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B-2016-1879CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1879 18871 HUNTER WAY CUPERTINO, CA 95014-3610 (375 34 057) HOMEOWNER BUILDER OWNER'S NAME: CHO DONG CHUL AND OK BUN DATE ISSUED: 11/28/2016 OWNER'S PHONE: 408-316-8034 PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor HOMEOWNER BUILDER Date X BLDG —ELECT _ PLUMB MECH X RESIDENIAL COMMERCIAL T 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: REBUILD (E) SFD (1237 S.F.); ADDITION (1165 S.F.); AND I hereby affirm under penalty of perjury one of the following two declarations: CONSTRUCT (N) GARAGE (400 S.F.) 1. I have and will maintain a certificate of consent to self -insure for Worker's REV #1 - DELAY POURING OF (2) FOUNDATION SECTIONS WITH Compensation, as provided for by Section 3700 of the Labor Code, for the (E) GAS PIPING AT ENTRY AND GARAGE - ISSUED 3/17/2017 performance of the work for which this permit is issued. REV #2 - REVISE FRAMING AND (1) BAY WINDOW FOR I have and will maintain Worker's Compensation Insurance, as provided for by BEDROOM #3 TO MEET EGRESS - ISSUED 4/3/2017 Section 3700 of the Labor Code, for the performance of the work for which this REV #3 - CHANGE LOCATION OF GAS LINE AND METER - ISSUED permit is issued. 6/14/2017 Sq. Ft Floor Area: 1565 Valuation: $250000.00 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: Occupancy Type: and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for 375 34 057 R-3 (Custom),R-3 (Custom),U (Private Gar / Ag Bldg),U inspection purposes. (We) agree to save indemnify and keep harmless the (Private Gar / Ag Bldg) 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 Signature Date 180 DAYS FROM LAST CALLED INSPECTION. OWNER -BUILDER DECLARATION Issued by: Abby A, gnde I hereby affirm that I am exempt from the Contractor's License Law for one of the Date: 11/28/2016 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 " ,t?'- I, as owner of the property, am exclusively contracting with licensed inspection. contractors to construct the project(Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: Signature of Applicant: Date: 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. ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 2. 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 is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 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 6Xpermit 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 Worker's Compensation laws of California. If, after making this certificate of Health & Safety Code, Section 25532(a) should I store or handle hazardous exemption, I become subject to the Worker's Compensation provisions of the material. Additionally, should I use equipment or devices which emit hazardous Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapty 9.12 and the Health & Safety Code, tions 25505, 25533, and ;5544. 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: relating to building construction, and hereby authorize representatives of this city CONSTRUCTION LENDING AGENCY to enter upon the above mentioned property for inspection purposes. (We) agree 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 sourc egulations per the Cupertino Municipal Code, Section 8. Lender's Address DECLARATION Signature Date ���� ARCHITECT'S 1 understand my plans shall be used as public records. CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDINCA�W V 1ff' 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(c cupertino.or4 --U G" I li`f V 1 J ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION)DEFERRED ORIGINAL PERMIT PROJECT ADDRESS ! 1 0 1 VAI+_, _ - �, r? OWNER NAME STREET ADDRESSI j CIITATE, ZIP . FAX vV t vv ` "' CONTACT NAME PHOT ( —0 r2 E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX Ch ❑ OWNER V'ER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 1:1 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME I LICENSE NUMBER LICENSE TYPE I BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK Lo CO3"H EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) E7QSTG 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 GARAGE AREA: LJ DETACH I ❑ ATTACH I # DWELLING UNITS`. IS A SECOND LCNTT ❑YES SECOND STORY ❑ YES - BEING ADDED? 