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05030141 CITY OF CUPERTINO %fa'v�v'x^' 'ra+--+,'�"!/-'��nssf&`�("�"�' - BUILDING DIVISION PERMI # �q .�9.. W t.: � '49 BUILDING ADDRESS: PFA '"%5030141 ER'S NAME: PENNin ISSUE DATE PHONE SANITARY CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH I� 00 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby afnrm that 1 w Ikna d under provinces of Chapter 9(commencing Job with Senior 7000)ofDivisim S of the Budrcnand Prefmalom Cnde,and my license is in full toce and eflgLL Lleenso Llan Gi t Lie. d c1 KITCHEN REMODEL r Data o ca new ✓1 CONTRACTOR: MUNDY CONSTRUCTION SERVICES INC ARCHDELT'S DECLARATION I undersand my plana shall W mad sa public rec'mds O ids Licensed Protuaional OWNER-BUILDER DECLARATION IS I krabywase .llove(Sec that 1 am exempt from the Con ons Co e:An so Law for the p O which reason.(Section b](D I.S.Business and P ,de oli Code:Any city s county $ which u,ine;berm•permit u,eaves the plic improve,h permh u m repair soy amuetam im,hepriortiulmbodfor ant w nen porisa is,of lossuch Lt=.gnndaatmem <,Ncommis enliRNCd pSecnat mdC pmvlewN of de Go ommeasand Profsdon,Capler9 Sq.Ft.Floor Area Valupljgn000 p that he Is m ea with Sedan 70)(1)the Division f r of wa sl cIed tuaand Profudons wd6mw)of BB$ Nat he b uempl Nereftom and der huh Iso Ne alleyctl eaemPda.MY violation of Sema 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type am mom Na five hundred dollars ISM ❑I.nowanarNaprapety,weryamplayeaswith warnnNeo-aamampenada, 37538022 . 00 wiR do Ne work.antl thesuucwrt 6notmtendedaroRend fmssk(Se.7011,Butlnew !� i t and Profession;Cade:The Contncwr's Lt,,.Lt.den nm apply w an owner of Required I119p n prope rywhohu ltaar imprmea Naaork r.andwhodoessuch whimself artluough his ll own employ=,provided Nat such Improvement art am intended aroRund tarsale It. hmvever,the building or Improvement is sold within ane year of completion.Ne wxr• bund"'will have du burden or proving Wt a did eI Wild or improve far purpose of VA-O 1, 2005] ole.). v, yr ❑1,u owner of the property,am ocontracting aoacwa m construct the project(See. Bottom and ans Cod )Doc Cuctneto'sU. Law d=rtaplyto. worproperty who WildaorImprove.thereon,acad .he eonacnt(m such projects wIN•conusowr(Oltensotl pursuant to thea Comncos BMUNW 1.C3 ILaw. ❑lam uempt antler See .B&PCfor this nasuc er Date WORKER'S COMPENSATION DECLARATION I hereby atMn under penalty of perjury new of the following dec6mtlens ❑t haw and wBl mainuin aCenificamof Conxent w wlf-imus far Workce Compett- station,In provided fm by Section 3700 of the labor Code,fm the performance of IN work for which this Permit Is Wood ❑1 have and will maintain W~s Compensation Imumact.as required by Seater 3700 of to labor Code,for the performance order,wort for which this permit to and. My Worker's Compensation Insurance carrier and Polity number ser: Carrier. P1f4 CE.f7wpy JNSr))polwy Na.: /1913-OZ-01 Oq CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Tb6 inion med not W completed If the permit 4faranchundred daRam(S100) or leu) 1=dry Nat in to performance of The work for which this permit 6 is ad,l dal am employ any person in any answer an an w become subject to Na Workers Compemation Laws of CalhtomlA Dam APPlilt NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should become sub)=to the Worms's Compensation prolsiou of the labor Code.yon rater Oforthwith comply with such provision or this permit shall be deemed rooked. CONSTRUCTION LENDING AGENCY ,y. I hereby affh,n thal there 6 a construction lending agearY fur the perfarmartm of Yr the wort for which Nu permit 6 issued(pts.3097,Civ.C.) QLanders Name Landers