �'tiLGg vvtzEtlEtv.`. Commercial Bldgs: Provide a completed Hazardous. Materials Disclosure D Srat�taTa Q :YIIBLTC'o cs.' A _ form if any Hazardous Materials are being used as part of this project BARGE `�` F€REDEPT, . _ Copy of Planning Approval Letter or Meeting with Planning prior t0 �'.�' ` s � t DJ§T'iUCT submittal of Building Permit application.X&JOR, CI;. tNiVq z€ _M 4 r Tf A B1dgApp_2011.do revised 06121111 M/ CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15110011 10204RICHWOOD DR CUPERTINO CA 95014 (369 08 028)110208 RICHWOOD DR CHOI HENRY AND CUPERTINO, CA 95014-3361 (369 08 028) JACQUELIN 10210 RICHWOOD DRIVE OWNER'S NAME: CHOI HENRY AND JACQUELIN DATE ISSUED: 02/18/2016 OWNER'S PHONE: 6504502363 PHONE NO: 6504502363 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor CHOI HENRYAND JACQUELIN Date 2/18/2016 _ BLDG —ELECT _ PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH _ RESIDENIAL _ COMMERCIAL T with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: ADD (N) ATTACHED 2ND UNIT (639 S.F.) I hereby affirm under penalty of perjury one of the following two declarations: r. 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. 2. 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 permit is issued. Sq. Ft Floor Area: Valuation: $120000.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: ordinances and state laws relating to building construction, and hereby 369 08 028 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, costs, and PERMIT EXPIRES IF WORK IS NOT STARTED 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 with all non -point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION. Code, Section 9.18. Issued by: PAUL O'SULLIVAN 106nLS 9 i f lJ� Signature Date 2/18/2016 g Date: 2/18/2016 dj d� OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material bein installed. If a roof is following two reasons: installed without first obtaining an inspection, I agree to remov, all new materials for 1. I, as owner of the property, or my employees with wages as their sole inspection, compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: iz I, as owner of the property, am exclusively contracting with licensed Date: 2/18/2016 _77 contractors to construct the project (Sec.7044, Business &Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" O R BETTER 1. 1 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance, as provided for California Health & Safety Code, Sections 25505, 25533 and 25534. I will by Section 3700 of the Labor Code, for the performance of the work for which maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the this permit is issued. Health & Safety Code, Section 25532(x) should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued, I E material. Additionally, should I use equipment or devices which emit hazardous 1 air contaminants as defined by the Bay Area Air Quality Management District I shall not employ any person in any manner so as to become subject to the will maintain compliance with the Cu ertino Municipal Code, Chapter 9.12 and Worker's Compensation laws of California. If, after making this certificate of the Health & Safety Coe ctions 25505, 25533, an 4. exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall Owner or authorized agent: V r be deemed revoked. Date: 2/98/2016 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGEN certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency ror the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C. relating to building construction, and hereby authorize representatives of this city, Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in ARCHITECT'S DECLARATION consequence of the granting of this permit. Additionally, the applicant I understand my plans shall be used as public records. understands and will comply with all non -point source regulations per the Cupertino Munici al Code, Section 9. - Licensed / Professional Signature Date 2/18/2016 l GONSTRJCTION PERMIT APPLICATION C0Wi%4UNITY DEVELOPNrEN T DEPARTNAENT • BUILDING DIVISION 10300 T ORRE AVENUE • CUPER T INO, CA 9501.4-3255 isim (408) 777-3228 • FAX (408) 777-3333 - buildinggou[)erzino.org