B-2017-1490 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1490
10252 RICHWOOD DR CUPERTINO,CA 95014-3361(369 08 025) C W BUILDERS INC
SARATOGA,CA 95070
OWNER'S NAME: RYU JEKWAN DATE ISSUED:09/06/2017
OWNER'S PHONE:408-218-7771 PHONE NO:(408)740-8039
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class a Lic:#826394
Contractor C W BUILDERS INC Date 09/30/2018 X BLDG X 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:
TEMP POWER POLE(100 AMP)
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
Ra 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. Sq.Ft Floor Area: Valuation:$1200.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 369 08 025
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 ap icant understands and will comply with all non-point
source regulati• ss er the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Sign.t 'i _O„/,/Air Date 09-06-2017 Issued by:Kim Dunbar
Date:09/06/2017
O R-BUILDER DECLARATION
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 roofmg material being installed.If a roof is
1. I,as owne '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:09-06-2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. 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
pen/lit 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
air contaminants as defined by the Bay Area A' uality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupert' m ' Code,Chapter 9.12 and
exemptioti,'I'become subject to the Worker's Compensation provisions of the the Health&Safety Code, do• „:is ,,25 3,and 25534.
Labor Code,'I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized ag
APPLICANT CERTIFICATION Date:09-06-2017
I 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. I understand my plans shall be used as public records.
Licensed
Signature Date 09-06-2017 Professional
CONSTRUCTION PERMIT APPLICATION
\ / COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
[ 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
/ �9O
4„.„1.194.., (408) 777-3228 • building@cupertino.org cupertino.org PEMIT#B 1
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. L'J MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS a%®2-c\ ,jC. r^ / Q... i//*%'e AT'N
OWNER NAME �c7 } b � gy� PHONI�� V�2.1� — 1/ �n n E-MAIL
STREET ADDRESS l/� CITY, STATE,Z IPII/ I(J'(�
NTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
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0 ARCHITECT 0'OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT ENGINEER 0 DEVELOPER ❑TENANT (
rCONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIIP -. PHONE
DECRIPTON e po q ek— / I 70e)
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❑SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES S TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5)
' REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED
BATHROOM SF SF ' SF SF ❑DETACHED
•
EXISING ❑YES EICHLER ❑YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS❑NO 0 NO ❑NO •
DWELLING SECOND DWELLING OYES 0 ATTACHED DETACHED'OTHER
. UNITS a I UNIT ADD ETON: ❑NO S F
POOLS". ❑FIBERGLASS ❑VINYL-LINED ❑GUNITE ❑PREFABRICATED
• POOL-SF SPA-SF I ;SPA ATTACHED El YES 0 NO I TOTAL-SF , 0 .
RECE�o :Y: Krey'pN: '
Commercial or:Multi-Family Buildinis with Public Swimming Pools requires Department of Environmental Heath approval (/(/ (VJ
RE-ROOF'EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO IF NO PLYWOOD ❑'h" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
1=1 YES I/OF,fLAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER • •12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES OWOOD SHINGLES 0 OTHER
*Provide a signed copy of the C ipertino's Tear-Off Policy SF Sof SQUARES
By my signature below I certifyito each of the following: I am the property owner 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 tate laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified property for insp ctio ur• -:. I acknowledge and authorize all information coi ail ed o. this application form
to be made available for public record f
Signature of Applicant/Agent. . Date: •
SUPPLEMENTAL INFORMATION REQUIRED .
*New SFD/Second Dwelling Units'Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letteir dr Meeting with Planning prior to submittal of Building Permit application.
HOA-Provide a letter of apprdval from the Home Owner's Association ,
BldgApp_2017.doc revised 08/01/17