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B-2016-2613CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT :B-2016-2613 1151 S STELLING RD CUPERTINO, CA 95014-5020 (362 22 016) HOME TECH CONSTRUCTION HOLLISTER, CA 95023 OWNER'S NAME: PARK CHAEUN AND CHON DAVID ET AL DATE ISS D: 11/04/2016 OWNER'S PHONE: 408-963-3697 PHONE NO: (831) 638-1723 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #748910 Contractor HOME TECH CONSTRUCTION Date 05/31/2018 X BLDG X ELECT -PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing _ MECH X RESIDENTIAL._ CQMMERCIAL 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: 1 ST FLR, EXTEND BEDROOM/DEN & ADD 1/2 BATH (145 S.F.); RELOCATE (E) ELECTRICAL W, TER; CONVERT BEDROOM TO i. I have and will maintain a certificate of consent to self -insure for Worker's DEN AND REMODEL BEDROOM (250 SQ FT); DEMOLISH STORAGE Compensation, as provided for by Section 3700 of the Labor Code, for the SHED (80 SQ', FT). 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: 145 Valuation: $33000.00 APPLICANT CERTIFICATION 1 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: Occupancype: and state laws relating to building construction, and hereby authorize 362 22 016 Deferred Submittal (R -3),R-3 (Custom) 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 this permit. may accrue against said City consequence the granting all Additionally, the applicant understands and will comply with. all non -point WITHIN 180 DAYS' OF PERMIT ISSUANCE OR , source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature / //ate 11/04/2016 Issued by. MELIS. OWNER -B ILDER DECLRATION Date: 11/04/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the RFQOF 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 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) 2. 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: 11/04/2016 I hereby affirm under penaltyof perjury one of the following three declarations: 1. 1 have and will maintain a Certificate of Consent to :self -insure for Worker's AT,T, ROOF COVERINGS TO BE CLASS "A" OR BETTER _ 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 a 1 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. 1 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 shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I 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, S etions 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. i Owner or authorized agent: APPLICANT CERTIFICATION Date: 11/04/2016 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 applicant understands ARCHITECT'S DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 1 understand my plans shall be used las public records. Signature Date 11/04/2016 g -I Licensed Professional CUPERTINO -M NF.W CCINRTRT 1f17`V W CONSTRUCTION PERMIT, AfION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buiidingQ)cupertiilo.ara � Z -0oti�� (7 I JL 1 A nnl'rlA'KT I r-1 I A T =T A TTnxT l PROJECT ADDRESS Cc e rh no APN # C 2 L, 2 - OWNER NAME IrVIGi'P.U:VI rL.�4G. PHONE'S STREET:ADDRESS L a4� e U CITY, STATE, ZIP f FAX CONTACT NAME _, PHONE t - E-MAIL " STREET ADDRESS CITY, STATE, Zit' (fit s s1 FAX Wf OWNER El :OWNFR-BUILDER ❑. OWNER AGENT O CONTRACTOR 11 CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMET$ ® LICENSENUMBER LICENSE TYPE BUS, LIC 0 COMPANY.NAME E-MAIL - FAX . STREET ADDRESS CITY, STATE, ZIP ,. PHONE ARCHITEMENGINE•ER NAME � �� �.� I� LICENSE NUMBER „ ` r n ��� `^ SUS. LIC R Ar f 1 1�1 try l I.... 'v(Tr. 1. 1. e� COMPANYNAME N I A - - E-MAIL j� T( A 11 6:C V ti-k0C). CDv14 FAX STREL•'1'ADDRL+55/( UKi41G BVI S� C!'fY',S'I'ATE,"G]Y �.tE fi�5. (A- 45D93�: 1HONL�4-314 m7+33 _D�CRItTIONDF:WOR.ICi -.."S' p " �D7LiISf�i`1_. HA I,- cd f bad mc'vii bvl. •-& T &-r .-Ro G: r C 2,5 S Fel o ccuh i i'1 of e'! e chC i%'Hlr EXISTING USE: PROPOSED US'.tB - CONSTR. 