CUPERTINO, f 29 NEW CONSTRUCTION u ADDITION ❑ ALTERATION / TI 7 REVTST0W i n'FFRR R'R.Tn t5 110// 07RT(-J'KTAT.'DVI? u PROJECT A DRESS to� � v �l 00 r I APN n to OWNER NAIYM Pgnru PHO KO9 ~ 36s E•IJAIL hen �! i a d 0) to, ry STREET AXI)RESSIVJ"J. CMZ t5�v�� CITY, c ATB, ZIP ` I� er n q � 14 CONTACT NAME�-- PHONt E-MAM Inti . e I P �- � , STREET ADD 1b W CITY, STA- Z �� f [� J ® FAXf K7 —6.35 F" 0 OA'M ❑. OWNER -BUILDER ❑ ORINLRAGEN-r ❑ cOITPrACTOR ❑ COA'TRACTORAGEIQT ❑ ARCEtITECT 9fENGLNTBEER ❑ 1 EvELOPER ❑ TENAh-r CONTRACTOR NAME LICn'NSENU11113ER LICENSETYPE ( BUS. LIC COI,IPANY NAN S I E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP I PHONE, I ARCHTTECTTNGINEERNPME�91�t� /I� I LICENSENUMBERogA '[' BUS. LIC V > COMPANY NA S/ ')wne_e4-(nQ E-MAIL egrenmn Ing 6"A FP STREET ADDRESS t,32 6 17 Ivi IW� IP OP ? a S70 L DESCRIP T ION OF WORK New w '2r A unli- E)asw liUSEPROP�pO�7ST=n USE ,,� d?j �1 CONST& TYPE n' STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA NEW FLOOR AREA % I DE 1,10 AREA TOTAL NET AREA ( .- BATHROOM KITCHEN REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL. DEMPORCH AREA GARAGE AREA; LJDETACH- 0 ❑ ATTACH ;V DAELLING UNITS: ISASECOND UNTT YES SECOND STORY I BEr.NG ADDED? ❑NO ADDITION? '0 PR '•A.°PLICATION ❑YES IF 1'FS, PRMVE COPY OF PLA,WING APPL m ❑ NO PLANR.ING APPROVAL LETTER IS THE BLDG :ii\'-- -.-_ TO V?.LUA ION EICHLER HOME' _ air By my signature below, I certify to each of the following: I am the property owner or authornz Qen e prope I owner's behalf. I have rex application and the information I have provided is correct. I have read the Description 31 it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b +" " cons` ction.I authorize represent Ino to enter the above -identified property for inspection purposes. f Signature of Applicant/Agent: r LTJ Date: Ltf 0/ 20(S SUPPLEMENTAL INFORMATION REQUIRED10_ - UT1�G cI;IP� EN 0 ❑ os' JBT7ILDL� Pi�NRz «EGA New SFD or Multifamily &-vellings: Apply for demolition permit for existing building Demolition permit is required prior to issuance of building _ z permit for new buil-ding _L� �I stlsL< rT� R&� LEFT _ Commercial BIdas: Provide a completed Hazardous Materials Disclosure cSr> �DARD r PUBISC oxxs s form if any Hazardous Materials are being used as part of this project.— _ Copy of Planning Approval Letter or Meeting with Planning prior to Building Permit s�RDTsrRrcr submittal of application.rLoR'`TAR ' - F Ea_VSRO-. NT4Z,.IiEASTA - _ B1dgf4pp_M1: doc revised 06121/11 05 CITY OF CUPERTINO 10 FEE ESTIMATOR — BUILDING DIVISION rADDRESSRICHWOOD DR DATE: 11/02/2015 REVIEWED BY: NIELISSA APN: 369 08 028 BP#: *VALUATION: E$120,000 r District, School t or addn'Z into. *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Const uction PRIMARY SFD Or Duplex USE: 2nd Unit? •' Yes � No PENTAMATION PERMIT TYPE:. 1 R3SFD2ND WORK ADD N ATTACHED 2ND UNIT 639 S.F. Suppl. PC Fee: (j) Reg. 0 OTJ SCOPE hrs $0.00 OCCUPANCY TYPE: TYPE OFR. FLR AREA CONSTR. s.f. PC FEES PC FEE ID BP FEF S BP FEE ID R-3 (Custom) . U-B,111-B,IV,V-B 639- 1 $2,654.00 IR3PLNCK ; $1,666.00 IR3INSP TOTALS: 639 $2,654.00_ _ -p $1,666[00 [ _i I 1,1ech. Permit Fee: f1l/ur.Rl:fcela..l('t,41J. Afech, Insp. Fee: I7ik'xII Plumb. Peiwiir Fee: cif erPlui 2b lasp. Plumb. Imp. Fee: Plan Check E16C. Perm t Fee,- T ( 1her E;ec. Insp.E Elec. Imp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sew District, etc.. These ees are based on the prelimina information available and are only an estimate. Contact the De r District, School t or addn'Z into. FEE ITEMS (Fee Resolution .1.1-053 Eff. 7jdJ3 FEE QTY/FEE MISC ITE S Plan Check Fee: $2,654.00 Select a Misc Bldg/Stru or Elementof ture a Building Suppl. PC Fee: (j) Reg. 0 OTJ 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,666.00 Suppl. Insp. Feer Reg. 0 OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1 #new units $687.10 (lininistrative Fee: Work Without Permit? 0 Yes (E) No $0.00 Advanced. Planning Fee: 1PLLONGR $89.46 Select a Non -Residential Building or Structure Travel.Docuinentalloti .l'c'c,:5: Strong Motion Fee: IBSEISMICR $15.