B-2017-0817 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0817
10705 FLORA VISTAAVE CUPERTINO,CA 95014-1610(326 08 012) CHRIS LEE&
ASSOCIATES
SANTA CLARA,CA
95051
OWNER'S NAME:JEON JOONG SMITH AND KYU RAN DATE ISSUED:10/02/2017
OWNER'S PHONE: PHONE NO:(408)313-7775
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic.#845171 X BLDG_ELECT X PLUMB
Contractor CHRIS LEE&ASSOCIATES Date 08/31/2018
I hereby affirm that 1 am licensed under the provisions of Chapter 9(commencing X MECR 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:
ADDITION TO FAMILY ROOM AND KITCHEN(554 S.F.);DEMO
I hereby affirm under penalty of perjury one of the following two declarations: CARPORT;REMODEL ENTRY,EXISTING KITCHEN,DINING&
r. 1 have and will maintain a certificote of consent to self-insure for Worker's OFFICE(283 S.F.);RELOCATE FURNACE AND WATER HEATER;
Compensation,as provided for by Section 3700 ofthe Labor Code,far the RELOCATING GAME ROOM FRONT DOOR TO REAR AND
performance ofthe work for which this permit is issued. CONVERT TO SECOND DWELLING UNIT;DEMO CARPORT
.
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 REVISION#I: REVISE WINDOW OPENING AT
permit is issued. AUDITION/KITCHEN;REMOVE 2ND DWELLING UNIT FROM
APPLICANT CERTIFICATION SCOPE.-ISSUED 4-6-2018
I certify that I have read this application and slate that the above Sy.Ft Floor Area:554 Valuation:$100000.00
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 APN Number: Occupancy Type:
Inspection purposes.(We)agree to save indemnify and keep harmless the 326 08 012 R-3(Cutin")
City of Cupertino against liabilities,judgments,costs,and expenses which
may accrue ai said Clty in consequence of the granting of this permit.
Additionally,he app ant understands and will comply with all non-point
source mgu tions per h C ertino Municipal Code,Section 9.16. PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Signature Date 04106-2018 180 DAYS FROM LAST CALLED INSPECTION.
OWNER-BUIL DER DECLARATION Issued by:Jasmine Archbold
1 hereby affirm that I am exempt from the Cmrtractor's License Law for one of the Date:10/02/2017
following two reasons:
1. I,as owner ofthe property,or my employees with wages as their sale RE-ROOFS:
compensation,will do the work,and the structure is not intended or offered for All roofs shall be inspected prior to any rooting material being installed.If a roof is
sale(Sec.7044,Business&Professions Code) installed without first obtaining an inspection,1 agree to remove all new materials for
z 1,as owner ofthe property,am exclusively contracting with licensed inspection.
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: Signature of Applicant:
z. I have and will maintain a Certificate o£Consent to self-insure ha Worker's Date:04/06-2018
Compensation,as provided for by Section 3700 of the Labm Code,for the
performance ofthe work for which this permit is issued, ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 oftlrc Labor Code,for the performance ofthe work for which this HAZARDOUS MATERIALS DISCLOSURE
permit is issued I have read the hazardous materials requirements under Chapter 6.95 of the
3. Icertify that in the performance ofthe work for which this permit is issued,I California Health&Safety Code,Sections 25505,25533,and 25534.I will
all not employ any person in any manner so as to become subject to the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Worker's Compensation laws of California.If,after making this certificate or Health&Safely Code,Section 25532(x)should I stare or handle hazardous
exemption,I become subject to the Worker's Compensation provisions ofthe material.Additionally,should 1 use equipment or devices which emit haz:redous
Labor Code,l must forthwith comply with such provisions or this permit shall air amtan in'ats to dullarditby t 13ay Aren Air Quality Management District 1
be deemed revoked. will maintain compliance wh to Ct ertino MwUcipal Code,Chapter 9.12 and
the Health&Safety ode,Sec'ons 25505,25533,and 25534.
APPLICANT CE12'PIFICATION
I certify that 1 have read this application and state that the above information Is owner or authorized agent:
correct.I agree to comply with all city and county ordinances and state laws Date:04/06-2018
relating to building construction,and hereby authorize representatives of this city CON TRUCTIO LE DI AGENCY
to enter upon the above mentioned property for Inspection purposes. (We)agree I hereby affirm that there Is a constructio ending agency for the performance
to save indemnify and keep harmless the City of Cupertino against liabilities, of work's for which this permit is issued(Sec,3097,Civ C.)
judgments,casts,and expenses which may accrue against said City in Lender's Name
consequence of the granting of this permit.Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal Lender's Address
Code,Section 9.18.
