B-2016-2894CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2894
5986 SUTTON PARK PL CUPERTINO, CA 95014-3531 (375 35 027)
KEN LIN
CONSTRUCTION INC
SAN JOSE, CA 95138
OWNER'S NAME: KAO WILLIAM W AND SHEN YUJUNG
DATE ISSUED: 03/31/2017
OWNER'S PHONE: 408-517-9875
PHONE NO: (408) 872-2898
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class a Lic. #996087
Contractor KEN LIN CONSTRUCTION INC Date 08/31/2018
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:
FRONT ADDITION - (I) BEDRM, BATH & LAUNDRY (496 S.F.);
I hereby affirm under penalty of perjury one of the following two declarations:
REMODEL KITCHEN (125 S.F.); REMODEL MASTER & HALL BATHS
1. I have and will maintain a certificate of consent to self -insure for Worker's
(118 S.F.); RECONFIGURE/REMODEL LIVING RM/FAMILY
Compensation, as provided for by Section 3700 of the Labor Code, for the
RM/MASTER BEDRM (463 S.F.)
performance of the work for which this permit is issued.
REV #1 - CHANGE KITCHEN LAYOUT - READJUST WINDOW,
z. I have and will maintain Worker's Compensation Insurance, as provided for by
REMOVE WALL PARTITION, ADD PANTRY; FAMILY ROOM -
/+ All Section 3700 of the Labor Code, for the performance of the work for which this
READJUST SLIDING DOOR - ISSUED 6/19/2017
7 permit is issued.
APPLICANT CERTIFICATION
Sq. Ft Floor Area: 496
Valuation: $250000.00
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
375 35 027
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.
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.
Date 6/19/2017
Signature
Issued by Abby Mende
OWNER -BUILDER DECLARATION
Date: 03/31/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of theF.>r
ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
r. 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: 6/19/2017
I hereby affirm under penalty of perjury one of the following three declarations:
r. 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.
HAZARDOUS MATERIALS DISCLOSURE
z. 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. I 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
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 25505, 25533, and 25534.
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 6/19/2017
1 certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
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.
1 understand my plans shall be used as public records.
Signature Date 6/19/2017
Licensed
Professional
CONSTRUCTION PERMIT APPLICATIftp i��
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
' _' (408) 777-3228 •FAX (408) 777-3333 • building(a�cuoertino.org
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CUFERT[NO 1
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❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS ! > APN #
OWNERNANM PHONE i E-MAIL
STREET ADDRESS CITY, STATE, ZIP FAX
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CONTACT NAME PHONE r E-MAIL
STREET ADDRESS CITY, STATE, ZIP ^ �a FAX
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OWNER El OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER t 0 r� � LICENSE TYPE ^ BUS. LIC #
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ARCMTECT/ENGINEER NAME V � l ' LICENSE NUMBER l BUS. LIC # xv
COMPANY NAME r"E-MAILr1 Xhi��,6 �k.FCOt ,
STREET ADDRESS
CITY, STATE, ziP r PHONE
DESCRIPTION OF WORK
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EXISTIN SE PROPOSED USE CONSTR, TYPE #sT S
` 3 USE TYPE OCC. SQ.FT. VALUATION (S)
STG _ NEW FL80R Itmo TOTAL
1 AREA 1 / (JI (, AREA TBT AREA )
BATHROOM f� KITCHEN (v OTHER L
REMODEL AREA I 7� REMODEL AREA REMODEL AREA 4& &
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: 0 DETACH
❑ ATTACH
# DWEL.L UNITS`. IS A SECOND UNIT 9YES SECOND STORY []YES
BEING ADDED? NO ADDITION? )gNO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES IVED BY _ TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER ROME? j �( NO - v
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act od the property owner's behalf. I have r ad 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..bu ing co truction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: l -V
SUPPLEMENTAL INTO TION REQUIRED ; PLAN CHECK , <„ , d ; Iiovruvc'si .
