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03110146 CITY OF CUPERTINOT� <r FII � BUILDING DIVISION PERNIICd#'I,11.%TQ4t �, BUILD`NV01 cE1s:WILLOW GROVE LN KEY CONSTRUCTION P�MuN'63110146 WNER'!T RO HOHENNER 1240 ##C PEAR AVE. PEBMrrLTlTgAP4 2003 PHONE: MOUNTAIN VIEW, CA 94043 SANITARY NO. CONTROL NO. ARCHITECVENGINEER: PHONEk BATHROOM REMODEL BUILDING PERMIT INFO are, BLDG ELECT PLDMB MECH iso . �rii. + 5 � # ; d TO ARRANGE INSPECTION - O O O G� INSP$G"1'IOiS y' JOB DESCRIPTION Y' T,r INSPEGS; CALL777.3228 MONDAY-FRIDAY 24 HOURS }p' FSC. .�? RESIDENTIAL, iq. - BEFORE REQUIRED INSPECTION,JOB ADDRESS ❑SFDWL ❑ KITCHEN REMODEL FOUNDATION/PIERS/H.D.S. AND PERMITp ARE NEEDED WHEN PHONING. ❑ADDITION ❑ PLUMBING RE-PIPE ou UFER GROUND ❑ MULTI-UNIT ❑ STRUCTURAL Eic� PAD/SETBACK-CERT MODIFICATION RESIDENTIAL_COMMERCIAL_OTHER_ 0INTERIOR 0 CHIMNEY REPAIR N H^� GARAGE SLABS/PREGUNITE IMPROVEMENT 0SWIMMING POOLS 2 HAZARDOUS FIRE AREA ❑BATH REMODEL/REPAIR FI DEMOLITION �� .PO R,CTfJ COrtGRET.I:,,''f}N'Ct4'AB„4V ;HA$�BEEN•S[�NE"'q' UNDERGROUND/SLAB ❑OTHER - ¢a AYES Ifyea-Iuntlersund Nele ClauA mol usembly it mquiad. - F`c UNDERGROUND PLUMBING - i � UNDERGROUND ELECTRICAL ❑ NO huttil I.C.B.O.4 y,, s;'�is .o n IeI 1PpDR',FI(,'fQATJNT' Agb'AFIj1$BEEN"$ICINETS,+ FxIS'1_-ING ROOF COVERING ❑NEW BLDG/ADDITION ❑DEMOLITION UNDERFLOOR PLUMBING ❑.TENANT — ❑ FOODSERVICE UNDERFLOOR MECHANICAL Number of existing coverings IMPROVEMENT UNDERFLOOR ELECTRICAL Tobeamoved Tobereteined El OTHER UNDERFLOOR FRAMING VENTS UNDERFLOOR INSULATION >- TYPE OF ROOFCOVERING PLACE NbSijB:k7..Qb J"IJt TILABV,4{k1AS'':I} EXISTING: PROPOSED ROOF SHEATH/DIAPHRAGMguilt-U Roof PLUMBING — p ❑ Built-Up Roof ' TUBS&SHOWER PAN Lj Asphalt Shingles - ❑Asphalt Shingles Wood Slukea MECHANICAL z7 ❑Wood Shakes ELECTRICAUPOOL BOND Waod Shingle O Wood Shingles FRAMING/STAIRS/E EGRESS Other(Specify) ❑ Other(Specify) INSULATIONNENTILATION lo I Provide I.C.B.O.Report No. n,C�¢VERa�Iq,WpRlfa0RnL,W ,14A$'BP.h, Provide Mfgr.lnstallatian Specs. EXTERIOR SHEAR/HOLD DOWN INTERIOR SHEARMOLD DOWN SHEETROCK/SHEETROCK SHEAR REQUIRED INSPECTION SPECIAL INSPECTION RE DATE INSP ❑ EXTERIOR LATH/W-SCREED SHOWER LATH . F�'ptTAP�QF��P'GAS1'E.l}"fSMT,R:AB4?V�.. : F.N StGN�p� '',` SCRATCH COAT SEWERIWATER TEMPORARY APPROVALS OCCUPANCY C) y �n PLANNING 777-3308 y > GAS TEST L4 q GRADE(P.W.777-3354) IMPORTANT M' z FIRE-CALL(408)378-4010 When a permit has expired,a charge totaling one-half HANDICAP the fees to obtain a new permit must be paid to o wELECTRICAL PLUMBING reactivate the permit. y gy O Z MECHANICAL ENERGY If a permit has been expired for more than one year, a VISUAL FINAL ONLY charge totaling the full fees to obtain a new permit BUILDING must be paid to reactivate the permit. RC�NCYnp_F 9VI,A'Iri'GG-I$Np, 'kT�RMPT ° - "��" ❑ Initials VNTILBIUILDI�NGPI kLIS�NEDBY. Valk I0 . INSPECTOR �,,,�• al ` CERTIFICATEOFOCCUPANCY ❑ PRE-INSPECTION: PLYWOOD: IN-PROGRESS: INSP. DATE INSP. DATE INSP, DATE TEAR OFF INSPECTION: BATTENS: FINAL: INSP. DATE INSP. DATE INSP. DATE NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION CITY OF CUPERTINO gem 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp: Rng : Sub: Blk: Lot : APN . . . . . . . . . 37538022 . 00 DATE ISSUED. . . . . . . : 03/18/2004 RECEIPT # . . . . . . . . . : 24879 REFERENCE ID # . . . 04030170 SITE ADDRESS . . . . . : 6052 WILLOW GROVE LN SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : HARRO & MARIANNE HOHENNER ADDRESS P.O.BOX 700-067 CITY/STATE/ZIP . . . : SAN JOSE, CA 95170 RECEIVED FROM . . . . : HARRO HOHENNER TTEE CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : HARRO & MARIANNE HOHENNER ADDRESS . . . . . . . . . . : P.O.BOX 700-067 CITY/STATE/ZIP . . . : SAN JOSE, CA 95170 TELEPHONE . . . . . . . . : • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 117 . 