0 ADDITION? ANO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ ]'ES RE CE D TOTAL VALUATION: PLANTNING ADPL #❑ NO PLANNING APPROVAL LETTER EICHLER HOME? KO �%t � s f� By my signature below, I certify to each of the following: I am the property owner or authorized agent to It on the roperty owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of yN7ork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to uilding c do uthorize representatives of Cupertino to enter the above identified property for inspection purposes. Signature of Applicant/Agent: Date: hP- SUPPLEMENTAL INTFORNMTION REQUIRED PLS;, CHECI .T ]PE RouTTi�cs%TP ❑ ovER THE coul.TER ❑ Buu Dm GpLAxItE«w INIew SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building° , permit for new building. EXPRESS ❑ PLANNIN,GPLAN RENTEw _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTAND4RD ❑ rLBLICRORLs form if any Hazardous Materials are being used as part of this project.El LuicE ❑ i>1zEnEPr Copy of Planning Approval Letter or Meeting with Planning prior to ❑ ❑ snNITARYSE«ER submittal of Building Permit application. iIAIOR DISTRICT ` ❑ ; EN�TF ONXENTAL BldgApp_2011.doc revised 06121111 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building0kupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESSO/y � / P (� 4 tev APN �'�dk7 7 OWNER NAME l {�j OWN DR S ft-v DESCRIPTION OF WORK: We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. Please read and initial each statement below to signify you understand or verify this information.) Ly - 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not pr vide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my i urance coverage for injuries to workers on my property. 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for t e construction and are not hiring a licensed Contractor to assume this responsibility. 3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her me instead of my own. C4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license n tubers on permits and contracts. 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the to I value of my construction is at least five hundred dollars ($500), including labor and materials, I may be c nsidered an "employer' under state and federal law. 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to 4 employment compensation for each "employee." I also understand my failure to abide by these laws may subject e to serious financial risk. 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by li ensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work performed under contract with a licensed general building Contractor. 8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderFornl 2010.doc revised 04/14/10 d��9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California -Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State L' ense Board (CSLB) at 1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed ntractors. TI 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I e party legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that, as the parry legally and financially responsible for this proposed construction activity, I will abide applicable laws and requirements that govern Owner -Builders as well as employers. CL12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be require,' to be presented when the permit is issued to verify the orooertv owner's sianature. `l /1 1 / . /, / — Property Owner's Signature: &/- _ ( I (/V � Date: 0 / < '�-/ / -------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderFarm 2010.doc revised 04114110 CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 18871 HUNTER WAY CUPERTINO, CA 95014-3610 (375 34 057) OWNER'S NAME: CHO DONG CHULAND OK BUN OWNER'S PHONE: 408-316-8034 LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor HOMEOWNER BUILDER Date 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. I hereby affirm under penalty of perjury one of the following two declarations: 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. 2. 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. APPLICANT CERTIFICATION 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 indemnify and keep harmless the 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 source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 17 hereby affirm that I am exempt from the Contractor's License Law for one of the g 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) ,I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 2.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. 