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09110017CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20874 HANFORD DR CONTRACTOR: K & M DEVELOPMENT INC PERMIT NO: 09110017 OWNER'S NAME: MARTHA KANG 10387 MIRA VISTA RD DATE ISSUED: 08/26/2010 ` 'ER'S PHONE: 4083905127 CUPERTINO, CA 95014 PHONE NO: (408)253-9787 13 LICENSED CONTRACTOR'S DECLARATION r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Z3 Lic. # r Contractor /��/� •-�'�'%Q'� pat �Z� ' MECH'r RESIDENTIAL COMMERCIAL 1 hereby affirm that I am licensed under the provisions of apter 9 JOB DESCRIPTION: NEW 2-STORY SFDWL(4457SQ) & GARAGE(637SQ) (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: 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. Sq. Ft Fh or Area: Valuation: $700000 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. APN Number: 32630059.00 Occupancy Type: APPLICANT CERTIFICATION certify that 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, WI THIN 180 DAYS OF PERMIT ISSUANCE OR costs, and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. 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• Issued b y ,. Date: 2 �� Signature Date �Z� /� i OWNER-BUILDER DECLARATION RE-ROOFS: All roofs: hall be inspected prior to any roofing material being installed. If a roof is 1 hereby affirm that I am exempt from the Contractor's License Law for one of installed N iithout first obtaining an inspection, I agree to remove all new materials for the following two reasons: inspectior. 1, 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, Signature of Applicant:_ Date: Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1 hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 1 have and will maintain a Certificate of Consent to self-insure for Worker's I have re. A the hazardous materials requirements under Chapter 6.95 of the Compensation, as provided for by Section 3700 of the Labor Code, for the Californi r Health & Safety' Code, Sections 25505, 25533, and 25534. 1 will maintain performance of the work for which this permit is issued. complian :e with the Cupertino Municipal Code, Chapter 9.12 and the Health & 1 have and will maintain Worker's Compensation Insurance, as provided for by Safety Cc de, Section 25532(x) should 1 store or handle hazardous material. Section 3700 of the Labor Code, for the performance of the work for which this AdditionsLlly, should I use equipment or devices which emit hazardous air contaminants as defined by' the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued, 1 shall Health & Safety Code, Sections 25505, 25533, and 25534. 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 J P p Owner or a roriz entT Daterp Z 6 /p forthwith comply with such provisions or this permit shall be deemed revoked. _ ONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION 1 hereby a ffirm that there is a'construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued (Sec. 3097, Civ C.) correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities, judgments, co- and expenses which may accrue against said City in consequence of the g ; o this permit. Additionally, the applicant understands and will comply ARCHITECT'S DECLARATION W;. t non-point source regulations per the Cupertino Municipal Code, Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20874 HANFORD DR CONTRACTOR: K & M DEVELOPMENT INC PERMIT NO: 09110017 OWNER'S NAME: MARTHA KANG 10387 MIRA VISTA RD DATE ISSUED: 08/26/2010 OWNER'S PHONE: 4083905127 CUPERTINO, CA 95014 PHONE NO: (408)253-9787 ❑ LICENSED CONTRACTOR'S DECLARATION r r r BUILDING INFO: ELECT License Class ,Lic. # /4/_/t,fT /' 13 PERMIT BLDG PLUMB r r r Contractor /� �/� �� Dat . �26 ` 1 MECH RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of apter 9 JOB DESCRIPTION: NEW 2 -STORY SFDWL(4457SQ) & GARAGE(637SQ) (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: 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. Sq. Ft Floor Area: Valuation: $700000 1 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. APN Number: 32630059.00 Occupancy Type: APPLICANT CERTIFICATION 1 certify that 1 have read this application and state that the above information is correct. l 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs, and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. 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. Issued bye Date: Z�U Signature Date ❑ OWNER -BUILDER DECLARATION RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection, l agree to remove all new materials for the following two reasons: inspection. 