14040180 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21535 ADDINGTON CT CONTRACTOR:BAY AREA CUSTOM PERMIT NO: 14040180
BUILDERS INC
OWNER'S NAME: ROAN JYUE-MIN ET AL 1002 S DE ANZA BLVD STE Al DATE ISSUED:04/25/2014
OWNER'S PHONE: 4087779972 SAN JOSE,CA 95129 PHONE NO:(408)446-1200
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL
REMODEL(E)KITCHEN(180 S.F.)&3(E)BATHROOMS
License Class Lie.# y (250 S.F.)
Contractor / y Afiea l�o,)�e+m, &6,
I hereby affirMJthat I am licensed under 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. Sq.Ft Floor Area: Valuation:$59000
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;35622029 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 180 DAYS F " INSPECTION.
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 Iss ��// Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18. �l
t //r RE-ROOFS:
Signature Date 7 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.
C1 OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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,
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. I 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 25505,255553/3,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
Compensation laws of California, If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
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
918.
Signature Date
CONSTRUCTION PERMIT APPLICATION O
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 �b
CUPERTINO (408)777-3228• FAX(408)777-3333•buildina a.cupertino.ora.
❑NEW CONSTRUCTION ❑ ADDITION +❑ ALTERATION/Tl ❑ REVISION/DEFFR'RED ORIGINAL PERMIT#
PROJECT ADDRESS �p ( j � n /dl h / 0 h C+ C- /(e 44' N# -3 5
OWNER NAME--,,-I J <'T (� PHOT'E 1 E-MAIL Cam/
� -�'��-�� fat-���99�
STREET ADD 5 Ufae n // c, I CITY, STATE,ZIP I FAX
CONTACT NAME l [,( > PHONE E-MAIL
STREET ADDRESS I CITY,STATE, ZIP FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR N4ME � r' 1I LICENSE NUMBER LICENSE E BUS.LIC#017.1
CO SNY NAME E-MAIL I n�� C 'A C CJ 1 FAX /
STREET �e 4h 2-,A I �� ' CITY,STATE�kIJ •l.1 16(� I PHONE
_,q 6^'i
ARCHITECT/ENGINEER NAME I LICENSE NUMBER BUS.LIC R
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK /
I eim-P de, I /r, '�e c,,, �e/- 1�zp1CcC/n t(-i ,fit
VCAM +en, Co, thqf> VtPgr�JQ e(P- Y1L
EXISTING USE I PROPOSED tiSE I CONSTR.TYPE I k STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)DEMOTAL
AREAL I NAREA OOR I AREAO I T NET AREA
BATHROOM I KITCHEN OTHER
REMODEL AREA �� REMODEL AREA / CI_r� I REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑` DETACH
I_ ❑ATTACH
#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 ?_ -_ �,.-u-' ' ,,;�;', ='` _ '„� #;r'- TOTAL-VLUATION: P
NO PLANNII.G APPL I ❑NO PLANNING APPROVAL LETTER EICHLER HOME? - , •"P 4-9 't,
By my signature below,I certify to each of the following: I am the property owner or authorized a Eem;pIlty owner'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 is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. Iau orize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: E ''"� Date: lc--,4,e
SUPPLEMENTAL INFORMATION.REQUIRED
��,�.��- C1�CKTIPE�.-a_`�•�-�-=.,��'�; RONTL'�G.SL�_��--�z�a.�'rW
New SFD or Multifamily dwellings: Apply for demolition permit forR T> cot = -BUILDING raN I;E- I °
existing building(s). Demolition permit is required prior to issuance of building j ter=-' - wa =r{;°"��
permit for new building. EXPx�ss a "�a� iA r`t:IN'gPLAiiiit viy
I. Ra -
_
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 's- nn.,,«- a" zI�LIC.�oxics`F - -
- �� .:
form if an Hazardous Materials are being used as art of this project. - � _ ,.. a,..- � Pw�
412GE`
Co of Planning Approval Letter or Meeting with Planning prior to j”
PY g PP g �P �..
g qua ;rte+,:,_m SA1�TT4RY SE�VRD7STRICT ;<
submittal of Building Permit application.
.'*' :euv :�'�: ;;ENVIRO]Y➢4E1VT?.I`;"I�AlTFI�F'-:�-;��:
BldgApp_201 1.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21535 ADDINGTON CT 1 DATE: 04/25/2014 REVIEWED BY: MELISSA
APN: 356 22 029 1 BP#: *VALUATION: 1$59,000
xPERMIT TYPE: Building Permit 1 PLAN CHECK TYPE: Alteration / Repair
PRIMARY I I SFD or Duplex PENTAMATION 1 R3SFDRE
USE: PERMIT TYPE:
WORK I REMODEL (E) KITCHEN (180 S.F.) & 3 (E) BATHROOMS (250 S.F.)
SCOPE
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a � -w „r
a ..
Lk":r. tzars C,oErx � Pl wd). Plon Check � � I_,��r. l i u?('h vk
frclt Prrrierl/:>c'.: 1 Plumh. Pe mif F"e'
F-1 I
t-1tc< 1p"o. J,ce Plunih. h?sp. 1'ee: ii(c�c.Intt;.;'cr
NOTE: This estimate does not includefees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff: 711113) FEE QTY/FEE I MISC ITEMS
Plan Check Fee: $0.00 250 s.f. Remodel,Bath(<=300 sf)
Suppl. PC Fee: (j) Reg. ® OT 0.0 hrs $0.00 $626.001 1REMRESBAT I A
PME Plan Check: 1 $0.00 180 s.f. Remodel,Kitchen(<=300 sf)
Permit Fee: $0.00 $626.00 I IREMRESKIT
Suppl. Insp. Fee: Reg. ® OT p p hrs $0.00
PME Unit Fee: 1 $0.00 1
PME Permit Fee: I $0.00
Consirmlion Tax:
,(r 11?L111S'F1'I1T1"f" Fec:
Work Without Permit? ® Yes (F) No I $0.00 I 1 0
Advanced Planning Fee: 1 $0.00 Select a Non-Residential G
1�ftv�i Ooum nc rvation Fees: 1 1 I Building or Structure
Stronp- Motion Fee: IBSEISMCR 1 $5.90 Select an Administrative Item
Blda Stds Commission Fee: IBCBSC r $3.00 1
t11 � $8.90 $1,252.00 TOTAL I $1,260.90
x �
Revised: 04/01/2014
A�4\Y)Q
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COWUNITY DEVELOPME J DEPARTMENT
BUILDING DIVISION- 3UPERTINO
APPROW—D \IAO
This set of plans and specificati sMUSTbekeptatthe
job site,during construction. It! unlawful-to make any
cl,,iangas or alterations on sa e,ortodeviate
therefrom,without approval from he Building Official.
The stamping of this plan and speci 'cations SHALL NOT
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Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
C O P E RT I N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: Zl,rj?S jh pjrJ ( PERMIT# yU�Dl:BO
OWNER'S NAME: 'r7�0-/0,rn IVo i�� , j PHONE#��0���'% -�l ��'Z
GENERAL CONTRACTOR:,. Ca;q /4-1'ec� CC-t3to% 811/,10/M13SINESS LICENSE#
ADDRESS: /fie ,;�A " n1va CITY/ZIPCODE: Ira,, l'5-/jq
*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(§ /2 / T
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE#
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
A
Linoleum/Wood
Glass/Glazing
v
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date