12060028CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10439 PLUM TREE LN
CONTRACTOR: COSTA BELLA
PERNTIT NO: 12060028
BUILDERS
OWNER'SNAME: SUN YUAN YUAN
PO BOX 2963
D,%rE ISSUED: 06/05/2012
OWNERS PRONE: 4087721829
SANTA CRUZ, CA 95063
PHONE NO: (831) 8189847
LICENSED CON "IRACI'OR'S DE(:I,ARATION
F— F r
//�� &3S
BUILDING PERNII'f INFO: BLDG KLECI' PLUMB
License Class r✓ tLic.N yee6
r F r
Jf- I1fPV" c.�
CUlilraelor yr-w— Ualc � /
%IF,(II RESI DF:]I L\L CON?IF.RCI ki.
hcrchy affirm that l am licensed tinder the provisions of Chapter 9
JOB DESCRIP'T'ION': KI'I'C'I II(N REMODEL 130 SQ I
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
hereby affirm under penalty of perjury one of the following two declarations:
I have and swill maintain a certificate of consent to self-insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, f'or Elie
Sq. 1'1 Floor Arra:
V:duadiun: S19853
performance of the work fix wshich 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 [hc work for which this
APN\umber: 31(,33084.00
Ottup:mry''Fypc
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 propcny for inspection purposes, (We) agree to save
180 DAl! OM LAST CAL D INSPEC ION.
indcnnil'y' and keep bunnless the City of Cupertino against liabilities, judgments,
costs, and expenses sshich nv accrue against said City in consequence of the
✓�
Z G
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all nun-point source regulations per the Cupertino Municipal Code, Section
9.18- C
4 D-"
RE-ROOFS:
Signature ice) Date S� /
All rook shall be inspected prior to any rooting material being installed If a roof is
Installed without first obtaining an inspection, I agree to remove all nes, material., Ibr
inspection.
❑ O\aNF.R-BUILDER DF,CLARA"I'ION'
Signnure of Applicant Date.
hereby affirm that I nm exempt from the Contractor's License Law fur tine of
the following two reasons:
ALL ROOF COVERINGS 1'0 BE CLASS "A" OR BE 1-1 ER
1, as owner of flic property, or nip employees with wages as their sole compensation,
,% ill do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
L as owner of Elie property, ;,in exclusively contracting with licensed contractors to
I IA'ZARDOUS NIA'I F.RIALS DISCLOSURE
construct Elie project (See 7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 695 of the
California llcalth & Safe( r Code. Sections 25505, 25533, and 25534. I will
I hcrchy affirm under penalty' of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.1'_ and the
decfa ra lions:
Ilculth & Safety Code, Section 25532(x) should I store or handle hazardous
I have and swill maintain a Certificate of Consent to self-insure for Worker's
material. AJdilionafly, should 1 use equipment or devices ww hich caul hazardous
Compensation, its provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bav Area Air Quality Management District 1
performance of the work for which this permit is issued
will maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and
I lave and will maintain Worker's Compensation Insurance, as provided for by
he work far hich this
Section 3700 of the Labor Code, for the performance ohw
the llcalth & Safelr Code. Sections 25505 15533, and 25534.
/L--�" S //
Ows'ner Uatc:`�/!!!
pcnnil is issued
or authorized agent: —
I certify that in the performance ol'the work for which this permit is issued. I shall
not cloploy lin)person in any manner so its to become subject to the Worker's
Compensation laws ofCallfi rnia. If. alter making this certificate rlf excluptlon, I
CONS'l RIV I ION LENDING :M. ENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby all-un that there is a construction lending agency for the perfornance of
forth, 111 comply %, Ell such provisions or this permit shall be deemed revoked,
work's liver which this permit is issued (Sec. 3097, Civ C,)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
I certify [hat 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 propcny' for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCIIITEC"I"S DECLARA"IION
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 ([Its permit Additionally, the applicant understands and will comply
with all non-point source regulations per [he Cupertino Municipal Code, Section
Licensed Professional
9.18,
Signature Date
CITY OF CUPERTINO
Imo% I FEE;ESTIMATOR -BUILDING DIVISION
NOTE: This estimate does not includejees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the Preliminary information available and are only an estimate. Contact the Dept for addn't info.
FEE ITEMS (Fee Resolution 11-053 ED.' 7/1/11)
ADDRESS: 10439 Plum Tree Lane
DATE: 06/05/2012
REVIEWED BY: Sean
,I lerh. Perma Fee:
APN:
BP#:
'VALUATION:
$19,853
°PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
like. My,. Fvc:
PENTAMATION 1R3SFDREM
PERMIT TYPE:
WORK
Kitchen remodel 130 sq ft).