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $5.00 $5,117.161 $0.00 _ L v T $5,117.16 Revised: 10/01/2015 ZM CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15110011 1020§RICHWOOD DR CUPERTINO CA 95014 (369 08 028)110208 RICHWOOD DR CHOI HENRYAND CUPERTINO, CA 95014-3361 (369 08 028) JACQUELIN 10210 RICHWOOD DRIVE OWNER'S NAME: CHOI HENRY AND JACQUELIN DATE ISSUED: 02/18/2016 OWNER'S PHONE: 6504502363 PHONE NO: 6504502363 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lie. # Contractor COI HENRY AND JACQUELIN Date 2/18/2016 —BLDG —ELECT —PLUMB MECH RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: ADD (N) ATTACHED 2ND UNIT (639 S.F.) I hereby affirm under penalty of perjury one of the following two declarations: 1. 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. r. 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 Sq. Ft Floor Area: Valuation: $120000.00 this permit is issued. APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: ordinances and state laws relating to building construction, and hereby 369 08 028 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, costs, and PERMIT EXPIRES IF WORK IS NOT STARTED 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 with all non -point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION. Code, Section 9.18. 9 Issued by: PAUL O'SULLIVAN VU025 >.Signature Date 2/18/2016 Date: 2/18/2016 /iZva� OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1. I, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: 2, I, as owner of the property, am exclusively contracting with licensed Date: 2/18/2016 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 declarations: r. 1 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance, as provided for California Health & Safety Code, Sections 25505, 25533, and 25534. I will by Section 3700 of the Labor Code, for the performance of the work for which maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous this permit is issued. material. Additionally, should I use equipment or devices which emit hazardous s. I certify that in the performance of the work for which this permit is issued, I air contaminants as defined by the Bay Area Air Quality Management District I shall not employ any person in any manner so as to become subject to the will maintain compliance withMuno Municipal Code, Chapter 9.12 and Worker's Compensation laws of Califomia. If, after making this certificate of the Health & Safetyns 25505, 25533, an 4. exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shallOwner or authorized agent: be deemed revoked. Date: 2/18/2016 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance I certify that I have read this application and state that the above information is of work's for which this permit is issued (Sec. 3097, Civ C.) 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 Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in ARCHITECT'S DECLARATION consequence of the granting of this permit. Additionally, the applicant I understand my plans shall be used as public records. understands and will comply with all non -point source regulations per the Cupertino Munici al Code, Section 9. Licensed Professional Signature Date 2/18/2016 1 CONSTRUCTION PERMIT APPLICATION CO(�/iUNITY DEVELOPNiEN T DEPARTh4ENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 r (408) 777-3228 - FAX (408) 777-3333 • building QcuDertino.ora fC�U P E RT i tit O- r _� ^ ^ l !J I/ W -EW CONSTRT IC'TT(lN I I AnnTTTnN I I AT TPR ATT(lN/TT I I R,.VTCT(1TT/nT:r'rD1?=n nZT!_TkTAT DT: %, X PROSECT ADDRESS/ CD1 f 9�oa�®� APN R b ®3 OWNER NAPS PHO .0® E.I✓_SII. D 3 S h n �a � STREET ADDRESS 10210 VICkWoddDr-CIi1, A CI A CONTACT NkVE C- - �� PHONE NAIL p STREET ADDR AS CITY, STA ZIP r� F OWheR ❑. OWNER-BMDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTORAGENTr ❑ ARCHITECT �ENGINE—Ek ❑ DEvELOPER ❑ TENA1vT CONTRACTORNAhrr- I LICENSE NUMBER I LICENSE TYPE I BUS. LIC R COMPANY NADSE ) E•1JAIL FAX STREET ADDRESS CITY, STATE, ZIP I PHONE ARC"r1TECTrNGINEER A}✓E pA9L F� / j LICENSENUMSER � � ( BL'S.LICn oe r COMPANY NAMEE-MAIL � ( yy FA 9- 104 e-eiv ()erg n een STREET f.DDPEESS C STA IP ( 1 t San Clam 2 ,32 � _ a T S7 DESCRIPTION OF WORK Ne Vq U r 9 EXIS USE