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B-2017-0197V CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0197 10338 COLD HARBOR AVE CUPERTINO, CA 95014-3328 (369 09 029) S J K GROUP INC SANTA CLARA, CA 95050 OWNER'S NAME: WOO WILLIAM KWAN HO AND YAN YUEK LEE TRUSTE DATE ISSUED: 02/01/2017 - OWNER'S PHONE: 408-605-8855 PHONE NO: (408) 781-3109 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lic. #101845 Contractor S J K GROUP INC Date 03%31/201 g X BLDG —ELECT X 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: REMODEL BATH (120 SF); GAS LINE (1) FOR FIREPLACE; 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. . 1 have and will maintain Worker's Compensation Insurance, as provided for by _Section Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $5000.00 APPLICANT CERUEICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 369 09 029 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 may accrue against said City in consequence of the granting of this permit. 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 4/20/2017 Issued by: ABBY AYENDE OWNER -BUILD R D . RATION Date: 02/01/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: 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: 4/20/2017 I hereby affirm under penalty of perjury one of the following three declarations:ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE 2, I 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 air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of 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, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. C O or authorized agent: APPLICANT CERTIFICATION Date; 4/24(2917 -� I certify that 1 have read this application and state that :the above information is CO STRUCTION E .�_ A �f 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 and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. i understand my plans shall be used as public records. Signature Date 4/20(2017 Licensed Professional CS � � �7� � �.e_ C(b-ZC)1��D1�1�--FSS-2�l �. (D�3 k'' �rC � �z�-r' ) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10338 COLD HARBORAVE CUPERTINO, CA 95014-3328 (369 09 029) OWNER'S NAME: WOO WILLIAM KWAN HO AND YAN YUEK LEE TRUSTE OWNER'S PHONE: 408-605-8855 LICENSED CONTRACTOR'S DECLARATION A_RATION License Class ]a Lic. #874887 Contractor PETER CONSTRUCTION Date 03/31/2018 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. 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 CONTRACTOR: PERMIT NO: B-2017-0197 PETER CONSTRUCTION SUNNYVALE, CA 94089 DATE ISSUED: 02/01/2017 PHONE NO: (408) 529-2787 BUILDING PERMIT INFO: BLDG —ELECT X PLUMB MECH X RESIDENTIAL _ COMMERCIAL DESCRIPTION: ODEL BATH (120 SF); GAS LINE (1). FOR FIREPLACE;' :TRICAL OUTLET (1) , 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: Valuation: $5000.00 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 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 02/01/2017 OWNER -B II ! R DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. 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: 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. 3. 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 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 02/01/2017 APN Number: Occupancy Type: 369 09 029 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar Date: 02/01/2017 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: 02/01/2017 TO BE CLASS "A" OR 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, Sections 25505, 25533, and 25534. Owner or authorized agent: �,/,/%� Date: 02/01/2017 f L1.1� ON TR TION LENDING 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 I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 •FAX (408) 777-3333 • building(a�cupertino.or- CUPERTINO I `i7 —2 0f ❑ NEW CONSTRUCTION n ADDTTION -f� AI. PP ATTr)NT PI n I?UATTCTnTT i ----- -- vT�ivuvtu,rbrClvul � PROJECT ADDRESS C U 3` ( t� d j� APN # 3&0 OWNERNAME� h f/'l/ WOO PHONE � 7th`// (may `s ��✓J ljV 1 Cl s7 E-MAIL •-W&o `� 4 STREET ADDRESS !C9 `, 3 7q- &)i L CITY, STATE, ZIP ' FAX CONTACT NAME ` `� PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER El TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE {f� BUS. LIC # 2q) 3 �°n 1 F/ COMPANY NAME I e Z{(j�- E-MAIL -- C^}^Lt it FAX 1 cn, �t I STREET ADD SS 0 s, CITY, STATE,g? PHONE ARCHITECTMNGINEER NAM LICENSE NUMBER BUS. LIC #�F31� COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRII'TION OF WORK %__' � /�. � `-^ i t/l...UG'"t i C / V J �^��✓-.3 � �/ �'C r ,'-� � G'�(...