B-2016-2657CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR:PERMITNO: B-2016-2657
7852 LILY CT CUPERTINO, CA 95014-4212 (359 03 015) OK BEE KIM
CAMPBELL, CA 95008
OWNER'S NAME:
1 1
PHONE NO: (510) 557-4176
LICENCED CONTRACTOR'S DECLARATION I BUILDING PERMIT INFO:
License Class a Lic. #638489
Contractor OK HEE KIM Date 01/31/2018
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.
I hereby affirm under penalty of perjury one of the following two declarations:
i. 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.
z I have and will maintain Worker's Compensation Insurance, as provided for by
V 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 u derstands and will comply with all non -point
source regulations per the „i.tpe no Municipal Code, Section 9.18.
Date 4/5/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
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
I certify that 1 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 4/5/2017
BLDG X ELECT _ PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
FRONT & SIDE YARD - LIVING, DINING, BED/BATH, STUDY &
FOYER ADDITION (1,119 S.F.); KITCHEN REMODEL (200 S.F.);
FAMILY RM/OFFICE REMODEL INCLUDING REMOVE FP &
INSTALL (I) BAY WINDOW (490 S.F,); UPGRADE PANEL, SAME
LOCATION (200 AMP); RELOCATE GAS METER, SIDE YARD; (N)
COVERED FRONT PORCH (61 S.F.);
Sq. Ft Floor Area: 1119 1 Valuation: $200000.00
APN Number: Occupancy Type:
359 03 015 Deferred Submittal (R -3),R-3 (Custom)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: AbbyAvende
Date: 03/03/2017
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: 4/5/2017
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 unci al Code, Chapter 9.12 and
the Health & Safety Code, Sectiand 25534.
Owner or authorized agent:
Date: 4/5/2017
I hereby affirm that there is a construction lendi ig agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
AR HIT CT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUH DING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2657
7852 LIIY CT CUPERTINO, CA 95014-4212 (359 03 015)
HOMEOWNER
BUILDER
OWNER'S NAME:
BUILDING PERMIT INFO:
License Class Lic. #� y
Contractor HOMEOWNER BUILDER Date !
X BLDG X 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:
FRONT & SIDE YARD - LIVING, DINING, BED/BATH, STUDY &
I hereby affirm under penalty of perjury one of the following two declarations:
FOYER ADDITION (1,119 S.F.); KITCHEN REMODEL (200 S.F.);
1. I have and will maintain a certificate of consent to self -insure for Worker's
FAMILY RM/OFFICE REMODEL INCLUDING REMOVE FP &
Compensation, as provided for by Section 3700 of the Labor Code, for the
INSTALL (1) BAY WINDOW (490 S.F.); UPGRADE PANEL, SAME
performance of the work for which this permit is issued.
LOCATION (200 AMP); RELOCATE GAS METER, SIDE YARD; (I)
2. I have and will maintain Worker's Compensation Insurance, as provided for by
COVERED FRONT PORCH (61 S.F.);
Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area: 1119
Valuation: $200000.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
359 03 015
Deferred Submittal (R -3),R-3 (Custom)
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.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 3/3/2017
Issued by: Ab -by yende
Date: 03/03/2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RErROOFS:
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 propert3; 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)
z: I, as owner of the property, am exclusively contracting with licensed
Signature ofApplicant:
kcontractors to construct the project (Sec.7044, Business & Professions Code).
Date: 3/312017
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
Q n all 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
maintain compliance with the Cupertino Municipal. Code, Chapter 9.12 and the
permit is issued.
s. I certify that in the performance of the work for which this permit is issued, I
performance
Health & Safety Code, Section 25532(x) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
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.
Owner or authorized agent:&!` `�
Date: /3/3 2017 — '
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
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
ARCHITECT'S DECLARATION
and will comply with all non -point source regulations per the Cupertino Municipal
I understand my plans shalt be used as public records.
Code, Section 9.18.
Licensed
Signature )' Date 3/3/2017
9
Professional
l