SCOPE
$0.00
NOTE: This estimate does not includejees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the Preliminary information available and are only an estimate. Contact the Dept for addn't info.
FEE ITEMS (Fee Resolution 11-053 ED.' 7/1/11)
Alech. New Check
Plumb. Plnn Chu,k
Dec. Plan Check
,I lerh. Perma Fee:
- Plumh. Pcraw ree:
filar:. Purmh Fve:
(hlrer.Vreh. Inst,,
Oilier Plumb Insp.
Oilier filer. h;11,
,Hrch. hup. r,re:
Plumb. hrep. Fee:
like. My,. Fvc:
NOTE: This estimate does not includejees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the Preliminary information available and are only an estimate. Contact the Dept for addn't info.
FEE ITEMS (Fee Resolution 11-053 ED.' 7/1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
130 s.f.
$588.00
Remodel, Kitchen (<=300 sf)
1REMRESKIr
Suppl. PC Fee: 0 Reg. 0 OT
FO.OThrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee.0 Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Cuns(rli
nrliun te:
A(bninislrrrlive Fec.
0
0
Work Without Permit? 0 Yes, E) No
$0,00
Advanced Plannine Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
%7rmc! Docuu7enlaNnn Fees:
Stronc Motion Fee: IBSEISMICR
$1.99
Select an Administrative Item G G
(3
Blde Stds Coin inission Fee: 1BCBSC
$1.00
SUBTOTALS:
1 '$2.99
$588.00
TOTAL FEE:
1 $590.99
Revised: 05/01/2012
F
NNEW
i
CITY OF
CUPEI�TINO
Buildine D
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
t
JOB ADDRESS- PERMIT #
OWNER'S NAME: .pati a�--� -- PHO 2:2/2 f/f-Yd`!7
GENERAL CONTRACTOR:.6o 1,t #
I am not using any subcontractors: S i�
Signature Date
Please check applicable subcontractors and complete the following information:
Owner/Contractor Signature
G �s/-7--
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature
G �s/-7--
Date
3 ITEMS OF 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 31633084.00
DATE ISSUED.......: 06/05/2012
RECEIPT #.........: BS000017001
REFERENCEID # ...: 12060028
SITE ADDRESS .....: 10439 PLUM TREE LN
SUBDIVISION .......
CITY CUPERTINO
IMPACT AREA .......
OPERATOR: SylviaM
COPY # : 1
OWNER ............:
SUN YUAN YUAN
ADDRESS ..........:
10439 PLUM TREE LN
CITY/STATE/ZIP ...:
CUPERTINO, CA 95014
RECEIVED FROM ....:
COSTA BELLA
CONTRACTOR .......:
JEFF THRANOW LIC # 32636
COMPANY ..........:
COSTA BELLA BUILDERS
ADDRESS ....;......:
PO BOX 2963
CITY/STATE/ZIP ...:
SANTA CRUZ, CA 95063
TELEPHONE ........:
(831) 818-9847
FEE ID
UNIT QUANTITY
AMOUNT PD -TO -DT THIS REC
----------
NEW BAL
----------
----------
1BCBSC
-----------------------
VALUATION 19,853.00
---------- ----------
1.00 0.00
1.00
0.00
1BSEISMICR
VALUATION 19,853.00
1.99 0.00
1.99
0.00
1REMRESKIT
SQ FEET - 1.00
588.00 0.00
----------
588.00
0.00
----------
TOTAL PERMIT
---------- ----------
590.99 0.00
590.99
0.00
METHOD OF
PAYMENT `AMOUNT
-
REFERENCE NUMBER
--------------------
-----------------
CHECK
--------------
590.99
------------
3576
TOTAL RECEIPT
--7
590.99
6/4/2012
COSTA BELLA BUILDERS F2+8;C1 6�R�
BY JEFF THRANOW
A Division of Pacific Compass, Inc. JUN U 5 2012
P.O. Box 2963 Lic# 654886
Q Santa Cruz, CA 95063 BY:_®
Costa Bella (831) 462-0580
BUILDERS (831) 46 Fax
jell ancosttabellaabellabuilders.com
Permit Scope
Yuan Yuan Sun C""v
10439 Plum Tree Lane Offic'
LLLL����
Cupertino, CA 95014 .
1. Demolition:
• Includes demolition and removal of kitche al ts, counted
Ing
appliances. „v apaT1P1O
rtment
• Haul away demolition debris. amu"
• Floor plan to remain as is. JUN 0 5 2012
REVIEWED FOR COMPLIANCE
2. Electrical: Reviewed By.
• Run new circuits from panel to code per design.
