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04010004 (2) BUILDING DIVISION PERrVCONTRACTI)RINFORMA�JN� fkd ,3'a BUILDING ADpRESS: PERMIT N.04010004 OWNER'S NAME: PERMITL4UBDATR MONS: SANITARY N0, CONTROL NO. ARCI{ITECT/ENGINEER: ' BUILDING PERMIT INFO BLDG ELECT PLUMB MECH �m2 OLICENSEDO O O D DCONTRACTOrp pECON U`uF$ 1 hembhumblyefOrm That I em lianscd under provisions ons of of Chapter 9(commencing lob De D(( � ¢ with Section 1"lrfDivlaicA,.r NC Realness and Pmreuiens Code,and my license is .t9ug 1pB(�"A®dp, ^aj B; in full force and effect. q? License Class Lie.. PARTITION THE FAMILY RO 3 Date Contract., ECL MASTER BEDROOM �4 - ARCHITECTS DECLARATION 88 Iunderatandmy plans reboil he uscdupuMic records ��1�1 _ .v p�ol Pry - JUN I.9 L 4 goy Lncntsd PmRmonal 5 OWNER BUILDER DECLARATION Z 0 0 I hereby affirm the I em cacmpe from the Contractors License Low for the tyq p y+Ett, p O following hereby ir,,.(Section,I t.5,Businessfraud he ontrac Code:Any city w county {®� tlytl pub/Jqj, o $�,! which require a permit hz emuiru0.eller,borrow,demolish,or repair any structete prions its issuance.also requires the applicant for such permit file a signed statement - a that he is licensed pursuant mla theprovisionsoftheConnector'sLicensew(Chapter9 Sq. Ft. Floor Area Val �� (commencing with Stadion 1000)of Division 3 of the Business and Pmfusinns Court)or I;9QP000 +jt that he if esempt therefrom and the basis for the alleged eemption.Any violation or Section 1031.5 by any applicant for a pemtll subjects the applicant to,civil penalty of not mem than RK hundred dollar,(SSW). APN Number Occupancy Type ❑1,se owner of the property,or my empleyccs with wages AS their sole compensation, 31630070 . 00 will do one work,and theauunme is nolimended ar.rfc.d boreal,(sec.7W.Desinu and Pmfeulmha Cade:The Conte cure,Licerve Law does not apply to an ower of Required Inspections property who builds or improves therson.and who tlas such whrkhimaelf or through his tom employees,provided that Such Improvements arc not intended clattered for Sale,if. however,the building or improvement is Sold within ane year ofcompledon,the owner. builder will haw the homm of Proving than be did not build or improve for purpose or sale.). t�h as owner of the property,am"elusively contracting with licensed contractors to wnnroct the Project(Sac.74)A14.Business and Profesal0ns Code:)no Canftaclori U. cents law does not apply w an owner of propeny who Wilds or improves thereon,and ho contracts for such projects with a eontrscmr(s)licensed pursuant o the Comascroes License Law. ❑l am exemptL and.Sec. B 6 P C for Ed.thome Ownr� l�� SC 1/)-/0Y WORKBft'SC M SATION DE6�ATION i hertby affirm under penalty of perjury ore or the following declarathang ❑I have and will mainein a Cmdficate of Consent o sel6lnaue for Worker's Carrion. action, As Provided far by Setion 5100 of the labor Codc.far Ne Prado..of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Seddon 3100 ofdmLAWfCodc,(or the perfmunmea of Ne wort for which Nis poem it is issued. ' My Work,fa Compensation Insurance carrier and Policy number,art: Cartier. Polity No.: CERTIFICATEOF COMPENSATION WORKERS' COMPENSATION INSURANCE or (This scctinn need not be completed if the permit is fn one hundred dollars(S W) Ice.) 1 anify the in the performance of the work for which this permit is Issued.I Shall not employ any person in any manner an As 10 h,romc aubjccl to the Work na''Campcnsadon Laws of California.Dat. Applicant NOTICE TO APPLICANT,IL after making this Ccnifcate of Exemption,you all() IJ .JObecome auhjen nu the Worker's Compensation provisions of the Lahor Code.you must fore with comply with such provision or this perm itshall be dccm,drevoked. Z .