00 35 . 10 0 . 00 35 . 10 0 . 00 BPERMFEE VALUATION 6, 000 . 00 117 . 00 0 . 00 117 . 00 0 . 00 BSEISMICRE VALUATION 6 , 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00 BPLANCHK PERMIT FEE 117 . 00 99 . 45 0 . 00 99 . 45 0 . 00 ---------- ---------- - --------- --------- - TOTAL PERMIT 252 . 15 0 . 00 252 . 15 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ---- -------- ---------------- -- CHECK 252 . 15 104 TOTAL RECEIPT 252 . 15 • 0 � 4RITY OF CUPERTINO ITY OF PERMIT APPLICATION FORM O t{ 03 6 �� • CUPEkTINO APN # '7 Z/ Date: r Building Addr s: ailing Address (if iffere t fro building address): bo 2 //''LV ow �YDve L„ �„-fico 0, Box 700-067 CA q-s/7 Owner's Name: Phone#: Q_1,ro bat re 6 `nehhn-- 1/019�- vY6 -2- S19 License#: O why/Bk:� W Contact: I Phone: q08'-yY6-z 819 Cupertino Business License#: lit ianne o hevlhsv Fax: YOS - 73- 379 Building Permit Info: p� Bld Elect I]- Plumb M Job Description: Residential ❑ 16aerci Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: ,MLType of Constructi n: v U Please check this project is a second-story,addition: ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERl Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX hid/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax-Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING WN BMITIGATC Comm. Housing Mit. Fee BUILDING * z1 X60 lof3 � / a �� SITY OF CUPERTINO 4 CUPEI�TINO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmos beric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interc for PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIIZHAN A/C Units <= 10,000 cfrn MECHANICAL BREMAPPLI Apphance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BRENMELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL 2 of 3 CITY OF CUPERTINS' , CITY° PERMIT APPLICATION FORM ' CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMTHEATR Theatrical Ligbting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSVIW Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING • • 3 of 3 CITY OF CUPERTINO ' ' u ' " ^�- ; BUILDING DIVISION PERMIT CONTRACTORANFO RMANON BUILDING ADDRESS: KEY CONSTRUCTION PERMIT ND03110146 OW (,RQVR LN OWNER'S NAME: PERMIT LSSUE DATE RRO HOHENNER 1240 #C PEAR AVE, 11/24/2003 E; SANITARY NO. CONTROL NO. (650) 965-1256 ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG 0 ELECT LUMB PMECH 0 0 306 LICENSED CONTRACTOR'S DECLARATION ! 1 bemby affirm Naman et 1 am Harmed under provisions or Chapter 9(comaing lob Description with section Taro)or Division 3 of the eusiness.nd Proreah,n Cede.and my license I. a fun fora and effect.guj8 BATHROOM REMODEL Co.,. oz IoaneCla. ., - _ . Dem�/-2 -ala af ARCHITECTS TIJ?EECLARATf N Inn a n ,al,all ny�rda s Limned Pndc u OWNER-BUILDER DECLARATION ii I I hereby affirm that 1 em exempt from the Convenors License Law for the DO following moon.(Secdun IID 1.5,Business and Profession Cade:Any city or county $ which requires a Permit to construct,sun,improve,demolish,w repair any atrucmm $21000 iLr prior to its issuance,also requites the applicant for such permit to Me a signed statement gTC that he is licensed pursuant the provisions fine Contractors Llceno law(Chepmr 9 Sq.Ft. Floor Area Valuation tt 2C� (commencing with Section 7")of Division Sof the B usiness and Professiom Code)or e} that he Is exempt therefrom and the buss for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of eT 0 