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11110001 { CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10410CALVERTDR CONTRACTOR:UNIVERSAL PERMIT NO: 11110001 CONSTRUCTION OWNER'S NAME: SUNGNAM WON 10410 CALVER'1'DR DATE ISSUED:11/01/2011 1*R'S PHONE: 4082023290 CUPERTINO,CA 95014 PHONE NO:(408)252-8894 ❑ LICENSED CONTRACTOR'S DECLARATION /^ c�y BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r� License Class /7_ Lic.q /S s J MECH r RESIDENTIAL r COMMERCIAL r Contractor til. In)01--3 Date 11 Ig 11 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEMPORARY POWER POLE (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 1 hereby alarm 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 Fluor Area: Valuation:$200 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:37518005.00 Occupancy Type: APPLICANT CERTIFICATION I 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 stale laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harrnless the City of Cupertino against liabilities,judgments, 180 DAY FROM LAST CALLED INSPECTION. 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 Issued by: 9.18. Signature Date h /2-Al RE-ROOFS: OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is 1 hereby affirm that 1 em exempt from the Contractor's License Lew for one of installed without first obtaining an inspection,I agree to remove all new materials for inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(x)should 1 store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should 1 use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this 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,I 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 Owner or au a enl: Compensation laws of California. If,after making this certificate of exemption,I Date; become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall he deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save i nify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION 'Unand expenses which may accrue against said City in consequence of the g of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. wim all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date • CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37518005 . 00 DATE ISSUED. . . . . . . : 11/01/2011 RECEIPT #. . . . . . . . . : BS000015200 REFERENCE ID # . . . : 11110001 SITE ADDRESS 10410 CALVERT DR SUBDIVISION . . . . . . : CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SUNGNAM WON ADDRESS . . . . . . . . . . : 10410 CALVERT DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : UNIVERSAL CONSTRUCT CONTRACTOR . . . . . . . : WON, SUNG NAM LIC # 21242 COMPANY . . . . . . . . . . : UNIVERSAL CONSTRUCTION ADDRESS . . . . . . . . . . : 10410 CALVERT DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (408) 252-8894 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- lADMIN HOURS 1. 00 41. 00 0.00 41.00 0 .00 1BCBSC VALUATION 200.00 1. 00 0.00 1.00 0 . 00 1BSEISMICR VALUATION 200.00 0 .50 0.00 0.50 0. 00 1EPERMITFE FLAT RATE 1. 00 44:00 0.00 44 . 00 0 . 00 IERT<200 UNITS 1.00 44 . 00 0.00 44 . 00 0 . 00 1TRAVDOC FLAT RATE 1.00 44 .00 0.00 44 .00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 174 .50 0.00 174 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 174 . 50 #5222 --------------- TOTAL RECEIPT 174 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER • CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION • ADDRESS: 10410 calvert dr. DATE: 11101/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: $200 "PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY SFD Of Duplex PENTAMATION 1 REAP14 USE: p PERMIT TYPE: At WORK temo power Poie SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERT<200 100 Amps $44 TOTALS: $44.00 Mech. Plan Cheek Plumb. Flan Check Elec. Plan Check 0.0 his $0.00 Mech, Powdl Fee: Phnnb, Fermi hue; Elec. Permit Fee: IEPERMIT lrch. hap, Other P'h,mh Intl,, Other Eleo. InsP. 0.0 hrs $44.00 ,ikch.Insp. lege: Plumb. /n.sp, Fee: tiler. hop. Few: NOTE: This estimate does not include fees due to otter Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the prelimina Information avallable and are only an estimate. Contact lire Dept for addn'I info. FEE ITEMS (h'ce Resolution 11-053 Eft 7/1111) FEE QTY/FEE MISC ITEMS !'Ian Check Fee: Suppl. PCFee PME Plan Check: $0.00 Permit Fee: Suppl. Insp Fee PME Unit Fee: $44.00 PME Permit Fee: $44.00 (,Onstruction Tna Administrative Fee: (ADMIN $41,00 Work Without Permit? 0 Yes 0 No $0.00 Advane ed Plnnninrg Fenny: Travel Documentation Fee: ITRA VDOC $44.00 A Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item • Bld¢Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $174.50 $0.00 TOTAL FEE: 1 $174.50 Revised: 10/01/2011 • � � � � Jvv I GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 • CUPERTINO (408)777-3228• FAX(408)777-3333• buildinal')a cuoertino.orD MISC PLUMBING /y. ).y/MECHANIICAAL I ' ELECTRICAL //�rr. )[]MISCELLANEOUS �//� /w�� PROIECT ADDRESS 104/0 �C�/1 C.�(-��/Cq. YYG�VC $7 �f, �I / pi Vq D `� V OWNER NAME.S J/\(C3) /—t - I J6r-, P�'j S-31 I 2- Z I v S REETADDRESS CITY, STATE,ZIP FAX CONTACT NAME PHONE E-MAIL STREETADDRESS CITY,STATE, ZIP FAX OWNER ❑ OWNER.BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ AACAITYCT ❑EsoNYER ❑ DEVELOPER ❑TFNANT CONI7UCTOA NAME r �� LICENSE NUMBERv LICENSE TYPE BUS.IICa f7�73 q-0COMPANY NAME V, r, !Cyar E-MAIL FAX STREET ADDRESS C/ ] CITY.STATE ZIP PHONE y ARCHTTECUFNGNEER NAME LICENSE NUMBER BUS.LIC a CONMANYNAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE Ad k ❑YES I9 T SE Of ❑SFO wDUPLEX [3 MULTI-FAMD-Y PR02C[N WBDUNp [3 YFS PRO`7 FID BLDG AN ❑YES BUDDNO: COMMERCIAL URBAN INTERFACE AREA [3 NO FLOOD ZONE 0N EICTO.FAHOMET 0N DESCRIPTION OF WORK �b ,� `.IULI& TOTAL VALUATION: �0 RECEIVED BY: By my signature below,I certify to each of the following: 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 is comet j have teed the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinancesend state laws relating m building c structiont I authorize representatives of Cupertino to enter the above-identified prop for inspection pu@oses. Signature ofApplimt(AgeaL, Date: SUPPIMYOiTAL INFORMATION REQUIRED OFFICE USE m OVER-THE-COUNTER 6 ❑ EXPRESS Y U u ❑ STANDARD e: u ❑ LARCE a, ❑ MAJOR MPPMua4pp 101 Ldoc revised 06/11111 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOBADDRESS: lt)410 CALJ�Cl v . PERMIT# OWNER'S NAME: Sur4 tel. Wo PHONE# — 31 6— 126 t GENERAL CONTRACTOR: SVpAn /,) . W6/J BUSINESS LICENSE# q5-35-00 ADDRESS: IC>410 CA-1 V&V-t '1712— CITY/ZIPCODE: a Sv l *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 am not using any subcontractors: 11 2 t -71) S� nature Date Please check applicable subcontractors and complete the following information: ✓ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum /Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date