ARCHI'1'ECI"S DECLAI2Aq'lON
Signature Date 04/06-2018 1 understand my plans shall be used as public records.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10705 FLORA VISTA AVE CUPERTINO, CA 95014-1610 (326 08 012)
CONTRACTOR:
CHRIS LEE &
ASSOCIATES
SANTA CLARA, CA
95051
PERMIT NO: B-2017-0817
OWNER'S NAME: JEON JOONG SMITH AND KYU RAN DATE ISSUED: 10/02/2017
OWNER'S PHONE: PHONE NO: (408) 313-7775
LICENSED CONTRACTOR'S DECLARATION
License Class GENERAL BUILDING CONTRACTOR Lic. #845171
Contractor CHRIS LEE & ASSOCIATES Date 08/31/2018
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:
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.
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
OWNER - BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor’s License Law for one of the
following two reasons:
1.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)
2.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 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
BUILDING PERMIT INFO:
X BLDG X ELECT X PLUMB
X MECH X RESIDENTIAL COMMERCIAL
JOB DESCRIPTION:
ADDITION TO FAMILY ROOM AND KITCHEN (554 S.F.); DEMO
CARPORT; REMODEL ENTRY, EXISTING KITCHEN, DINING &
OFFICE (283 S.F.); RELOCATE FURNACE AND WATER HEATER;
RELOCATING GAME ROOM FRONT DOOR TO REAR AND
CONVERT TO SECOND DWELLING UNIT; DEMO CARPORT
REVISION #2: REPLACE SUB-PANEL (100 AMP) - SAME LOCATION
- ISSUED 7/24/18
REVISION #1: REVISE WINDOW OPENING AT
ADDITION/KITCHEN; REMOVE 2ND DWELLING UNIT FROM
SCOPE.-ISSUED 4-6-2018
Sq. Ft Floor Area: 554 Valuation: $100000.00
APN Number:
326 08 012
Occupancy Type:
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: Jasmine Archbold
Date: 10/02/2017
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:
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 Address
ARCHITECT’S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional________________________________________________
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0817
10705 FLORA VISTAAVE CUPERTINO,CA 95014-1610(326 08 012) CHRIS LEE&
ASSOCIATES
SANTA CLARA,CA
95051
OWNER'S NAME: JEON JOONG SMITH AND KYU RAN DATE ISSUED: 10/02/2017
OWNER'S PHONE: PHONE NO:(408)313-7775
•
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#845171
Contractor CHRIS LEE&ASSOCIATES Date 08/31/2018 X BLDG _ELECT X PLUMB
X 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:
ADDITION TO FAMILY ROOM AND KITCHEN(554 S.F.);DEMO
I hereby affirm under penalty of perjury one of the following two declarations: CARPORT;REMODEL ENTRY,EXISTING KITCHEN,DINING&
1. I have and will maintain a certificate of consent to self-insure for Worker's OFFICE(283 S.F.);RELOCATE FURNACE AND WATER HEATER;
Compensation,as provided for by Section 3700 of the Labor Code,for the RELOCATING GAME ROOM FRONT DOOR TO REAR;DEMO
performance of the work for which this permit is issued.leo
CARPORT
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:554 Valuation:$100000.00
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 326 08 012 R-3(Custom)
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to::ve inde'-'ify and keep harmless the
City of Cupertino againstii�bittfie , •5.me, s, .sts,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against sa' dy i co ce the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the ap Ircant un-ers•. a snd . I comply with,all non-point
source regulatio s per the r up ;% -ipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
t re ", 10/2/2017 Issued by:Jasmine Archbold
I Date: 10/02/2017
OWNER-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 roofing material being installed.If a roof is
• 1. 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: 10/2/2017 •
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
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
material. Additionally,should I
shall not employ'any person in any manner so as to become subject to the use equipment or d V ice ch emit hazardous
air contaminants as defined by the Bay Are, • ••. 'y nagement District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino' pal rode,Chap
mter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,
be deemed revoked. O'"er or authorized.agent:
APPLICANT CERTIFICATION %'ate:10/2/2017 I
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.
