12040067 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10154 MINER PL CONTRACTOR: __.............. PERMIT NO: 12040067
OWNER'S NAME: LEE JAI-Kt1EN1 ET AL N, l7 S- DATE ISSUED:04/112012
OWNER'S PHONE: 4085686400 v PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATIONgU1LDING PERMIT INFO: BLDG r ELECT r r
PLUMB
License Class____ Lic.N 7-7037,-L r r r
/� ��/�^+,���� MECH RESIDENTIAL COMMERCIAL
Contractor Uj;i48V/✓� 7 Daic 'l�r-ft-4-2—
hereby affirm that I am licensed under the provisions of Chapter JOB DESCRIPTION: SINGLE FAMILY DWELLING TWO(2)BATHROOM
(commencing with Section 7000)of Division 3 of the Business&Professions REMODEL(I 15SQFT)AND KITC14EN
Code and that my license is in full force and effect. REMODEL(108SQFT}NON-STRUCTURAL
1 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 Sq,Ft Floor Area: Valuation:$36000
permit is issued.
APPLICANT CERTIFICATION APN Number:31626075.00 Occupancy Type:
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 slate 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments.
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Issued by: ��7 Date: /It
,
Signature Date ( �.
❑ OWNER-BUILDER DECLARATION
RF,-ROOF'S:
1 hereby affirm that I am exempt from the Contractor's License Law for one Of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code).
AL1.ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSIIRE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code.Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area.lir Quality Management District 1 will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Codo, ections 25.505,25533,and 25534.
Compensation laws of California. If,alter making this certificate of exemption,I
become subject to the Workers Compensation provisions of the Labor Code,I must Own o rize a -1.7r/ v
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING.AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and slate laws relating for which this permit is issued(Sec 3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit-Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18- 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
RESIDENTIAL PROJECT COVER SHEET
AQ1Mfln, n.
Assessor's Parcel Number:
Name of owner.
Project address. M 1 NC--tZ PL
Contact person. �/1��� /��� Phone. �Fl1'� God- fie, APR 2011
Fax. '
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 inside the garage? X'�V
Is privacy protection planting required for the project? Y
Build it Green Total Points
On what floor(s) is work being done?
Brief description of work.
Code editions: 2010 CBC &72N)2010 CFC N)2010 CMC 4-N)
2010 CPC j1J7)- N)2010 NEC 93N)
..I
California Green Building Standards Code
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5 BUI pIVII,SIOON�N-.�C�P TpI�NG �S
Effective 1/01/111 A—P— 090 U_— _ cc}
This set of plans and specifications MUST be kept.at the
Job site during construction. It is unlawful to make any
changes or alterations 'on same,or to deviate
therefrom, without approval from the Building Official.
The stamping of this plan and specifications SHALL NOT
be held to permit or to be an approval of the violation
of any onProvisions of any city Ordinance or State Law.
BY-I I
DATE
PEFivHT NO. /'Lb L.�IJO 7
Plan Review Process Work Book Page-8- Revised 12/21/10
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Io �.S•4 MINER '�L . C�p�RTIKo � C� `� 5 ° Ig- � --
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 31626075. 00
DATE ISSUED. . . . . . . : 04/11/2012
RECEIPT #. . . . . . . . . : BS000016525
REFERENCE ID # . . . : 12040067
SITE ADDRESS . . . . . : 10154 MINER PL
SUBDIVISION . . .. . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LEE JAI-KUEN J ET AL
ADDRESS . . . . . . . . . . : 6770 CHARLENE CT
CITY/STATE/ZIP . . . : SAN JOSE CA, 95129
RECEIVED FROM . . . . : RONG K KUANG
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :,
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 36, 000. 00 2. 00 0 .00 2 .00 0. 00
1BSEISMICR VALUATION 36, 000.00 3 . 60 0.00 3 .60 0. 00
1REMRESBAT SQ FEET 115.00 588.00 0.00 588 .00 0.00
1REMRESKIT SQ FEET 108.00 588.00 0.00 588 .00 0 .00
TOTAL PERMIT 1181.60 0.00 1181.60 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 1, 181.60 MC
---------------
TOTAL RECEIPT 1, 181.60
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10154 miner pl. DATE: 04/11/2012REVIEWED BY: bobs.
APN: BP#: `VALUATION: $36,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFDorDuplex PE1R3SFDREM
USE: PERRMITMITTYPE:
TYPE:
WORK sfd remodel 2 baths and kitchen remodel non structural.
SCOPE
,I h•c/r. l'!an('b,rck Plumb, Plop Check F.'le<:. Plan C/nsk
rNaclr. Permir Fee: Fill,mh. Pe"'Jil Fee lilac. Permit Fra:
OdleHee. /nlp. Other Plumb Insp. Other Elec.Imp.
