10090048 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20635 KIRWIN LN CONTRACTOR:HERITAGE PERMIT NO: 10090048
CONSTRUCTION AND
NER'S NAME: DORICE HU 13622 SARAVIEW DR DATE ISSUED:09/08/2010
OWNER'S PHONE: 4083661710 SARATOGA,CA 95070 PHONE NO:(408)867-6881
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r- ELECT r PLUMB r
License Class�j�C Lic.# -6 S1 5172 F r r°"
cc--,, MECH RESIDENTIAL COMMERCIAL
Contractor 'r _ Date -�7g�1 O
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMODEL BATHROOM(NO STRUCTURAL)90SQ&
(commencing with Section 7000)of Division 3 of the Business&Professions DEMOLISH
Code and that my license is in full force and effect. EXISTING FIRE PLACE;NO STRUCTURAL&NO RE-ROOF
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.
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
permit is issued. Sq.Ft Floor Area: Valuation:$14900
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:35918001.00 Occupancy Type:
correct.I agree to comply with all city and county ordinances and state laws relatinl;
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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
ature Date S gm Issued by: f! y—�- Date:
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one o F RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensatior, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
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
1 certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I mus:
forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent:
P Y P P Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 relatinl; I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
the above mentioned property for inspection purposes.(We)agree to save Lender's Name
.;mnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY O:? CUPERTINO
4 ITEMS OF 4 PERM:[T RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: B.Lk: Lot:
APN . . . . . . . . : 3:1918001 .00
DATE ISSUED. . . . . . . : 03/08/2010
RECEIPT #. . . . . . . . . : B;3000011405
REFERENCE ID # . . . : 1 )090048
SITE ADDRESS . . . . . : 2 )635 KIRWIN LN
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . C'JPERTINO
IMPACT AREA . . . . . . .
OWNER DORI CE HU
ADDRESS . . . . . . . . . . : 2 )635 KIRWIN LN
CITY/STATE/ZIP . . . : C'JPERTINO, CA 95014
RECEIVED FROM . . . . : HERITAGE CONSTRUCTI
CONTRACTOR . . . . . . . : H'JNG VAN TRAN LIC # 25516
COMPANY . . . . . . . . . . : HERITAGE CONSTRUCTION AND
ADDRESS . . . . . . . . . . : 13622 SARAVIEW DR
CITY/STATE/ZIP . . . : SARATOGA, CA 95070
TELEPHONE . . . . . . . . : ( 108) 867-6881
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 14, 900 . 00 1 .00 0 .00 1. 00 0 .00
1BSEISMICR VALUATION 14, 900 . 00 1.50 0. 00 1.50 0 .00
1REMRESBAT SQ FEET 90. 00 570 . 00 0. 00 570 . 00 0 .00
1SUPINSFEE HOURS 1. 00 126 . 00 0. 00 126 . 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 698 .50 0 .00 698 .50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 698 .50 #3580
---------------
TOTAL RECEIPT 698 .50
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: 1$14,950
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Du lex It)I.2L PENTAMATION 1GENRES
USE: p 11 F1tJEt 1'.I. �. PERMIT TYPE:
WORK
SCOPE
"c'h Pi<.rr,(h, Phr�,th 1'lutr(Yrs°r°i (it'c�. Pi.rtr Ch,zic
14" h a F'c'e' T'lun:fr. Permit Fcc Lice Prnrri;1�:'e-