0 Occupancy Type not more than five hundred dollen(5500). CI I,.owner or the properly,a my employees with wages a their ole cumper cellon, will do rite wank end the Dome is not intended or.1fml forsak(Sex.7014,Business Required Inspections and Profession Code:The Conusctors License Law taw donot apply m an mwmr of 9 P popery who builds or improves themon.and who doesauchwarkhmself or through his own employees,provided that such impmvemenu tee not inended croRemd Russia.If. however,Ne building or improvement is sold within one year of completion.the owner. builder will have the burden of moving that he did not Wild or improve for murpasc of m1eJ. ❑1,as owner of the property,am exclusively contracting with licensed convenors to conston the pojen(Sec.7044,Business and Profession Cade:)The Omtracu i Li. ane law don not apply an an owner of property who Wilds or improves themon,and who contracts for such projects with a amtacmr(s)licensed pursuant w the Cantaelor. License IAw. ❑1 an exempt under Sec. ,B k P C for this esson Owner Dam 10WORKER'S COMPENSATION DECLARATION I hereby&Mme under penalty of perjury one of Ne following declatations: 1 have and will maintain.Ceniaam of Covent to sdFiosuo for WorkersComPen- ation,u provided for by Section 3700 of the labor code,for the performance of the wart for which this Permit is issued. ❑1 haw and will maintain Worker's Compensation Insurance.As required by Section 37W of our labor Code,for the performance of the work for which this Permit is Wood, My Worker's gonpensation lnanrance carrier and Policy number am: artier. Policy No.:! C.14ATE OF EKEMPTION No: WORKERS' COMPENSATION INSURANCE (This secdon rad an,be completed if th permit is roroa hundred did).($100) Or lea.) 1 anify that in the performance of the work for which this Permit is isswA,l shell not ' employ any person in any manner o As in become subject m the Workers'CamPenalion laws of C.ffmnix.Dae Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become object to the worker's Compensation previsions of the labor Code,you must z forthwith comply with such provision or this Permit shall be deemed revoked. zCONSTRUCTION LENDING AGENCY t r I hereby affirm that Neo is a aontruclum leading.gmay,Tor the pellimom oo of x t7 the.,it for which this permit is issued(Sce.3097.Civ.C.) W Q lender's Name jz Lender's Address V Q 1 certify that 1 hew read this application and cum that the show Intmmadun is .wE comet,Iagree to comply with all city and county ordinances nd shote laws relating to C) building conwnion,and hereby authorise repmacnutiws of this city to enter upon the W .how-mentioned property for inspection purposes (We)agree m ave,indemnify and kap harmless the City of Cupertino against D,, liabilities.jodgmenWcosu end rexmenses which may in any way...galnt aid City U G7 7 in consequence of the Starting of permit. APPLICANT UNDERSTANDS ND ILL COMPLY WITH ALL NON-POINT Issued-by:S4tQ� Date tSOURCE REGULATIONS. + e Z (-2cf.c3 Re-roofs roofApplicantlComoelOr -0an HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle haraboul material red by Ne Cupenio Mon dial Code.Chapter 9.11,and the Health and S.fnyStellan15531(07 \ /` All roofs shall be inspected prior to any roofing material being installed. ❑Yes Dr Nu Will the applicant or future building Occupant use equipment or davits.which If a roof is installed without first obtaining an inspection,I agree to remove tit havardeos air conarrom.to dcfrned by the Bay AMA Air Quality Management all new materials for inspection. uia7 Yea I haw mad the ha odousmatarials requimmcnts under Chaper 6,95 of thc Califor. „ Held S.Riy Cock,Section 25505.15533 and 25534.1 mmicrsuM thaif tis building doss not currently how a m...e that it u my m,p raihility m arrdry tis occupant of the Etomcnta whot $the all i A ..f.Cerdficae.foceupany. Signature of Applicant Date mc, ratahmnzed e,am Data AlLroof coverings to be Class "B"or better CITY OF CUPERTINO " �" BUILDING my1SION P�RMI CQNbUG-TOR, NFORMA BUILDING ADDRESS: KEY CONSTRUCTION PERMIT rIo03110146 R'S NAME: PERMIT ISSUE DAM .RRO HOHENNER 1240 #C PEAR AVE . 