��-`„� r r EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA ,rj > REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: ISA SECOND UNIT E] YES SECOND STORY E] YES BEING ADDED? ❑ NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RE E BY TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NOvldw- _ �I By my signature below, I certify to each of the following: I am the property owner or authorize agent to act on the properly owner's behalf. I gave. read 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 applicable local ordinances and state laws relating to building construction. I autho,= representatives of Cupertino to enter the above -identified propertyfor inspection purposes. Signature of Applicant/Agent: e2 ���Date: —45/— ^f3/— SUPPLEMENTAL SUPPLEMENTAL INFOIGIATION REQUIRED PLAN CHECK TYPE R UTING SLIP 11 OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ New 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 ❑ 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 El MAJOR ❑ sArrlTauY SEWER DisTxlcT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 0-&,, /A SMOKE / CARBON MONOXIDE ALARMS 1 r ' OWNER CERTIFICATE OF COMPLIANCE ,g. COMMUNITY DEVELOPMENT DEPARTMENT.BUILDING DIVISION 10300 TORRE AVENUE e CUPERTINO,CA 95014-3255 C' CUPE 2TINO ° lea? _ ` ( r (408)777-3228®FAX(408)777-3333° buildinc7(a.cupertino.orq _ Permit No. -.N, Address = �- ' '+'� "" #ofAlarms Smoke: ''_ Carbon Monoxide: PERMIT CANNOT SE FINALE]).AND+COMPLET.ED I71 TIL T.t.S CERTIFICATE HAS BEEN-Sid-NEI).AlslipTT NEB TO THE KILDING DilaSIQN PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314, 2013 CBC Sections 420 6 and 907.2.11.2 where no interior access for _ _,inspections are required. __ __ _ _y _ _ £ - _- _ ___ , _ _ 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 I SMOKE ALARM CO ALARM_ Outside of each separate sleeping area in the immediate vicinity of the X bedroom(s) . - — _k � On ever level of a dsvellinc unit including basements x ___________H Within each slee itirti room _ X ___________—___I Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with 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 CBC Sections 9072T1T 4 arid-420"6-.2-.-An electrical permit is-required for= alarms which must be connected to the building wiring. As owner of the above-referenced property,I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes.The alarms have been tested and are operational, as of the date sib ed below I have read and agree to compI.,4 the terms-nd conditions of this statement Owner(or Owner.Agent's), ame: ( ,r �,e' / / Date: 1.r .� ,)(7 t/ld Signature. - i. ( g Contractor Name: / L. Signature. Lic.# Date:(( . / "; �" o1/ Smoke and CO form.doc revised 03/18/14 WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE 1.1COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION Sie 4' 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO ' ( p08)777-3228•FAX(408)777-3333•buildinq(cicupertino.orq @ 7 Owner Name 4411 Permit No. i 17 Address _ 2 ,1t '6' 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. [ ' No Go to Question 2. 2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property or its plumbing,installation of water-conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. _ Skip-the rest of the fowl and sign-bottom of form.- - .,- 111-No Go to Question 3. 3. Is water service permanently disconnected for your building? DI Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. No Go to Question 4. 4. Is your real property built and available for use oroccupancy on or before January 1,1994? "El 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. ❑ Yes 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.. 5. Please check ONE of the following: - )L 3 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). 0 My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1,2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. _On or.;before,January 1,-201_9,-all_non-compliantplumbing-fixtures_shall be replaced with.water conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements).scommercial realproperty. See Civil Code Section 1101.5. My property is a 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). I,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 1101.1 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 page. Owner or Owner Agent's Signature: ` �` ,�p Date: Upon completing and signing this Certi 1c,�te, e ea - it to t1 ur1di -Division in order to final your b lding p-rmit.' SB4072015.doc revised 08/26/15