04040064 CITY OAF CUPEICHNO
BUILDINGDIVISION PERMIT CONT.kWT,Q INF RMATION '',
BUILDING ADDRESS: WEST HOME AIR PERMIT"004040064
22449 CUPERTINO RD
OWNER'S NAME: PERMIT MUE DATE
SUNNY VIEW LUTHERAN HOME 5801 SANTA TERE 2004
ONE: SANITARY NO. CONTROL NO.
��(o D') 2$`3 G/3 � o (408) 202-9693
ARCIInLCT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
vOp LICENSEDCONTRACTOR'S
under
DECLARATION �l �®
y U¢F 1 iherebyon70 e)Grm that 1 am licensed under provisions of Chapter a(commencing Job Descr i■�q
n<nwith Scaice and )ecDivision3of the Ousincsx and Profession Codc,ana my license is
_< mmBnrreandarlrort. 6toA4'I'ft REPLACING 2 BOILERS
�? License Class L—ZO Lic.a
ZFW Dale LI Q VI Contraclnf OCT �,� �Qq�
r/ ARCHnLCI'S DEChARATI N {
C 1 understand my plans shall he used as public records
J aa..0
a g 7 Licensed hereby fowl tl��
OWNER-BUILDER DECLARATION I tBf�A�-®Ipyl
a 5 I hereby mfrm That 1 am exempt from tc Contractors o e License Law for the
p o which foldr,in,rcosna(Seethe]o LA Business and improve
de i oli Code Any ally or county
<m pooch requires a pannh m arims the
1,plate,nt porn,demolish,or repair any structure
poou_y that he its issuance.pursantto the lbovisiocant foeruch Contrarminaflea,Law shapter l
Y��a tmmemigwithSection700cpmvavoion3orthe eBusinlarandPrmlaw(Cnaptary Sq.F[. Floor Arca Valuation
(commencing with senmr 7000)of Dmiaion3nnne Business and Peare,ainns eaWehr
ai1,3— that he is author themfrom and the basis for the alleged a telydon.Any violation of
Section 7031.5 by any applicant for a permit subjects to applicant to a civil penally of 3W14a4l A,;r00 Occupancy Type
not more than five hundred dollars(SSW).
❑ I.as owner ofthe pmmoy,or my employees with wages az their sole compensation,
will do tc work,and the sure um is not intended or offered for sale(Sec.7044,Business
ana Professions Cade:The Conuannr'a License Law does not apply to an owner or - Required Inspections
property who builds or improves taeon,and who doessuch work himself or through his
own employees,provided that such improvements are not intended or offered for sale.IL
however,the buildi ng or improvement is sold within one year or completion,Ne owner.
builder will have the burden of proving that he did net build or improve for pmpmc of
sale.).
I,as owner of Ne property,am exclusively contracting wit licensed conuacton to
contract the project(Sec.)Odd.Business and Professions Cwe:)The Contractor's Lf.
runic Law docs not apply to an owner of property who Milds or impruvas human,and
who contracts for such projects with a cornractor(s)licensed pursuant to the Contractor's
Licnse Law.
711 am exempt order Ste. .B A,P C for this mazon
Owner Dole
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of to following declarations:41 -
1 have and will maintain a Ccrti5eme ie Conscot tu scl6inaum for Worker'sCompen-
satirn,az provided for by Scctinn 3700 of to Labor Code.for to performance of the
work for which this permit is jssuctl.
I have and will maintain Worker's Compensation Insurance,as requited by Section]IXI or to Labor Coe,for to perfmmanm of to work for which this permit is iaued.
My Worker's CompensationInsurance carrier and Policy torr a
Carie" Sftn'K F'aM(� PolicyNo.: ISN 35"}�°
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
G-ria section need nm w emode¢d lithe permit is fm one hundred dollars(5100)
or less.)
.1 certify that in the performance of the work for which this permit is issued.I shall not
employ any penton in any manner sex as In become subject In the Workeri Compensation
Laws of California.Date
APPliea h
NOTICE TO APPLICANT:IL after making this Cerd ficam of Esemprion,you should
become subject to the Worker's Compensation provisions of the Labor Cole,you must
.J7 fonhwi to comply with such provisions or this perm i t shall hc deemed mvoked.
Z0
CONSTRUCTION LENDING AGENCY
j-+� I hereby affirm that there is a conslrvction lending agency for lie performance of
fL'
the work fur which this permit is issued(Sec.AMP,Civ.C.)
W Under's Name
0. Tinder's Address
az
U O 1 certify that 1 have read this application and some that the shout information is
D. F cora.1 egret to comply with all city and county ordinances and so¢laws relating to
0Ubuilding construction,and hereby authorise representatives of tis city to enter upon the
T W ahanomenhoned property for inspection Insinuates,
(We)agree to save,indcmni fy and keep harmless the City of Cupertino against
Fliabilities,judgments,costs and expenses which may in any way see=against said City
U in consequence of the granting of this permit
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:S4(aDale y O
SOURCE¢E U AT
1 y/9/o`A Re-roofs
Signature of Applreant/Comeactor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will to applicant or future building occupant store or handle ham,d ous material
az de0red
toy
to CupcnLou Municipal Code.Chapur 9.11,and the Hcalt and Safety
;;Fes
.sc�toy 25511(a)? All roofs shall be inspected prior to any roofing material being installed.
c Nu
Wf11 tc appucam or mature bailding attaVret tae awiphem or deices which If a roof is installed without firs[obtaining an inspection,I agree to remove
It hazardous air contaminants az defined by the Bay Arca Air Quality Management all new materials for inspection."