Signature Date 10/2/2017 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0817
10705 FLORA VISTAAVE CUPERTINO,CA 95014-1610(326 08 012) CHRIS LEE&
ASSOCIATES
SANTA CLARA,CA
95051
OWNER'S NAME:JEON JOONG SMITH AND KYU RAN DATE ISSUED:10/02/2017
OWNER'S PHONE:408-292-7785 PHONE NO:(408)313-7775
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class E Lic.#845171
Contractor CHRIS LEE&ASSOCIATES Date 08/31/2018 XBLDG XELECT XPLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X 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:
ADDITION TO FAMILY ROOM AND KITCHEN(554 ST.);DEMO
I hereby affirm under penalty of perjury one of the following two declarations: CARPORT;REMODEL ENTRY,EXISTING KITCHEN,DINING&
r. I have and will maintain a certificate of consent to self-insure for Worker's OFFICE(283 S.F.);RELOCATE FURNACE AND WATER HEATER;
Compensation,as provided for by Section 3700 of the Labor Code,for the RELOCATING GAME ROOM FRONT DOOR TO REAR AND
Aerformance ofthe work for which this permit is issued. CONVERT TO SECOND DWELLING UNIT;DEMO CARPORT
z. I have and will maintain Worker's Compensation Insurance,as provided for by REVISION#2:REPLACE SUB-PANEL(100 AMP)-SAME LOCATION
Section 3700 of the Labor Code,for the performance of the work for which this -ISSUED 7/24/18
permit is issued. REVISION#1:REVISE WINDOW OPENING AT
APPLICANT CERTIFICATION ADDITION/KITCHEN;REMOVE 2ND DWELLING UNIT FROM
I certify that I have read this application and state that the above SCOPE.-ISSUED 4-6-2018
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 Sq.Ft Floor Area:554 Valuation:$100000.00
Inspection purposes.(We)agree to save Indemnify and keep harmless the
Cityof Cupe .o alnst liabilities,judgments,costs,and expenses which
may accrue gamst id City in consequence of the ranting of this permit. APN Number: Occupancy Type:
Additionally the applic t understands and will com ly with all non-point 32608 Olt R-3(Custom)
source regu ations per th Cups o un'ipal Cad ,Section 9.18.
Signature Date 07/24/18 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
OWNER-BUILDERDECL"'
180 DAYS FROM LAST CALLED INSPECTION.
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons: Issued by:Jasmine Archbold
r. I,as owner of the property,or my employees with wages m their sole Date:10/02/2017
compensation,will do the work,and the struchom is not intended or offered for
sale(Sec.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed RE-ROOFS:
contractors to construct the project(Sce.7044,Business&Professions Code). All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without fust obtaining an inspection,I agree to remove all new materials for
I hereby affirm under penalty of perjury one of the following three declarations: inspection.
r. 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 Signature of Applicant:
performance of the work for which this permit is issued, Date:07/24/18
z. 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
permit is issued.
s. 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 HAZARDOUS MATERIALS DISCLOSURE
Worker's Compensation laws of Califorms,If,after making this certificate of I have read the hazardous materials requirements under Chapter 6.95 of the
exemption,I become subject to the Worker's Compensation provisions of the California Health&Safety Code,Sections 25505,25533,and 25534.I will
Labor Code,I must f6rthwith comply with such provisions or this permit shall malealtcompliance with the Cupertino Municipal Cade,Chapter 9.12 and the
Health&Safety Code,Section 25532(a)should I store or handle hazardous
be deemed revoked. material.Additionally,should I use equipment or devices which emit hazardous
APPLICANT CERTIFICATION air contaminants as defined by the Bay Area Air Quality Management District I
I certify that I have read this application and state that the above information is will maintain compliance with the upe fro Municipal Code,Chapter 9.12 and
correct.I agree to comply with all city and county ordinances and state laws the Health&Safety Code Sectio 25505,25533,and 25534.
relating to building construction,and hereby authorize representatives of this city
to enter upon the above mentioned property for Inspection purposes.(We)agree Owner or authorized agent:
to save Indemnify and keep harmless the City of Cupertino against liabilities, Date:07124/18
judgments,costs,and expenses which may accrue against said City In CONSTRUCTION LEN G A ENCY
consequence of the granting of this permit.Additionally,the applicant understands I hereby affirm that there Is a construction lending agency for the performance
and will comply with all non-polnt source regulations per the Cupertino Municipal of work's for which this permit Is Issued(Sec.3097,Civ C.)
Code,Section 9.18. Lender's Name
Lender's Address
Signature Date 07/24/18