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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 B nR rr.ruat RFR AATT3 PROJECTADDRFSS /G y �/ q n� / AP4s OWNER NAME S�-Nue,-A (/-QMH PHO 7 C8, 7�1/O Z� E-MAIL O / STREET ADDRESS SC �� FAX . CI Y. STATE. 21P�u TMR CONTACT NAME PHONE,r3/ `YO(yr%. E-MA0.�rT�GWTR T STREET ADDRESS r)�C y„, CffY. STA IIP /O <,i 9 F Sczas�c 3/ ❑ 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 �/ �'[G�Ji N-e-�1 /ter/✓ �J[� griN /'4C 2/V /r ['u1'^ '% CorK_P� Qr� i .ry n1 �/ ('r.Le✓ 3 iN+..i J=CfuiS` J�1t n nwL) G.P;.f/ rCIP.:7 /-/-f ' /G�t �' j• 1�f4'%•v r�e*yyva� /�'Kr ��v.r� eve% -i. �>�!r.,� leaf . �J Tvr4 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