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 indemnify and keep harmless the 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 source regul tions per the Cupertino Municipal Code, Sectionp.18. f/l an l l Date 4/3/2017 CONTRACTOR: I PERMIT NO: B-2016-1879 BUILDER ISSUED: 11/28/2016 PHONE NO: BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: REBUILD (E) SFD (1237 S.F.); ADDITION (1165 S.F.); AND CONSTRUCT (N) GARAGE (400 S.F.) REV #1 - DELAY POURING OF (2) FOUNDATION SECTIONS WITH (E) GAS PIPING AT ENTRY AND GARAGE - ISSUED 3/17/2017 REV #2 - REVISE FRAMING AND (1) BAY WINDOW FOR BEDROOM #3 TO MEET EGRESS - ISSUED 4/3/2017 Sq. Ft Floor Area: 1565 Valuation: $250000.00 APN Number: Occupancy Type: 375 34 057 R-3 (Custom),R-3 (Custom),U (Private Gar / Ag Bldg),U (Private Gar / Ag Bldg) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Ayende Date: 11/28/2016 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 4 201 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous 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 the Health &Safety Code, Se tions 25505, 25533, and 2553 . j Owner ogr�authorized agent: Date: 4/3/2017 r CONSRTCTTON LE" G AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION understand my plans shall be used as public records. Licensed Professional i CONSTRUCTION PERMIT APPLICATION s-.'.. COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(d)cupertino.org CUPERTINO ❑ IQEW CONSTRUCTION a ,CTIO� LSI ADDITION ALTERATION/ TI REVISIO / DEFERRED ORIGINAL PERMIT # ri PROJECT ADDRESS � FAPN # r ®�k�i 51 --T OWNERNAME PHONE w E-MAIL STREET ADDRESS CITY, STATE, ZIP O` FAX t-3/ S t A CONTACT NAME l PHONE E _MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NA.NIE Me� LICENSE NUMBER LICENSE TYPE BUS . LIC # COMPANYNAME E-Nan FAX STREET ADDRESS TY, STATE, ZIP PHONE ECT/ENGINEER NAME LICENSE NUMBER r BUS. LIC #Y NAME E-MAIL FAX ADDRESS - CITY, STATE, ZIP PHONE DESCRIPTION OF WORK f3t-,/ `Y)NDJW_e.)�.�.� EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES " USE TYPE OCC. SQ.FT. VALUATION ($) E{ISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER - REMODEL AREA REMODEL AREA REMODEL AREA PORCH ARER- DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: 0 DETAC [] ATTAC I # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION DYES IF YES, PROVIDE COPY OF PLANNING ADPL # ❑ NO PLANNING P. PPROVAL LETTER IS THE BLDG AN El YES EICHLER HOME? ❑ NO REGEIVEDBY: }' I�- TOTAL VALUATION: By my signature below, I certify to each of the following: I•am the.property owner or authorized agent to act on the property owner's behalf. I have read this application and the, information I have provided is correct. "I have read the D%Ji o Work and verify it is accurate. I agr a to com ly with all applicable local "for ordinances and state laws relating to buil construction. I a tliorize rrepie eutatives o -Cupertino to enter the abe=T `.grope inspection purposes. Signature of Applicant/Agent:z l / Date: SUPPLEMENTAL lNFORM7t0N REQUIRED PLAN CHECK TYPE ROLMNG SLIP OVER THE-THE LJ BUiI DINGPLANREVIWtiry�iry New SFD or Multifamily dwellings: Apply for demolition permit forj� existing building(s). Demolition permit is required prior to issuance ofbuilding permit for new building. ❑ EXPRESS a PLANNINGVLAN RFVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ 'STANDARD El PUBLIC WORKS_ fo_rm if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIREDEPT -- _ Copy of Planning Approval Letter or Meeting with Planning prior to L] NIAaoR ❑ SANITARY SEwERDISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp 2011.doc revised 06121111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1879 18871 HUNTER WAY CUPERTINO,CA 95014-3610(375 34 057) HOME Mak►` VSIA i 061a 2–. OWNER'S NAME: CHO DONG CHULAND OK BUN DATE ISSUED:11/28/2016 OWNER'S PHONE:408-316-8034 PRONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic.# Contractor HOME Date kVilealiNVels iletticior X BLDG _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: REBUILD(E)SFD(1237 S.F.);ADDITION(1165 S.F.);AND I hereby affirm under penalty of perjury one of the following two declarations: CONSTRUCT(N)GARAGE(400 S.F.) i. I have and will maintain a certificate of consent to self-insure for Worker's REV#1-DELAY POURING OF(2)FOUNDATION SECTIONS WITH Compensation,as provided for by Section 3700 of the Labor Code,for the (E)GAS PIPING AT ENTRY AND GARAGE-ISSUED 3/17/2017 performance of the work for which this permit is issued. 2. 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:1565 Valuation:$250000.