1(O.l TYPE VZ' N STORIES USE TYPE OCC. SQ.FT, VALUATIONS) EX[STGt ARL'A�y�t� NEW FLOOR. AREA 1��1_ DEMO AREA • TOTAL I�cf NET AI a �nl BATHROOM KITCHEN - O'rHER- REMODFLARF.A eREMODEL AREA RFMODELAREA 12-5 FORCH ARRA DECK AREA TOTAL DEt'KJPORCff AREA " GARAOF AREA: []1I DETACH N DWELLING UNITS: ISA SECOND UNI'[ [] YES SECOND STORY O YLS f BEINGADDED? NO ADDITION? NO PRE -APPLICATION Z'ES IF YES, PROVIDE COPY OF IS THE BLDG AN DYES .. .. :.. TOTAL VALUATION: PLANNENG ADPL$ ND F,'�LRI;,I �a4PROVAL LETTER EICHLER HOME? NO p0. By my signature below, I certify to each of the following: I ant the property owner or authorized ant to s e property oer s e : -have read this . iE it is ac t . agree to comply with all applicable local application and the information Ihave provided is correct. I have read the Description or Work andcr ordinances and state laws relating to building construction. I authorize representatives of Cupertino,to enter the above-identifiedfar inspection purposes. 1properly Signature of ApplicantlAgent: Date: `�/ -36 / I SUPPLEMENTAL TNFORMATION REQUIRED PLANCHECKTYPE . ROUTING,SLIP ' O OVER-TIIErCOUNTER C] BUILDING PLAN REVIEW _ New 5FD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is requited prior to issuance of building permit for new building. 0 EXPRESS Q PLANNING PLAN -REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11 STANDARD I] PUBLIC lioatKs Term if any Hazardous Materials are being used as part of this project. (] LARGE FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to © AliAJOR SANITARY SEWER DISTRICT submittal of Building Permit application. - 0 ENVIRONNIENTALHEALTA Ble1 4pp_2011.doc revised 06121111 11041 CUPERTINO 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(a.cupertino.orq PURPOSE TI -as 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 vicuuty of the bedroom(s) X X On every level of a dwelling unfit 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 alarins combined with smoke alarms shall comply with CBC 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 alann(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms specified below have been tested and are operational, as of the date signed below �+ ,ll Address- I � � S�L11 A �XM 4'0 3 cA �Jv�� Permit l\To � —Za f 6- � 6 (.� s Specify Number of Alarms # Smoke Alarms. # Carbon Monoxide Detectors i I have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: ! A Da Signature Ute"" te: X1251, -' K ea?*-*- J'0 Contractor Name: Signature Lic.# Date: Smoke and CO form.doc revised 09,27/16 WATER -CONSERVING PLUMBING FIXTURES 1 OWNER CERTIFICATEF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT a BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE - CU ERTINO, GA, 95014-3255 (408) 777=3228 ® FAX (408) 777-3333 m buildin-gAcupertino,om Owner Name ' _t o Ar j Permit Nod Q —2t) 14 Address _� 1_( �i s � (th_Q �e ® f l-Vto 7—rA '-1) / 1. Is your real property -a registered historical site? 4V❑ Yes Civil Code Sections 110 1. 1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. 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 Cade Sections 1101.1 through 1101.8 do not apply. 0 The licensed -plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. Ltd 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 forma C"No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, -1994? 19, 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. es My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. Please check ONE of the following; 13 --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). My property is a multifamily.residential real property. See Civil Code Section 1101.5. On and after January 1,;2014, specked 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 improvernents). ❑ 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 -conserving plumbing fixtures in accordance with Civil Code Sections 110 1. 1 through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements„ and that the water -conserving plumbing fixtures comply with the requirements as indicated in the table on the following nage. Owner or Owner Agent`s Upon completing and signing this Certificate, pld'ase return it to the Building Division in order to final your buildina vermit. SB4072015.doc revised 08126/15