�~.zCONSTRUCTION LENDING AGENCY _ F (hertby afnrm Nu dereits construction lending agency l'nr She Performance of un work for which this promb I.Wood(Sec.3091,Cu.C.) a Q aendcr's Name z LCndcr'A Add.. U 0 _ 1 cenify list 1 have cad thio application and me Nan the above information is W f-acorrect.I agree to comply with all city and county.Ninaras and tete laws elating to DU building convection,and hereby atubonaa rcpmsenmlwa of this city 10 cnterupon the W ahovc-m,miunWpmpcntsran and gallows purposes Q. (We)-ghee th eve,indemnify and keep harmlcu the City at Copertino.,aims Pry oebili acs,judgMOMS.,ofthe centssang espcmes whicM1 may in any way recce,against said City 1 t.) z in eonseganec of the gaming of this permit SOURCE REGULATIONAPPLICANT S. Issued AND WILL COMPLY WITH ALL NON-POINT Issued by: (a Date (/Y/o revere of App tnnUContracm Re-roofs HAZARDOUS MATERIALS DISCLOSUR Dene Will theapplicant-1 future building Occupant ,are Or handle hazardous material Type Of ROOF AS dc0ncd by the Cupertino Municipal,Code,Chapter 9.13,and the Health and$,rely Code,Section u532(a)a ❑Yu [IN. All roofs shall be inspecte7,prior to any roofing material being installed. Will the applicant or future building occupant no equipment ordcvim which If a roof is installed without first obtaining an inspection, I agree to remove emh hazardnus air em m mutts u darned by He Bay Arca Air Qu-lily Management opeme all new IT for inspection. �Ycs KNu , I hove reel the hezamous materials econfronts under Chapter 695 of the Califon. his Health h Safety Colic,Seddon 25.515,35533 end 25534.1 understand thv ifft building does not currently hoe a tenant,that b is my rrsponsibiliry m notify the pauper,of the hequie�mcnts�which most�W met�poi �to issunncc opo CcNhcato rOccup (" , ey2/u(� Signature of Applicant Date waza' uraohoreeJag,m V Date All roof coverings to be Class "B" or better CITY OF CUPERTINO em 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp : Rng : Sub: Blk: Lot : APN . . . . . . . . : 31630070 . 00 DATE ISSUED. . . . . . . : 01/02/2004 RECEIPT # . . . . . . . . . 24131 REFERENCE ID # . . . : 04010004 SITE ADDRESS . . . . . : 19971 MER RITT DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : DEREK CHANG & SHUCHIN LIN ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2443 RECEIVED FROM . . . . : DEREK CHANG CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , • TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ----- ----- ---------- - ------- --- ---- BPERMFEE VALUATION 30, 000 . 00 340 . 00 0 . 00 340 . 00 0 . 00 BPFIXTURE UNITS 3 . 00 24 . 99 0 . 00 24 . 99 0 . 00 BPLANCHK PERMIT FEE 340 . 00 289 . 00 0 . 00 289 . 00 0 . 00 BPREPIPE NO OF FIXTURE 3 . 00 24 . 99 0 . 00 24 . 99 0 . 00 BPSEWAGE UNITS 1 . 00 62 . 16 0 . 00 62 . 16 0 . 00 BPSEWER SEWER SYSTEM 1 . 00 19 . 98 0 . 00 19 . 98 0 . 00 BPVENT UNITS 1 . 00 8 . 33 0 . 00 8 . 33 0 . 00 BENERGY PERMIT FEE 340 . 00 102 . 00 0 . 00 102 . 00 0 . 00 BPWATER UNIT 1 . 00 8 . 33 0 . 00 8 . 33 0 . 00 PPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 BREMFIXT NO. FIXTURES 10 . 00 11 . 10 0 . 00 11 . 10 0 . 00 BREMRECEPT NO. OUTLETS 3 . 00 3 . 33 0 . 00 3 . 33 0 . 00 BRFMVENFAN NO UNITS 1 . 00 42 . 02 0 . 00 42 . 02 0 . 00 BREMVENSYS NO UNITS 1 . 00 9 . 50 0 . 00 9 . 50 0 . 00 BSEISMICRE VALUATION 30 , 000 . 00 3 . 00 0 . 00 3 . 