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14040191CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10373 MENHART LN CONTRACTOR: EMPIRE FLOORING & PERMIT NO: 14040191 DESIGN CENTER OWNER'S NAME: HOON SANG YI 495 E BROKAW RD DATE ISSUED: 04/28/2014 OWNER'S PHONE: 4086214828 SAN JOSE, CA 95112 PHONE NO: (408) 213-0996 JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ LICENSED CONTRACTOR'S DECLARATION REMOVE & REPLACE ONE (1) BEAM & (1) FOOTING #M:?,? REV # 1- REVISE ( E FOOTING WITH STRUCTURAL _License Class ,$- _Lic. DETAILS - ISSUED 5/22/14 Contractor r Date Av�lx I hereby affirm that I am licensed under the provisions Cha ter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 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. Sq. Ft Floor Area: Valuation: $4000 `- 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 APN Number: 37515045.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter LED INSPECTION. 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 may accrue against said City in consequence of the Issued by: ZZ granting of this permit. Ad 'tionally, the plicant understands and will co n source r ulations e e Cupertino Municipal Code, Section with all non -point p p p 9.18. _ Date_�� RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is Signature installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or vices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Qu ity Management District I will maintain compliance with the C.'no Muni ' al ode, Chapter 9.12 and performance of the work for which this permit is issued. 1 have maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25 25533, nd 534. and will Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date:. permit is issued. 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO 1 (408) 777-3228 • FAX (408) 777-3333 • building0cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION F]ALTERATION / TI 154EVISIO / DEFERRED ORIGINAL PERMIT # / `L a 7 _01 PROJECT ADDRESS !/v���e�P.e. / APN # OWNER NAME PHONE / LtO�% z/ ®e Q v E-MAIL STREET ADDRESS @ — t Q�✓� CITY, STATE,, ZIP F� CONTACT NAMEJ/� mGd /Q OZ .,)a PHONE -OF 6 I 7 / a � J STREET ADDRESS CITY, STATE,, ZIP I el FAX( ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Q/N Q LICENSE NUMBER (IC NSE TYPE o ` J BUS. LIC # COMPANY NAME.��/��i� E-MAIL 1h FAX STREET ADDRESS CITY, STATE, ZIP YTTAIokct�,eD CSa4c 61Je� //.2 P NE oa .L/ OM 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 1 # STORIES USF. TYPE OCC- SQ 1-1, A:ALGAIlO]lS� EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES BEING ADDED? []NO SECOND STORY ❑YES ADDITION? []NO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO R TOTAL VALUATION: By my signature below, I certify to ea?ofe followi I am the pro owne authorize o act o roperty o s behalf I have read this application and the information I havco ct. I have re a Description of Work and veri s accurate. ee to com ith all applicable local ordinances and state laws relating to cons on. I a ri representatives of Cupertino to enter the abov entifie rty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEME7TAL'7VOrwRMAtION REQUIRED _ New SFD or Multifamily dwellings: Apply for demolition permitforVER-THE-COUNTER existing building(s). Demolition permit is required prior to issuance of building permit for new building. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. PLAN CHECK IS PE ROUTING SLIP �M4 EXPRESS ❑ STANDARD ❑ LARGE ❑ MAJOR ElBUILDING PLAN REVIEW ❑ PLANNING PLAN REVIEW ❑ PUBLIC WORKS ❑ FIRE DEPT ❑ SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH BldgApp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10373 MENHART LN CONTRACTOR: EMPIRE FLOORING & PERMIT NO: 14040191 DESIGN CENTER OWNER'S NAME: HOON SANG Yl 495 E BROKAW RD DATE ISSUED: 04/28/2014 OWNER'S PHONE: 4086214828 SAN JOSE, CA 95112 PHONE NO: (408) 213-0996 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL LICENSED CONTRACTOR'S DECLARATION REMOVE & REPLACE ONE (1) BEAM & (1) FOOTING License Class 0 e-45- Lic. #,9� T Contractor,eA& Date I hereby affirm that 1 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. I hereby affirm under penalty of perjury one of the following two declarations: 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 Valuation: $4000 performance of the work for which this permit is issued. Sq. Ft Floor Area: 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 APN Number: 37515045.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 DAYS FROM L D INSPECTION. upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, the / costs, and expenses which may accrue against said City in consequence of Issu Date: granting of this permit. Additionally, the pplicant understands and will comply with all non -point source r gulations pe a Cupertino Municipal Code, Section 9.18. �( /� Lj Signature Date_Y/gll RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is i— installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) HAZARDOUS MATERIALS DISCLOSURE property, rty, am exclusively contracting with licensed contractors to 1, as owner of the roe y g construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: I have will maintain a Certificate of Consent to self -insure for Worker's Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous and Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cuperti o Munici I Code, Chapter 9.12 and performance of the work for which this permit is issued. 