Addmu �z O I ceNfy that 1 have read thin application and saw that she ahove infomuuw I. I.;'! correct 1 Anne to amply with all Ay and county ntdinemof and mm nto upon e Ritow-mennuwniroend herfor by impcdadnrposes tiro of win city weter upon Ue li7 above-(We)name d In save, for ImpeNuc Map ha (We)epic w nter wdi expenses cad hcep ha=les tier City of Ctrycnst s iddnst ^y Ilabilitlnmence of Wanda'" whlehtnaywany way aceruc against said City O In eottegucnce of the{Taming of roll APPLICANT U ERSTAND?;A WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE R '3 p Re-roofs Sign or ApplicandC Date H ARDOUS MATERIALS DISCLOSURE Type of Roof Will we applicant or Itmem building cecupowntom or handle homed.mutual as dented by the Cupertino Municipal Code.Carter 9.12.and the Health and Safety 4 Sedan25532(a)7 All roofs shall be inspected prior to any roofing material being installed. 11d, C3 Yen qNe Will the applicant or future Wilding occupant use equipment Of dcvi=which If a roof is installed without first obtaining an inspection,I agree to remove emit hnartlnaa air anuminae u defined by Ne Bay Ams Air Quality Management all new materials for inspection. District? ❑Yes spa' I have read the hicani m materia requirements underompter 695 arta Califor- n6HnIN8SalNyCole.S=ias25 577 and2553/.lundmsund dm iftie Wilding d=not commtiy a mnankdut it 4 y maponslhiliry w neory de accumnat m de mquke tptlor ssuaneafaCerdncatearOcapaney., _ Signature of Applicant Date r car suthavrd a at All roof coverings to be Class "B"or better City of Cupertino Plan Check Transmittal Permit# 05030141 Control# Project RES.KTCHN RMDL 'Plancheck# 1 Address 6052 WILLOWGROVE FileDate 03/10/05 LANE Owner HOHERNER Description RES KTCH.RMDL, NO STRUCTURAL Plan Check Status (attach comments and return to Building with plan set) Pian Dept check# Date Due Date Staff Comment Date Approval? Buildin 1 03/10/05 1 03/24/05 1 LARRY 1 03/10/05 Assessor 1 1 03/01/05 03/15/05 1 SENT 1 03/10/05 • Additional Plan Check Fee ❑ Hours Plannina Fees Housing Mitigation Fee Amount Heart of the City Specific Plan Fee Amount • CITY OF CUPERTINO Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp : Rng: Sub: Blk: Lot : APN . . . . . . . . : 37538022 . 00 DATE ISSUED. . . . . . . : 03/10/2005 RECEIPT # . . . . . . . . . : 28892 REFERENCE ID # • . . : 05030141 SITE ADDRESS . . . . . : 6052 WILLOW GROVE LN SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : HARRO & MARIANNO HOHENNER ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014 RECEIVED FROM . . . . : MUNDY CONSTRUCTION CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , • TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 40 , 000 . 00 453 . 60 0 . 00 453 . 60 0 . 00 BPFIXTURE UNITS 1 . 00 9 . 00 0 :00 9 . 00 0 . 00 BPLANCHK PERMIT FEE 453 . 60 605 . 33 0 . 00 605 . 33 0 . 00 BPREPIPE NO OF FIXTURE 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00 BPTRAP NO OF TRAPS 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00 BPVENT UNITS 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00 BPWATER UNIT 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00 BENERGY PERMIT FEE 453 . 60 217 . 73 0 . 00 217 . 73 0 . 00 BREMINHOOD NO UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00 PPLBG . SQUARE FEET 280 . 00 22 . 40 0 . 00 22 . 40 0 . 00 BREMVENFAN NO UNITS 1 . 00 45 . 39 0 . 00 45 . 39 0 . 00 BSEISMICRE VALUATION 40 , 000 . 00 4 . 00 0 . 00 4 . 00 0 . 00 BUSLIC FLAT RATE 1 . 00 102 . 00 0 . 00 102 . 00 0 . 00 ELECTRIC SQUARE FEET 280 . 00 22 . 40 0 . 00 22 . 40 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 MPERMFEE SQUARE FEET 280 . 00 22 . 40 0 . 00 22 . 40 0 . 