B-2018-0611 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0611
19772 WHEATON DR CUPERTINO,CA 95014-2458(3l6 28 002) OK HEE KIM
825 S SAN TOMAS
AQUINO RD 26
CAMPBELL,CA 95008
OWNER'S NAME: DATE ISSUED:06/05/2018
OWNER'S PHONE: PHONE NO:40s-440-6468
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#63i 8489 X BLDG$ELECT—PLUMB
Contractor OK HEE KIM Date 01/31/2020 —
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH$RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. SOB DESCRIPTION:
ONE STORY ADDITION AT REAR OF RESIDENCE(745 ST..);(N)
I hereby offirm under penalty of perjury one of the following two declarations: COVERED PORCH(27 S.F.);(N)WINDOW IN BEDROOM I;
1. 1 have and will maintain a certificate of consent to self-insure for Worker's RELOCATE(E)200 AMP ELEC PANEL;RE-ROOF;TEAR OFF
Compensation,as provided for by Section 3700 of the Labor Code,for the EXISTING SHINGLES;INSTALL LIGHT WEIGHT TILES ON THE
performance of the work for which this permit is issued. EXISTING HOUSE-(21 SQ)
' 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:745 Valuation:$125000.00
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 31628 002 R-3(Custom)
representatives of this clly 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 applicant understands and will comply with all non-point
source regulations pertheCupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature( Date 06-05-2018 Issued by:Kim Dunbar
Date:06/05/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
fallowing two reasons: All roofs shat]be inspected prior to any roofing material being installed.If a roof is
r. 1,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 die structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. 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:06-05-2018
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTOR
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. HAZARDOUS MATERIALS DISCLOSURE
z. 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 Coliforms 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
s. I certify that in the performance ofthe work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ son in an manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
p y any per y 1 .it 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 with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,l must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:06-05-2018
1 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 Clty 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 ARCtuTECT'S DECLARATION
Code,Section 9.18. 1 understand my plans'shall be used as public records,
SignatureLicensed
Date 06-05-2018
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0611
19772 WHEATON DR CUPERTINO,CA 95014-2458(31628002) OK TEE KIM
825 S SAN TOMAS
AQUINO RD 26
CAMPBELL,CA 95008
OWNER'S NAME: DATE ISSUED:06/05/2018
OWNER'S PHONE: PHONE NO:408-440-6468
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#638489
Contractor OK HEE KIM Date 01/31/2020 X BLDG X ELECT_PLUMB
I hereby affirm that t am licensed under the provisions of Chapter 9(commencing —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:
ONE STORYADDITION AT REAR OF RESIDENCE(745 S.F.);(N)
I hereby affirm under penalty of perjury one of the following two declarations: COVERED PORCH(27 S.F.);(N)WINDOW IN BEDROOM 1;
t. I have and will maintain a certificate ofconsent to self-insure for Worker's RELOCATE(E)200 AMP ELEC PANEL;RE-ROOF;TEAR OFF
Compensation,as provided for by Section 3700 of the Labor Code,for the EXISTING SHINGLES;INSTALL LIGHTWEIGHT TILES ON THE
performance of the work for which this permit is issued. EXISTING HOUSE-(21 SQ)
I have and will maintain Worker's Compensation Insurance,as provided for by REV#I-RECONFIGURE DOOR&WINDOWS-ISSUED 6/21/1.8
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued Sq.Ft Floor Area:745 Valuation:$125000.00
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 31628 002 R-3(Custom)
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 applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 6121118 Issued by:Kim Dunbar
Date:06/05/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt Brom the Contractor's License Law for one of theRE-ROOFS:
following hwo reasons: All roofs shall be inspected prior to any roofing material being installed If a roof is
t. I,as owner of the property,or my employees with wages as their sale 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.
W,(Sve.7044,Business&Professions Code)
e. 1,as owner of the property,am exclusively contracting with licensed Signature ofAppiicauC
contractors to construct the project(Sec.7044,Business&Professions Code). Dote:6/21/18
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. 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
z. 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 Cade,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued, maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store or handle hazardous
shall not employ n n an annex so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
p y a y person i y m 1 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 with the Cupertino Municipal Code,Chapter 9.12 and
exemption,l became subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked, Owner or authorized agent:
APPLICAN'PCERTIFICATION Date:6/21118
I certify that I have read this appllcalion 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. 1 understand my plans shall be used as public records.
Signature Date 5121/18 Licensed
Professional