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 the Health &Safety Code, Sections 2 , 25533, 25534. `L, Owner or authorized agent: Date: / 7 permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of become subject forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name - APPLICANT CERTIFICATION Lender's Address - 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 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT' BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(akupertino.or4 ❑ NEW CONSTRUCTION ❑ ADDITION 119 ALTERATION / Ti ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS Tc,_375 He0 fit- Zti �,h APN# OWNER NAME C54 w ! / "I `T� /oz (.2)yg'z ,F E-MAIL STREET ADDRESS /O-3 H�/ ' X ' " �Y CITY, STATE, ZIP e-11,1 9b 42 > C Q FAX I T CONTACT NAME ' PHOT'(67��r�SI� I E �J11///L' /DD/! •/ie STREET ADDRESS (/G❑�JOWNER CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER AGENT Jq CONTRACTOR ❑ CONTRACTOR AGF.T ❑ ARCHraCT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME /15 n� Q LICENSE NUMBER c7 ry LICENSE TYPE c/s BUS. LIC 4,,_ COMPANY NAME�e FAX - STREET ADDRESS ^ `. , yl n CITY, STATE, ZI y S //z P NE D ARCHITECT/ENGINEERNAME I LICENSENUMBERe - r� J BUS. LIC# COMPANY NAMEp I -/�C./ �G E-MAIL r FAX "0%J 7/ 1tAo /C.rrl-1/�i1Q/i/ lllC- ��� /1/ ✓ : i STREET ADDRESSCITY, i 87© hay,l;� ��, i4�e• STATE, QIP S/zs-- PHONE iYo�)3777aec DESCRIPTION OF WORK��✓���+' 1 Xe„K EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT, VALUATION (S) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA /U BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH [:]ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEIN'ADDED? ONO ADDITION? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YESRECEIv ' h ex s � ;; ; •; TOTAL VALUATION: PLANNING APPL # ❑NO PLAN'NINGAPPROVAL LETTER EICHLERHOME? ONO -,�`� �,� .-►- By my signature below, I certify to each of the following: I am thf property ox�mer or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is co 'ect. I havead t Description of Work and verify it is accurate. I agree to comply with all applicable local w ordinances and state las relating to building con ction. I horiz epresentatives of Cupertino to enter the above -identified property for inspection purposes. Signature ofApp] icant/Agent: Date: ) SUPPLEMENT (FORMATION REQUIRED PLAN CHECK TITE I ROUTLNG sLiP New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building ovEx;rH>,couI,TER BUILDING PLAN P.EVIEW X, Permit for new building.❑ permitwwo. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure * s n § I'Um. form if any Hazardous Materials are being used as part of this projectCopy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. 0 -SA r". - - -- - _ ❑'ENN'IRO]VTIENTAI:;HEALTH BIdgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO R%_�R7. FFF FgTTMATOR - BUILDING DIVISION o �- NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Publi/ t , Sanitary Sewer District, School n: f—i eThoco Foot aro hacod nn tho nroliminary infnrmation available and are on1fatAstimatJ Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution I1-053 Ef' 7.1:13) ADDRESS: 10373 MENHART LN DATE: 05/22/2014 REVIEWED BY: MELISSA N APN: 375 15 045 BP#: 14040191 PERMIT TYPE: woRK REV # 1 -REVISE E FOOTING WITH STRUCTURAL DETAILS -ISSUED 5/22/14 SCOPE o �- NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Publi/ t , Sanitary Sewer District, School n: f—i eThoco Foot aro hacod nn tho nroliminary infnrmation available and are on1fatAstimatJ Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution I1-053 Ef' 7.1:13) FEE Y/FEE MISC ITEMS Commercial Items 0 Miscellaneous Items G) Commercial Items G) Miscellaneous Items Q i -T— SUBTOTALS: TOTAL FEE: Revised: 04/01/2014 CITU C)F C TTPF,RTINO n..u:.. uJ,.-L.. t:•:.,, Co ;t—, .q~or DictricL .School NOTE. This estimate does not inctuae fees aue to otner uepurtrrtca.a i. "'S': •-� -- -- --_, _ __ _, _ _ _ rnntart the Dent for addn'l info. District, etG . These fees are based on the preuminary FEE ITEMS (Fee Resolution 11-053 E . 7.%1 131 FEE ESTIMATOR - BUILDING DIVISION ..•.» ..• QTY/FEE ADDRESS: 10373 MENHART LN DATE: 04/28/2014 $0.00 REVIEWED BY: MELISSA APN: 375 15 045 BP#: *PERMIT TYPE: Building Permit PLAN CHECK TYPE: `VALUATION: $4,000 Alteration /Repair PRIMARY SFD or Duplex USE: $0.00 PME Plan Check: PENTAMATION 1 GENRES PERMIT TYPE: i WORK SCOPE REMOVE & REPLACE ONE�1) BEAM_& (1�FOOTING $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00- 0 Work Without Permit? O Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential G Building or Structure Q Strom; Motion Fee: 1BSEISMICR $0.50 2.0 hrs Inspections $278.00 1STINSP Inspection, Hourly Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $417.00 TOTAL FEE: $418.50 n..u:.. uJ,.-L.. t:•:.,, Co ;t—, .q~or DictricL .School NOTE. This estimate does not inctuae fees aue to otner uepurtrrtca.a i. "'S': •-� -- -- --_, _ __ _, _ _ _ rnntart the Dent for addn'l info. District, etG . These fees are based on the preuminary FEE ITEMS (Fee Resolution 11-053 E . 7.%1 131 to ormuuvn uruaausc FEE ..•.» ..• QTY/FEE �••• »•- -�--• - - -- - MISC ITEMS Plan Check Fee: Hourly Only? Q Yes Q No $0.00 1 hours Plan Check, Hourly $139.00 1STPLNCK A Suppl. PC Fee: Q Reg. Q OT 0.0hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00- 0 Work Without Permit? O Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential G Building or Structure Q Strom; Motion Fee: 1BSEISMICR $0.50 2.0 hrs Inspections $278.00 1STINSP Inspection, Hourly Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $417.00 TOTAL FEE: $418.50 Revised: 0410i1z0 i4 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date t/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile ;y Owner / Contractor Signature Dante