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 375 34 057 R-3(Custom),R-3(Custom),U(Private Gar/Ag Bldg),U representatives of this city to enter upon the above mentioned property for (Private Gar/Ag Bldg) 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 granting of this permit. PERMIT EXPIRES IF WORK IS NOT STARTED 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 Date 3/17/2017 ' Issued by:AbbyAyende OWNER-BUILDER DECLARATION Date: 11/28/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: . RE-ROOFS: 1. I,as owner of the property,or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed.If a roof is compensation,will do the work,and the structure is not intended or offered for installed without first obtaining an inspection,I agree to remove all new materials for (sale(Sec.7044,Business&Professions Code) inspection. -1,.,---I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). Signature of Applicant: Date:3/17/2017 I hereby affirm under penalty of perjury one of the following three declarations: i. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL 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. de i' HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the //ihave 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 p permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will 3. I certify that in the performance of the work for which this permit is issued,I maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the shallHealth&Safety Code,Section 25532(a)should I store or handle hazardous 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 exemption,I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cu.ertino Municipal Code,Ch ter 9.12 and Labor Code,I must forthwith comply with such provisions or this permit shall the Health&Safety Co etions 25505,25533,a '2 34. be deemed revoked. C' APPLICANT CERTIFICATION Ow en or authorized agent: I certify that I have read this application and state that the above information is Date:3/17/2017 correct.I agree to comply with all city and county ordinances and state laws CONSTRUCTION LE NG AGENCY relating to building construction,and hereby authorize representatives of this city I hereby affirm that there is a construction lending agency for the performance to enter upon the above mentioned property for inspection purposes. (We)agree of work's for which this permit is issued(Sec.3097,Civ C.) to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit dditionally,the applicant understands Lender's Address and will comply with all non-point source re ulations per the Cupertino Municipal Code,Section j 18. ARCHITECT'S DECLARATION I understand my plans shall be used as public records. -Signature '` Date 3/17/2017 Licensed L 1 Professional _ft:1-, /1 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 1`I$ ,' 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildinq(a,cuprtino.orq CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI REVISION/DEFERRED ORIGINAL PERMIT# ZSA k'-' 141 PROJECT ADDRESSIasi,1 t� t r y '�.. APN# �5 OWNER NAMEC \WY_ �,J h,_�� ��t L® PHO a 1 P J6 , `�(A°T(✓!ov E-MAILCom:\r-4-..cAlto.03-„,..., ,cTa, STREET ADDRESS vo�'{r j��a CITY, TATE,ZI/jP`��� ( N- Qt''�-/,.�+�\\ FAX CONTACT NAMEstv ! 1 ° STREET ADDRESS(41 y Al Y kri CITYYTTATE4 f (A. Cob 6 FAX �(f ` gtt11 �( � �1.� J 1 ❑OWNER LJ OWNE'RR-BUILDER 0 I OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT 0" ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT CONTRACTOR NAME !Btl^� ®.ta mat-,+• LICENSE NUMBER LICENSE TYPE BUS.LIC# 1®cw 111 V �* COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK , =G 7-tmoi✓-4 tX/1`7t7/ (` A /7_11/ . t /�"-,r7' /94vi7 ,4.,-7/1"c,7.E= EXISTING USE PROPOSED USE CONSTR.TYPE it STORIES - _ USE TYPE OCC. SQ.FT. VALUATION($) 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 GARAGE AREA: 0 DETACH ' 0 ATTACH It DWELLING UNITS: ISA SECOND UNIT DYES SECOND STORY DYES BEING ADDED? 0 N ADDITION? 0 N ��p�j��yV� PLANNING APDL N# ❑NOS IF YES,N PRNG R COPY E IS ICTHE LR BLDG AN 0 YES R]j! 1Y: TOTAL VALUATION: PLANNING ADPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? 0 NO (/r' _ By my signature below,I certify to each of the following: I am the property owner sr authorized agent to act on e property owner's behalf. I have read this application and the information I have pro 's es is correct. I have read the Descrip'on of Work and verify it is accurate. I agr-e to comply .ith all applicable local ordinances and state laws relating to buil+ .g'onstruction. I authe b e repr-..