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B-2016-2308
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERM! NO:B-2016-2308 22563 WOODRIDGE CT CUPERTINO,CA 95014-2674(342 15 064) THD AT-HOME SERVICES INC ATLANTA,GA 30339 OWNER'S NAME: KIM INSOO AND YUNSOOK DATE 1,0: SUED:07/13/2016 OWNER'S PHONE:408-230-5885 PHONE (770)779-1423 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#836021 Contractor THD AT-HOME SERVICES INC Date 04/30/2018 X BLDG _ELECT _PLUM B _ 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: REPLACE WINDOW-MASTI R BATHROOM;REPLACE PATIO' I hereby affirm under penalty of perjury one of the following two declarations: DOOR-FAMILY ROOM i. 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. 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: Valuatio ;$5552.00 APPLICANT CERTIFICATION' 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 APN Number: Occupal cy Type: and state laws relating to building construction,and hereby authorize 342 15 064 representatives of this city to enter upon t�in�difty entioned property for inspection purposes. (We)agree to save nd keep harmless the City of Cupertino against liabiliti judg and expenses which PERMIT EXPIRES I F WORK IS OT STARTED may accrue against said City' ons ence of the granting of this permit. WITHIN 180 DAYS F PERMIT ISSUANCE OR Additionally,the applicant u d st ds and will comply with all non-point source regulations per th C ino Municipal Code,Section 9.18. 180 DAYS FROM LA ST CALLED INSPECTION. .Signature_ Date 7/13/2016 Issued by:Abby Ayende Date:07/13/2016 OWNER-B D DECLARATION I hereby of that I am exempt from the Contractor's License Law for one of the following reasons: All roofs shall be inspected prior t any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining ani ispection,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) 2. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:7/13/2016 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 I AAT RIAL DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous mate ials 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 Co le,Sections 25505,2 533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 5532(a)should I sto a or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I e equipment or devi es whic hazardous air contaminants as defined by t Bay Area Air ali n ment District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with th Cupertino u 1 e,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the health&Safety Co e,Sectio 25 ,. 33,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Oer or authorized agent: r APPLICANT CERTIFICATION C.Date:7/13/2016 I certify that I have read this application and state that the above information is N TR LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there isc struction lending ag ncy for the performance relating to building construction,and hereby-authorize representatives of this city of work's for which this per is ssued(Sec,3097,'C iv 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 T' DE ARA N Code,Section 9.18. I understand my plans shall be u ed as public records. Licensed Signature Date 7/13/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228• FAX(408)777-3333•buildingO)cupertino.org w �� CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS � VVW ,� APN# r .� 6 OWNERNAME 2%0`0 U'l, d PHOYE108 `�,11 -S65,(- E-MAIL STREET ADDRESS CITY, STATE,ZIP FAX CONTACT NAME PHONE 10_B7 t_` SSO E-MAIL STREET ADDRESSqqo 1 CITYSTATE, FAX OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR CONTRACTORAGENT ❑ ARCHITECT ❑F GINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEA LICENSE �R` S LICENS YPL BUS.LIC# V t L (3 COMPANY NAME ! E-MAIL ` FAX STREET ADDRESS �ry„„ CTTY�Sp,T9A^'TE, b G I l PHOT o✓16 ,1—! S t_f}y. ARCHITECT/ENGINEER NAME �f� LICENSE NUMBw EER BUS.LIC# �a�lJ COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK � Q `� 7aUX \N EXISTING USE _ PROPOSED USE CONSTR TYPE #STORIES USE TYPE OC SQ.FT. NfALUATION($) EXISTG 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 I GARAGE AREA: DETACH r ❑ATTACH #DWELLING UNITS: ISASECONDUNIT ❑YES SECONDSTORY ❑YES BEING ADDED? ❑NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN RECEIVED$Y, � ( T 'JON: L PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? g 1r f i By my signature below,I certify to each of the following: perty owner or authorized agent to act on the properly o)mer's behalf. haver ad this application and the information I have provided is .I read the Description of Work and verify it is accurate. I agrec to comply with all app"cable local ordinances and state laws relating to building ns authorize representatives of Cupertino to enter the above-identifie prop rty for Ispectiol I purposes. Signature of Applicant/Agem: Date: ' SUPPLEMENT ATION REQUIRED ' 'IP Q -,' PLANGIECTTYPE "., 2�' „xn< ROifi1IN SLIP New SFD or Multifamily dwellings: Apply for demolition permit for -(ri�ER T�-CO[7NT`ER © BUILDIN�TLx1N REYiEw existing building(s). Demolition permit is required prior to issuance of building permit for new building. g EXPREs © rAlvrtrNP RviEw� ltes s� _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD ❑ �UBLIc woxi�s ' form if any Hazardous Materials are being used as part of this project. r �`.�ARGE=�'' � ❑>FIREDEPT-.- _Copy of Planning Approval Letter or Meeting with Planning prior to ZW ❑+1ViA70R" r 'SANITARXRE RDISTRICT submittal of Building Permit application. - i=:., a.. . ❑.�I�1'IRONNfENT L HEAG'1T[ "":`'• ' ldgApp_2011.doc re vised06121111