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14020150CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21052 WHITE FIR CT CONTRACTOR: KITCHENS BY MEYER PERMIT NO: 14020150 OWNER'S NAME: LUM DARREL W AND CHERRYL O TRU 861 E EL CAMINO REAL DATE ISSUED: 02/25/2014 OWNER'S PHONE: 4082554899 MOUNTAIN VIEW, CA 94040 PHONE NO: (415)968 -8318 lam' LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL REMODEL (E) KITCHEN (100 S.F.) License Class Lic. # 2 Contractor k(// e,�_s (%J 4ly—V to '�C.f'l I hereby affirm that I am licensed under the of Chapter 9 (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: have and will maintain a certificate of consent to self - insure for Worker's mpensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $26816 rformance of the work for which this permit is issued. ave 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: 35905112.00 Occupancy Type: rmit 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 DAB M 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 ed Date: Z .L granting of this permit. Additionally, the applicant understands and will comply with all non -point source re ulations r the Cupertino Municipal Code, Section 9 18. 2 ���/ RE- ROOFS: Signature ate Y 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. 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 complianc 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, ections , and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Z _z S y Owner or authorized age1Date:' 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 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 CONSTRUCTION PERMIT APPLICATION p� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 A CUPERTINO (408) 777 -3228 • FAX (408) 777 -3333 • building(ftupertino.ora ` - ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION / DEFERRED\ ORICUNAi. PFRK4TT 8 PROJECT ADDRESS .✓I tDs-2 W �;L 7'r e r, �, L ° FAPN4 O OWNER NAME V y,eA q,eL_ UAW PHONE(4,, 0,15/5_ E-MAIL STREET ADDRESS )jOS7 Wy L f „ JZ Cr. CITY, STATE, ZIP u pt*, , � I Ca .q (, FAX ACT NAME DR v y n i �G („ � ` 1 L „ � PHONE ` (�(� _� I E-MAIL ETADDRESSa, 06 -2- Whl' n f ,n Cl-- CITY, STATE,{zip I� iin'l 1 c &i � F� NER ❑ OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT [CONTRACTOR NAMF, LICENSE NUMBER LICENSE TYPE BUS. LIC # ANY NAME T ADDRESS Q„ 9 1 ('J`(� r' L CITY, STATE, ZIP ,nn V n ' ,1 C 9 �ry i I ' �'�'1N I/l �l PHONE / TECT/ENGINEER NAME FLICENSE NUMBER BUS. LI{C # #`JV"��/O COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION ^ /�/ OF WORK �7 1 � P� �RTION EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO I TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN - OTHER REMODELAREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK /PORCH AREA GARAGE AREA: DETACH ATTACH #DWELLING UNITS: IS A SECOND lIN1T YES SECOND STORY []YES BEING ADDED? ❑NO ADDITION? ONO, PRE - APPLICATION [3 YES IF YES, PROVIDE COPY OF IS THE BLDG AN su PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO d aF P ? k `'Zx TOTAL VALUATION: By my signature below, I certify to each of the f wing: I am the property owner or authorized agent to on owners behalf. I have read this application and the information ve provi orreo ave read the Description of Work and verify r is accurate. I agree to comply with all applicable local ordinances and state laws rel b ' I a o representatives of Cupertino to enter the above - identified perry for inspection purposes. Signature of Applicant/Agen . Date: 22 77PPLEMENCAL INFORMATION REQUIRED _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building for building.; ,BUTNG PI AN REVIF2W A permit new _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure To—rm. if any Hazardous Materials are being used as part of this project. 70 x 7 _ Copy of Planning Approval Letter or Meeting with Planning prior to 3 y submittal of Building Permit application. 