-n 'ves of Cupertino to enter the aboo�v@,iden. e. .:pe .'or inspection purposes. Signature of Applicant/Agent: P 1 t�_A" �'" Date: VJ SUPPLEMENTAL INFORMA 01N REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑.OVER-TFiE-couNTER ❑ BUILDINGPLANREVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure -❑ STANDARD ❑ PUBLIC WORKS form 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 [] MAJOR ❑ SANITARY SEWERDISTRICT submittal of Building Permit application. ' ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 13-2016-1879 18871 HUNTER WAY CUPERTINO, CA 95014-3610 (375 34 057) HOMEOWNER BUILDER OWNER'S NAME: CHO DONG CHULAND OK BUN DATE ISSUED; 11/28/2016 OWNER'S PHONE: 408-316-8034 PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor HOMEOWNER BUILDER Date 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: REBUILD (E) SFD (1237 S.F.) ADDITION (1165 S.F.); AND I hereby affirm under penalty of perjury one ofthe following two declarations: CONSTRUCT (1) GARAGE (400 S.F.) 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. 2. 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: 1565 Valuation: $250000.00 APPLICANT CERT_ IFICATION certify that Ihave read this application and state that the above - information is correct. I agree to comply with all city and county ordinances APN Number: 'Occupancy Type: and state laws relating to building construction, and hereby authorize 375 34 057 R-3 (Custom),R-3 (Custom),U (Private Gar /Ag Bldg),U representatives of this city to enter upon the above mentioned property for (Private Gar /Ag Bldg) 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 granting of this permit. PERMIT EXPIRES IF WORK IS NOT STARTED 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 Date 11/28/2016 Issued by: Abby Aygnde OWNER -BUILDER DECLARATION Date: 11/28/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: RE -ROOFS: 1. I, as owner of the property, or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed. If a roof is compensation, will do the work, and the structure is not intended or offered for installed without first obtaining an inspection, I agree to remove all new materials for sale (Sec.7044, Business & Professions Code) inspection. z!/ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). Signature of Applicant: Date: 11/28/2016 I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self -insure for Worker's ALL 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. z I have and will maintain Worker's Compensation Insurance, as provided for by HAZARDOUS MATERIALS DISCLOSURE iP Section 3700 of the Labor Code, for the performance of the work for which this I have read the hazardous materials requirements under Chapter 6.95 of the permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will a. I certify that in the performance of the work for which this permit is issued, I maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &Safety Code, Section 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 equipp ment or devices which emit hazardous use equipment 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 exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chap 9.12 and Labor Code, I must forthwith comply with such provisions or this permit `shall the Health & Safety Code ctions 25505, 25533, an 5 be deemed revoked. OWner or authorized agent: APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is Date: 11/28/2016 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 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance to enter upon the above mentioned property for inspection purposes. (We) agree of work's for which this permit is issued (Sec. 3097, Civ C.) to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands Lender's Address and will comply with all non -point source regulatiopf per the Cupertino Municipal ARCHIT CT' D R TION Code, Section 9.1 1 understand my plans shall be used as public records. Signature Date 11/28/2016 Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 18300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 . FAX (408) 777-3333 • buildingOcupertino.org CUPERTINO NEW CONSTRUCTION VEi ADDITION FXA1,TRIZATTOW/TT -RPVTCTnN/T-, .V?QTZRn nnT(`TNTA-nFur,rrTR PROJECT ADDRESS" ) j� � ] H IAV441-0m, 41-0m � b APN # �j OWNER NAME �* `A'' COMPANY NAME PHONE nh H -MAIL STREET ADDRESS I -11 ` 4 r '_ Ij i vl �( CITY, STATE, ZIP /� + ,yam V{/1 X CONTACT NAME J t i i Nq A ,� LICENSE NUMBER �w PHONE jry �� /� E-MAIL . �a STREET ADDRESS 2t1 J��* CITY, STT ZA FAX ❑ OWNER 11 OWNER -BUILDER XOWNER AGENT 1 CONTRACTOR ❑ CONTRACTDRAGENT 1:1 ARCSITECT ❑ ENGINEGR ❑ DEVELOPER E3 TENANT CONTRACTOR NAME �--� LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PiIONE y.