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15050171
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 736 MILLER AVE CONTRACTOR:MOO POK LEE PERMIT NO:15050171 OWNER'S NAME: MOO POK LEE 736 MILLER AVE DATE ISSUED:05/28/2015 OWNER'S PHONE: 4084728908 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL TO CLEAR CODE ENFORCEMENT CASE: CORRECT License Class Lic.# ILLEGAL GARAGE CONVERSION BACK TO GARAGE& Contractor Date DEMO/CLOSE DOOR I hereby affirm that I am licensed under the provisions of Chapter 9 OR ACCESS FROM SFD TO ACCESSORY STRUCTURE (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:$0 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 APN Number:37542009 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 18 A INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of th Date: 2� granting of this permit. Additionally,the applicant understands and will comply ss with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. RE-ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for my inspection. OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of Wotwo reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER fi, 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, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533 and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: permit is issued. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 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 to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9 18. Signature It �J CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•building(aDcupertino.orq ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED 4-2— ORIGPERMIT# PROJECT ADDRESS APN 9 ? 7� — O OWNER NAME PHONE4 pkk MAIL STREET ADDRESS•� / M I le. CITY, STATE,ZIPc� n^� FAX CONTACT NAMEPHONE r ) -MAIL LA STREET ADDRESS l AveCITY,STATE,ZIP FAX [ I V �7- El \ OWNER -%4.OWNER-BUILDER ❑ ORTIERAGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINES ❑ DEVELOPER ❑ TENANT CONTRACIORNAME LICENSE NUMBER LICENSETYPE BUS.LIC R COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC n COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK 10 15— 0 40<)r be--f 1uee-5j E)aSTING USE PROPOSED USE COrSTR.TYPE n STORIES USE TYPE OCC. SQ.FT. VALUATION(S) F>aSTG NEW FLOOR- DEMO TOTAL AREA AREA AREA NET AREA BATHROOM. KITCHEN., OTHER. REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDETACH []ATTACH A!DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY []YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES TOTAL VALUATION: PLAQNINGAPPL -�•= By my signature below,I certify to each of the following: I am the property owner or authorims's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it' acc agree to comply w1 1 applicable local ordinances and state lays relating to ilding construction. I authorize representatives of Cupertino to enter a above-iiden`"fie(d�pro erty for inspection purposes. Signature of Applicant/Agent: Date: 7C Jf yf1" 6 SUPPLEMENTAL INFORMATION REQUIRED New SFD or Multifamily d«,ellings: Apply for demolition permit mm for oui ilcoul.�R 1 ziuu�iric iAixE*vTY existing building(s). Demolition permit is required prior to issuance of building �Yk r x permit for new buildinxPLss e pL�nt.7�uvG eyAiJxE ✓ } �y _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Q_ srAl�utD w� F� DC7 pws form if any Hazardous Materials are being used as part of this project. r _Copy of Planning Approval Letter or Meeting with Planning prior to © MA70R SxjI�ITARY SEROJIt�IS�RIOT submittal of Building Permit application. BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 736 MILLER AVE DATE: 05/28/2015 REVIEWED BY: MELISSA APN: 375 42 009 BP#: *VALUATION: $200 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Du lex PENTAMATION 1 GENRES USE: p PERMIT TYPE: i WORK To Clear Code Enforcement Case: CORRECT ILLEGAL GARAGE CONVERSION BACK TO GARAGE SCOPE & DEMO/CLOSE DOOR OR ACCESS FROM SFD TO ACCESSORY STRUCTURE Wch. Plan Check P1e1117h.Plan(:'heck Elec.I'lan Check .11ech. Perim/Fee: Pla mb. Permit Fee.: 'I", Permii Fee: Other Alech. Insp. Other Plumb Insp. Other Glee Insp. EI Ylech.Insp. fee: Phunb. Insp.Fee: Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District etc.). These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 ff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 1 hours Plan Check,Hourly Suppl.PC Fee: Reg. 0 OT 0.0 hrs $0.00 $143.00 1STPLNCK PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp.Fee-.(F) Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: Work Without Permit? 0 Yes () No $143.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential 0 Travel Documentation Fees: Building or Structure Strong Motion.Fee: IBSEISMICR $0.50 1.0 hrs Inspections Bldg Stds Commission Fee: IBCBSC $1.00 $143.00 ISTINSP Inspection,Hourly 'SUBTOTALS:- $144.50 $286.00 TOTAL FEE: $430.50 Revised: 05/07/2015 n� r " OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO. CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•building Qcupertino.org —" 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-ADDRESAIRN., --TBIP# ,OWNER NAME OWN_R DD ESS., [)ESS CRIPTION OF WORK:' _ Demo SCC So r _ uor e 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.) I understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner- B ,[der"building permit that erroneously implies that the property owner is providing his or her own labor and material p r onally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an nlicensed person and his or her employees while working on my property. My homeowner's insurance may not pr ide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my in a ance 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 th onstruction and are not hiring a licensed Contractor to assume this responsibility. 3. 1 understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may pro ct myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her nam; instead of my own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license nubers on permits and contracts. j 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the t to value of my construction is at least five hundred dollars ($500), including labor and materials, I may be co idered an "employer"under state and federal"law. 6. 1 understand if I am considered an"employer" under state and federal law, I must register with the state and fed-ral government, withhold payroll taxes, provide workers'compensation disability insurance, and contribute to uRT,mployment compensation for each "employee." I also understand my failure to abide by these laws may subject to serious financial risk. 7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family res dentia)structures cannot legally build them with the intent to offer them for sale, unless all work is performed by H nsed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is •erformed under contract with a licensed general building Contractor. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for n financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction e ects in the workmanship or materials. OwnerBuildeYForm 2010.doc revised 04/14/10 9. I understand I may obtain more information regarding my obligations as an "employer"from the Internal Rev nue Service, the United States Small Business Administration, the California Department of Benefit Payments, agdhe California Division of Industrial Accidents. I also understand I may contact the California Contractors' State Lse Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed aipi Aractors. 0. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I 'Lla arty legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide b, ill applicable laws and requirements that govern Owner-Builders as well as employers. L�� 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the in mation l 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 ally financial loss you may sustain as a result of a complaint.-Your only remedy against unlicensed Contractors maybe in civil court. If 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 maybe 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 otethose Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the fallowing 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 veri the property owners si ature. Property Owner's Signature: Date: A _ --------------------------------------------------------------------------------------------------------------------------------------------- (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: Name of Authorized Agent: Tel No Address of Authorized Agent: 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: OwnerBuilderForm 2010.doc revised 04/14/10 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RTI N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: C r Ave C�' ?G-�E ; �j\10 PERMIT# OWNER'S NAME: ;vim. S Lk V (�� el PHONE# L�°�1 �— ©cam GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *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. _ I am.not using any subcontractors: s Signature Date Please check applicable subcontractors and complete the following information: V 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