PROPOSED USE CONS iR TYPE 4 STORIES J�1 �P, t 1 USE TYPE ( OCC. SQ.FT. VALUATION (S) AREAen G NAREAEW / 4 DEMOI AREA TOTAL NTr AREA I I. BATHROOM KITCHEN OTS -TER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECYUP 0RCH AREA GARAGE AREA: LJ DETACH 0 ❑ ATTACH I �DPIELLINGUI : 15ASECONDURrP YES SECOND STORY f BEING ADDED? ❑NO ADDITION? Jr'0 PRE•APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNENGAPPLR ❑NO PLANIIZNGAPPROVA.LLETTER TO VALUATION- - IS THE BLDG AN Cr'IZ - �Him EICHL£RHOh4E' -� _ WIM By my signature below, I certify to each of the following: I am the property owner or author iz _en e prope,, oHmer's behalf. I have rea application and the information I have provideds correct. I have read the Description orl - '� it is accurzte. I agree to comply -with all applicable local ordinances and state laws relating to b "` ' cans` i ction.®I authorize represen Ino to enter the abovge-identifleJd properyyfor inspection purposes. Date: � / 2o( SignatureofApplicant/Agent: r ti0 211 SUPPLEME1\TTAL MT OR-MATION REQUIRED - fl O RTHF COL'tTER New SFD or Multifamily d- elhgs: Apply for demolition permit for RM BTJIIDL�GPL�RESZEiY- existing building(s). Demolition pennit is required prior to issuance of building _ v� Eizi ss� PI 4'�ALRGPL RE�7EY permit for new building. Commercial Bldg: Provide a completed Hazardous Materials Disclosure =1� �rA.nARD pi�BLi�oRres _ porn if any Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or Meeting with Planning prior to z submittal of Building Permit application. = _-,� T `t.� E�•��on�,�Rnrsl.z�ai%I� - Bidg.4pp_2011.doc revised 06/21/11 im CITY OF CUPERTINO WANA 111)7A IPVF. F.CTTMATnR — RITTIMINr DIVISION . ADDRESS RICHWOOD DR DATE: 11/02/2015 REVIEWED BY: MELISSA APN: 369 08 028 BP#.. *VALUATION: 1$120,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex � 2nd Unit? =' Yes No PENTAMATION 1R3SFD2ND USE: PERMIT TYPE: WORK ADD N ATTACHED 2ND UNIT 639 S.F. hrs $0.00 SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. R-3 (Custom) 11-8,111-B,IV,V-B 639 $2,654.00 JR3PLNCK $1,666.00 IRNNSP I TOTALS: I 639 I $2,65400 $1,666.00 _11ech:Plan Check _lleell. Permit Fee: t)th i .;:Vech..Insp. Akch; Insp Fee: Plumb. Plan Clieck l 1ec. Plan Check Plum, b, Permit Fee: Flee: Perivit Fee: Other P1ui b .hzsp. Other F'Iec. Ixisp. Plumb. Insp. Fee: flee. Insp. Fee: Pls.; Pr.AHr Wnrkc Firv- Ranitary .4ewer District. School b d the reliminar in ormath available and are only an estimate. Contact the Dept for addn'l info. Dastrzct, etc.. These ees are ase on FEE ITEMS (Fee Resolution l l-Os3 E : 7ff 11113). FEE QTY/FEE MISC ITEMS Plan Check Fee: 1 $2,654.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,666.00 Suppl. Insp. Feer Reg. 0 OT . 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 _71 Construction Tax: IBCONSTAXR1 #new units $687.10 0 Administrative Tee: Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: IPLLONGR $89.46 Select allon-Residential Building or Structure O - Travel Documentation 1,7ees: � Strong Motion Fee: IBSEISMICR $15.60 Select an Administrative Item Bldgds Commission Fee: IBCBSC $5.00 �_V -- -------- 7a] iBITA $5,117.16 $0.000hI'E` $5,117.16 ft Revised: 10/01/2015 COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 ® FAX (408) 777-3333 - buildina(0)CUDertino.org For residential single family or duplex construction, there are cases where gas and electric -utilities are requested to be released prior to the issuance of the certificate of occupancy. Upon approval from the building inspector, the City of Cupertino is allowing both utilities to be released prior to the final, sign -off of the building. INSTRUCTIONS 1. Download this form at: http://www.cupertino.org/index.asDx?Dage=297. 2. Complete the form and obtain signatures from both the owner of the property and the primary contractor. 3. Fax, E -Mail, Mail or hand deliver the original signed form to: City of Cupertino Building Division Attn: Utility Release Request Form 408-777-3228 office 10300 Torre Ave. 408-777-3333 fax Cupertino, CA 95014 buildinggcgpertino.org 4. Schedule a Gas Meter Release inspection (#403) and/or Electric Meter Release inspection (#404). Please note, a Gas Test inspection (#506) is required prior to or at the same time of the Gas Meter Release inspection. BUILDING INFORMATION (Please complete the following information): APN 36908-028 LpG PERMITI: 15110011 05 Oct 2016 ,SITE 102.ichwood Drive, Cupertino CA 95014 ADDRESS: OWNER'S NAME: Henry Ch6 PHONE #'. 