B-2016-1473CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1473
22643 WOODRIDGE CT CUPERTINO, CA 95014-2686 (342 15 072)
OMEGA
CONSTRUCTION
SAN JOSE, CA 95117
OWNER'S NAME: HUANG AN-CHENG AND CHEN SZU-NING
DATE ISSUED: 06/13/2016
OWNER'S PHONE: 408-540-4078
PHONE NO: (408) 605-8113
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic. #586016
X BLDG
Contractor OMEGA CONSTRUCTION Date 01/31/2018
—ELECT _PLUMB
MECH X 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:
CONSTRUCT (N) 2ND STORY ADDITION (530 S.F.); INTERIOR
I hereby affirm under penalty of perjury one of the following two declarations:
REMODEL OF FOYER AND BATHROOM (60 S.F.) AND REPLACE 3
1. I have and will maintain a certificate of consent to self-insure for Worker's
SKYLIGHTS
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
/10 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
Sq. Ft Floor Area: 1060
Valuation: $180000.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
342 15 072
342
Deferred Submittal (R-3),R-3 (Custom)
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, 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 /13 2016
Issued by: Abby Ayende p� �y ��Qy
AA
Date: 06/13/2016 `/ ►� v
OWNER-BUILDER DER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE.-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
t. I, as owner of the property, or my employees with wages as 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: 6/13/2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
t. 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
2. 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
Worker'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 permit shall
�1
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 6/13/2016
I certify that I have read this application and state that the above information is
CONSTRU TION LEND F Y
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a construction lending agent a 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 applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
I understand my plans shall be used as public records.
Licensed
Signature Date 6/13/2016
professional
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W H. YANG
STRUCTURAL 'ENGINEERING SERVICE MFILk
10' lb,
October 2, 2016
City of Cupertino, Inspection Services
10300 Torre Avenue
Cupertino, CA 95014-3255
Attn: City Inspector
Re PERMIT #: 2016-1473 - (APN# 342 15 072) pow
bnA
Owner: HUANG AN-CHENG AND CHEN SZU-NTNG
Address: 22643 WOODRIDGE CT
This is to certify that in accordance with Section 1710 of the California Building Code, we have
provided special inspection for the following construction:
High strength bolts for steel moment frame connections tighten to specified torque as
specified by EOR.
The special inspection were performed by the undersigned Registered Structural Engineer in the
State of California. Based upon inspection performed, it is our professional judgment that, to the
Voest of our knowledge, the inspected'structural work was performed '*in accordance with the
approved plans, specifications, and applicable workmanship provisions of the California Building
Code.
Very truly yours,
10,
S5347
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UC
FC
W. H. Yang, PhD, SE
CC. Jung Huh/General COntractOr
1164 SUSAN WAY, SUNNYVALE, cA 94087-1659 T: 408.329.8787 F: 408.228.5176 E: w.x YANG@z IOTM kIL.COM
W. H. YANG
STRUCTURAL ENGINEERING SERVICE F1FAU�Z V)D
September 15, 2016
City of Cupertino, Inspection Services
10300 Torre Avenue
Cupertino, CA 95014-3255
Attn: City Inspector
Re: PERMIT #: 2016-1473 - (APN# 342 15 072)
Owner: HUANG AN-CHENG AND CHEN SZU-NING L�-
Address: 22643 WOODRIDGE CT
This is to certify that in accordance with Section 1710 of the California Building Code, we have
provided structural observations for the following construction:
Epoxy application for anchorage bolts and hold-down anchor rods at existing concrete
foundations;
Timber framing and connections;
Steel Moment Frame, and welding & bolting.
The structural observations were performed by the undersigned Registered Structural Engineer in
the State of California. Base upon observation performed, it is our professional judgment that, to the
best of our knowledge, the observed structural work was performed in accordance with the
approved plans, specifications, and applicable workmanship provisions of the California Building
Code.
Very truly yours,
W. H. Yang, PhD, SE
FESS{�
LU S5347
EXP .6�� u,!$
CAL�
CC. Jung Hun/General Contractor
1164 SUSAN WAY, SUNNYVALE, CA 94087-1659 T: 408.329.8787 F: 408.228.5176 E: W.H YANG@IIOTMAIL.COM
Project Name:
Project Address:
Project Description:
CALGREEN SIGNATURE DECLARATIONS
228143 WOODRIDGE CT. REMODEL AND ADDITION
22643 WOODRIDGE CT.
INTERIOR REMODEL AND SECOND STORY ADDITION
SECTION 1 — DESIGN VERIFICATION
Complete all lines of Section 1 — "Design Verification" and submit the completed checklist (Columns 1 and 2) with the
plans and building permit application to the Building Department.
The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and
certify that the items checked above are hereby incorporated into the project plans and will be implemented into the
project in accordance with the requirements set forth in the 2013 California Green Building Standards Code as
adopted by the City of Cupertino.
Owner's Signature Date
5ZU-NTNG CHEN
Owner's Name (Please Print)
Design Professional's Signature Date
SHEN-I CHIOU _
Design Professional's Name (Please Print) _
Signature of License,, /)
P, rroffessional responsible for CalGreen compliance Date p
th
vo
Name of License Professional responsible for CalGreen compliance (Please Print) Phone
sc,h r "60 o carch. net.
Email Address for License Professional responsible for CalGreen compliance
SECTION 2 -- IMPLEMENTATION VERIFICATION
Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section
2 to the Building Department prior to Building Department final inspection.
I have inspected the work and have received sufficient documentation to verify and certify that the project identified
above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of
the 2013 California Green Building Standards Code as adopted by the City of Cupertino.
S, Cf - 117'
Signature of License Professional responsible for CalGreen compliance bate
N _z Q 44b''318 311fl f
Name of License Professional responsible for CalGreen compliance (Please Print) Phone
Email Address for License Professional resoons IGreci
REVILWEU £vh� CJDL CO PUANCE
Page 5 of 5 Review .d 3y: Phucing Devrie5 Calrreen, 2014.dar reiised 11104/14
Date: 06iG9116