• Provide and install nine (9) LED retrofit kits at existing re essed light
locations.
• Verify that the owners' installed smoke detectors and a Carbon
Monoxide alarm are properly located and functioning.
3. Plumbing:
• Install recessed water supply at refrigerator (same location).
• Install recessed gas supply at gas range (same location).
• Return to connect faucet after countertop installation is complete.
4.
S.
Drywall:
• Patch drywall as needed for remodel work.
• Texture all kitchen and dining room walls and ceiling with an "old
world" style finish. COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION - CUPERTINO
Cabinets: APPROVED
Install cabinets per plan.
This set of plans and specifications MUST be kept at the
lob 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 provisions of any City //Ordinance or State Law.
BY �� HfITGI�
DATE
PERMIT NO. Z:0�2 CO �f1'
Wal
1CCUPERTINO
1 NFW CONSTRUC
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 950143255
(40188))777-3228 • FAX (4(0088) 777-3333 • buildina(d)cuoertino.ora
t
ION I 1 ADDTON VI Af TFRATiON/T7 F1 RFV19f1N/nEFFRRFn
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PROJECTADDRFSS /G y �/ q n� /
AP4s
OWNER NAME S�-Nue,-A (/-QMH
PHO 7 C8, 7�1/O Z� E-MAIL
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STREET ADDRESS SC ��
FAX .
CI Y. STATE. 21P�u TMR
CONTACT NAME
PHONE,r3/ `YO(yr%.
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STREET ADDRESS r)�C y„,
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT -6I CONTRACTOR 11CONTRACTORAGEN7 ❑ ARCHr CT ❑ ENGMER ❑ DEVELOPER ❑ T A,NT
CONTRACTOR NAMEif, iF T/y;ZAn/Onl
LICENSE NUMBEIVS (��
G
LICEN TYPE
BUS. LIC#
�c//
'r
COMPANY NAME//��
411 6r/416,4-
, /,J
EMAIL �
FAX
.Jcr-wt�
STREET ADDRESS ,�'
%d'�!� 1(// A''sli
CfTY, STATE, IIP
C 7/d 4 'IS'o: t
PHONE
d 3 / P&
ARCHTTECTZENGINEER NAME /
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY. STATE, LP/
DESCRIPTION OF WORK /� (, /PHONE
(f J� , / ✓L ' O.t /N 11ryt
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griN /'4C 2/V /r ['u1'^ '% CorK_P� Qr� i .ry n1 �/ ('r.Le✓ 3 iN+..i J=CfuiS`
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EXIS USE
PROPCW USE
CONSTA TYPE
.V/'r3
4STORIES
y
USE
TYPE
OCC.
sgrn
VALUATION (S)
TG
ARE
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET.AREA
l72. 1✓
�
3
130
/
BATHROOM KTICHFN OTHER
REMODELAREA REMODELAREA 13c jS REMODEL AREA
PORCH AREA DECKAREA
TOTAL DECK/PORCIIAREA GARAGE AAFA DETA
ATTACHCH
A DWELLING UNITS:
IS A SECOND UNIT I IYES
SECONM57ORY []YES
BEING ADDED? TIL110
ADDITION' ;PO
PRE-APPLICAnON C] YES IF YES, PROVIDE COPY OF
PLANNING APPL# NO PIANNINGAPPRO`/ALLETTER
0TBE BLDG AN BYES
EICKLER 110 E? NO
RECEIVED
TOTAL VALUATION:
�l
By my sipanrre below, I certify to each of the following: 1 am the property owner or authorized agent to act on the pi- perry owner's behalf.'[ have read this
application and the information I have provided is correct I have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local
ordinances and state laws relating to buil g cons$$��JJca. . I authorize representatives of Cupertino to enter the above= property for inspection purposes.
gentifled
Signature of Applicant/Agent: Date:/' ✓ L17
SU?PLEMENTXL INFORMATIONPEQ=D
PLAN CHECK TYPE
ROUTING SLEP
OVER-TRE-COfINTEA
�BLTI.DING PIAN REVS
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
.
permit for new building.
❑ ExPRESS
❑ PLA,NNINGPLANREVfEW
Materials
__Commercial Bldgs: Provide a completed Hazardous Disclosure
❑ STANDARD❑
PUBLIC WORKS
rm
foif any Hazardous Materials are being Used as part of this project.
❑
LARGE
❑ FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
❑ xA1oR
❑
submittal of Building Permit application.
SANITARY SEWER DISTRICT
❑ eNVIROhMENTAL REAL TB
Blag.4pp_201 Ldoc revised 06/21/11
P/uLe