0 hC-r.1f' 't. fvl..", Otnr�r 1'f�trt7,T;Inti'; Ut;?F r l ier If�sjr. Li
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS(Fee Resolution 09-051 Ef'. 7;1/10) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.f. Remodel,Bath(<=300 sf)
Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 $570.00 IREMRESBAT
PME Plan Check: $).00
Permit Fee: ISUPINSFEE $).00
Suppl. Insp. Fee-0 Reg. 0 OT 1.0 hrs $123.00
PME Unit Fee: $).00
PME Permit Fee: $).00
Cou,ar action 7 ax
Acoustical Fee: 0 Yes 0 No $).00 0
Work Without Permit? 0 Yes E) No $).00 0
Planning Fee: $).00 Select a Non-Residential 0
li-crvel lkocnrrrcrrtttrtinrr I`Cea_
Building or Structure 0
Strong Motion Fee: 1BSEISMICR $1.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $123.50 $570.00 TOTAL FEE: $698.50
Revised: 9/01/2010
S - w a� —1
�a�L o
IN A(;(
CUP[HTINt_r r;t>E ,'AND CHS NANCES
SIGNED
this set of plans and specifications MUS-,
he kept on the Job at all tinleS and,t's
.,niawful to make any changes or alteration,
on same without written pernussion frorr
the Building DeF)artn;Pr?t Crty of - pe
-he stamping o urtino
this{Idn an�j s 'c i rcationr
:SHA([ NOT be held?„perm;,or to he ar,
lopr oval of the vi
)P in`✓rrn
visrons
REPLACE (E) WINDOW WITH SCOPE OF WORK
(N) WINDOW, SAME SIZE WITH 2. REPLACE REPLACE (ACDF DOW (SAME SIZE)
TEMP. GLASS.
3. ADD ONE RECESSED LIGHT OVER TUB
4. ADD ONE EXHAUST FAN WITH LIGHT
(N) RECESSED LIGHT 5. RETILE SHOWER WALL AND FLOOR.
WITH �4L R I� � °,R �' Lc '1 P
>� p COVER L .2 n,
REPLACE (E) VANITY F (N) FAN WITH ENERGY
LIGHT FIXTURE WITH EFFICIENT LIGHT
OCCUPANCY SENSOR
BATHROOM 1100R PL N
v4 = -o
C 5 C
� jo -) Ct-k-�
2, 00? G c C-
00mvow PRCBATHROOM REMOSHEET DEL FOR TITLE: SHT N0.
Consulting Engtnewv THE HU RESIDENCE PLANS A1.1
105 JIM'""YCA 20635 KIRWIN LANE
Tik4ae)725-= CUPERTINO, CALIFORNIA FN.E NAME DATE:q & i
CITY OF ..0(�' PERTINO
ADDITION/REMODEL
CUPERTINO FEE SCHEDULE
APN# Date:
Is a 2° unit bein added? Yes ❑ No ® If es, lease fill out the ermit a lication for 2°d unit.
Building Address: _Zo (-) 5 V p kw';;r,3 __ UA-til E
Mailing Address (if different from building address):
� Ar
Owner's Name: Phone#
bora
Contractor: Phone#: ( q t �t> 0;2—
i�Z< Fax#:
Cupertino Business License: State Contractor License#:
Contact: Phone#:
Fax#:
Landscape Ordinance Compliance:
Landscape area in sq. ft. (includes all irrigated areas): _�- A
If 2,500 sq. ft. or less, compliance with the Lands,-.ape Water-Efficiency Checklist is required.
If more than 2,500 sq. ft., a complete Landscape :'?roject Submittal is required.
Compliance Method: ❑ Plant Type— ❑ Water Bud et
Building Permit Info: Hillside ElBld . El Elect. ® Plumb. Mech. ❑
Job Description:
Addition-What is being added?(Be Specific):
What is being remodeled (not including addition)? F34_11A
Remodel Includes Re-Roof. Yes ❑ No IR If yes list number of squares
Remodel Includes Structural: Yes ❑ No WSJ
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 !Ia T Other
Type of Construction (Usage Class): Occupancy Type: �=3
1-A, 1-B EJ II/III/V-A ❑ II/III B, IV-HT,V-B ®' Valuation:
Please check this box if the project is a
Project Size: Express E� andard ❑ Large ❑ Major❑ second-story addition ❑
Please complete relevant portion of the Green building
Checklist& attach it to the application or if applicable, Green Building Points Achieved: ,�y
include in plan set& the sheet index. C/
Revised 05/18/10
01-C__