B-2016-2729CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10408 COLBY AVE CUPERTINO, CA 95014-2401 (316 29°042)
CONTRACTOR: PERMIT NO: B-2016-2729
OK BEE KIM
OWNER'S NAME: KANG SUWON AND LEE SO JUNG
CAMPBELL, CA 95008
DATE ISSUED: 12/09/2016
OWNER'S PHONE: 408=718-9813
LICENSED ONTRACTOR'cD>
PHONE :(510)557-4176
rrARATrpp�*
BUILDING PERMIT INFO:
.License Class.B Lic. #83848
Contractor 9K HEF KIM Date DjQ1 /2018
X BLDG —ELECT PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business & Professions
_
X MECH X RESIDENTIAL _ COMMERCIAL
Cade and that my
license is in full force and effect.
JOB DESCRIPTION:
I hereby affirm under penalty ofperjury one of the following two declarations:
1 ST FLOOR ADDITION GUEST BEDRM/TWO BATHROOMS/ LIVING
i. I have and will maintain a certificate of consent to self -insure for Worker's
RM (710 SF); COVERED PORCH (35 SF); IST FLOOR REMODEL
Compensation, as provided for by Section 3700 of the Labor Code,. for the.
MASTER BEDRM/DINING (350 SF); INSTALL PREFAB GAS
performance of the work for which this permit is issued.
FIREPLACE; REPLACE SLIDING DOOR IN (E) DINING RM.
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
permit is issued.
APPLICANT ERT1T+ireTIOl�T
Sq. Ft Floor Area: 710 Valuation: $100000.00
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
APN Number: Occupancy p y Type:
construction, and hereby authorize
representatives of this city to enter upon the above mentioned property for
inspection
316 29 042 R-3 (Custom)
.
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
source regulations
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
per the%C1 no Municipal Code, Section 9.18.
_l
180 DAYS FROM LAST CALLED INSPECTION.
Signature
/ Date 1219/2016
Issued by: Abby A ode
12/09/2016
0MRDate:
- I N
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
RE -ROOFS.
1. 1, as owner of the property, or my employees with wages as their sole
compensation,
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
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 properly am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 12/9/2016
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 "All 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.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements Chapter
Section 3700 of the Labor Code, for the performance of the work for which this
under 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
s. 1 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 25532(x) 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
exemption, I become subject to the Worker's Compensation provisions of the
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
Labor Code, I must forthwith comply with such provisions or this permit shall
the Health & Safety Code, Sections 505, 25533, and 25534.
be deemed revoked.
i? r
Owner or authorized agent:
AU I NT RUFI ATION
certify that I have read this application and state that the above information is
Date: 12/9/2016
CONS TR TION
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
I hereby affirm that there is a construction lendncy for the performance
of work's far which this permit is issued (Sec. 3P'97, iv C.)
to enter upon the above mentioned property for inspection purposes. (We) agree `
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Date 12/9/2016
SignatureProfess
Licensed
onal
rCUPERTINO
I I NRW PnW.QTRTrC"
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT* BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAx (408) 777-3333 -building@cupertino.org
rrnm n enntmrnnr r—I kT TAW A TTnTT , TT
BidgApp_2011,doc r ised 06121111
PRo3ECTADDREss 10408 COLBY AVENUE
APN# 316-29-42 as
OWNER NAME 'Steve Kang
PHONE 408.718.9813
E-MAIL Stevekang89@gma>l.com
STREET ADDRESS 10408 COLBY AVENUE
CITY, STATE, ZIP CUPERTINO, CA 95014
FAX i
i
CONTACT NAME Byoung Choi
PHONE 510.847.9237
E-MAIL byoungarch@yai oO.COM
STREET ADDRESS 267 Curtner Ave. #12
CITY, STATE, ZIP Palo Alto, CA 94306
FAX
17 OWNER ❑;OWNER-B1JuMFR E3owNmAGENT 13CONTRACTOR CONTRACTOR iA ARCHITECT ❑ CNGWEER ❑ DF,VP,io ER ❑ TENANT
CONTRACTOR NAME.- -
LI SE NUMFR
6 �i
LICENSE TYPR6
JBUS. LIC #
COMPANY NAME / E-MAIL
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ri6l"tErx nn) OWY d, (f
FAX
cry
TZT V,D Cr)S_s A26 CITY, STATE, ZIP LJ w n /rJ
PHONE J
ARCHITECTIENGINEER NAME By ng Choi LICENSE NUMBER 0-34042
BUS, LICE
COMPANYNAME Byoung Choi Architect
E-MAIL byoungarch@yahoo.com
FAX
STREETADDRESs 267 Curtner Ave. #12
CITY, STATE, ZIP Palo Alto, CA 94306
PRONE 510.847.9237
13ESCRIFrIQrii'Ot��'v-i?re`if=- - -�--
710 sf Residential Addition to the front of oxistinq house. Sco a of work includes
modification of existing master bed room, a dition O -ed /One bath roor�n and
extension of living room. Existing Garage and other areas to remain.