,tkrh. /)I,/)- 14r: P1111111). /mp. Fee: Elec.Insp. Fee
NOTE:This estimate does not inchidejees due to other Departments(Le.Planning, Public Works, Fire,Sanitary Sewer District,School
District,eta). These fees are based on the prelinddna information available and are only an estimate. Contact the De t or addn'!info.
FEE ITEMS(Fee Resohnion 11-053 E1L 7/1111) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 115 s.f. Remodel,Bath(<=300 sf)
Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $588.00 IREMRESBAT
PME Plan Check: $0.00 108 s.f. Remodel, Kitchen(<=300 sf)
Permit Fee: $0.00 $588.00 IREMRESKIT
Suppl. Insp. Fee:Q Reg. 0 OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Canso action Tax.
Adrrtiui.wrrrtire Pec: 0
Work Without Permit? 0 Yes (E) No $0.00 0
Advanced Planning-Fee: $0.00 Select a Non-Residential
Trrn'c:1 Dncrunentrninn Feer: Building or Structure 0
Stront± Motion Fee: IBSEISMICR $3.60 Select an Administrative Item
131da Stds Commission Fee: IBCBSC $2.00
SUBTOTALS: $5.601$1,176.001 TOTAL FEE: $1,181.60
Revised: 04/01/2012
Ckj '0-e( fi- -1 2 o
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DMSION
10300 TORRE AVENUE•CUPERTINO,CA 950143255 13
CUPERTINO (408)777-3228• FAX(408)777-3333•buildinD(�cuoertino.orD
❑NEW CONSTRUCIION ❑ ADDITrON ❑ ALTERATLON/TI ❑ REVISION/DEFERRED ORIGINAL FERN=R
PROJECT Anna.ESS L I 'Ft° ' ko_-2-(,o - (D-7-S
OWNER NAME - '�'� n 'J I PHONE v - �Q /,r g-MAO.
STREET ADDRESS of (r (vhf, L CTI'Y.STA'[E. �S a al 0 I FAX
CONTACT NAME 1 I-�L PHONE gMAE,
czrl-'k'T'c
STREET ADORPSS CITY.STATE, ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARC arrECT ❑ENODtmt ❑ cupm IPER ❑TDwN
CONTRACTORNAME W•AYA/L LICENSE NUMBER o3 Z TICFNSETYPE RUR,
ISCN
CONVANYNAME+d X1j',;,vjGtl �G CTGu C o E-MAIL EET �p S A t r co.00%� FAX
STRADDRESS �Ox a3�igI� QTY.ST"'fE (� 9Z FHONE L6 0( -2-37&-
.
ARCID cvEN0NM NAME LICENSENUMBER BUS.LICI
COMPANY NAME E-MAB. FAX
STREET ADDRESS CITY.STATE ZIP PHONE
DESCRIPTION OF -
t
00TIN0 USE PROPOSED USE CONSTATYPE SSMRMS
USE. TYPE OCG SQ11'. VALUATION(S)
EXEAREA NEW FLOOR ADEMREA TOTAL
AREA AREA ARRA TOTAL
BATHROOM Rn4Pt� OTHER
REMOD¢ARE1//-s-I
REMDD¢ REMODEL AREA
PORCHAREA I D=ARFA TOTAL ELTOPORmr AREA GARAGEAREA: DETACH .
ATTACK
R DWELLING UNITS: SA SECOND UNIT Elva S&CON-OSTORY YES
REING ADDEDT ❑NO ADDMONT ❑TO
PRE-APPLICATION ❑YES IFYES.PROVMECOFYOE ISTHERLDGAN ❑Y6 RECEIVED BY: TOTAL VALUATION
PIANNINGAFPLa
EI PLANNINOAPPROVALLSTIER ELCHLRRHOMST C]NO
By Dry signature below,I cerof7 to each of the following•. I am The property OWcCr or mrdwrized anent to act on the prppertyownds behalf.•f have read this
application and the information I have provided is cc== I have read the Description of Work and verify it is accurate. I agree to comply with an applicable local
ordinances and state laws relating to burl ' g [aurh0=representatives of Cupertino to eater the above-identified property for inspection purposes.
Signs ture of Applicattr/Ageae Date: 217/7
SUPPLEMENTAL 1NF TION REQUMD PTAH CE1XCETYPR M—MG SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for LY�ovER-T�tomrrER BOH.DmG PrA.a arnEw
existing bmldng(s). Demolition permit is requited prior to issuance of building
permit for new building. ❑ �esss ❑ PLANeffitc PrAn xEVD,w
_Commercial Bldgs: Provide a completed Hazardous Matnials Disclosure 11 STANDARD ❑ PUBLIC WORM
form if any Hazardous Mate ials,aro being used as part of this project ❑ r eRCZ ❑ I=bEPr
Copy of Planning Approval Letter or Meeting with Planning prior to ❑ M OR ❑ aANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ M"TROMbtENTAL HEALTH
BldgApp_201 Ldoc revised 06/21171