7DPT J f _ � s� � SAN AAYSF1SyE&DISTRW! E*gRONMENTALHEALTH _. BldgApp_2011.doc revised 06121111 IM-7, CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc ). These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn7 info. FEE ITEMS (Fee Resolution 11 -053 a.711113) 21052 WHITE FIR CT DATE: 02/25/2014 REVIEWED BY: MELISSA IlaADDRESS: APN: 359 05 112 BP #: *VALUATION: 1$26,816 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex Suppl. PC Fee: O Reg. OT PENTAMATION PERMIT TYPE: 1R3SFDRE WORK REMODEL E KITCHEN 100 S.F. SCOPE NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc ). These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn7 info. FEE ITEMS (Fee Resolution 11 -053 a.711113) IN . a i'f(tn t i er k Plan Check Fee: ph n b. Man Che:eA i iPC. 1' w L;hac1 lfz>c;l�. P?rruit Fee: Suppl. PC Fee: O Reg. OT I'h.tmh. Permit Pee: Ir, k., Pear It fee: olr/wr A"!,-:ch. Irs.;'p PME Plan Check: C)lher I'iulnb Irts7), off( er k"lec" Insp). �td� =ch, tap. Permit Fee: TIt rub. Ins��, T4,e�. aec�. Lisp, NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc ). These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn7 info. FEE ITEMS (Fee Resolution 11 -053 a.711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. $626.00 Remodel, Kitchen (< =300 sf) 1REMRESKIT Suppl. PC Fee: O Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:O Reg. O OT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 'Ichnirri,4trafive Fee: O O Work Without Permit? O Yes F No $0.00 Advanced Plannin& Fee: $0.00 Select a Non - Residential Building or Structure O � �, _ ��1`c7r2/ ut�cr2t7±7t'74llaYZtT3q � "K'Ea4: Strong Motion Fee: IBSEISDIICR $2.68 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 an ., $4.68 $626.00 TOTAL FEE- 1 $630.68 Revised: 01/15/2014 04/25/2014 11:43 6509688206 KBM PAGE 01/01 Amw- ] tchwn r by Meyer KITCHENS & BATHS DESIGN • SALES - INSTALLATION 278 Castro Street, 650 - tai. View, CA 94041 p 650. 9GFi. 7866 a ISUBCONTRACTOR LIST PROJECT" NAME; Darrel and Cherryl Lum 21052 White Fir Court Cupertino, ca. 95014 1 UMG (COUNTER TOPS) 6318 GIGUERE CT SAN JOSE, CA 95133 408 - 347 -3300 2 MERCADO TILE (TILE WORK) 'j/ 3 JDW PAINTING (PAINTING) P.O_ Box 7172 San Jose, San Jose. California.. United States, 95150 (408) 2924913 1784 Chevalier Drive San Jose, CA 95124 408 -499 -1910 11+1090(50 &-�6 -60a CA LIC# 753883 b2--,,Z58-V,5— CA LIC # 388542 CA LIC # 780825 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 C U P E RT I N O Fax: 408 - 777 -3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: t ©,Sa ' i` �. PERMIT # Igo Z OWNER'S NAME: e( 0, C e v M PHONE # 410 ZS-S-- q GENERAL CONTRACTOR: Cement Finishing BUSINESS LICENSE # ADDRESS: jS(0 ( f,, C— Cprrf „” p /4 Vio- v CITY /ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino -. business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED :>A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: s/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Date o© LO F el rr r.pnRTIIENT Dui' rANC Li; s ,' C triliia0 oil M X00 M Tn cr?( Of { tnrs ai,' ? -Pr O f r^ ri: -r MUST !_e ..__. O, t }i c p7k ,,r'Ovral firer} 0 BU'.iC -10C (),q s,l•.:ii. (� f s6 "v�.`t::i0i7.�i t]� "r�• ter" � .rte%' La U. 1 �1 Z 'y DATE " rj C_ K_(4-GW4e4._) QeP-,LO D e, V (c) CUPERTINO fauiiding Oeparbnent ��s FHB 2 5 201 COMPLIANCE Reviewed Bf Copes, Zol"3 C (3G/ C F-c) CEC J CMC� A P L � &19rA J CoT_>e� r �eCope CvP e -�rNv OLAoP Cc De CH des t N ems; M - Cp� a�vsa r.� OLMIM �_� A45 e� r 17-o- x`79 -�'i6r Wt �� r• �1 6"4tt' O 1,QaA--1 VL9- ".) C'A - gce oyo LIZ ,"4<; it )41 rL7 WlaI( J All dimensions _size designations given are subject to verification on lob site and adjustment to fit job conditions. .1 A 351411 H -WR` �.-,! 9Q`B12 -D3 S kee_�- I-,v r_�, e sc , ��� �� p e ®sue p���e��. ��►� Cherryl -Darrel Lum.EXISTING PLAN.kit N OD n 3 n C0 ,� CJW r7 20 2U it, This is an original design and must TECHNOLOGIESM not be released or copied unless applicable fee has been paid or job order placed. All Drawing #: 1 -Sig 4ed: 2�22/2p 14 . i� /")n i d Scale: 0 1/2" = F w PI4AL �`�f3nm - ll�_^� TK �✓ W�(bi �r�l`L hw, r[r -�-1 6D'7KWY-* o aT CST G✓3 � ►mow'( �wITGH -ti�i� G" ^"7 A%?, 17WITC -i . Q)7HWA✓HW, Lb P WN2 WVyfn P004"kL L-T • WP - (0 �Icb pma LT. ) �2 w 0 PWIACE CUPERTINO Building Department FEB 2 5 2014 EVtEVVED -FOR CQD� COMPLIANCF�; Pviewed By: ��� All dimensions _size designations — - "7 given are subject to verification on job site and adjustment to fit job 2�o5 W n/1 a �� C,��� r ,' co ditions. _ Cherrvl -Darrel Lum4. Lkit ,� iJn7 2 'D TECHNOLOGIES Do 1 -1 B12-D3 ( I.) 4r_yvrF- A CN) X17 still#. CNN OU B31 FH -12- I B31 FH -12- wr't- l( L) 0Qe2 coo �_ e TO (�) G,,,-- 'd67 VQ6,61, -(V VWAi3 1 FH -1 Cfkl,6MT TOIUWA-1 I'M This is an original n�nlil Desed: 11/16/2013 not be released or coned unless Pri ,fil: 11/22/2013 applicable fee has been paid or job order placed. All (no dims) Drawing #: 1 Scale : 0 1/2" = V ,kV