00 MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 -- ------- ---------- ---------- ---------- TOTAL PERMIT 1667 .41 0 . 00 1667 .41 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ---------------- - ------------ ------------------ K ----_1667 . 41 12910 TOTAL RECEIPT 1667 .41 *ITY OF CUPERTINO* CUPERTinio PERMIT APPLICATION FORM APN# 0.2�-L- - Date: Building Address: !! ,, Mailing Address (if different from building address): 605-.2 zil ow erovc Owner's Name: /w Phone#: / hen er 7 "02 /tel Contract r:License#: un s o�7G9 Contact: Phone: 91/6-6 S!/ Cupertino Business License#: e W Fax: $ (, Building Permit Info: \ Bldg Elect Plumb L9 Mech ❑ Job Description- Residential Residential E ,1, cIen eltovcllio Commercial ❑ Sq-.Ft. Floor Area: $/Sq.Ft.: PO Cost of Project: Occupancy Group: ,G c� oao Type of Construction: Please check this box if the project is a 40 —/ second-storyaddition: ❑ Project Size: Standard E Lar e ❑ Major ❑ Quantity Fee ID Fee Description ' Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 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 1 of 3 � 6 7, �� tawWITY OF CUPERTIN04 CUPEf�TINO PERMIT APPLICATION FORM Ahk Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Iris ection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE . PblU 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 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 BREN AIRHAN A/C Units <= 10,000 din MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways . ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREWMAT 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 BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 *CITY OF CUPERTINA } CUPER,TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, 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 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 MPER 4FEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING ZLF p PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR PlanningLon Range Residential PLANNING ZADDCHG Address'Chane BUILDING • 3 of 3 CUPEkTINO Y Assessor's Parcel Number:3 7.5'- 3F- 0. 2-2,- Name 2, - Name of owner. 4,—ro ,' Ma - rinKo ^ `t LAC- Contact Project address. 605.2 1,}f 11ocJ 4ro,re L AC- Contact person. 4(?sfe r -:Z611s011k Phone. -)8 1"16- L Y/( Fax. `ICY, ��E- FQf f Net square footage of lot. Existing Proposed Square footage: First floor: 8a sG y7renO,,'L 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 On what floor(s) is work being done? �/ Brief description of work. renlac ,•- P4 of k C /CA a/24unce5 1 /1 eo t/oar "Code ed'ition's:2001 CBC (Y -N)2001 CFC (Y-N)2001 CMC (Y-N) 2001 CPC (Y- N)2001 NEC (Y -N) AIPPMvF-0 F2ECEIVEI� EffgR4iNpW#1022wBH TM°cm Of CUPERTINO CODES AM �C MAR 9 2005 Z i DTPA / )) - alE�rkuc 'nra �or �e J'(rce Th;s set v r 3ijsand �ltkmb ST be �,. .o.. a aN tirr�s and A w '."tl to COPY �t on ems n2Y.o tt�y '.�r�n9 or xbereticde C • OFFICE hout r ,y;. �•Ir,isuon fnxn Ula L�. "g • _ r•: G:.. .l.ia ynn arxt spadNc: I . t o-!. .il ::U I,.. 'C' vL'imlt or to b. i Z. nt the woiabon at any pto4m, i i Plan Review Process Work Book Page-8-Revised 4/28/04 q 1 • 1 I f 6 5 s - If' 1 "R r. -ia�ry Ina/ ! a a�� Cc �7a�7o. (a-ohe.� nr� -rlr.rr ;y Co�sT rj /o�e Lane PDljs� 1306 • nc Gf,�. �SDI`7 /9h U &efk) fs�16 dpi/ Ph No hla Gs-S l� / /a ce 1'iie�T %n �I�i57i�iy LDca7la s 1 s, f o 0 r � 110 o a s • i �tC 1 � GJ �P�7T r y aero Ina r i a ��� Cn o7rao7c. (4.0 , oe P. �'�lrrn�y Co�sT Grp e Lane PD gel. /3ad �amPhr tc 2Y� L, o '°� y0�f769 sTl;,5 5hw,s I p I I 13r - -' - — — GFt i u J 0 - 5 V- - i �IPnT Jamar^./ a p,7o C �1 �/ Lpcb (4-o b�17,171 �Jrvnc�y sT �cy5 V Z 1,f� icv /rose Lv,7e P4 �e� 13&46 . Ph