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B-2017-1993CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1993 10026 ORANGE AVE CUPERTINO, CA 95014-2816 (3 57 17 114) OWNER BUILDER OWNER'S NAME: DATE ISSUED: 01/17/2018 OWNER'S PHONE: PHONE NO: LIC .NS D CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor OWNER BUILDER Date X BLDG —ELECT X PLUMB MECH RESIDENTIAL X 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: TENANT IMPROVEMENT (996 SQ FT) - EPRIS MULTI SHOP. I hereby affirm under penalty of perjury one of the following two declarations: 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 performance of the work for which this permit is issued. i. 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 Sq. Ft Floor Area: Valuation: $13000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 357 357 17 114 A (Tenant Improvements),M (Tenant Improvements),M and state laws relating to building construction, and hereby authorize (Tenant Improvements),A (Tenant Improvements),A representatives of this city to enter upon the above mentioned property for (Tenant Improvements),A (Tenant Improvements),A inspection purposes. (We) agree to save indemnify and keep harmless the (Tenant Improvements),A (Tenant Improvements),A City of Cupertino against liabilities, judgments, costs, and expenses which (Tenant Improvements),A (Tenant Improvements),A may accrue against said City in consequence of the granting of this permit. (Tenant Improvements),A (Tenant Improvements) Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. PERMIT EXPIRES IF WORK IS NOT STARTED Signature Date 1/17/2018 WITHIN 180 DAYS OF PERMIT ISSUANCE OR OWNER -BUILDER DECLARATION 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: Abby Aygnde r. I, as owner of the property, or my employees with wages as their sole Date: 01/17/2018 compensation, will do the work, and the structure is not intended or offered for V L sale (Sec.7044, Business & Professions Code) RE -ROOFS: 2. I, as owner of the property, am exclusively contracting with licensed All roofs shall be inspected prior to any roofing material being installed. If a roof is contractors to construct the project (Sec.7044, Business & Professions Code). installed without first 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. 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 Signature of Applicant: performance of the work for which this permit is issued. C2. Date: 1/17/2018 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. 3. I certify that in the performance of the work for which this permit is issued, I HAZARDOUS MATERIALS DISCLOSURE shall not employ any person in any manner so as to become subject to the I have read the hazardous materials requirements under Chapter 6.95 of the Worker's Compensation laws of California. If, after making this certificate of California Health & Safety Code, Sections 25505, 25533, and 25534. I will exemption, I become subject to the Worker's Compensation provisions of the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Labor Code, I must forthwith comply with such provisions or this permit shall 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 air contaminants as defined by the Bay Area Air Quality Management District I APPLICANT CERTIFICATION will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I certify that I have read this application and state that the above information is the Health & Safety Code, Sections 5505, 25533, and 25534. 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 Owner or authorized agent: to save indemnify and keep harmless the City of Cupertino against liabilities, Date: 1/17/2018 judgments, costs, and expenses which may accrue against said City in CON T UCTION IIENDING AGENCY 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 -point 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 1/17/2018 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. CONSTRUCTION PERMIT APPLICATION FM- I I COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION I• I 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 MI I(408)777-3228- lit lilriincravctinorfinnwo PEMIT#B- W '�� CUPERTINO I REV # DEF # ❑ NEW CONSTRUCTION I -I ADDITION F1 ALTERATION n f.l. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA PROJECT ADDRESS APN B 1 10026 Orange Ave. 357-17-060 OWNER NAME PHONE E-MAIL Jeffrey Hu 408 886-0731 STREET ADDRESS cl lI . ti 1A II:, ZIP 10028 Orange Ave. Cupertino CA 95014 ❑ CONTRACTOR NAME ❑ OWNER -BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE STREET ADDRESS CITY, STATE, ZIP E-MAIL PHONE BUS. LIC i ❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT ❑CONTRACTOR AGENT❑ ENGINEER ❑ DEVELOPER 91 TENANT CONTACT NAME E-MAIL Bora Kang chanjooleel@gmail.com STREET ADDRESS CITY, STATE, ZIP PHONE 20540 Stevens Creek Blvd. #28 Cupertino CA 95014 1650)815-9779 DESCRIPTON Tenant Improvement for E ris multi shop retail ❑SINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL 0 COMMERCIAL USE TYPE OCC SQ.FT. VALUATION (S) EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES 2 TOTAL NET SF Retail 1996 REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ ATTACHED BATHROOM SF SF SF SF ❑ DETACHED EXISING ❑ YES EICHLER ❑ YES SECOND STORY ADDITION ❑ YFS FIRE SPRINKLERS ❑x NO ® NO 19 NO DWELLING SECOND DWELLING ❑ YES ❑ ATTACHED DETACHED OTHER UNITS; I UNrF ADDITON: ❑ NO S F POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GU^NITF ❑ PREFABRICATED POOL - SF SPA - SF SPA ATTACHED 11 YES ❑ NO TOTAL - SF RECEIVED B1": TO AL VALUATION: Commercial or Multi -Family BrrildinSs mith Public Swimming Pauls requires Department o, f Environmental He alh m1prmral RE -ROOF EXSI1NGROOF TYPE: ❑BUILT-UP ROOF []ASPHALT SHINGLES❑WOOD SHAKES❑ WOOD SIiINGLES ❑7TLE OTHER(SPECIFY) REMOVE /REPLACE ❑ NO IF NO PLYWOOD ❑ e� ❑ 3/8" PT-YWOOD TYPE: PITCH- ROOF CLASS 0YES x OF LAYERS THICKNESS ❑ 5/8" OTHER ❑OSB ❑ CDX OTHER '12 A PROPOSED ROOF TYPE: ❑BUiL.T-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑WOOD SHINGLFS ❑ OTHER *Provide a signed copy of the Cupertino's Tear -Off Policy SF lrof SQUARES By my signature below I certify to each of the following: I am the property owner or authorized agent to act on the property owners 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 construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. I acknowledge and authorize all information contained on this application form to be made available for public record. Signature of Applicant/Agent: Date: 11/28/2017 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 BldgApp_2017.doc revised 08101.117 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina(Qcupertino.or4 Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS )02-6 v r -k t /jv� APN �� _ �� �Z�� OC7 BP# . F09 Zvi ' 1Cl OWNER NAME TE,fGe H OWNER ADDRESS /0,0 2,6 DESCRIPTION OF WORK: (Am t 04 12 POVt•1--t � `f,6 C, I/ 1Y We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. ), " 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. j�A 3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. sy- 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. )(1 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. &-L7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. J-118. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OivnerBuilderFornt 2010.doc revised 04/14/10 J-1 9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. P 1 10.1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. S� 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. 4` 1 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: 1 f !f Zo c.D --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: �(l0 26 �1-vl ;i�2 �'� �_ �'"�`� QA- q 5 (-f Name of Authorized Agent: ti ( -P�- Tel No 4 Address of Authorized Agent: /0C) LG Oke- o CC--a1r o (� as I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: Oi+�nerBuilderFor•n: 2010.doc revised 04114110 GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CU O, CA 95014-3255 (408) 777-3228 •FAX (408) 777-3333 • building(cupertino.orp MISIC 11 ^�� ,UMBING [—]MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 10026 Orange Ave APN# OWNERNANIE Jeffrey Hu PHONE 408-886.0731 a -MAH, jeffrey.hu@dynastycupertino.com STREET ADDRESS 10026 Orange Ave CITY' STAT&'ZIP Cupertino CA 95014 FAX CONTACT NAME Daniel Lee PHONE 650316.9779 &MKIL chanjoolee1@gmail.com STREET ADDRESS 20540 Stevens Creek Blvd #28 CITY, STATE, ZIP Cupertino CA 95014 FAX ❑ OWNER ❑ OWNER -BUILDER 0 OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHUE•CT ❑ ENGINEER ❑ DEVELOPER © TENANT CONTRACTOR NAME Marti's Plumbing LICENSENUMBER 968020 LICENSE TYPE C36 HUS. LIC# Sole Prop COMPANY NAME Marti's Plumbing E-A' mjserrano32@gmail.com FAX STREET ADDRESS 10260 Imperial Ave CITY, STATE, ZIP Cupertino CA 95014 PHONE 408-426.6627 ARCIETECT/ENGINEMR NAME LICENSENUMBER HUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑SFDur DUPLEX ❑ MULTI-PAMILY BUILDING: QCOMMERCIAL PROJECTINWILDLAND El YES URBAN INTERFACE AREA ®NO PROJECT IN ❑ YES FLOOD ZONE m NO ISTHRBLDGAN ❑ YES IDCHLERIIOMEP m NO DESCRIPTION OF WORK Run new pipe for 5 fixtures, Details: Execute 4" main to new fixture location (waterground), Repipe cold water from main cut off valve and upsize for new design 1" Copper pipe, Repi a hot water from new water heater to new design and pipe waste of 5 fixtures TOTAL VALUATION: ®3 r ao v RECENED�,TY Gt/ By my signature below, I certify to each of the foil wing: 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 1 et. ha a rca Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building c ucti an ❑ze re resentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent Date: 11/6/2017 SUPPLENffiNTAL INFOR7REQUIRED OFFICEUSE .ONLY ❑ OVER-THE-COUNTER +�F:-: ❑ EXPRESS WU Z m ❑ STANDARD ❑ LARGE ❑ xrA.IOR J.. MEPMiscApp_2011.doe revised 06/21/11