12050110 CITY OF CUPERTINO BUILDING PERMIT
B1111.DINGADDRESS: 10645JOUIN WAY CONTRACI.OR-TB0—r0-I3E PERMIT NO: 12050110
ED
OWNER'S NAME: SUN TJEN FAM DATE ISSUED:05/11/2012
OWNER'S PIIONE: 4257853840. ` �. PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRl TION: RESIDENTIAL L.COMMERCIA
License Cl asses Lick 4-36 -0'f REMOVE FIREPLACE LOCATED IN LIVING ROOM,
// PANEL
Contractor Jad--On /a/c- Date--.'�7w—nliz. UPGRADE 200 AMP
I hereby affirm that I am licensed under the provisions of Chapter9 '
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
1 hereby affirm under penally 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
perfomtance of the work for whichthis permit is issued. Sq.Ft Fluor Area: Valualion:$2400
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of(be work for which this APN Number:35919010.00 Occupancy"type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and stale 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 FROM LAST CALLED 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 �/Yr/✓ 174l7--e-1`-1
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9-I8.
Signature DRF.-ROOFS:
�'Z� - ale 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.
❑ ON'NF:R-RIIILDF.R DECLARATION
I hereby affirm that 1 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
I,as owner of the property,or my erhployms 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). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safely Code,Sections 25505,25533,and 25534. 1 will
I hereby affirm under penally of perjury one of the following three maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
declarations: Ileallh&Safety Cade,Section 25532(x)should I Blore or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 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 Ileallh&Safety Cade.Sections 25505,25533,and 255.34.
Section 3700 of the Labor Code,for die performance of the work for which this !� Z
permit is issued.
Owner or authorized agent: �� \ �_ Dale:
1 ccnify that in the performance of the work for which this permit is issued,I shall
not employ any person inany manner so as to become subject to the Worker's
Compensation laws of Califomia. If,alter 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
1 ccnify that I have read this application and state that the above information is
correct.1 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, ARCI I ITECT'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
9.18.
Signature Date
CITY OF CUPERTINO
7 ITEMS OF 7 - PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 35919010 . 00
DATE ISSUED. . . . . . . : 05/11/2012
RECEIPT #. . . . . . . . . : BS000016793
REFERENCE ID # . . . : 12050110
SITE ADDRESS . . . . . : 10645 JOHN WAY
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER SUN TJEN FAM
ADDRESS 10645 JOHN WAY
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JACKSON LUK
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
---------- ------------- ---------- ---------- ---------- ---------- ----------
-ADMIN HOURS 1 .00 41 .00 0.00 41.00 0 .00
1BCBSC VALUATION 2,400 .00 1.00 0. 00 1 .00 0 . 00
1BSEISMICR VALUATION 2,400 .00 0.50 0. 00 0 .50 0. 00
1EPERMITFE FLAT RATE 1. 00 44 . 00 0 .00 44 . 00 0. 00
1ERT<200 UNITS 1.00 44 . 00 0 . 00 44 . 00 0 . 00
1STINSP UNITS 1 .00 130 . 00 0 . 00 130 .00 0 . 00
1TRAVDOC FLAT RATE 1 .00 44 . 00 0. 00 44 .00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 304 . 50 0 .00 304 .50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 304.50 VISA
---------------
TOTAL RECEIPT 304 . 50
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10645 John Way DATE: 05/11/2012 REVIEWED BY: Sylvia
APN: BP#: 'VALUATION: $2,400
*PERMITTYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex PENTAMATION 1 REAP2
USE: PERMIT TYPE:
WORK REMOVE FIREPLACE LOCATED IN LIVING ROOM PANEL UPGRADE 200 AMP
SCOPE
Il.•rh. I7un Y'hsk
Plumb. flan Check Elec. Plan Check 0.0 Ins $0.00
meah. Penni,Fce: Plumb. Permit Fee: Elec. Perron Fee: IEPERAIIT
Oder lleeh. Ina'p. Othur Plumb Inst'. Li I Other Elec. Insp. 0.0 hrs $44.00
Mech. bap. I Plumb. b,ep. Petr Vew.hrsp.Fdc:
NOTE: This estimate does not include fees due to other Departments(ie.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prefiWna in ormadon available and are only an estimate Contact the De r or addn 7 info,
FEE ITEMS(Fec Resolution 11-053 E0' 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 200 amps Electrical
Suppl. PC Fee: Q Reg. Q OT FO.OThrs $0.00 $44.00 /ERT<200 I Services
PME Plan Check: $0.00
Permit Fee: Hourly Only? Q Yes 0 No $0.00
