03030113 (4) CITY OF CUPERTINO + =`r Uc' "y'" a '»^
BUILDING DIVISION PERMIT ' coN ',� 3TOYt Imo, '.I,D�rRgl��-', j..;
BUILDING ADDRESS: PERMIT N0.
WESTHILL CONSTRUCTION CO
OWNE I'EIIh1R L%
5354 RUCKER DR
(408) 395-4361 SANITARYOL NO.
ARCH=113NOINEER: BUILDING PERMITINFO
BLDG 0 PLUMB O
3o j
LICENSED CONIRACfOR'SDECLARATION
�tt'J I hereby anion thin i am licensed under prevision or Chapter9(commencing Job Description c�1
withScckr7 )ofDlvbuon3mff Saai. ityrofotakencade.ami Iicemela
in gull forts are0. BATHRM REMODEL
0004 1� tIV
Lmerm Cies• IJc.R .
a Dam — home
C.
ARCHIIECTSDECr ON JUL 2 2 2003
I undersand my plain shall be used u pts c records
�p Licensetl Pmtcaalonal ��'�®I�^
a
OWNER-BUILDER DECLARATION G
1 hereby.Olin that 11. ,Bumps s an the Canlnnars License Law far the
p o whichfollowre uIre,a(Section 703 1.5,Business and Pmfmli demolish,or Any city m manly
3 which its l ma a pectis m c ims the alma Mforsu rmittfi repair ed attempt fit'+ pdorthaiauncaalmrcqulres previsionapplicant ofthe Conumcmit to Blea LAw(chemenl
mommencngwit punupen mine pmvialnm of the Comodrama llmmeiaw(Chapmr9 $q.Ft.Floor Area V8l,3.[ion
(commencing with Section 700D)set Division3 of al Business andon.Any losdon)of $22 V U
�.. Se t io u ea5 b tang applicant
and the aper for me alit{m esempdoa Anyil penalty
of
Section e,than by nary applicant far a permit the applicant a a civil penalty of ��ppyy p3ap7as,a {I��
Out more,lawn Bw hundred dollars(SSoO). 3 CO 3.3'17�7r 0 0 Occupancy Type
❑I,uownerof Nepmpany.mmyemployeswithmsecuth*nlcmmpe dm,
wllldo the work,and the structure Is notimmnded oroeend forule(Ses.7na,Bunneu
hind Profeadom Cmc:71m Contactors License law does oat apply m an owner of 101 — FOUNDANOtiFd Inspections
pmpenywhe buildsmimprvws Nneomandwhodoeaauchwmk hlmselfmtluouth hu 102 — PIERS
ore employes,provided that such lmpmwmenu an not Intended moRertd for sale If. 103 — IJFER
hastier,the building a enl r Improwmmid within one year of cma
oPledis,the own -
uk�wlBban disburden ofpromng*at hedid nmbuild mImp.par pupnx of 104 - REBAR
❑1,pe Owner of the progeny.am eacivalvely eo m cting with Ike" tmvactm m 105 - ANCHOR BOLTS
conswm the project(Sea 70",Business and Professiam Ceder)The CmusetNs U. 106 — SEWER & WATER
ecru law dace ant apply to an owner of property who builds or impmme,Unman.am.
s
who contrafor, m
such projects with pursuantmo
)licensed to comors 202 — UNDERFLOOR PLUMBING
re IAW❑lmeorempt undeSee. ,BkPCfor Ms masn 203 - UNDERFLOOR MECHANICAL
Damn Dam 204 - UNDERFLOOR FRAME
WORKERS COMPENSATIONDECLARATION 205 - UNDERFLOOR INSULATION
Ihereby affirm under penalty of pedury one of the following declantioa 301 — ROUGH PLUMBING
w and will malnulr a CeNResu of Cement to self-lmum fm Workers Cosine. 302 — TUB & OR SHOWER
for which this pe by
iSection
1+o�d7700 of the labor Coda for the perfomuma of the 303 - ROUGH MECHANICAL
❑I have and will maintain Warkera Compensation Imurance,as required by Section 304 - ROUGH ELECTRICAL
3700 of the lobar Cade,for the performance of the won for which this permit is Issued. 305 — FRAME
My Workeb Cnmpen atim In me ca m and P cy numbunm: '
pip _ tyal,t ppl)m. 306 - HOLDOWNS
ceRrIPICATaoPPrxeMPno o)dwoRKEns 307 - INSULATION
mMPENSAnoNlrnuannce 308 - SHEETROCK
Or ICIL)fr4 seclim need not be completed lithe permit is fm one hundred dollan(S las) 309 - EXTERIOR LATH
1 Q"fy Out In the performance of the such for which this permit is issued,fans rot 310 INTERIOR LATH
employ any person In mycounter an u in become subject m tleWmkrn'Compewuon '
La11 — SCRATCH COAT
Laws of California.California.Dam
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT:If.after making this C<NRcam of Exemption,you should
become subject so par Workm'a Compensation provision of the later code,yin muss 501 - FINAL ELECTRICAL ENERGY
0Z forthwith comply with such powi inthis lermitshall beresume remked 502 - FINAL PLUMBING ENERGY
z�
CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
[r.. r I hereby snare dist them It.construction hording agency for the perform.of
ck > the worst for which this permit rissued(Sec.3W7,Civ,C) 504 - FINAL BUILDING ENERGY
W^q Lende ,Add
sanderes Addrepe 505 - FINAL ELECTRICAL
DZ
U O 1 canlfy that I haw read this application and win thin the shoe information is 506 - GAS TEST
