B-2016-1442 CITY OF1CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1442
7530 WATERFORD DR CUPERTINO,CA 95014-5234(366 16 013) HOMEOWNER/BUILD
ER
OWNER'S NAME: Changyu Lee DATE ISSUED:02/26/2016
OWNER'S PHONE:408-887-1299 PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor HOMEOWNER/BUILDER Date X BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X 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:
RECONFIGURE AND REMODEL 2(E)MASTER BATHS(101 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 REV#I-REMODEL MASTER BEDROOM AND DOWN STAIRS
Compensation,as provided for by Section 3700 of the Labor Code,for the BATHROOMS-ISSUED 6/10/2016
performance of the work for which this permit is issued.
z. I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3706 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$30000.00
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 ordinances "N Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 366 16 013
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 600/2016 Issued by:ABBY AYENDE
Date:02/26/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License iLaw for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages las their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:6/10/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
1. orker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this pemrit shall w
be deemed revoked. Owner or authorized agent: /f
APPLICANT CERTIFICATION Date:6/1012016
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the abplicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date10 2016 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1442
7530 WATERFORD DR CUPERTINO,CA 95014-5234(366 16 013) OWNERBUILDER
OWNER'S NAME: Changyu Lee
DATE ISSUED:02/26/201.6
OWNER'S PHONE:408-887-1299
PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class Lie.#
Contractor OWNER/13ILDER Date .X BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X 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:
I hereby affirm under penalty of perjury one of the following two declarations: CONFIGURE AND REMODEL 2(E)MASTER BATHS(101 S.F.)
1. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 ofthe Labor Code,for the
performance of the work for which this permit is issued.
2. 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 permit is issued.
APPLICANT CERTIFICAT ON Sq.Ft Floor Area: Valuation:$30000.00
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 366 16 013
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
granting of this permit. Additionally,the applicant understands and will WITHIN 180 DAYS OF PERMIT ISSUANCE OR
comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Issued by:MELISSA NAMES
Date Date:
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(See.7044,Business&Professions Code) Signature of Applicant:
2. I,as owner of the property,am exclusively contracting with licensed Date:
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"OR BETTER
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 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(a)should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
the Health&Safety Code,Sections 25505,25533,and 25534.
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
be deemed revoked. Owner or authorized agent:
Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for 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
consequence of the granting of this permit. Additionally,the applicant ARCHITECT'S DECLARATION
understands and will comply with all non-point source regulations per the I understand my plans shall be used as public records.
Cupertino Municipal Code,Section 9.18.
Licensed
Signature Date Professional
i
- CONSTRUCTION PERMIT APPLICATION
I
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
I
10300 TORRE AVENUE•CUPERTINO,CA 95014=3255
!a 1
GUFERi-INCJ (408)777-3228• FAX(408)777-3333•build ingCa-)cupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI [jrREVISION/DEFERRED ORIGINAL PERMIT# 16 vV'6— 4447
'-
PROJECT
PROJECT ADDRESS StO ,n /�,^'� X77,n '.^I J ✓✓��lX v
OWNER NAME 6 VVATF—!' I�`�CI`V/ vl PHONE fd_ p p q✓pq E-MAIL
STREET ADDRESS CITY,STATE,ZIP 60 FAX
CONTACT NAME PHONE,,hg_ D�^_ gn E-MAIL
57
STREET ADDRESS CITY,STATE,ZIP 6 b Y FAX
❑ OWNER ❑ OWNER-BUDDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME � � � � LICENSE NUMBER5-% ,15'-33 LICENSE TYPE BUS.LIC# 3 T
COMP NAME E-MAIL FAX 7 J
r-RF S . ucep 449 t;uvry
STREE J2D ESS CITY,STATE,ZIP PHONE-7- 13 9 5 4
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NEFAREA
BATHROOM KITCHEN OTHER
REMODELAREA �• REMODELAREA REMODELAREA
PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARP'GE AREA: E]DETACH
❑ATTACH
#DWELLING UNITS: ISA SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? ❑NO ADDITi3ON? ❑NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE�LDG AN ❑YESREC>~IUED BY; TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHL�R HOME? ❑NO
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 riead the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I autho�&e representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: _ _ _ Date: q t n2T74
SUPPLEMENTAL 1NFORMATI Q1RED PLAN CHECKTXP,E" ROUTINGSLIP,
New SFD or Multifamily dwellings: Apply for demolition permit for. ❑<oYER T13E coUNTR ❑ BUILDING rLAN REv1Ew
existing building(s). Demolition permit is required prior to lissuance of building
permit for new building. j ❑:',EXPRESS ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous 1Vaterials Disclosure ❑;STANDARD ? ❑ PUBLIC wORKs
form if any Hazardous Materials are being used as part of is project.
' RGE': ❑.FIRE DEPT,
❑ LA = '
_Copy of Planning Approval Letter or Meeting with Planning prior to "
❑;MAJOR ❑"SANITARY SEWER DISTRICT ,
submittal of Building Permit application.
❑ ENVIRONMENTAL,HEALTH
B1dgApp_2011.doc revised 06121/11
_ 41-O. _ REVISION
J0 0
OPY
THIS PLAN L 9�E � IIN ON
THE J0 �� PI d I W m '\l
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DUAL FLUSH
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COMMUNITY DEVELO ; �W 1 =t AI�EIQi - - SCOPE OF WORK
BUILDING DIVISION -�► ERTI '� JACUZZI TUB WI MOTOR ACCESS
APPROVED
i
This set of plans and specification. MUST be kept at the - - -
- - - ------ -- -- - - ---
job site during construction. It is a lawful to make any
changes or alterations on sa 13,or to deviate
therefrom,without approval fron I he Building Official.
The stamping of this plan and spe ications SHALL NOT
bo'held to permit or to be an ap r►►val of the violation
of any provisions of any City Orc it ance or State Law.
BY bW- —
DATE -. (j
PERMIT NO.
CIS
Y -G- ,,:0-"1,
�
F I., JUN
NEW FLOOR PLAN (REVISED
Scale: 114"= 1 '-0” 13-Y
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