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14020150 REV1 CITY 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 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ,�5 REMODEL(E)KITCHEN(100 S.F.) License Class_ Lic.# 23 V I REV#1-RELOCATE OUTLET RECEPTACLE ON n PENINSULA &2 SWITCHES FROM PENINSULA TO HALLWAY WALL. Contractor ate ADD(1)PHONE JACK-ISSUED 3/5/2014 I hereby affirm that I am lice's d under a provisions of hapter 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: 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:$26816 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:35905112.00 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 OLPW+ IT 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 FRO LLED 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 Issue ate: with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. I ROOFS: any r Signature � �SlDate All roofs shall be inspected prior to y 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) 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,Sectiorif 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this ` permit is issued. / Owner or authorized agent: Date: G 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 ARCHITECT'S DECLARATION indemnify 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 CONSTRUCTION PERMIT APPLICATION l COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 V CtJPERfiI't+t0 (408)777-3228 FAX(408)777-3333•buildingacupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION/TI REVISION/DEFERRED ORIGINAL PERMIT# �� PROJECTADDRESS :Z © ^ ` n r �- APN# '2 C, q O / 'L OWNER NAME �J►�u 1 IPHONE(k �� dilEMAIL STREET ADDRESS i CITY, STA P / f FAX CONTACT NAME �� �. PHONE �`7( / E-MAIL STREET ADDRESS + r (G CITY,ST ZIP ^ j/ _ l (/ V�r FAx p ❑OWNER ❑ OWNER-BUILDER 13OWNER AGENT KNTRACTOR ❑ HITE CONTRACTOR ❑ ARCCT ❑ENGINEER 11DEVELOPER ❑8"TENANT —7 CONTRACTOR NAm jjj0,)/j - LICENSE NUMBER LICENSE TYPE BUS.LIC## lu COMPANY NAME �1 wuw E-MAIL FAX( -G1�6 STREET ADDRESS �\1 CITY,S ZIP tuiv PHO -7 ?i1' ' ARCHI TECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME EMAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK ' ' ^ ' � L' `'^A EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER' REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKMORCH AREA I GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? . ❑NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES �the TOTAL VALUATION: PLANNING ADPL# r_1NOPLANNING APPROVAL LETTER EICHLER HOME?By my signature below,I certify to each of the following: I am the property owner or authorized agent toproperty owner's behalf. I have read this application and the information I have provided is correct I have read the es ription of Work and v I it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildingc do . I authorize pr sentatiwrs of Cupertino to enter the above-ide ified ope for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFO ION REQUIRED 4 zrrpycsl " _New SFD or Multifamily dwellings- APP1 'for demolition permit for ����•. �,E iHLD ty���N existing building(s). Demolition permit is required prior to issuance of building t permit for new building. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or-Meeting with-Planning prior to submittal of Building Permit application. B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 21052 WHITE FIR CT DATE: 03/05/2014 REVIEWED BY: MELISSA APN: 359 05 112 BP#: 14020150 *VALUATION: Iso 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: p PERMIT TYPE: WORK REV# 1 - RELOCATE OUTLET RECEPTACLE ON PENINSULA& 2 SWITCHES FROM PENINSULA SCOPE TO HALLWAY WALL. ADD (N) PHONE JACK- ISSUED 3/5/2014 t 14""31 Plumb,fico CbecJ I'icc. Plan 1'(>rtttit Fee: Tlhr mb. 11crm;t Fear: ,Wn_'L insp 1. liver Plumb Irene. Li 0/I1er t`fr-:c Imp, Li 1Ir:cr lta/a. r��e: I'r'Imb, Insp. Fire: I>iec,Ivsty 1 :e NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These _f -fees are based on the relimina inormation available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 a.' 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? ®Yes (E) No $0.00 0 hours Plan Check,Hourly Suppl. PC Fee: (j) Reg. ® OT 0.0 1 hrs $0.00 $139.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. ® OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 {`C IIW(iiO7 1I LV. "�L;i`rr ttatt,s li r(ri�� PCc 0 Work Without Permit? ® Yes (E) No $0.00 E) Advanced Planning fee: $0.00 Select a Non-Residential Building or Structure !'rat 'cl f`)o(:trrn(,nfa7ion Pees: Strom Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 IMI ® $0.00 $139+.011) TOTAL FEE: $139.00 Revised: 01/15/2014 CN) l�L-T- IWC+�, MTV-7 Pao 1 T5 �� (apt aGE 3DYYm ,� W`(bI I�tu�L W, i 70 ROM �� c��.�MOuti GJ3 klol /7v4l-rw �)sup 1239-1: .IW3021-12W1239 1 W3421�12 FO 24 11 G14"( '1\ 511s/1 - �b ' DVM Pt Mei� t w I'TCN Ak?, -7' WITCy F -W �k�+14� B12-D3 r! (� �Lr 4 (Q? 1°W G IE D �7. / ,__I` •�-- - PT PM 3 Q Lib tt�K LIT Lb CN)�42 �'rAA cod V5 WALL,000-Coin V _ I LVi R { �7 k1 Sai (ll�n5 Ce!?. ^( :fIC• �!,��,UST be'ke'pt at the _ ;" j� t 633— fCa.. =( t I 011.iuk` Er:!C'1 �t l L'e i tl't1� L3 �c!r «�ry I S''!"ai �' •'ailt' (?l:;�'s!i int C1C tiS , ulr^rFl,1/!!ti"font ctppro c.l fro:-n tha,, QU!Ic.in Off'dal. � - _ {R The starripli­;cf�. .:$this PL:n i]'.c S• L 1,10T b7" h iG tt.) !^•5.:�1!i or to b £n 'oval of the VIGia ion © any Prov! ! Is lance or Sta'Lo L. BY B31T B31 FH-12- B31 FH-1 2- TE PERMIT-NO. I 7j0 11-3 - BFO o _ O(O fo J** FFm'1C-E. CO 4 pO-V POW D _ w p �(��ilL1 'T TO I�.MAInI All dimensions f� _size designations 20This is an original design and must Des ed: 11/16/2013 given are subject :ect to verification on TECHNOLOGIES C H N O L O G I E 5 I i not be released or copied unless Pri 11/22/2013 job site and adjustment to fit job applicable fee has been aid or job . l J J PP p 2 0�7-z_ H r rr- 4--f) CT _ ���!,�i�,� co di ions. order placed. �" cF W'A� w N Do r� Iz 2D - •; a;; a V ty% Cherryl -Darrel Lum4.Lkit All (no dims) Drawing #: 1 Scale : 0 1/2" = F