1, 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, Signature of Applicant: Date: Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 1 have and will maintain a Certificate of Consent to self -insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation, as provided for by Section 3700 of the Labor Code, for the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & I have and will maintain Worker's Compensation hrsurance, as provided for by Safety Code, Section 25532(a) should I store or handle hazardous material. Section 3700 of the Labor Code, for the performance of the work for which this Additionally, should I use equipment or devices which emit hazardous air permit is issued. 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 1 certify that in the performance of the work for which this permit is issued, l shall Health & Safety Code, Sections 25505, 25533, and 25534. 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, l Owner ora ent: become subject to the Worker's Compensation provisions of the Labor Code, l must Date: forthwith comply with such provisions or this permit shall be deemed revoked. ONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's 1 certify that I have read this application and state that the above information is for which this permit is issued (Sec. 3097, Civ C.) correct. l agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save Lender's Address 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 ARCHITECT'S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CUPEIkTINO CITY OF CUPERTINO NEW SINGLE/MULTI FAMILY DWELLING PERMIT APPLICATION FORM APN # �2 � 3Q rJq Date: Are you adding a 2"d unit? Yes El No If yes, You also need to fill out the permit application for a 2"d unit. Building Address: 20 VLy Mailing Address (if flifferent from building address): 0.38lqoo Owner's Name: Phone #: A�q'j6P �(f- 3�d SfZ Do you have the planning Residential Design Review/Minor Residential Permit approval? Yes No If yes, please provide a copy of your planning approval letter.. Planners Name: fj�(J ��jIQS If no, see Planning before submitting plans to the Building Department j Have you applied for the demolition permit? Yes Ll NoRl Applicant Signature (Notified of Demo If no, pick up application and procedures. Re uirement Contractor: Phone #: 3 L Fax #: Contractor License #:/�/G,[ M71111� ` Cupertino Business License #: Contact: Pick MW4 of Phone #: f — ' C, L Fax #: 06- % Z Alternate Contact: Phone #: Fax #: Single -Story Two -Story Three -Story Basement Hillside Multi -family ❑ Apartment ❑ Condo ❑ Townhouse ❑ Sq.Ft. Living Area -Including Basement & Attached Garage: Sq. Ft. Garage (Detached Only): Living area: Basement: Attached Garage: 6,5;sr- Total Sq. Ft: Sic Valuation: i� 700 poo Job Description: 1�"&Pbr G8) h6wA440 A N&W 2• S fakr sti Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V -B v R3 Project Size: Standard Kr___ Lar e❑ Major E] Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Green Building Points Achieved: n For help, contact Build it Green at www.builditLreen.org[� Revised 06/10/09 M CITY OF CUPERTINO NEW SINGLE/MULTI FAMILY DWELLING FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type 1RIINSP Apt Bldg inspection fee B 1R1APT 1 R 1 PLNCK Apt Bldg plan check fee B 1RIREINSP Apt Bldg repeat unit B 1RIAPTR Ins ection fee 1 R 1 REPLNCK Apt Bldg repeat unit plan B check fee 1 R3INSP Dwellings Inspection B 1R3SFDW 1 R3PLNCK Dwellings Plan Check B 1R3REPINSP Dwellings Repeat B 1R3SFDR Inspection 1R3REPPLNC Dwellings Repeat Plan B Check 1 R3HINSP Dwellings Hillside B 1R3HILL Inspection 1 R3HPLNCK Dwellings Hillside Plan B Check 1R3HREINSP Dwellings Hillside B Repeat Inspection 1R3HREPLNC Dwelling Hillside Repeat B Plan Check 1R3ALTINSP Dwellings Alternate B 1R3SFDALT Materials 1 R3ALTPLNCK Dwellings Alternate B Materials 1GARDTW<=1K Detached Garage Wood B 1 GARDTM<=1 K Detached Garage B Masonry / 1 BCONSTAXR Constax—Resi/Mobile B 1 BMITIGATR Residential Housing PL Mitigation Fee-chrg only if lot is vacant or it is a subdivision -see lana in 2 of 3 M CITY OF CUPERTINO NEW SINGLE/MULTI FAMILY DWELLING FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES / 1BSEISMICR Seismic Residential B �0 y 1 PLLONGRNGR Long Range Planning/Residential PL / 1BPWSVCS Main Water Service P 1BSWIM Swimming Pool B 1PCESS For Ea.Cesspool P 1PATMOBF For Atmospheric Type Vacuum Breaker - backflow not included in item 1 1-5 5+ P 1PPRSEWG Ea. Private Sewage Disposal System P 1PRSEWER For ea building sewer, sanitary sewer, & ea trailer ark sewer P 1 BPSPRINK For ea. Lawn Sprinkler Sys on any one mtr, incl. backflow protect device P 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 BUSLIC Business License B 3 of 3