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
----- --
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PROJECT ADDRESS C U 3` ( t�
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APN # 3&0
OWNERNAME� h
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PHONE � 7th`// (may `s
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E-MAIL
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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
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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