EXISTING USF
PROPOSED USE CONSTR.
TYPE
# STOIUM
-
RESIDENTIAL
RESIDENTIAL
V -B
1
I
USE
TYPL
occ.
SQ.Fr.
VALUATION {$)
EXISTO
AREA 1,555 SF
NEW FLOOR
AREA 710 SF
DFMO
AREA
TOTAL
NETARnA 2,265 SF
BED/BATH/
V -B
R
710 SF
-
100,000
BATHROOM KITCHEN
REMODEL AREA N/A REMODELARF,A N/A
OTHER. -.
REMODELAREA N/A.
LIVING. ROOM
PORCH AREA
DECK AREA TOTAL DF.CK/I'ORCH AREA
'ARAOE AREA; DETACH
- -
35 SF
N/A 35 SF
I
I N/A ❑ ATTACH
RDWELLING UNITS:
ISA SECOND UNIT ❑YRS
SECONDSTORY []YES.
N/A
BEINGADDED? NO
ADDITION? ®NO
PRE -APPLICATION Q YES n+ YES, PROVIDE COPY OF
IS THE BLDG AN [] YES -.
,RE -
- TOTAL VAL ATION:
PLANNINGAPPL# ®NO PLANNING APPROVAL LETTER
-
EICHLERHO.ME? ®.NO
-
.....
10),000
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 beluflE I have red this
application and the information I have provided is correct, I have read the Description of Work and verify it is accurate. I agree to comply with all app icable local,\
ordinances and state laws relating to building construction. I aIthorizerePresentatives of Cupertino to enter the above -identified property for inspevtior purposes.
Signature of Applicaut/Agent: Date:
SUPPLEMENTAL INFOR ATION REQUIRED '
Pi iiPi CHECK TYPE :
ROUTIN. SLIP
p:. avER 7iiE COUNTER
L7 BUILDING PLAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for
existing buildings). Demolition permit is required prior to issuance of building
permit for new building.
C]. EXPRESS* ss
C7 rinNNnvc PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ : s*400 RD
E)- PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
p LAiti. ,
itenEPT..
_ Copy of Planning Approval Letter or Meeting with Planning prior to
`?�.ioR
Q SANITARYSE '
submittal of BuildingPermit application.
DISTRICT,
D' ENVIRONMENT HEALTH
BidgApp_2011,doc r ised 06121111
CAPEX ENGINEERING INC
PO BOX 14198, FREMONT, OA 94539
Tel. (510) 668-1815 Fax. (510) 490-8690
Building Department
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014
Subject: Residence at
10408 Colby Ave.
unertino. CA
Dear Sir
June 19, 2017
(Perm 1016-2729)
SPECIAL INSPECTION SERVICES FINAL AFFIDAVIT FOR ALL
THREADED ROD BOLTS INSTALLATION WITH EPDXY
CAPEX ENGINEERING INC., has provided testing and special inspection services at
the subject site in accordance Agth section 1701 of the California Building Code (2016
Edition) as listed below
(1) Inspection of (4) 5/8" o x 12" min. embedment, all threaded rod bolts installation
with Epoxy for Holdown placement at specific location.
(2) All drilled holes for receiving all threaded rod bolts installation were cleaned of
dust and debris and adequate in depth to embed into existing concrete.
Personnel under the general supervision of a registered Civil Engineer performed these
inspections. Based on the inspections performed and upon our, substantiating reports that
the inspected work was performed, to the best of our knowledge, in conformance with the
approved plans and specifications and the applicable workmanship provisions of the
California Building Code. g
Sincerely,
CAPEX ENGINEERING INC.,
ary su,
Principal
0