14060199I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10206 ENGLISH OAK WAY CONTRACTORS-+$)-- TO -BE PERMIT NO: 14060199
DE1 RMINEl1
OWNER'S NAME: JONG WAN KIM I(1 _ / j DATE ISSUED: 06/30/2014
I OWNER'S PHONE: 4084406168 1 . 1 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
//�
License Class__ Lic. #p
Contractor jPc°t�d1�/ /tryr� Date 30
1 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.
1 hereby affirm tinder 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.
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.
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 �3 0 %
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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 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:
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 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
1 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, 1 must
forthwith comply with such provisions or this permit shall be deemed revoked.
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.
Date
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑
REMODEL BATHROOM 55 SQ FT, AND 300 SQ FT TO
MASTER
SUITE
Sq. Ft Floor Area: I Valuation: $24000
I APN Number: 34212080.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS F 7T CALLED INSPECTION.
Issued by: 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.
Signature of Applicant:
Date:
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 Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent: Date:
CONSTRUCTION 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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Profession
1!3
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building c1cupertino.orq
Cl ok
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❑ NEW CONSTRUCTION ❑ ADDITION
Rq ALTERATION / TI
❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROTECT ADDRESS
U /1�-
W'fl
TYPE I
7APN #
OWNERNAME
EXISTG
NEW FLOOR DEMO
C ONE
n
E-MAIL
STREET ADDRESS �2 6 �1Et L1 S N
G (d
CITY, STA`TJE, ZIP
c,9 , Sa
FAX
/
CONTACT NAME
AREA (� 1
PHONE
AREA
E-MAIL
NET AREA
(..
RBCEIV BY
TOT V. UATION.
STREET ADDRESS CITY, STATE, ZIP AX
16 zc e
X. OWNER OWNER -BUILDER ❑ OWN'ERAGENT ❑ CON-rRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME I NSE NUMBER G� LICENSE TYPE BUS. LIC #
COMPANY NAME E-MAIL FAX
STREET ADDRESS 5 Atauie
' tl . 7 r CITY, S ;,L, i Lew cA - 2:�4 E, ZIP PHONE
ARCHITECT/ENGINEER NAME_ LICENSE NUMBER BUS. LIC #
L>>Av(C� P�Q� X137y/ o
COMPANY NAME �C E-MAIL FAXr
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STREET ADDRESS t{ CITY, STATE, ZIP PHONE r
Io � � �'t i v,� C� i'ZT(4 (Aa, �i6 7`i
DESCRIPTION OF WORK
1'-
15�ATTACH
USE
TYPE I
OCC. I
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR DEMO
TOTAL
Or r
BEINGADDED" IVO
ADDITION"
7❑AYES
AREA (� 1
AREA
AREA
NET AREA
(..
RBCEIV BY
TOT V. UATION.
PLANN'NINGAPPL# [:]NO PLANNLN G APPROVAL LETTER
EICHLER HOME" NO
BATHROOM 4j
KITCHEN
OTHER
l
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 constru on. I authorize representatives of Cupertino to enter the above -identified property, for inspection purposes.
SienatureofApplicant/Agent:
Date:
REMODEL AREA t,5
REMODEL AREA
REMODEL AREA
ROUTING SLIP .
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
PORCH AREA
DECK AREA
BUILDI�GPLAI�REVIEW
TOTAL DECKIPORCH AREA GARAGE AREA:
DETACH
D PLANNI1cPLANREVIER'
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ s%naxn k
Bld,-App_2011.doc revised 06/21/11
15�ATTACH
# DVTLLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
Or r
BEINGADDED" IVO
ADDITION"
7❑AYES
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN
RBCEIV BY
TOT V. UATION.
PLANN'NINGAPPL# [:]NO PLANNLN G APPROVAL LETTER
EICHLER HOME" NO
-
OD
By my signature below, I certify to each of the following: I am the property oN+mer or authorized agent to act on the property owner's behalf. I have 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 constru on. I authorize representatives of Cupertino to enter the above -identified property, for inspection purposes.
SienatureofApplicant/Agent:
Date:
�D
SUPPLEMENTAL )Tt OI��A ON UIRED
PLAN CHECKTJTE
ROUTING SLIP .
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
tiERxH�coulvTEx
BUILDI�GPLAI�REVIEW
permit for new building
EaPltEss`
D PLANNI1cPLANREVIER'
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ s%naxn k
D PusLlc{voxxs
_
form if any Hazardous Materials are being used as part of this project.
❑ FIRE
LARc!
WEPT
—Copy of Planning Approval Letter or Meeting with Planning prior to
❑ au�oR
k
C7 sAI�IxARY sEYr�Rnlsrxrcr m
submittal of Building Permit application.
Bld,-App_2011.doc revised 06/21/11
FMPS,
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10206 english oak way
DATE: 06/30/2014
REVIEWED BY: Mendez
APN: BP#:D
D v
`VALUATION: 1$24,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE:
Alteration / Repair
PRIMARY SFD or Duplex
USE:
Suppl. PC Fee: 0 Reg. d OT
PENTAMATION 1R3SFDREM
PERMIT TYPE:
WORK
remodel bathroom 55 sq ft and 300 sq
ft to master suite
SCOPE
300 J s.f.
$418.00
Remodel, Other
1REMRESOTH
NOTE; This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E '. T'l '13
FEEQTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= s.f.
$626.00
Remodel, Bath (<=300 sf)
1REMRESBAT
Suppl. PC Fee: 0 Reg. d OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
300 J s.f.
$418.00
Remodel, Other
1REMRESOTH
Permit Fee:
$0.00
Suppl. Insp. Feer Reg.
Q OTQ,Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
J_7__
0
E)
Work Without Permit? 0 Yes Q) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
0
Strong Motion Fee:
1 BSEISMICR
$2.40
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$3.40
$1,044.00
TOTAL FEE:
$1,047.40
Revised: 04/0112014