B-2071-1786 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1786
19381 GREENWOOD DR CUPERTINO,CA 95014-3415(375 43 003) R B TRAVIS
LIVERMORE,CA 94551
OWNER'S NAME: PARK KIHOON AND HWANG INHYE DATE ISSUED: 10/18/2017
OWNER'S PHONE:408-603-5954 PHONE NO:(925)443-8304
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC=36 Lica#671157
Contractor R B TRAVIS Date 05/31/2019 X BLDG _ELECT X 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:
REPLACE WATER MAIN SERVICE
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
�t;iCompensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
"IP 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:$2400.00 '
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 375 43 003
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
. Addition. ', he applicant understands and will comply with all non-point
source ,-gul.tion per the' upertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Jj �r
� t re /L':ktit. * Date 10/18/2017 Issued by:AbbyAyende
' Date: 10/18/2017
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: 10/18/2017
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
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 ani,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 Air Quality Management District I.
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance wi the uper'no Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Sat'. y Code Sec ,ns 25505`5533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall I As
be deemed revoked. r irM/
„.9 neer or authorized age t: 1 JimAff
• APPLICANT CERTIFICATION • Date:10/18/2017
I I certify that I have read this application and state that the above information is CONSTRUC ION LENDNG 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 i'CHITEC ' r CL• • •TIO
' Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 10/18/2017 Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
=' 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
� 2o ri— rj--A0
w , °'a; (408) 777-3228 • buildinOcupertino.orn PEMIT#B- -
CUPERTINO REV# DEF#
. ❑ NEW CO/�N7STTRnUCCTIION ❑ADDITION/'' ❑n ALTERATION ❑T.1. ❑MEPP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT/r1•.-I) \./�Ree , v3 V II p f APN# .3_15
C 1.4 00.
L 'lS - 'WJ
O l NAME i Tgie� 6015m 6D� �07 r., E-MAIL
S, E ADD SS CITY,STATE,ZIP � '`1/
4- i3% I Lot-� ,�-off. etec[e LUZQ�r�1�v CA S, i
CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME V, LICENSE NUMBER • LICENSE TYPE
2 \3 -(e*-Q;5 pIwi4W 6 //
I STR5 7C DD ESS J i !i[I e' C L �E. I4W&-c Com", go
i / • I
E-MAIL PHONE zsABUS.LIC u
0 ARCHITECT ewNER ❑OWNER AGENT 0 CONT CTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT
•
CONTKC
N tE E-MAIL ..
K 140
•
STREET ADDRESSCITY,STATEIP '
i , PHONE
•
DECRIPTON -• Ii or N440 Li t Ia sV ice= Rie, c/7/71 1.GIMP e-Aek
To tient
❑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 I TOTAL NET SF USE TYPE DCC SQ.FT. VALUATION(5)
•
REMODEL 'REMODEL KITCHEN REMODELOTHR GARAGE 0 ATTACHED
BATHROOM SF . SF' SF SF ❑DETACHED
EXISING ❑YES EICHLER ❑ YES SECOND STORY ADDITION ❑DYES
El SPRINKLERS NO ❑ NO
DWELLING SECOND DWELLING''❑YES 0 ATTACHED DETACHED OTHER
UNITS I UNIT ADDITON: ❑NO S F
POOLS( ❑ FIBERGLASS ❑'VINYL-LINED 0 GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED 1=1 YES 0 NO I TOTAL-SF '
RECEIVFU BY: TO�7Q.L AL J 1(
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Envirwmlenlal Healh approval
/\/, ,pnn r' 1 ( (
RE-ROOF EXISTING ROOF TYPE: El BUILT-UP ROOF ❑ASPHALT SHINGLES El WOOD SHAKES❑WOOD SHINGLES TILE OTHER SPECIFY)1 7 //
REMOVE/REPLACE❑NO IF'NO PLYWOOD ❑1„. ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
❑YES l<OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER ,12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES❑WOOD SHINGLES 0 OTHER -
*Provide a signed copy of the Cuperti . s Te. -Off Policy SF . i<of,SQUARES
By my'signature below I certify to etch of the followie•: I am h: property owner or authorized agent to act on the property owner's behalf. 1
have read this application arid the'nformation i hay- •.rovid, •. ' orrect. I have read the Description of Work and verify it is accurate. I agree
to comply with all applicable loc.l ordinances an: .ta, 1. -.atin• to building construction. I authorize representatives of Cupertino to
enter the above-identified proper y for insne ID .rt-. knowle.g- -cid authorize all information contained on this application form
to be made available for public re ord. / r :� � f 0���y
Signature of Applicant/Agent: A4 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 Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA-Provide a letter of approval from the Home Owner's Association - ,
Bldg,4pp_2017.doc revised 08/01/17