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B-2016-2091CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-2091 7770 ROBINDELL WAY CUPERTINO, CA 95014-5013 (362 23 007) DA CHUNG INCORPORATED SAN FRANCISCO, CA 94122 OWNER'S NAME: N KEN JEN-GOW AND WANG DAPHNE LEI -HUNG . DATE ISSUED: 09/29/2016 OWNER'S PHONE: 408-896-1868 PHONE NO: (415) 385-7206 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #809529 Contractor QA CHUNG INCORPORATED Date 06/30/2018 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: CONVERT/REMODEL BEDROOM #1 INTO A FULL BATH AND I hereby affirm under penalty of perjury one of the following two declarations: STORAGE CLOSET (130 SQ FT); CONVERT!REMODEL BEDROOM i. I have -and will maintain a certificate of consent to self -insure for Worker's #5 INTO A FULL BATH AND WALK IN CLOSET (100 SQ FT); Compensation, as provided for by Section 3700 of the Labor Code, for the REMODEL BATHROOM #1 & #2 (100 SQ FT); CONVERT BEDROOM performance of the work for which this permit is issued. have #3 INTO A DEN AND ADD EXTERIOR DOOR AND REPLACE z I and will maintain Worker's Compensation Insurance, as provided for by WINDOW; ADD WINDOW AND REPLACE WINDOW IN MASTER Section 3700 of the Labor Code, for the performance of the work for which this BEDROOM. permit is issued: APPLICANT CERTIFICATION - Sq. Ft Floor Area: Valuation: $135000,00 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 APN Number: Occupancy Type: inspection purposes. (We) agree to save indemnify and keep harmless the 362 23 007 City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point PERMIT EXPIRES IF WORK IS NOT STARTED source regulations per the Cupertino Municipal Code, Section 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LASTJCA L INSPECTION. Sign eDate 09/29/2016 OWNER -BUR DER DECLARATION Issued by; MELI SA Date: 09/29/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons:. 1. I, as owner of the property, or my employees with wages as their sole RE -ROOFS: compensation, will do the work, and the structure is not intended or offered for All roofs shall be inspected prior to any roofing material being installed. If a roof is sale (Sec.7044, Business & Professions Code) installed without first obtaining an inspection, I agree to remove all new materials for z. i, as owner of the property, am exclusively contracting with licensed inspection. contractors to construct the project (Sec.7044, Business & Professions Code). Signature ofApplicant: I hereby affirm under penalty of perjury one of the following three declarations: Date: 09/29/2016 i, 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 3700 of the Labor Code, for the performance of the work for which this HAZARDOUS MATERIALS DISCLOSURE permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 3. I certify that in the performance of the work for which this permit is issued, I California Health & Safety Code, Sections 25505, 25533, and 25534. I will shall not employ any person in any manner so as to become subject to the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous Worker's Compensation laws of California. If, after making this certificate of material. Additionally, should I use equipment or devices which emit hazardous exemption, I become subject to the Worker's Compensation provisions of the air contaminants as defined by the Bay Area Air Quality Management District I Labor Code, I must forthwith comply with such provisions or this permit shall will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and be deemed revoked, the Health & Safety Code, Sections 25505, 25533, and 25534. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is Owner or authorized agent. . correct. I agree to comply with all city and county ordinances and state laws Date: 09/29/2016 relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance to save indemnify and keep harmless the City of Cupertino against liabilities, of work's for which this permit is issued (Sec. 3097, Civ C.) judgments, costs, and expenses which may accrue against said City in Lender's Name consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Lender's Address Code, Section 9.18. ARCHITECT'S DF. RATION I understand my plans shall be used as public records. Signature Date 09/29/2016 CONSTRUCTION PERMIT APPLICAT[ON COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255' CUPERTii+t© (408) 777-3228 - FAX (408) 777-3333 -building(5moer'tho orq NEW CONSMUCTION ❑?ADDITION TE L410N I TI ❑ REVI ON / DEFERRED ORIGn,?AL 11MU TT R Kama a 13 MEW PROJECT ADDRESSi [ I ! APh' R v✓ dj tjlj m l 4 # Otl WERN11,1F ti PHONE � � E-T&JI FAX STREET ADDRESS ;v e et , MY, STATE, ZIP : e CA Ito( Y; I E-A24fL% CONTACT NAME lscc6, "0NE &0^ 9V �C ,h , Et ETRADRESS [i►iel CriY, STATE, ZIP !"ffC` FAXL i4OV,'NER. 13 owalER-maDER ORTn .R•AGENT 13 Cp TRACTOR ❑' CONTRALTORACENT ❑ ARCHITECT 0 ENGA'£ER ❑- D£VELOPUL ❑ TENANT CONTRACTOR NAAiE �--1 f° t� LICEI�TSEAT MBER' �� S� LICE? SE TYPE may. SU$,IfC# ���•� COW AM NAMOB � E-MAIL FAX STREET ADDRESS CITY, STATE ZIP PY.ONE ARCHITECT&NOMERNA IE I LICi ,'S£NUIJB£it BUS.LIC,: COMPANY NAME E-MAIL FAX STREET ADDRESS � CITY, STATE, ZIP PHONE -AIP7lON OP \110 4litt l +-1 0 wi iCldlS� i YIfCYr`Gj{$ CJ Ii6t, F-XiSTiNG tJS PROPOSED L'SE Comm.. nzv RSIORIES USE TYPE f I� DCC. SQ,FT, { I \tAS.i3AT'lON fS} EXiSTG NEW FLOOR DPh1O TOTAL AREA AREA A.P A NET AREA BATHROOh! R£h40DELAREA 7ITCY.