11/24/2003 PHONE: SANITARY NO, CONTROL NO. (650) 965-1256 ARCHITEC tENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ;Oo LICENSED CONTRACTOR'S DECLARATION' r(IJ 01 hereby affirm that I am licensed under provisions of Chapter 9(commencing b Description with Section 7")of DivuE.a 3 ar Ne Business end Pfu(ess me,Code,and my license is +❑ in full force andeffem. 420897BATHROOM REMODEL Z ice as Class Llc.N _ =�p Data /I—I - - Contract.,VCtj LS.VCT. e ARCHITCLTS ECLARATI�N e s 1 u �shall oh RATIOd. N epy Licensed Pr.rc o 1 /�a-� S OWNER-BUILDER DECLARATION 1 hereby alarm that I am exempt from the Contractor's License Law for in 0, 00 following mason,(SecJun](131.5,Business and Profession Code:Any city or coon which requires a permit to construct,alma improve,demolish,to repair any mortes $21000 5z„ poor ha its issuance,also requires the applicant for such permit to Rle a signed sutem. t 5 Ft.Floor Valuation Ytp that he is licensed pursuant to the provisions of the Convector's License Lew lChaptor q. 3$ (commencing with Section ID00)af Division 3.1 the Busimasand Prof.,sinusCndc) r 3 Net M1e u exempt therefrom and the hues for the alleged cxemptlon.Any vinlalion Section 7031.5 by any applicant for a Permit subjects lie applicant to a civil penalty o Occupancy Type not more than five hundred dollars(SSW). ❑Las owner of the property,or my employees with wag.,as their mle mmpenmdon, will do the work,and the swctom is not intended oroRered(anal.(Sec.IDC.Business End Profession.Code:The Convenor's License Law does not apply to an owner of Requ' a nspections p,aperty whomploye buildsor ided thaver t mhimpoovndwho usdoes suchwark endedomtrenedNroughhis mant f, f� however,the building ri prove ant is old wit in not ear of ompleemd for mie.lf, 1�/u� f Illi however,the building or improvement Ia sold within one year of completion,the ow builder will have the burden of proving Net W did not Wild or improve for purpO sale.). I ❑I.as owner of the progeny,am exclusively contracting with licensed a scion to construct the pmjecl(Sec.WM,Business and Professions Code:)The nrictor's Li. cense Law does not apply to an owner of property who builds or i over themon,and, who contracts for such projects with a contractor(s)licensed put M 1.11mcm,nomon" License Law. ❑1 an exempt under Sec. B&P C for this reason Data WORKER'S COMPENSATION DECLARATION I hi ,affnm antler penally o(perjury one of hasfollowing tletlaralions: ❑I have and will maintain a Cenificute ofConsent o selt-insum ror Workers Compere union,m provided for by Section 3]00 0(the Lobar Code,for the Performance of the work for which this pennil is issued. ❑1 have and will maintain Workers COMPettsad0m Insurance,as required by Section 3]00 of the labor Code,for the performance of the work for which Nis perm it is issued. My Workers o ,varomron Insurance carrier and Policy number me MOT GT Policy No.:%3 S74In,9—Z&)0 CERTIFI ATEOFEKEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section recd not W completed if the permit u furore hundred dollars(Slip) or less) I certify that in the per(ormanco of the work for which this permit is issued.I shall not employ any