10040162 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10839 BROOKWELL DR CONTRACTOR:TBD-TO BE PERMIT NO: 10040162
DETERMINED
-IWNER'S NAME: LEE YU-CHENG&NANCY HUI-YING DATE ISSUED:04/27/2010
OWNER'S PHONE: 4083525802 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class_ 8 — Lic.# P o �' / KITCHEN REMODEL& NO
; STRUCTURAL,NOLLIIGHTING,
Contractor S 7 ate —Z '2-010 INCLUDING 2 BATHROOM;INCLD
I hereby affi m that I am licensed under the provisions of Chapter 9 ELECT/MECH/PLMBING;NO
(commencing with Section 7000)of Division 3 of the Business&Professions REROOF&NO STRUCTURAL**SEE MEMO**
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:$9500
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:36921031.00 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 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 Issued by: a l Date:
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
'-ignature Date "2 E/ v 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-BUILD 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)
1,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. I 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 Owner or authorized agent:
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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
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
-on the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
.emnify and keep harmless the City of Cupertino against liabilities,judgments,
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 2— --�U
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36921031. 00
DATE ISSUED. . . . . . . : 04/27/2010
RECEIPT # . . . . . . . . . BS000010274
REFERENCE ID # 10040162
SITE ADDRESS 10839 BROOKWELL DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER LEE YU-CHENG & NANCY HUI-YING
ADDRESS 10839 BROOKWELL DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : PETER WANG
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
---------- -------------
---------- ---------- ---
1BCBSC VALUATION 9, 500 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 9, 500 . 00 1. 00 0 .00 1 . 00 0 . 00
1REMRESBAT SQ FEET 70 .00 1140 . 00 0 . 00 1140 . 00 0 . 00
1REMRESKIT SQ FEET 120 . 00 1140 . 00 0 . 00 1140 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 2282 . 00 0 . 00 2282 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ---------------
CASH 2, 282 . 00 10839 Brookwell Dr
---------------
TOTAL RECEIPT 2, 282 . 00
CITY OF CUPERTINO
ADDITION/REMODEL
CUPEkTINO PERMIT APPLICATION FORM
APN # � � �� � � � �, Date:
"
Is a 2 unit being added? Yes L] No If yes, please fill out the permit application for 2unit.
Building Address:
Mailing Address (if different from building address): y
Owner's Name: v ' 'Phone'-W: .�
Contractor: r Phone#: /
Fax #:
Contractor License#: o0D 7 D(7/ 7
Cupertino Business License#: A,5 ./
Contact: Phone#:
Fax#:
Building Pe t Info:
Bldg. Elect. Plumb. Mech. Hillside E]
Job Description:
Addition-What is being added?(Be Specific):
/VL9
,7-t4&�d ' 7-w° LIA4-6- ,e6an►
What is being remodeled (not including addition)?
Remodel Includes Re-Roof: Yes ❑ No Z 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___L' Bath � Other
O
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B 0--- �L
Valuation: �{�I �3'�ro Please check this box if the project is a
77 second-story addition ❑
Project Size: Express ❑ Standard ❑ Large ❑ Major❑
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.