W "correct.I agree,to comply with all city and county on imncm and sum lam totaling to 507 - FINAL PLUMBING
building conswctim,and hereby hoNve p cnuliws ofthr city to cnmr upon the
W shove-mentioned y rl on a FINjj#NG
4.0.1 (We m in a ,I d ter sed harmlw the City of cupenino agnms 0 9 FIN
fq' Iabllitl Q mu,c n ea sus 1 mryinmywayaamcagasnslaldaty,
J 7 A m mac firm n0 of 1
Ll low ANT N PCr
COMPLY WITHALL NON•P Nr Issued by: 5 Date
U RE LA N
3 7A p� Re-roofs
( w Signal ppBcenVConsnclnr
HAZARDOUS MATERIALS DISCLOSUIIE r Type of Roof
Will de applicant Or future building msupset atom orhaum hnArdou material
as;dclined by the LLpenmo Municipal Cmc,Chapter 9.1x,and me Health and Steely
Code.Dyes. 532(.)7 as All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or retain bylidoul aecupm,use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
a»nlnm elr conuminanm dcfood by me Area Air Quality Management all new materials for inspection.
❑Yin No
than to u' stunder Chaptm6,95ofine Califor.
nit Hulthd:S yC S. 255361muferunalmuifmc building
does ran dy possibility to rectify the omupan athe
requimmen soh um m m a(:auf me �. Dz Signature of Applicant Date
f Owner per aumodrzd agent'— Dom J All roof coverings to be Class"B"or better
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CRY OF CUPERTINO o 3 d 3 l3
��rYor PERMIT APPLICATION FORM
CUPERTINO
EN Date: � 3Budress: Z 2 3 7 S
BIn r:ca
Owner's Name: //� Phone#:
/
Contractor: License#:
SES I i^i tl Co�s�rwvf,on 1a�!o+Ev
Contact: Cupertino Business License#:.,
Building Permit Info:
B dg IrJ10� Clect Pl b I Mech
Jo criptioon/
Residential gPf-h4x PR r+o� Commercial ❑
Sq.Ft. Floor Area: 42 $/Sq.Ft.:"
Cost of Project: 1'\ Occupancy Group:
Type of Construcu :
r kie-v +411 ✓i
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
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
Am
BMITIGATC Comm. Housing Mit:Fee BUILDING
z�3� 1
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ego .
ATY OF CUPERTINO •
CUPEIZ`TINO PERMIT APPLICATION FORM
QuantityFee 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
BOVERTRYIE Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
—� BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pb1g 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 Repipe 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 Pipe PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL
BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREM3USWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation ofFumace MECHANICAL
BREMFURNOV Relo Furnace> 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
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CITY OF CUPERTEA
aC10F PERMIT APPLICATION FORM
CUPEkTINO
uanti Fee ID Fee Descri tion I Fee Group
BREMPOWER Power Device/Annaratus ELECTRICAL
BREMRECEPT Rc tl, Switch &Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT R air/Alter Heatin MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Si s Add Branch ELECTRICAL
BREMSIGNS Remodel Signs.Mar uee ELECTRICAL
BREMTHEATR Theatrical Li tin Fix ELECTRICAL
BREMVENFAN Vent Fan Sin le Duct MECHANICAL
BREMVENSYS Ventilation S terns MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL S ecial T----44-- BUILDING
BSWIM SwimmingPool BUILDING
BTEMP Tem or Power ELECTRICAL
BTEMPPERM Tem or Bld Permit BUILDING
BTEMPSVCS Temn Dist Svcs g—E—E,
CTRICAL
BUSLIC Business License ILDING
ELECTRIC Electricals foot CTRICAL
EPERMITFEE Elec Permit IssuanceEj!! CTRICAL
MPERNIFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mecb Permit Issuance MECHANICAL
PPERMITFEE Plumbin Permit Issuance PLUMBING
PPLBG Plumbin Fees foot PLUMBING
ZADDCHG Address Chane BUILDING
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03/13/03 13:19 FAX 650 654 6219 ORACLE
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5olutlons for your dcelgn and building needs
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CitY of CuPerti 10n from
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M IPPrO " be he'd to Pec fications
val of
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H " Inv CiV Anance MY/s/0",
or State Caw
PROP05E .D PLAN A
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