person in any mmnersn as to become subject to the Worker:''Compensation Law.orcalifomia.Data t Applicant - NOTICETO APPLICANT:if,after making thin CeniOeam of Enrapdon,you should - become subject to the Worker's Campenmtion provisions of Ne Iahnr Cndc,you must 0 fanhwi0i e.mply with such Provisions or this permit.hall W deemed ranked. tiCONSTRUCTION LENDING AGENCY jr r•y I hereby affirm that Nem is a construction lending agency far the performance of 'Ya the work fur wbi,h this Permit I.issued(Sec.3097,Civ.C.) WM Q Lender'.Name , z Lenders Address U Q 1 certify that 1 have read this application and state that the above information is W E' correct 1 agrae to comply with all city and county ordinances and sok Tawe rclulimg to CU building convection,and hereby authorise representatives of this ity to cntcr upon the ISI above-mentioned Property ran inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against fQ'/3 liabilities,Judgments,costs and expenses which may in any way we=against mid City U7 in eansequenca of the granting Of this permit. G APPLICANT UNDERSTANDS ND ILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. /(-Xy 07 Re-roofs and To of ApplicanVContracmr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant ur future building oecupantstom urhandle hazardous material m deMcd by the Cupenlno-ciPal,Code.Chapter 9.11,and the Health and Safety _ ode,Section 25532(a)? All roofs shall be inspected prior to an roofing material bei. Installed. ❑Yea Na P P Y g g If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupam use equipment or Devices which emit haearduus air conmminanM defined by the Bay Area Air Quality Management all new materials for inspection. Di.trict? ' ❑Yes 11 I have mail the hanrdous materials requirements under Chapter6.95 of the Califon - me Health&Safety Cod.,Sections 25505,35533 and 25534.1 undersuntl Nat if the building does not currently have a mnmt.Nat It is my responsibility to notify the Occupant of the rcyvircmcntsw 'uh most M et Ze or a cetdficma or Cgcxgoey. Signature of Applicant Date nor rawhori'rcdagent Date All roof coverings to be Class"B" or better CITY OF CUPERTINO .nA "'120, BUILDING DIVISION PERMIT CONTRACTOR INFORMTJON � ' �= t BUILDING ADDRESS: _ KEY CONSTRUCTION PERMIT ND03110146 6052 WILLOW CROVR T.N OWNER'S NAME: PERMIT ISSUE DATE RRO HOHENNER 1240 #C PEAR AVE 11/24/2003 E: SANITARY NO. CONTROL NO, (650) 965-1256 ARCHITEC rENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 i00 LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licenced undcr provisions of Chapter 9(Commencing Job Description E with Section 70I11Bnf Division 3oftm Busincssand Professions Cade,andmy license is infall omclass amat. �f BATHROOM REMODEL iate CI �Lic.K it•❑ Dam �/�2 •©'A Cus ,m WCxL- ^�� ARCHITECTS ECLARATI N f e4a lu .,m am shell and. e�c >iU nd e C h Licensed Profc o a OWNER-BUILDER DECLARATION qL a 8 1 hereby affirm that I am exempt from the Contractor's License Law for the OO following mamm.(section 7031.5,Buainom and Professions Cade:Any city ar County <a E� which requires a permit to construct,alter,improve,demniish,or repair any structure $21000 as smarm its issuance.almmquirec the applicant torment Permit o file a signedamteocal Za that he is licensed pursuant to the previsions of the Cmilrai UiumseLaw(Chapter 9 Sq. Ft. Floor Area Valuation . t-p (commencing with Section 70(10)of Division 3 of the Business and Professions Code)or Nat he is exempt therefrom and the baso for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects fee applicant to a civil penalty of not more Nan five hundred dollars($500). Occupancy Type ❑I,as owner of the preporty,or my employees with wages as their 90leeompensation, will do the work,and the swctme is not intended or offered forsde(Sec.7044,Business and Professions Code:The Connector,License Law does not apply m an owner of Required Inspections prolixity who builds or improves thereon,and who does such work himself or through his awn employees,provided that such improvements are not intended or offered for sales If, however,the building or ini,amommat is said within one year of completion,the owner builder will have the burden of proving that he did not Wild or improve for purpose of 1 sale.). —V ❑T.as owner of the property,am eselustvely contracting with licensed contractors to connect the project(Sec.7044,Business and Professians Cade:)The Contractors Li. crux law docs not apply to an owner of property who Wilds or improves thereon,and. who afor such projects with aconmacmr(s)licensed pursuant mthe Contractors LicenceseLaw. ❑l am exempt under See. ,B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 10 1 hereby affnm undcr penalty of perjury ow of Ne following decimations: have and will maintain a Certificate of Cerium to self-insum for Worker's Cooper- ' cation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is named. - ❑1 have and will maintain Worker's Compemation Insurance,m required by Section 3700 of the Labor Code.for the performance of the work for which this permit is issued, My Workers n pamenion Insurance carrier and Policy number am: - r� steer,�T p011cy FROM /3 9-78A 7-2d0 /5 CERTIFI ATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE f� (This acction need not be cumpolad if the permit is for one hundmddollars(5100) �J or less.) I comfy Nat in the performance of the work for which this permit is isued,l and]net employ any person in any manner sit as m become subject to the Workers'Compcnsalion Laws of California.Data Applicant .. _ . NOTICE TO APPLICANT:IL after making this Coniflcate of Exemption,you should Weome subject In the Weaken Compensation provisions of the La Car Code,you mon Q O forthwith comply with such provisions or this permit shall W deemed revoked. Z ti CONSTRUCTION LENDING AGENCY I hereby art.dominant is a connection lending agency far the pcommi of 7. the..,itper fur which this mit is issued(Sec.3097,Civ.C.) LQ Q Lender's Name az Lender's Address . O Q 1 certify That 1 have mad Nis application and surto that Ne shove information is It.F correct I agree to comply with all city and county ordinances and slate laws relating to - QU building connection,and hereby Whorixe representatives of this City to enter upon the � G ahovcmentinned property for inspection purposes. {{..�. (We)Agree to save,indemnify and keep harmless the City of Cupertino against f•4 fn liabilities,judgments,costs and expenses which may in any way accrue against mid City V 7 in consequence of the granting of this permit. r7 APPLICANT UNDERSTANDS ND ILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. / t-2.Y-C Re-roofs n rx cfApplumsoConaacmr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant ser fulum building occupant tiara or handle hazardous material as defined by the Cupertino Mun'cipal Code,Chapter 9.12,and the Health and Safety COJc,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.. E Na Will the applicant or future building occupant use cquipmenl or devices which If a roof is installed without first obtaining an inspection,I agree to remove haeardous air Councilman is defined by the Bay Area Air Quality Management all new materials for inspection. a? ❑Yes u I have mad Ne havardens materials requirements undcr Chapler6.95 of thc Califno me Health&Safcty Code,Sections 25505,25533 ad 25534.1 understand that iUW building docs not curtenlly have a tenant than it is my responsibility in molly the occupant of the mquimmcnIsW on t is eeofaCanlwamofUctimaty. Signature of Applicant Date - iter rauthm cdagen, Date Allroofcoverings to be Class "B'.' or better CITY OF CUPERTINO � syT.'a.T� x^ a;�. 