11010011 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10582 LONNA LN CONTRACTOR:T.W.Y.INC. PERMIT NO: 11010011
OWNER'S NAME: HSIEH-HO CHU 864 ARCTURAS CIR DATE ISSUED:01/03/2011
OWNER'S PHONE: 6506251586 FOSTER CITY,CA 94404 PHONE NO:(650)571-1728
LICENSED CONTRACTOR'S DECLARATION r r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
e
License Class Lic.# r r r
MECH RESIDENTIAL COMMERCIAL
Contractor � � ��� Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMODEL KITCHEN 99 SQ FT,228 SQ FT THROUGH OUT,
REPLACE 5 WINDOWS NON-STRUCTURAL
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I 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. Sq.Ft Floor Area: Valuation:$2000
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 APN Number:35919015.00 Occupancy Type:
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 WITIIIN 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 DAY FR 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 /,, 3 _ / I
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
9.18.
V�,, ( RE-ROOFS:
SignatureDate ( 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.
OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my employees 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). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I 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 Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this 1,4 ��
Owner or authorized agent: Date:
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after 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
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 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, ARCHITECT'S DECLARATION
sts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
anting 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.
Signatur Date
RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number:
Name of owner. f`4;eA- wy C- Cl�
Project address. ���Z L_6�t�•t� 1. Q.y1� ``'�
Contact person. U Phone. 7 S-78 q�
Fax.
t..
IL
Net square footage of lot. '
Existing Proposed r:'y
Square footage: First floor:
Second floor:
Garage:
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y N
-ivacy protection planting required for the project? '--Y N
Build it Green Total Points
On what floor(s) is work being done?
Brief description of or �� �� �� !'
Code editions 2 07 CB - N)2007 CFC -N) N CMC
2007 CP N)2007 NECAPP-N) 007
IN ACCORDANCE ITT ftp HE CITY 0,
CUPL RTINO CUD S AND ORUINANCE7
Effective 1/1/08 UATE_ f
SIGNE
This set of plans and specifications MUST
he kept on the fob at all times and it is
uniawfui to make any changes or alterations +
:$
on same without written permission from
the BuildingDe &r
The stain in o Department,
Ctity of Cupertino.
p g f P a;3specifications
SHALL NOT be held to permit or to be an
approval of the violation of an
of aY Provisions
ny
City Ordin,ince ur �tti aw.
Plan Review Process Work Book Page-8- Revised 06-15-10
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CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 35919015 . 00
DATE ISSUED. . . . . . . : 01/03/2011
RECEIPT #. . . . . . . . . : BS000012372
REFERENCE ID # . . . : 11010011
SITE ADDRESS . . . . . : 10582 LONNA LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HSIEH-HO CHU
ADDRESS . . . . . . . . . . : 10582 LONNA LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : TUNG SHENG SHO
CONTRACTOR . . . . . . . : TUNG-SHENG SHO LIC # 31032
COMPANY T.W.Y. INC.
ADDRESS . . . . . . . . . . : 864 ARCTURAS CIR
CITY/STATE/ZIP . . . : FOSTER CITY, CA 94404
TELEPHONE . . . . . . . . : (650) 571-1728
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 2, 000 .00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 2, 000 .00 0 .50 0 . 00 0 .50 0 . 00
1REMRESKIT SQ FEET 99 .00 570 . 00 0 . 00 570 . 00 0 . 00
1REMRESOTH SQ FEET 228 .00 380 . 00 0 . 00 380 . 00 0 . 00
1WINREP EACH 8 5 .00 380 . 00 0 . 00 380 . 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 1331 .50 0 . 00 1331 .50 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 1, 331 .50 visa
---------------
TOTAL RECEIPT 1, 331 . 50
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10582 lonna lane DATE: 01/03/2011 REVIEWED BY: bobs.
APN: BP#: *VALUATION: 1$2,000
q*PERMITT'YPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex ��(17.3I, PENTAMATION 1 R3SFDREM
USE: 1 1 C�OIJ.1 �£ z. PERMIT TYPE:
WORK kitchen remodel and patio repair non structral 5 window and door replacement non strucural all
SCOPE lighting to meet 2011 title 24 energy standards.
1""(:h. Plan Ch,( 7-1 k f h(mh, 1'k-w E`trc/" FFi..or C.`tzc-k
14"cil. 11"t-mil
0,icr Akch. htsp, (Y� LJ I
17 rh, Itsu 1 I'Ir,rit<r}. Ja i;. F
1'17('( lnap, FCC,
NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 info,
FEE ITEMS (Fee Resolution 09-051 Ef. 1711,140FEE QTY/FEE 1 MISC ITEMS
Plan Check Fee: $0.00 99 s.f. Remodel,Kitchen(<=300 sf)
Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $570.00 REMRESKIT
I
PME Plan Check: $0.00 = s.f. Remodel,Other
Permit Fee: $0.00 $380.00 IREMRESOTH
Suppl. Insp. Feed Reg. ® OT 0.0 hrs $0.00 0 # Window/Sliding Glass Door
PME Unit Fee: $0.00 $380.00 1 WINREP Replacement
PME Permit Fee: $0.00
C011S11-11CtiW7 1 ZL
Acoustical Fee. 0 Yes (E) No $0.00 0
Work Without Permit? 0 Yes 0 No $0.00
Planning Fee: $0.00
7i'cti'e'1 L)oc trrrr rztutr«rr l c '.s:
I
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS. $1.50 1$1,330.00 TOTAL FEE: $1,331.501
Revised: 12/07/2010
CITY OF
CITY OF CUPERTINO
ADDITION/REMODEL
CUPERTINO FEE SCHEDULE
APN# Date:
Is a 2" unit being added? Yes ❑ No I yes, please fill out the permit application for 2" unit.
Is this a 2"d story Addition? Yes ❑ No
Is this house an Eichler? Yes ❑ NoIf yes, needs Planning approval.
Building Address: ,
Mailing Address (if differ nt from b ' d' g ad ess):
t�0 OS
Owner's Name1*e: Phone#
Sid
Contractor: Phone#:
U'U C cy'Y! Fax/e-mail: �� (s 79 S
Cupertino Business License: State Contractor License #:
Contact: Phone#:
Fax/e-mail: 67 S- 7 9-9
Landscape brdinancel Compliance: rr �
Landscape area in sq. ft. (includes all irrigated areas):
If 2,500 sq. ft. or less, compliance with the Landscape Water-Efficiency Checklist is required.
If more than 2,500 sq. ft., a complete Landscape Project Submittal is required.
Compliance Method: ❑ Plant Type ❑ Water Budget
Building Permit Info: Bldg. ' Elect. -lumbing chanical Hillside LJ
Project Size: Counter ( x ress ❑ Standard ❑ Lar e ❑ Major ❑
Job Description: , CAYP � raW'e' -Flu V'r rA_v _ f
Addition-What is being added?(Be Specific). L 1117
All Uv -t Le-j
What is being remodeled (not including addition)? �
Remodel Includes Re-Roof. Yes ❑ No �If yes list number of squares
Remodel Includes Structural: Yes ❑ No
Do you have the pre-application planning approval? Yes ❑ No ❑
If yes, please provide a copy of your planning approval letter. Planners name:
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen Bath Other. ��b
Type of Construction(Usage Class): Occupancy Type: fL`
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT,V-B Valuation: ill
Please complete relevant portion of the Green Building
Checklist & attach it to the application or if applicable, Green Building Points Achieved:
include in plan set& the sheet index.