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14040110CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10206 ENGLISH OAK WAY CONTRACTOR: ALLIED CONSTRUCTION PERMIT NO: 14040110 BUILDERS INC OWNER'S NAME: JONG WAN KIM 1 875 MAUDE AVE #I I DATE ISSUED: 08/08/2014 OWNER'S PHONE: 4089963896 1 MOUNTAIN VIEW, CA 94043 + PHONE NO: (408) 440-6168 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # tp`7 Contractor Ill P 14 b>t.Date 8 irs 1 hereby affirm t aam If�censetT un arecr 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. 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. 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. 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 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 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 8ip '61 ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, 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, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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. 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. 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 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 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date BUILDING PERMIT INFO: BLDG r ELECT r PLUMB MECH r RESIDENTIAL r COMMERCIAL i JOB DESCRIPTION: CHANGE FIXED WINDOW TO OPERABLE WINDOW TO CREATE EGRESS FROM (E) DEN TO (N) BEDROOM Sq. Ft Floor Area: I Valuation: $500 APN Number: 34212080.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: 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 inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE, I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the llealth & Safety Code, Sections 25505, 25533, and 25534. Owner :4=d orized age Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(c cupertino.org F— NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT * PROJECT ADDRESS k C>--> � �t-11�,L1 Si -1- �A� W q APN # ,� 2— t:— v 8 G --[OWNER NAME 1% a"'6 w f PHONE � n A tJ t< c 4a8 � E-MAIL STREET ADDRESS �NVzL( CITY, STATE, ZIP FAX r Q ��T«►o «1 ,�1�a CONTACT NAME ` / t � PHOn')s � p, � � � E-MAIL V STREET ADDRESS2� CITY, STATE, ZIP fir. '� Com.. 4'; e (� FAX �a(i) q_(6 ��-►IP C./ e -ti 0v ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME i LICENSE BER LICENSE TY B BUS. LIC # COMPANY NAME E- F STREET ADDRES I CI , TATE, ZIP PHONE����� q ve ` C4. 2:Lal a— ARCHITEC IENGrNEER NAME LICENSE NUMBER C 2 I ,� �� BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 'r\_ P rOOU^ LUd LU N C N , �.N e t- •f` JU"%,kc10W 0.CCPSS EXISTING USE PROPOSED USE CONSTR TYPE # STORIES S •}�� f S ^—� y (TOTAL r Lt; a USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA Y 1'Jl REMODEL AREA jj� REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH ARE GARAGE AREA: E3DETACH �Q ATTACH I 7❑3YES DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY 6 ^ � BEING ADDED? X0 ADDITION', 8110 PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES TOTAL VALUATION: PLANNING APPL# ANO PLANNING APPROVAL LETTER EICHLERHOAIE? o By my signature below, I certify to each of the following: I am the property owner or authorized a roperty owner's behalf. I have rea 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 relatln tt}in construction. I thorize representatives of Cupertino to enter the above -identified property for inspection purposes. S i mature of App] icandAg Date: SUPPLEMENTAL INIFORMATION REQUZED PLA:cIcxT1PE -: - ROIiTLNcsIP New SFD or Multifamily dwellings: Apply for demolition permit for OVERTHE-CQUIITER�'� r�3 � BUII.DIIvCPEANRE. ,� existing building(s). Demolition permit is required prior to issuance of buildlnQ �" f tis 84 ' w �_Fp ``:'}s' el �zR permit for new building. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure being 0 EaPREss v 3- Dusr�`nl.�n n� ME D PIA N" PI AN;.. vTEtvs ` RV rush oRics. r§ ' form if any Hazardous Materials are used as part of this project. rt, _ Copy of Planning Approval Letter or Meeting with Planning prior to M ©"SATVITAR submittal of Building Permit application. OR�� -`.-•yt .v Y" j,-� -5 DIST CT �r ihN ,r +P EiCM Kb, - L �i;`EA'VIROrT114ENTAL.'HEALTIiu�?, B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FFF. FCTIMATOR - RIJI,DING DIVISION NOTE: This estimate does not includefees due to other Departments (i.e. ruinntng, ruottc rrurAs, rite, —uuuiuy—.5.1•• �••��• --1 _,i ..._ .6....-,.I:.....*---,;-f-.—i;n.—,nanAlo and aro only an estimate. Contact the Dept for addn'l info. District, etc. mese ees tire uusett vn uoe .e�..�at�• FEE ITEMS (Fee Resolution 11-053 Eff. 7:7/131 ADDRESS: 10206 ENGLISH OAK WAY DATE: 04/17/2014 REVIEWED BY: MELISSA APN: 34212 080 BP#: �l "VALUATION: $500 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex Supp/. PC Fee: Q Reg. Q OT PENTAMATION 1GENRES PERMIT TYPE: USE: $0.00 PME Plan Check: WORK CHANGE FIXED WINDOW TO OPERABLE WINDOW TO CREATE EGRESS FROM E DEN TO N SCOPE BEDROOM NOTE: This estimate does not includefees due to other Departments (i.e. ruinntng, ruottc rrurAs, rite, —uuuiuy—.5.1•• �••��• --1 _,i ..._ .6....-,.I:.....*---,;-f-.—i;n.—,nanAlo and aro only an estimate. Contact the Dept for addn'l info. District, etc. mese ees tire uusett vn uoe .e�..�at�• FEE ITEMS (Fee Resolution 11-053 Eff. 7:7/131 FEE - QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # $418.00 Window / Sliding Glass Door 1 WINREP Replacement Supp/. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT F0,0Thrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Coustrvcli()r17 Tr nv. rldni, E) Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fee $0.00 Select a Non -Residential Building or Structure Tr avcl DOcrunentaft.on Fees: Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg_Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.501 $418.00 TOTAL FEE: $419.50 Revised: 04/01/2014