3 ,'s�5gryip BUILDING'DIVISION PE i $a�S`Q3.\1+� i0R,W4 -OR *0111 1�I.4' �1.� BUILDwg16qUps:WILLOW GROVE LN KEY CONSTRUCTION PEMITNb3110146 _OER"ASRO HOHENNER 1240 #C PEAR AVE . P°amrr`TTY'01/2003 PHONE' MOUNTAIN VIEW, . CA 94043 SANITARY NO. COWFioLNO. ARCHITECT/ENGINEER: PHONE w: BATHROOM REMODEL BUILDING PERMIT INFO C rtz BLDG ELECT PLUMB MECH goo 0 0 0 0 i�'Fi Gdr'a3a^-�. wt'1�s ��,, z Tats ;, ;. ,� TO ARRANGE INSPECTION 30B DESCRIPTION �,�1e 7LdSP CTI NS;,.),r s, )r ,sDATE }N$PE("I� CALL 777.3228 MONDAY-FRIDAY 24 HOURS RESIDENTIAL .. i Sl BEFORE REQUIRED INSPECTION.JOB ADDRESS ❑ SFDWL ❑ KITCHEN REMODEL vt�uQ FOUNDATION/PIERS/H.D.S. AND PERMITM ARE NEEDED WHEN PHONING. ❑ADDITION ❑ PLUMBING RE-PIPE o u UFER GROUND - - ❑MULTI-UNIT ❑.MODIFICATION ON �o PAD/SETBACK-CERT RESIDENTIAL_COMMERCIAL_OTHER_ ❑ INTERIOR ❑CHIMNEY REPAIR ys^ GARAGE SLAHS/PREGUNITE IMPROVEMENT ❑SWIMMING POOLS 2—�� POUR?NO,CgNCRETE,S)NE(L ABOV,E,,HAS?BEENSIGNEDa4 "^a�' HAZARDOUS FIRR AREA ❑BATH REMODELJMPAIR❑ DEMOLITION >e6� W_ UNDERGROUND/SLAB - ❑OTHER Zi- ❑YES Ifys-1undemundussCluAofsmblyissuied. UNDERGROUND PLUMBING a. 9 UNDERGROUND ELECTRICAL ❑ No muiel Lc.B.o.w COMMERCIAL, €;DO NOT/POUR?FLOOR'UNTIL ABOVE'HA$BEEN'5IGNED •ig EXISTING ROOF COVERING ❑NEIWBLDG/ADDITION ❑ DEMOLITYN UNDERFLOOR PLUMBING ❑TENANT ❑FOOD RVICE UNDERFLOOR MECHANICAL Number of exsstiny coverings IMPROVEMENT UNDERFLOOR ELECTRICAL Tobemmoved Tre obemined ❑OTHER UNDERFLOOR FRAMINOVENTS UNDERFLOOR INSULATION / TYPE OF ROOF COVERING P4AcEn ,$uaPK oR,unrENa6v_ Asae NSI LA€p:x. EXISTINGc _PROPOSED: ROOF SHEATH/DIAPHRAGM Buil[-Up Raaf ❑ Buill-Up of PLUMBING TUBS&SHOWER PANAspholi Shingles ❑Asp IShinyles AN MECHANICAL Wood Shakes ❑ ood Shakes LECTRICAL/POOL BOND Wood 5hinyles Wood 5hinyles FRAMING/STAIRS/E.EGRESS Other(Specify) ❑Other(Specify) TNSULATION/VENTILATION — —Q 10 Provide LCB.0.Report No. g OVC"R3�Iq,WQRI� �`�*A$gYa'T(l $:H$EN'$I, '?05n4 Provide Mfyr.Installation Speo. EXTERIOR SHEAR/HOLD DOWN INTERIOR SHEAR/HOLD DOWN INSPECTION SPECIAL SPECTION REQUIRED DATE INSP SHEETROCK/SHEETROCK SHEAR Q ❑ EXTERIOR LATH/W-SCREED SHOWER LATH NpTAPE.Giz'E4ASTER'U"(�CIL�AyGY��HA$`B6EN.SIGtJED.'�'' . SCRATCH COAT SEW ER/WATER TEMPORARY APPROVALS OCCUPANCY O ZO '•.F,'1NALS� .aa;:'a us"s'-,` 'rs��kl:'�`a`s w'.R'"ilk 4s,.i.....'a,�I' ^ .' ZPLANNING777-3308 . . y 9 GAS TEST y p GRADE(P.W.777-3364) IMPORTANT D z FIRE-CALL(408)378.4010 When a permit has expired, a charge totaling one-half HANDICAP the fees to obtain a new permit must be paid to ELECTRIC L // reactivate the permit. PINFa J Z MECHANICAL / ` ENERGY ; If a permit has-been expired for more than one year,a VISUAL FINAL ONLY charge totaling the full fees to obtain a new permit BUILDING must be paid to reactivate the permit. ❑ OCCUPANCY OF BUILDING IS NOT BERMITTEA lllltlal5 UNTII.