� A a"'`TS W w++�:ME \ �` LICENSE NUMBER �w FiUS. LIC t COMPANY NAME y5f i l �f ilV ✓ � V •Y � li E-MAIL VK,0t 1 CC) i 3 FAX STREET ADDRESS ti CITY, STATE, ZIP bAh 4 7,>�' PFIO" Wo fry` EXISTING USE PROPOSED USE C- O+NE Ty M,�, - # STORIES K, y/YP, Y/&+7 USE TYPE OCC. SQ Q.F-T. VALUATION {$) NEW FLOOR DEMO TOTAL AREA „*y AREA -. AREA NETAREA 2402 BATHROOM REMODEL AREA KITCEEN RWODELAREA 1-oMTI',;-ngL AREA PORCHAREA DECKAREA TOTAL DECK/PORCII AKEA ) GARAGE UREA: DETACII - CH 12--f 1ref ( S DWELLING UNITS: IS A SECOND UNIT [] YES SECO STORY []YES EI:INGADDED? TO ADDITION? JKNO PRE -APPLICA'T'ION YES II•YES,PROVIDE COPY OF IS THE BLDG AN I-] Yr. RnCEI `£DTALVALUATION: PLANNING APDL N ;KNO PLANNING APPROVAL LETTER EICHLF,R HOME? By my signature below, I certify to each of the following; I am the property owner or authorized agent jpatL-roperty owner's' behalf. I have read this application and the information [have provided is correct. I have read the Description of Warlt and vg+rt is accurate. I agree to comply with all applicabie local ordinances and.state laws relating to wilding construction, I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature -of Applicant/Agent: Date: Of -03 -XV/6 SUPPLEMENTAL INFORMATION REQUIRED t . :':'-PLAtt,CHE:GK TS?F .. .. ROUTIiS.G SLIP ' . .:: New SFD or Multifamily dwellings: Apply for dein lition permit for VF -a0 f)R THE COiTh .......... BiliT iiT 1G 3 T A v REVIEW existing building(s). Demolition permit is required priorto issuance of building permit for new building. CI. E IZEss I PIA iItiG PLP N vsl Commercial Bldgs: Provide a completed Hazardous Materials Disclosure `Cl<'s sv ?3tn ©PusI lC hyo Form if any Hazardous Materials are being used as part of this project. - ::-....u.:;.rr..::... ........:::r,.:::c.;xc:�:r:::::.::-.=.r::-�r:_::_:rz.:a:;—::�'_-cc: r': �::-.=>i•:::. Copy of Planning Approval Tetter or Meeting with Planning prior t4 c;: a :-E? `.;='s ::.' a-:-",..- - ;;:-: a':=='?.:s < [:::Pi3"-:: `•::t submittal of Building Permit application. 17�oQfi sANIT�RY sa�vl x u;s�1zTC r Bldg -App Z&]Ldoc revised 06121ft.t v wwwwc OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 FAX (408) 777-3333 • building(�cupertino.org CUPER'TING Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESSkW j� r APN 0-1 BP# q OWNER N ME IK,��1 _Gl.o OWNER ADDRESS t���� � � + � �� r�® C10-01 1 DESCRIPTION OF WORK: We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the.permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify; this information.) `r 1.1 understand a frequent practice of unlicensed' persons is to 6i ,e ­the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. C 3. '1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that 1 may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to dist their license numbers on permits and contracts. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. �% • 6.1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject �)me to serious financial risk. l� • ` 7. 1 understand under California Contractors' State, License Law, an Owner -Builder who builds single-family residential structures cannot legally build' them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work isperformedunder contract with a licensed general building Contractor. E \ 8. 1 understand as an Owner -Builder if 1 sell the property for which this permit is issued', I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04114110 A` s I understand 6 may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors, �% • l 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. 1%11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide (�by(all applicable laws and requirements that govern Owner -Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes (to any of the information I have provided on this form. Licensedcontractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the prooertv owner's sianature. Property Owner's Signature: - ------------------------------------------------------------------------------------------ -- ------------------- --------- (NOTE. The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I' am the property owner for the address listed above and II personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, jform notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/14/10 Arnold Hom 10/11/16 Arnold Hom 10/11/16 Arnold Hom 10/11/16 Arnold Hom 10/11/16 Arnold Hom 10/11/16