13110108CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21584 LA PLAYA CT
CONTRACTOR: IC HOME DESIGN
PERMIT NO: 13110108
OWNER'S NAME: YUNG GARY TRUSTEE
248 RED OAK DR E STE E
DATE ISSUED: 11/15/2013
OWNER'S PHONE: 4087027347
SUNNYVALE, CA 94086
PHONE NO: (408) 718-7036
0 LICENSED CONTRACTOR'S DE I CLARATION
JOB DESCRIPTION: RESIDENTIAL=COMMERCIALD
REMODEL KITCHEN 80 SQ FT TO INCLUDE NEW
License Class Li,. #
CABINETS,
Contractor Ka AJt &pte (
FINISHES.. REMODEL M.SUITE TO INCLUDE BATHROOM
I hereby affirm that I am licensed under the provisions of Chapter 9
REMODEL 180 SO FT M,E,P'S
(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 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.
Sq. Ft Floor Area:
Valuation: $25000
ipave and will maintain Worker's Compensation Insurance, as provided for by
Vection 3700 of the Labor Code, for the performance of the work for which this
APN Number: 35623014.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DA OM LAST CALLED INSPECTION.
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
Issued by: Date:
with all non -point sour e regulations per the Cupertino Municipal Code, Section
9.18.
Signature 7 Date-
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,
0 OWNEJBUILDER DECL—ARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Low for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1, 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 o*ffered for sale (Sce.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLQSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health& Safety Code, Sections 25505,25533, and 25534. Iwill
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the C cipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Section nd 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date:
permit is issued.
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
CONSTRUCTION LENDING AGENCY
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
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C)
Lender's Name—
APPLICANT CERTIFICATION
Lender's Addres
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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional -
9,18.
Sign Date
I.
1O3OOTORREAVENUE ~CUPERTIND.CAS5O14-3255
(408)777-3228,FAX (408)777-3333^
J:1 NEW CONSTRUCTION F-1 ADDITION 19 ALTERATION / TI D REVISION / DEFERRED
PROJECT ADDRESS
APN #
IINI
PHONE E-14AIL
STREET ADDRES SS CITY, STATE ZIP
I CQ PER 14Q
911
CONTACT NAME
PHONE
E-MAIL
STRE ET ADDRESS
CITY, STATE, ZIP I
FAX
El OWNER OWN'ER-BUILDER 0 OWNER AGENT 13 CONTRACTOR 1:1 CONTRACTOR AGENT El ARCHITECT 171 ENGINEER 0 DEVELOPER TENANT
CONTRACTOR NAME 1,
LICENSE NUMBER
LICENSE TYPE
E -MAI&
FAX
1P
CITY, STATE, ZIP
HONE
oAk
ARCHITECT/ENGINEER NAME
I LICENSENUMBER
BUS. LIC #
COMPANY NAMEe–OR I �Q At Lim
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONEZ(Wib S:�C�
DESCRIPTION OF WORK j64-okL
EXISTING USE
PROPOSED USE CONSTK
TYPE
# STORIES
USE
TYPE
OCC
SQFT.
VALUATION
EXISTO
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NErAREA
BATHROOM
KITCHEN I
OTHER
PORCH AREA
DECK AREA
TQIALDECK/PORCHARE
GARAGEAREA: []DETACH
I
–Fiii--APPECATION
BEING ADDED? []NO
ADDITION? []NO
El YES IF , M, PROVIDE COPY OF
IS THE BLDG AN E] YES
TOTAL VALUATION:
PLANNINTGAPPL# E]NO PLANNING APPROVAL LETTER
EICHLER ROME? ONO
cooAf
By Iny signature below, I certify to each of the following: I am the property owner or authorizeZar property owner's behalf. I have read this
to act on the
v�i
application and the infonnation I have provided is co I. I have read the Description of Work an verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building con tj n. I aut ze representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature ofApplicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition perinit is required prior to issuance ofbuilding
permit for new building.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
�6_rm if any Hazardous Materials are being used as part of this project.
Copy of Planning Approval Letter or Meeting with Planning prior to
R
Tu—bmittal Building Permit
p:
of application.
86dgApp_30/ldoe revised O612l11}
VA CITY OF CUPERTINO
VVP
ADDRESS: 21584 la playa ct
FEE
QTY/FEE
'REVIEWED BY: mendez
APN:
�BP#:♦
VALUATION: 1$25,000��
*PERMIT TYPE: Bui I Iding Permit
Remodel, Bath (<=300 sf)
IREMRESBAT
i PLAN CHECK TYPE:
Alteration Repair
PRIMARY
SFD or Duplex
USE:
L
PENTAMATION
1R3SFDREM1
PERMIT TYPE:
PME Plan Check:
remodel kitchen 80 sqft to include new cabinets, finis remodel m.suite to include bathroom
$0.00
remodel 180 sq ft m,e,p's
-hes..
AA 111an I
ech, T'lan (.he(,,,k plumb, Mari Ch<wi!
F,,, 7rw il Fe,?h,;,mb, 11,rmif
-7 F 1111,C', fermi t Fee:
o
Other Elec, Insp, fher,Afeck Insp. Other Numb Msp. 07- LJ
A'Iech. insl'. Fee: PhIm1b, 11,w). FMEkc, Insp, Fee:
NOTE: This estimate does not include fees due to other Departments (ie. Planning, -puptic worKs,rare, aamraiy Sewer vasrruz, acnoot
e. I- -I.- :---. -I .— __1. .-aatisunto rA"Y"14 taco Giant fnr addii Y1 info.
FEEITEMS bee Resolution 11-053 Eff. 7111132
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= s.f.
$626.001
Remodel, Bath (<=300 sf)
IREMRESBAT
Suppl. PC Fee: (j) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
80 s.£
$626.0 oLj_R_E_IfE_sx_;T
Remodel, Kitchen (<=300 sf)
Permit Fee:
$0.00D�;
Suppl. Insp. Fee: (D Reg. 0 OTF
0,0 I
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
('Amsiruction TcLv:
,1%bninistrafive.Fee:
0
0
Work Without Permit? 0 Yes (j) No
$0.00
Advanced PlgDajp�Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
0
Travel Documentalion h
Slrgng -Motion Fee: IBSEISMICR
$2.50
Select an Administrative Item
BldgStds Commission Fee: IBCBSC
$1.00
UOTALS..,
RT
$3.50
0
$1,252.Oj
TO TAL FEE:
1 $1,255.50j
Revised: 10/01/2013
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: 2. 1 SA
SUBCONTRACTOR
OW-NER'SNAME: 69M CHEU
PHONE # 4L!0) &_IL"o I
GENERAL CONTRACTOR: ffQjQ; a C - AJ; j� r tj
BUSINESS LICENSE # 116 6_3
ADDRESS.:-,)_
U)J lu V L
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBC =CTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
04n-er / Contractor S_ign'a1Wre Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
rN
Electrical
Excavation
Fencing
\j
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
04n-er / Contractor S_ign'a1Wre Date
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