650-450-2363 FAX #: MAILING ADDRESS (if different from site address): CONTRACTOR: Same (owner builder) PHONE 650-450-2363 FAX #: CONTACT: Sei7ie PHONE #: FAX #: I request the City to release my utilities prior to obtaining a final inspection approval for the building. I fully understand the occupants of the building cannot move into the residence until they receive all of the required final sign -offs and the City has issued a certificate of occupancy for the bul ing. Owner: ....... ...................................... Henry Choi 05 Oct 2016 .................... Print: ...... ......... ................................ Date: ............................ Contractor: ............. ..... Print: ... Henry Choi .......................................... Date:. 05.0.ct..2.0.1.6 .... ..... ... ... UtilityReleaseForm_2011.doc revised 08109111 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(E)cupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your nam stin1g yourself as the builder of the property improvements spnieloew D i rL41MArA e)11 SITE ADDRESS ��DgTC14 (�%O e . . API 3%Gtjr D9� ZZ� BP# , IiOWNERNAME C/�o/ OWNER ADDRESS 10,2_/a lA16op Pr- rDESCRIPTION DESCRIPTIONOF WORK: 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.) 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. `fes _C_2. 1 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. 13. 1 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. lk_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. 1ot 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the al 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. e— 6. 1 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. �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. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for ny financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. 7k11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. 9—<12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information l have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint.. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verificatio acceptable to the city may be required to be presented when the permit is issued to verifv the property owner's sign re. Property Owner's Signature: L,!I� ) Date: (-+Gb 16i /V16 --(-N--O--T-E--:--The--Tc--ow--i-n-g-Au--th--oriza-ti-o-n--F--or-m---i-s--r-e-q--u-re--d -t-o--b-e---c-o-m--p--l-e-t-e-d--b--y--t-h-e--p--r-o-p-e--r-ty--o-wn-e--r--o-n-1-y- -w--h-e--n--d-e--s-i-g-n-a--t-in--g--a-n- n---- agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's drivers license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owners signature. Property Owner's Signature: Date: OwneYBuildeYForm 2010.doc revised 04/14/10 CUPERTINO Building Department CITY OF CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3228 • FAX: (408) 777-7606 OFFICIAL, NOTIFICATION OF NEW SUITE NUMBERS TO: All Agencies FROM: City of Cupertino DATE: February 01, 2016 RE: New/Change of Address APN #369-08-028 Please note the following new address: 10210 Richwood Dr is adding an attached 2nd unit. The main house will remain 10210 Richwood Dr and the new 2nd unit will be 10208 Richwood Dr. The new address will take effect 15 days from the date of this letter. See attached map. Please update your records accordingly. If you have any questions, please call me at (408) 777-3246. Sincerely, �� Susan Winslow Administrative Clerk Cupertino Building Dept 408-777-3246 or suew@cupertino.org PROP. LINE: 10.00' 13 in ry W. O lu Q d) P L6 cl- ADJACENTz ADJACENT HOME �(7 HOME 10188 i� 10224 RIGHWOOD OL RIGHWOOD DR M I NOUS DR rE) (E) ANDSGAP FLANr,)SGAFE LINE: 10.0 ' ( ) DRIVEWA DEY4AL )L Nps PE° --------------------- RiCHWOOD DRJVr= ----------------------------- (E) LAND5GAPE SIDE^ALK OPPOSITE HOME: 102 1 1 RIGHINOOD DR SITE P"N SCALE:1'=ze--W PROJECT: 162149 RICHWOOD DR