Dfstrio?
❑Yes Koo
I have mad tc hanNnus mawrials mquimmeno under Chapur 695 of to Califor,
nice HexldiG Safety Cnk,Secuom25515.35533 su 15534.Iundesured Oraldthe Molding
dors not currently haus a tenant that it is my roamnsihility to nouly the necepant of to
tegaimmentswhienmslMmcmpnura)issumecofaccnircamuracupaney. Signature of Applicant Date
f•X/L61/q I`L1
Owncroauthorizedsgcm Date All roof coverings to be Class "B" or better
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7 n m A $ PROJECT NAME: SUNNYVIEWWEST, BLDG.. CN e�? Nis
x @ FTH m BOILER REPLACEMENT dgEmg .a
ZZ < mfs
�. Nu po-g
0 ADDRESS: 22449 Cupertino Rd, Cupertino, Ca 95014 ��= csu,
Community Development
jE' [0300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY 0, Fax(408) 777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: 'Z 2 c�t� W�c rs �w '4V , PERMIT#
OWNER'S NAME: 9'u AA v t ✓e-fT PHONE # 26 3 C(
GENERAL CONTRACTOR: We-5T \A8v-- ,/ fl-,,r FAX # 3 63 '3 be3\
I am not using any subcontractors:_(,�
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
� -q� (t, 9�
Owner/Contractor Signature Date
n/b Sv bs .
(y
4. r , CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
JFPN # Date: b y s
Building Address: Ivl
22 /�!� 9 �C t r.^° rJ �� ailing Address (if different fro building address):
i C�arc; w , c A 95 o/N
Owner's Name: Phone#: �ieY) 2g'3 --N300 .IF
SU A V%y y-V C,„r W esr (2 C_"\\ (901W
Contractor: License#:
we}r t�� ,a-;r 8fl 98 '� d c-To
Contact: C- roS f Q j H✓ Phone: 2a 693 Cupertino Business License#: 2S 113
Fax: 64-3631
Building Permit Info:
Bldg ❑ Elect Plumb Meeh
Job Description: Y1I-eh Gly 1 P�5
Residential ❑ Commercial
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: i Coo Occupancy Group: 13
Type of Construction: Please check this box if the project is a
second-story addition: ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permit sq. foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL
Z BBOILER3 Boiler> 500K to 1 M 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 > I OOOA 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
1 of3 q /, 3 7
r
, - CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee 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 heric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pblg 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
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT 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
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
Ad IL BREMRESAPP Remodel Res A liance ELECTRICAL
BREMSIGNAD Rmd1 Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Mar uee ELECTRICAL
2 of 3
.� � CITY OF CUPERTINO E;
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Descri tion Fee Group
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 Swimmin 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
y
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t
3of3
Proposed alteration to existing exterior wall for: Mr. & Mrs Ken Chew
7847 Creekline Drive
Cupertino, CA
C*t'
Remove existing composite wood siding a install new ucco i
--- � '9
G
S 2 72004
APPROVED 06IN �R0Ai7CE VM JUE CRY
pEyt(I110 CO
IGNEDplan , ecifications MUST
his
oe kept on the lob at�l eseor,�altetr*ns
lawful to make_any Chang
on same without written:Permission frolr
the building Depttions
., City of Cupertino.
the stamping of this Plan and specifica
iHALL fSDT be held to permit or to be ar
..rival of the violation of anY promsio°s
i anv City )rd;nance or Smt i
Andy Horiuchi
General Contractor
847 Los Altos Ave
Los Altos, CA 94022
CIA
nLIc.78388 Tel, 1850) 9488 2028
Creekline Drive
Plot Plan Scale: 1/8 inch = 1 foot
Proposed alteration to existing exterior wall for: Mr. & Mrs Ken Chew
7847 Creekline Drive
Cupertino, CA
Remove existing composite wood siding a install new ucco
Si 2 7
_ . . • �� - 2004 •
p�pPfROVED oe
In AlxOttDA14CE VM TNF CO
pfRTll4o W ANO,CORA%=
TE
IGNED ecifications MUST
his set on Plae to at times and it is-UP .
oe kept _make any changes or. alterations
lawful to Permission from
an same without written
tte . Permission
the, building Dept., city
The stamping of this plan and specdieaborls
SHALL W01be held to permit or to be ar,
�.nval of the violation of any p+owst0^S
F am Citv lydmance or Sret
Andy Horiuchi
General Contractor
847 Los Altos Ave
Los Altos, CA 94022
CA LIc.78388� Te�1- (650) 948 2028
04
Creekline Drive
Plot Plan Scale: 1/8 inch = 1 foot