Suppl. Insp. Fee:Q Reg. Q OT 0,0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $44.00
Construction lite:
Administrative Fee: 1ADM1N $41.00 O
Work Without Permit? O Yes E) No $0.00
Advanced Plannine Fee: $0.001= hours Inspections t�
Travel Documentation Fee: 1TRAVDOC $44.00 $130.00 ISTINSP Inspection, Hourly 0
Strong Motion Fec: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $130.50 $174.001 TOTAL FEE: F$304.501
Revised: 04/01/2012
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228• FAX(408)777-3333• building(Dcuoertino.org I los O I I Q
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATIjON/TI EI REVISION/DEFERRED ORIGINAL PERMIT x
PROJECT ADDRESS / D / /1/ 7O/in �� CU�re%1+ "U APN4
b > J f C)
OWNERNAME S`t„ TJe� FQVV) PHONE E-MAIL
STREET ADDRESS CITY. ST TE ZIP o FAX
(-(0yr l/�G
CONTACT NAME T� - v /LI PHONE6rC-417-5P°r Y E-MAIL
STREET ADDRESS .J C�O� CO. ✓�w,^ CITY.STATE JZIP
��-�/' ln. �ifl�n FAX
❑OWNER ❑ OWNER-BUILOER ❑ OWNERAGENTI CONTRACTOR ❑CONTRARTORCAGENT ❑ ARCHITECT/ ❑ENLGMER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME(A C I� T I IC.r;b/ 91,1 ) Jlf _ -LICENSE NUMBEI9 / / 3 (�' LICENSE TYPE BUS.LIC a
COMPANY NAME C,{ C rr �-i 7,/. f�,, I E-MAB. / ` Y rJ FAX
STREET ADDRESS /R'Z L' C0� Orc�flG✓I G�O ZO�_crry.STPTF�ZIP I-t6 6A• 7/3e? PHONZi„7
ARCHITEC/ENGWEEfR•,NAME LICENSE NUMBER /'{ 7 BUS.LIC a
COMPANY NAME E-MAIL FAX
STREET ADDRESS Cr Y,STATE,ZIP ?HONE
DESCAIPTIONOFWORR te-f/ ? �OC)
L I'I (.Q' Q a1
EXISTING USE PROPOSEDUSE CONSTR TYPE 'STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXLSTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET ARFA
BATHROOM KITCHEN OTHER
REMODELAR-EA REMODELAREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA, DETACH
ATTACH
a DWELLINGUNM IS A SECOND UNIT 0 YES SECOND STORY ❑YES
BEING ADDED? ONO ADDITION? ONO
PRE-APPLICATION ❑YES D YES.PROVIDE COPY OF IS TBE BLDG AN ❑YES RECEIVED BY: TOTAL VALUATION:
PLANNNG MPLa 0 N PLANNING APPROVAL LETTEE EICHLER ROME? 0 N 2
.yn`7
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prpperty owner's behalf I have read this
application and the information I have provided is corem I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and smm laws relating to building construction. 1 authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agene Date: — //— /Z—
SUPPLEMENTALINFORMATION REQUIRED LAN CRECKTYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for ;73vER-lVE{OUNTER ❑ BUILDING PLAY REVIEW
existing building(s). Demolition permit is required prior to issuance of building/
permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REv EW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure E] STANDARIn ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ I=DE"
Copy of Planning Approval Letter or Meeting with Planning prior to ❑ NtUOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ e.V o MENTAr,HEALTH —11
Bldge4pp_2011.doc revised 06/21/11
L -
Lucky Interior Designs, Inc. 10645 John Way
1040 Corporation Way,Suite 206 - Cupertino, CA.
Palo Alto, CA. 94303
Office: 650-4274MM Fireplace removal and electrical panel upgrade
visit us online at www.LUCKYLLC.com [05-11-121
MAY 11 2012
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CUPERTINO
Bundle COMMl1NITY DEVELOPMENT DEPARTMENT
\ BUILDING DIVISION-CUPERTINO
Y 1 1 2012 APPROVED
This set of plans and specifications MUST be kept at the
REVIEWED R CODE COMPLIANCE s ',,during construction. It is unlawful to make any
chnges or alterations on same,or to deviate
Reviewed By: therefrom,without approval from the Building Official.
The stamping of this plan and specifications SHALL NOT
r�t , — be held to permit or to be an approval of the violation
of any provisions of any City Ordinance or State Law.
� C0 BY— s��N OFF1 DATE
t PERMITNO.
Building Sketch
Mg21-
SUN TJEN FAM
AOm155 10845 JOM W
Sa=CLwa SUM G Tb@ 95014
Latle WO F 80 t NA-0AB0079629
SECOND FLOOR
POOL 18S 195
YARD CLOSET
_ FAMILY MASTER
PATIO ROOM 13EDROOM
BATH
389
DIN64G
BEDROOM BEDROOM ROOM KITCHEN
Eq 3m
BEDROOM BATH ENTRY 16.8
LIVING
b_ 2 CAR _
25S ROOM `� GARAGE
135 19.9
COmmwrtf: IINI1 WCOSAtiOB Y®0•'1®a19W M 9Bf =ATF1 il@PWO9ID S W" =6 Ts B6INL S1W.I.�
TOl9 2589 SQ.". I 1Bl,moa mo 12th SO.". IIBICAT®BS C MA-
'AREA 7CALCULATIMS
l.'AREA`CALCULATIMS SUMMARY..::.:r: - ._.:LIVING AREA BREAKDOWN
MAI rlr.S noes 1917.8 1"7.9 rlr.t neer
cut wemtl neer 497.3 541.3 16.s 42 777.0
08A 4r4q. 399.0 )99.0 SS.S • 36:5 801.1
13.5 • 11.0 283.5
10.0 • 19.5 255.0
Lm viae[
19.5 • 35.5 497.3
Net LIVABLE Arra (RMAUWd) 2415 5118 (RmndeO) 2415
Fm SKTAM—WoTOTAV ap91>"w.TTae 9Y a h m ,m.-14M ALAM00E