00 0 . 00 EPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 MPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 ---------- ------ ---- ---------- ---------- TOTAL PERMIT 1055 .29 0 . 00 1055 . 29 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ------- - --------- ----------- - ------ ------------ CHECK 1055 . 29 266 OF AL RECEIPT 1055 . 29 { CITY OF CUPERTINO* p ( � a o CU CITY OF NO PERMIT APPLICATION FORM i FAPN# 311, 30 0�o Date:lding Address: q q. ,4 err' pr. ner's Name: (�QYepC ChAn d Sh�c�; Phone#: Contractor: .rBD License#: Contact: DereiK Chan Cupertino Business License#: /Building Permit Info: 1 El BI t (Iu� e 1 Job cription:a ntial ® -Pa trtN+,ml, Fmt o{ Q Fam;l Commercial �0 e Y Sq.Ft. Floor Area: $/Sq.Ft.: 0 Cost of Project: 3 d tnrl� Occupancy Gr p: Type of Constru N Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELE 200 Elec Svcs 600V <=200A ELECTRICAL Ell BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 3 1 of 3 Z7 t *CITY OF CUPERTINO* CUP TYOF O PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING. BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREMAFRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL • BREMPOWER Power Device/Apparatus ELECTRICAL 2of3 Sit CITY OF CUPERTINCO CITY OF PERMIT APPLICATION FORM CUP -T,INO Q6 apt#y Fee ID Fee Description Fee Group BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance7 ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL. Special Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot .. MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING BMISCELL Building Misc Fees BUILDING i I i i 3 of 3 • Address: 19971, Merritt Dr. Cupertino, CA 95014 Owner: Derek Chang & Shuchin Lin Project: Partition part of the family room to a.master bedroo • I2EC D Scope: 1. Adding an 15 feet interior wall. 0 2 2004 2. Move inward the interior wall of the den b -- 3. Partition the den to a bath room and a wal in closet. Adding a shower, toilet and vanity. 4. Shrink 6'x2' window in the den to 4'x2'. 5. Close out the 4'x3' window in the den. 6. Change the 6'x2' window to 6'x3' and shift to the left by 3 feet. 7. Change the 3' exterior door to 6' patio door. 8. Move outward the exterior wall by 2 feet. • 9. Close out the"exterior door and convert to 5'x3' window: OFRCE COPY pppROVED IN ACCORDA 1 pEWITH�EcR GlIPERT0 DATE G SIGNED ----"�'""""o This se a" nd specifications plans at W iI be ke on the job at all times end It s ttn lawful to make any Changes or sh@rsdan� on same without written perrrtit i the bU i11 n DoPt City of Cnpart{tM The stamping of tHis plan and`epaht6 btiAfls • $HALL NOT be held to parhilt or' tw®V191afls approval of dionttooOr 4+te�L@W. ��f any City 1 19971, Merritt Dr. •saaaaeeeaeeeeeee saeeeeoeeeseeaaa••eeeee eeeae� 6' x 2' window • 20' 6" 2] 4' x 3' window •aae •eeaseseeee•aeee�aeaesaaeseesaas eeaa 4' x 3' IE 7' window 15'6" 5 6' x 2'window F-4] • Current floor plan of the family room 19971. Merritt Dr. • 5' x 3' window 6' patio door 9' • Master bedroom �m window 151611 4' x 3' 01 window ZZZZZD PLOT PLAN.'{ 5'2" 5' 3' CQiECKF.D B$ 4 � JIDAIET closet O shower C DE11 4' x 2'window DWI. New Master bedroom after remodel f forooni kitchen family rcx�rn ,} garage "_1 dining room living room bathroom! ' ❑❑ 1 bathrrom2 ❑ bathloom3 i II 4 i bcdrooml ❑ bedr[xnn3 n n 19971 Merritt Dr. ilii ilii ilii iiii ilii ilii ���� ���■ ���� ■■■■ �� ■■�� ilii ii ���� ii ��■■� ■■■■� ■■� ■■■ � , . � �■■■■■ ���i�; i. , 6 � t ; , ����� J iii® ■■ ■■ ■■ ii �� o,��--- ---1, IMEN mo, - 3