-�
_ New SFD or Multifamily dwellings: Apply for demolition permit for3
' ❑ OVER THE-COiNTER ❑ zBUII DIIQG YLANREVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. O REss ❑T ArT>rcpLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STAIlDARD ❑ PUBLIC woRxs . ':
form if any Hazardous Materials are being used as part of this project. Q LAaGE ❑ 'FIiiEDEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to C] IKArox ❑ sAIQITARYSEV�ERDisTRICT
submittal of Building Permit application.
❑. EN«onfltNTALHEALTH'
BldgApp_2011.doc revised 06/21111
CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2894
5986 SUTTON PARK PL CUPERTINO, CA 95014-3531 (375 35 027)
KEN LIN
CONSTRUCTION INC
SAN JOSE, CA 95138
OWNER'S NAME: KAO WILLIAM W AND SHEN YUJUNG
DATE ISSUED: 03/31/2017
OWNER'S PHONE: 408-517-9875
PHONE NO: (408) 872-2898
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B: C-27 Lic. #22_QD_$7
Contractor KEN LIN CONSTRUCTION INC Date 08/31/2018
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:
FRONT ADDITION - (1) BEDRM, BATH & LAUNDRY (496 S.F.);
I hereby affirm under penalty of perjury one of the following two declarations:
REMODEL KITCHEN (125 S.F.); REMODEL MASTER & HALL BATHS
n. I have and will maintain a certificate of consent to self -insure for Worker's
(118 S.F.); RECONFIGURE/REMODEL LIVING RM/FAMILY
Compensation, as provided for by Section 3700 of the Labor Code, for the
RM/MASTER BEDRM (463 S.F.)
'performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
,/2.1-
rtSection 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area: 496
Valuation: $250000.00
`r/,, spermitisissued.
APPLICANT CERTIFICATION
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
375 35 027
R-3 (Custom)
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
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 r /�{/iili� n 11� J / t ! Date 3131/2017
Issued by: AbbyAyende
OWNER DECLARATION
Date: 03/31/2017
-BUILDER
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
n. 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 (Scc.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature ofApplicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 3/31/2017
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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
s. I certify that in the performance of the work for which this permit is issued, I
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: ( _
APPLICANT CERTIFICATION
Date: 3/31/2017
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,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
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 shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 3/31/2017
Professional
❑ I,TECONSTRUCTION
CONSTRUCTION PERM" . " �LICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 - B
(408) 777-3228 • FAX (408) 77T-3333 - build! np(a-)CUpert ino.org L
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ADDITION ❑ .kuERATio / TI ❑ REVISION / DEA D ORIGINAL PERNUT if
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PR-E•,4PPLIC.ATION° ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN �-' ��ILECEiVED. _��;==`i�;X�:=` TOTAL \'ALUATIUN:
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By my signature below, I certify to each of the fo]Iowing t I am the property oxmer or authorized agent to act on er[y owner's beha f. 1 have read this
application and the information I have provided is c 'ect. I have read the Description of Work and verify i late. I agree to comply with all applicable local
ordinances and state latus relating to bu5iding cons tion. I authorize representatives of Cupertino to enter the above -identified p ppity forinspectionpurposes.
: Date: l7
Signature of Applicant/Agent:
SUPPLEMENTAL INFORMATION REQUIRED
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1\ex SFA or�
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exisi' abuildino s. Dernition permit is required prior to issuance of building
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errnit for new building.
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form if any Hazardous AdaterialS are being used as part of this project.
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Bldglpp_2011.doc revised 06121/11
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NN Engineering Services 5.—?-H7 036-
•
P6-
• 22528 Poppy Drive - 1�
Cupertino,CA 95014 cT�Ji 6 g
408-873-7972
17141
6/28/2017
Cityrof Cupertino
10300 Torre Ave.
Cupertino, CA 95014
Re: 5980 Sutton Park PI., Cupertino, CA 95014
Dear Sir/Madam:
This is to, certify that I have performed the Hold Downs Epoxy inspection at the above
address.
Based upon my personal observation, it is my judgment that epoxy installations were
performed in accordance to the approved plans and manufacturer's recommendations.
Regards,
r s.ESS/
, 49- •I iiike,
C 58134
70 zp.6/30/2018
lik% OF,OA��Fo.
Nhu Nguyen ,