09030225 7777777
CITY OF CUPERTINO
BUILDING DIVISION PERMIT '0
BUILDING ADDRESS:
PERMIT NO.
10630 MORENGO JM CONSTRUCTION 09030225
OWNER'S NAME: PERMIT ISSUE DATE
JONG LEE
'NE: S AR CONTROL NO.
(408) 379-9852
ARCHI fECI7ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
v p C LICENSED CONTRACTOR'S DECLARATION Job Description
U I hereby affirm that I am licensed under provisions of Chapter 9(commencing
5 y�d with Section 70(X))of Division 3 of the Business and Professions Code,and my license is FIRE EMG RPR,R P LC 3 WNDW S&1 DR;RMV&R PL C 4 5 0 S Q FIRE
y in full force and effegl -7 t
Date
Class L�•p 7 DMGD STUCCO,RPLC36LF GTR&FASCIA,RPR
F Date Contractor
gg ARCHI7ECTSDEC o SHTRCKARNDWNDS&INTER
of"r I understand my plans shall be used as pub tc ords
�96U
4 Wyt Licensed Professional
o
0 W OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
p O following reason.(Section 703 1.5.Business and Professions Cafe:Any city or county
�u which requires a permit to construct.alter,improve,demolish,or repair any structure
aZprior to its issuance,also requires the applicant for such permit to file a signed statement
F x G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
X F- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $12000
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars($500). 37534C61 . 00
❑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 Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of q
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If.
however,the building or improvement is sold within one year of completion.the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑I,as owner of the property,am exclusively contracting with licensed conuaetors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sea B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,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 required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compe ation Insurance carrier and Policy number are:
Cartier.�., C Policy No.; LQ3�
CERTIFICATE OF EXF41PTION FROM WORMS
S'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person i y manner so become subject to the Workers'Compensation
Laws, Califo 'a tc
Applicant
NOTICE TOAANT:If,after m inag this Certificate of Exemption,you should
become subject Worker's Compcnsatio rovisions of the Labor Code,you must
Oforthwith comply wr such provisions or this permit shall be deemed revoked.
Z OZ CONSTRUCTION LENDING AGENCY
(�CA I hereby affirm that there is a construction lending agency for the performance of
p! .7 the work for which this permit is issued(Ser:.3097,Civ.C.)
WCL A Lender's Name
Z Lender's Address
U 0 1 certify that I have read this application and state that the above information is
LL" correct.I agree to comply with all city and county ordinances and state laws relating to
0 V building construction.and hereby authorize representatives of this city to enter upon the
U above-mentioned property for inspection purposes
a (We)agree to saw,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this emit. D e
r y APPLICA UNDERSTANDS AN WILL COMPLY WITH ALL NON-POINT Issued fry:
SOU GULA
Re-roofs
SignMil
pplicant/Conuactor Dam Type of Roof
HAZARDOUS MA DISCLOSURE
a applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code.Section 25532(a)? All roo's shall be inspected prior to any roofing material
C:1 Yes ®No
If a foo.`is installed without first obtaining an inspection,I agree
Will the applicant or future building occupant use equipment or devices which
Vo-v
.t hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
-Strict?
❑Yes QNo
I have read the hazardous materials,requirements under Chapter 6.95 of the Califor-
nia Health&Safety Cade,Sections 25505:25533 and 25534.I understand that if the building
does not curre I have a tenant Odt it if my responsibility to notify the occupant of the
require h mu prior to ssuartce of a Certificate of Occupancy. Signature of Applicant Date
Owner Fa '•red agent
Date All roof coverings to be Class';."or better
al CITY OF C UPERTINO
CUPEI�TINO GENERAL BUILDING
PERMIT APPLICATION FORM
.09
APN # �� Date:
31
a l .
Building Address: M
00
Mailing Address (if different from uilding address):
Y r
Owner's Name: Phone#:
jQn� Leyto -g3G7
HOA: (Exterior work only) Yes ❑ No
If yes, provide letter from HOA
Fonactor: Phone: 319 - 15 5'L
CoY. s-��u��NoYN Fax:
actor License#: G-t �7 36 0 5 6
rtino Business License#: 2,Q 5 rJ
Phone: -3 _ 9 8 5
act: J ef r 1
1 l Fax: 7J� 8 5-7
Residential ® Commercial
El
F-,
�e � ai �Job Description: � 1
i ' titCAP-
re, �,�vc_ c�t 5av L�Q7
Olt,, RQ+��®.t� L" SO �� � 4 r3v � ce. �aw.� e(11 Sju�1C�c
ZQ LF o� �� 1k u t CA J, jhe tt r 4�
i Y r .l t' a
nBIdg
ng Permit Info:
LAY Elect ❑ Plumb ❑ Mech ❑
Occupancy Type:
Type of Construction(Usage Class):
1-A, I-B ❑ II/III/V-A ❑ II/III B, IV-HT, V B —`3[�--
2
Square Footage:
Valuation:
Project Size: Express Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicat le, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at www.builditereen.or
Revised 02/05/09
CITY OF CUPERTINO
CITY Of GENERAL BUILDING APPLICATION
CUPEkTINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
ISTUCOAP Stucco Applications (up to 400 sf) B
ladditional stucco application
j 1 WINREP Replacement windows/sliding glass B
I door (ea 8 windows)
1 WINMEWSTR New Window-structural shear B
wall/masonry (includes plan ck fee)
IEPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
I PPERMITFEE Plumbin a Permit Fee P
1 ELCPLNCK Stand A:one Electric Pln Ck (hourly) E
1 MECPLNCK Stand A one Mechanical Pln Ck (hrly) M
1PLMBLNCK Stand A.one Plumbing Pln Ck (hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly tand alone
1 IBCBSC Cal Bld; Standards Commission Fee B ALL PERMIT
TYPES
1 BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
I TRAVDOC Travel &Documentation B
1BUSLIC Busine:;s License B
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Assessor's Parcel Number:
Name of owner. J 0 n C4e,
Project address. P,
_a Contact person. cZv�,� Phone. .� - J
F,,Lx 3 ��'- `� 8 FJ
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces ir..side the garage? =�N
,p
nivacy protection planting required for the project. Y
On what floor(s) is work being done?
Brief description la
of work. a C, 3 w�'W 5 Go Y-
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Assessor's Parcel Number:
Name of owner. J n qNA
Project address. o
Contact person. �Z'-'' Phone.
F,Lx.
Net square footage of lot. %
Existing Proposed
Square footage: First floor:
Second floor:
Garage: --
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces ir.side the garage? ?�N
.
required for the project? �Y
privacy planting
On what floor(s) is work being done? �J._
Brief description of work. a lug 3 w• w��`^' S a- °O r `° """S `�
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2008 CPC (Y -N)2008 NEC 07 -N)
Effective 1/1/08
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