***For Office Use Only***
Over-the-Counter ❑ Revised 07/06/09
CITY OF CUPERTINO
ADDITION/REMODEL
CUPE�TiNO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
ADDITIONS 1R3SFDADD
1PLLONGRNGR Long Range PL
Planning/Residential
1 R31NSP Dwellings Inspections B
1R3PLNCK Dwellings plan check B
1 R3REPINSP Dwellings Repeat B
Inspection
1 R3REPPLNC Dwellings Repeat Plan B
Check
1R3HINSP Dwellings Hillside B
inspection
1 R3HPLNCK Dwellings Hillside plan B
check
1R3HREINSP Dwellings Hillside B
Repeat Inspection
1R3HREPLNC Dwellings Hillside B
Repeat Plan Check
1R3ALTINSP Dwellings Alternate B
Materials Inspection
1R3ALTPLNC Dwellings Alternate B
Materials Plan Check
1 PCESS Cesspool P
1 PPRSEWG Ea. Private Sewage P
Disposal System
1 PRSEWER Sewers P
1BPSPRINK Lawn Sprinkler/Backflow P
1BPWSVCS Main Water Service P
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE SeismicResidential B
1RER00FRES Residential Re-roof Each B
100 SF
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
DECKS 1R3SFDADD OR
1R3SFDREM
1 DECKWOOD Deck (Wood)-Each B
(Each)
1 DECKRAIL Deck Railing-Each B
(Each)
GARAGES 1R3SFDADD OR
DETACHED 1R3SFDREM
1GARDTW<=1K Wood Frame up to B
1,000 SF (each)
1 GARDTM<=1 K Masonry up to 1,000 SF B
(each)
1 BCONSTAXR Construction Tax Res
(new detached garage)
PATIO'S OPEN 1R3SFDADD OR
1R3SFDREM
1PATIOWOOD Wood Frame up to 300 B
SF
1PATIOMETAL Metal Frame up to 300 B
SF
1 PATIOOTHER Other Frame up to 300 SF B
PATIO'S CLOSED 1R3SFDADD OR
& SUN ROOMS 1R3SFDREM
1PATIOENCLW Enclosed Wood up to 300 B
SF
1 PATIOENCLM Enclosed Metal up to 300 B
SF
1 PATIOENCLO Other Enclosed Patio up B
to 300 SF
1 COVPORCH Porch Covered-Each B
(Each)
REMODELS 1R3SFDREM
1 REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan
300 SF check
1 REMRESBAT Bath Remodel up to 300 B "
a SF
1 REMREOTH Other Remodel up to 300 B "
SF
RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number:
Name of owner. C-7,Z-4
Project address. ZQ �� 4 /—;
Contact person. w,4' Phone.
Fax.
Net square footage of lot.
Existin Proposed
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
Is privacy protection planting required for the project? Y N
uild it Green Total Points
On what floor(s) is work being done?
Brief description of work.
t �q r �f�-r`i•c�--�_fM C�v
Code editions: 2007 CBC -N)2007 CFC �N)2007 CMC )
2007 CPC -N)2007 NEC -N)
IN A(;r'ti{{()Arj, i dvllil IHF CITY OF
Effective 1/1/08 CUF'FRIIN;; (A)f ANE)ORDINANCES _
DATE._.___ Gj� 2-7-1,
SIG ED
This set of plans and
be kept on the lob at 111 times andications it SST
unlawful to make any changes or alterations
on same wrttrout w,itter,permission from
the Building Departn ont. City of C
Thuper ino.
e stamping of thy,Orta and specifications
SHAt L NOT b, hoa+j r(,Germit or to t),e an
approval of file .n�latu)n of any nrovisjons
of,any City Ch,1rn.:'- ';t,de Law.
Plan Review Process Work Book Page-8-Revised 8/05/08
IJ
v
r , r .
I if
i I
Vol <
o � �
CITY OF CUPERTINO BUILDING PERMIT 9-3.A= Z 777.
BUILDING ADDRESS: 10055 BYRNE AVE CONTRACTOR:CHARVEZ PERMIT NO: 10030126
CONSTRUCTION
YER'S NAME: MEHUL DHOLAKIA&PRACHI MEHTA 360 W 8TH ST DATE ISSUED:03/26/2010
OWNER'S PHONE: 4084214015 GILROY,CA 95020 PHONE NO:(408)893-7693
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class !� Lic.# �:`�%`Z i �/G ADD GUEST BATH,WASHER&DRYER AREA(72SQ)&
RMDL
Contractor CVALA,t1�� L,1� _ z_c. Date KITCHEN(220SQ),LIVING,OFC RM,BATH-
I hereby affirm that I am licensed under the provisions of Chapter 9 2(150SQ)&MASTER
(commencing with Section 7000)of Division 3 of the Business&Professions BATH
Code and that my license is in full force and effect. 4/12/10-REV#1 KITCHEN,LIVING,STRUCTURAL BEAMS FOR
I hereby affirm under penalty of perjury one of the following two declarations: COFFER CEILING
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:$90000
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:35711002.00 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 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
granting of this permit. Additionally,the applicant understands and will comply Issued by,;,. - " """�� �-- Date:
with all non-point sour a regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
ature Date 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 505,25 3,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
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
flding construction,and hereby authorize representatives of this city to enter
i the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
„,demnify and keep harmless the City of Cupertino against liabilities,judgments,
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 //C Date �G FD