`�B14ILDING FINAL[S SIGNED)Y BUILDING,�•,, �TNSPEC70R >s" 't ' vt -dR�` ,'- CERTIFICATE OF OCCUPANCY ❑ - PRE-INSPECTION: PLYWOOD: IN-PROGRESS: INSP. DATE INSP. DATE INSP. DATE TEAR OFF INSPECTION: BATTENS: FINAL: INSP. DATE INSP. DATE INSP. DATE NOTE: OSHA APPROVED ACCESSTO ROOF SHALL BE PROVIDED FOR INSPECTION APPROVED IN ACCORDANCE WITH THE CITY OF /� CUPERTINO CODES AILD ORDINANCES_ 6 5 ' 10 - 17 NOV 2 4 60 B . DATE SI(7NEDY set of pans snoeci,canons MUST oe kept cn tha ;ab a� all ty,e _nd it ', lawful to ma6:e e:zn.ea r alterations �� on same w;ih_u: 'n�ii;er. p;r,iss from the starri .m Gep^.ih pi c' C actino. / The stamping et ihis pion ^n pecificati ns iHALI NOT ba held to p:, it or to be ar rpproval of the vi^_:atian if if y provision, r any City Ordinance or Sta'a Law O / 7GF GFI r= 0 `Floresen C� 0 cco)) � cv Hohenner103 N /��� 6E'SZ_ X664 Willowgrove Ln Cupertino, Ca. 11/20/03 _ Y 49'9 12'5-- 12'8 24'8 Hohenner103_N T3 9'1 8'4 9/7/03 \/ t rr 2" //\ o O�Oo • oU n U o � zo - Lo �o r� o 00 T�l 5'10 18'6 F— CEI D 1 NOV2 200 BY: 12'4 13'1 25'5 1 • � 49'9 • • CITY OF CUPERTINO Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 37538022 . 00 DATE ISSUED. . . . . . . : 11/24/2003 RECEIPT # . . . . . . . . . : 23894 REFERENCE ID # . . . : 03110146 SITE ADDRESS . . . . . : 6052 WILLOW GROVE LN SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER HARRO HOHENNER ADDRESS CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014 RECEIVED FROM . . . . : KEY CONSTRUCTION CONTRACTOR . . . . . . . : RONALD KEY LIC # 23840 COMPANY KEY CONSTRUCTION ADDRESS 1240 #C PEAR AVE . CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 043 • TELEPHONE (650) 965-1256 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- -- - - - - ------- - - ------ -- --- ----- -- --- ------- - - ----- - -- ---- - - - - -- BPERMFEE VALUATION 21 , 000 . 00 267 . 00 0 . 00 267 . 00 0 . 00 BPFIXTURE UNITS 4 . 00 33 . 32 0 . 00 33 . 32 0 . 00 BPLANCHK PERMIT FEE 267 . 00 226 . 95 0 . 00 226 . 95 0 . 00 BENERGY PERMIT FEE 267 . 00 80 . 10 0 . 00 80 . 10 0 . 00 BSEISMICRE VALUATION 21 , 000 . 00 2 . 10 0 . 00 2 . 10 0 . 00 PPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 BUSLIC FLAT RATE 1 . 00 100 . 00 0 . 00 100 . 00 0 . 00 EPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 MPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 ---- ----- - ----- - ---- ---- - - - --- ----- - - - -- TOTAL PERMIT 816 . 03 0 . 00 816 . 03 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER -------- - - - - - -- - - --- - - - - ----- --- ----- - ------- - - CHECK 816 . 03 3601 'TOTAL RECEIPT 816 . 03 • �ITY OF CUPERTINO* 411°F a PERMIT APPLICATION FORM • CUPERTINO APN# 3 SCJ 2 Z _ Date: Building Address: Owner's Name: Phone#: A-Q- Contractor: Licens #: (&_ 0 S T' _. P'Z,J4 i c y-Lo 897 Co tact: Cupertino Business License#: I ) Ely Building Permit Info: Bldg [IJ Elect ❑ Plumb ❑ Mech ❑ Job Description/ Z3iti1 c � l�oow. [2 2 Tl�.ow•r—k L �yc�nri Residential LS Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of pr 'ect: Occupancy Gr � a-1 1 ova Type of Construction: Quantity Fee ID Fee Deschptron Fee Group BAPPLOTHER Other Appliances,,' MECHANICAL BBLDGFEE Bldg Permit sqZot BUILDING BBOILERI Boiler<= 19JA00 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1of3 OITY OF CUPERTINO a OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmos beric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING / BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE PbIg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backtlo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfhi MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BRENMXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 *ITY OF CUPERTINOO CUP TYOF O PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Sips, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection BUILDING BSWIM Swinuning Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPER vHTFEE Plumbing Permit Issuance PLUMBING PPL BG Plumbin Fee sq foot PLUMBING ZADDCHG Address Chan e BUILDING 3 of 3