$N OTHER REMODEL AREA REMODELAREA PORCHARSA DECK AREA TOHAREA GAP.AGEAP.£A; LiDETACH © ATTACH D a ELUNG UNITS: IS A SECO'iD U. © YES BENGADDED? © '0 SECOND STORY [:])'ES ADDITION? []I+TO ! A. 1 • (` PPt=-4PPLiG4T1O*2 [:)YES IF�wS,PP.OVIDECOPY OF ISTHMW)GAN ❑YES RR?Cb� ,!: ";.- .. � �- �'. # TdTALVALU.4TION: PLAtd7�3NO APPLR ❑ }.D PLAT,?iINO AFPROI�A.L LETTER EICXLER HOA'I€? ©NO yQ By my signature -below, I certify to each of the follow=ing: I z; the property owner or authorized ag&lMacto the behalf. 1 bade read this application and the infotmadon I have provided is correct, have read the Description of SNrorl€ and verify it IS accurate. I agree to comply with all applicable local ordinances and state law's relating to building conshuction. mhorize rep,esentatives of Cupertino to enter the zboae-identified property, for inspection purposes. Signature ofApplicartl,4gent: SU? PLEirjENTAL.I? IF0RMTTION RE LURED 4 �9^.:P�.�_'� CHECI.�7`P,£'z�;S�,= ,' -a•, 720LTygIa?i. SLiP� �..-��`�x.�e• ra'rk'",,44Y``i7r'�-": ' tip c� 1 '�iF;''.a�ls� '`i`5i'i"%J�S.�.•c'�a,=. BUILDI\GPL'�RHII£\I',iir } ° r ' T v New SFD or T�liltifanuly dal°ellin�s: ripply for demolition permit for -mit imaA building existin buildings . De1noiitioll et is r2 aired prior to ce of penriitforDewbuildin'g -, ;' ������� k� �� -� � pl;�titi�crD�4Tt���xE � • '�" 2'•.�;s.;:� c�`�x�`-�-.,y'.;-n �;K*, F..y:t;;.:'' -.• `ii'4•i3 ' E. . . f > .. I _ _ Canluercial Bldgs: Provide a completed Hazardous Kiat Iia1s Disc.oauie ;,. a tx ,� sT ti�Ain;' x '. ?' _ y- _' 3'( l ^ ��`.Z_s)s':Y :4-f i cf ,x.:+.'59 �tL.;�sx. , r...k-.� _.. LJF I EitCtVo t i 2}- i" F. +u-Ri•iK iO31I1 if any Hazardous l\�,areri2l5 are being used 25 Dai, GI This project. 4 �s � Yr ,�.��" � �� �,� ��•.. �x L•AP.GE•, '3 -2?, _ •+ ,i ter- �;, f;'.1- FIREDEPi'sz.aiva __ I Q A ro\lal Letter of l\feetira WithPlannin� prior to CO of Plaiming l�il o c i7 jr�;�`I y e 3 3 +rS iAdOR;: _'> -- ` -'• :.,� g•S�,iIT_LRlSi\I£R I_TItICTift; , ' :- subi�zittal of i3uildin� Pel -mita liczt10M P13 :s.,a y„y _ ;:r? 7 r x:� - r=:2 W. - `r.� th�q h � . a� �'°� aid' t I # y �: , ��:�_h: ;k: ,�; ” �ylx�:�'': ©6 t � :y'� 3a; ,.fry ��iL': _—k �. E\["IRd\94E;<T4L I3SALTH -t� .'i•.` BIdn :pp 201l.doc revised 06121/11 CUPE.RTINO ME SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(c)-cupertino.ong PERAW CANNOT BE :FINALED AND COMPLETED UNTIL THIS AAC'.RF.I+i1i CTf:'WD AIVn TWIMIDV "rrn 9rUV 'U1rTTr "TWIT T PURPOSE h This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CSC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufactarer's instructions and in compliance with the Califon -da Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. 1 have read and agree to comply with t e toms and conditions of this statement -caner(on Owner Agenf's) Name: Si na e ..................................................................?: Date .................. ............. .......................... Confracto1 Name: rSian fure........... ................................................�.Lic#............ ....................... a;D`ate .................. Smoke and CO forin.doc revised 03/18/14 CUPERTINO Owner Name Address Z t7990-- WATER­CONSERVIPLUMBING FIXTURES M OWNER CERTIFICATE OF COMPLIANCE COtv9€vtUN Tl' DEVELOPMENT DEPARTMENT - BUILDING DiVIISIO IN Plyz 10300 TORRE AVENUE - CUPERTINIO, OA 95014-3255 4tti8 777-3998 a 1=AX(408) 777-3333 - _b0dingftupertino.org I Permit Nod ��',L Z� r 1 L wt 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. N No Go to Question 2. 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. _ Skip the rest of the form and sign bottom of form. i No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. 9 Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 110 1. 1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. 5. Please check ONE of the following: 7 [fit My property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non- compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ Myproperty is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures.. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). ❑ My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water_ conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). 1, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water-conservi-ng plumbing fixtures in accordance with Civil Code Sections 1101.1 through 110.1.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -cons ervg plumbing fixtures comply with the requirements as indicated in the table on the following nage. - Owner or Owner Agent's Signature, 1 ;—i. Daf6-, 1 �L ,6— 2D 617 Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit. SB4072015.doe revised 08/26/15