00120024CITY OF- CUPERTINO' -'
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Bull.DIING DIVISION; PERMIT
CQNTRAC.TOR INFORMATION:
,BUILUINCADDRESS - �r)
11'04144 `fiL:.ICIA CT
BATH R(7Olil INC. "T1 -lF
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eRMIrNO001 ^Iy
OWNER'S NAME: -:
NF_LSOIV .DAVID.H' AND EI,IZAPE:T,H
L' 1.5,10 'W EL CAMINO REA,.
APPLICAIIO F,tl
1�.9Ii'lff //=.000
IIONE •�
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SANITARY NO '.' CONTROL NO. e ,
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• ARCIi I'1'CCt /ENGINF.EIt:
' BUILDING PERMIT INFO -
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BLDG ELECT PLUMB' ,' MECt{
/ LICENSED COY RACTOR S DECLARATION -
ICfloor, aphid thtlmh ed d P of 9(onm
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Job Description Y+
Section nnd Domor i f the Besides, add Poll ... mrs, Code ,nJ a, license
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is infall mor, and all 604 9-qz
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REMODEL OF 2 BATHROOMS
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IMCLARAI
ARCHITECT S ION
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j 1 I I J yp Iran, .lotto d a, Iniffila, records
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1 Lcn JP f..I
OWNER BUILDER DECLARATION
1 hereby rl that 1 am coarld firand the C , [!'cause L I the
loll g (Section 71 5 B : d Profession, C J Any 1)
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wh I requires permit construct. ' ❑ ra dernal isli, or repair any structure.
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elate nd 1_
ulr tegt'ns lhevolo off rmla,pennllLi
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that e licensed
mrou r ap . II n p . 'If the ,,rat i c w (Chapter 9
ed Law
or that fib lit t o Vflt1N) f D" 3 fill B a," P 1 Cndc)
orS ite'70 ryf tit f and the b r the Any leiau.
•Sq. Ft.,FloorArea
- �Va�t�O
alleged x pf
afScton90315hy any applicant rural etsde:pFll uanvlpmify,-
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chintaalb
•rrnrtmrmunnlsdhundred ad.rsstro) �,•,
� � APN Number �
�, OcclipancyType
D I a property, Y ply i tit P t
4245024:00
will J 0 work, J t he t is : intended r o R J t - t (See 71144 -
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'Bu ltd 1- f :, Code : TI C fir I L L 1 t pl I> f;
owwr of proper, Will ladd,o, nprme hashodn and vouridese, such work hmcif
I ,R�Ct�l1rC,�I�1$pections
1.01 — FOr�hItJ{{I J,' ❑I \I
or through his own cnrplayee., provided that such .impro varents are not intended ri
offered for side. If, hnwrver, the nnlldine ,, air rrn.coma, is bid wthin one Year of
r - 1,02 'P I FRS -
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LornFllefi thlowner- boulder will fired the humenaf proving fall hr did not braid or
npmveforperPosear.eole.,.
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- 103 — UFER -
`on ftEp p tlo evocatively contracting mr e couldn't... t
.1.b4. :REBAR --
t did p j t (See 7044 Dis e Plafi ,d, c e) The Contractor,
Lid L d pplyt OFraproped, son na p e,ffic
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ANCHOR BOLTS
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and I for such projects wim a erntramrrcs) licensed p : ant the,,
nrt troLicense Lw
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1,06 SEWER R WATER
D l Lou exempt andar,5ec: ,B& PC fc, this be..on
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'0c .— UNDERFLOOR PLUMBING
U'26
wee, Wad
WORKER'S COMPENSATION DECLARATION -
. -" UNDERFLOOR MECHANICAL
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Ihereby affirm under pennM1yofperjmy one fir the rnllm ,ir dedietans:
.� 204 — UNDERFLOOR. FRAME_' ..
o "1 have and will narntain a CerEiwle or Caused) a, selydsura for Worker's
105 — UhIDER( COOR INSULATION
. Crmpen..strm as provided rill by Sect a 3700 or me.l.anrt Cade. rot me
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y' 351. — ROUGH - R,1_UMB IAG -
pelfulahaded the work I,,, wh ' In': pe f d'
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ve and w'u ,a rat WorkcrsCo nl fora lnvumm as rcyu'md by Section
` 0f-• — TUB K. OR SHOWER
rth Lab,rC od f tiepeI. nl workI h hmspdrmt
- 303 rl ROUGH'MECHANICALMywt.c
k37W
p r cal ynf filar idle 'g, `r'>. Na.lcN1�3cZ� '
- .04 -- ,R000t"1 ELECTRICAL,.' .
&RI'IFCAI ION 01' EXEMPTION FROM WORKERS'
jQiS — FRAME
COMPENSATION INSURANCE
366,'s- HOCDOWNS
(This : tolum, need fiatneermndadaimp itis(rranenilwrmdrller"
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($pH) , Sex.)
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377 INSUrATION -
I trym.t' a the Poidarnounce of he k to, ra,h moferionat isissued,'I
�s08 — 5HEETRpCI,
shall i ply y p a Y nn r s a 1 lime subject f the Wo'kcm
Crmpemnnon Laws df Crr,rnri Date
.
1 .30'3 — LATH . -
Appnaa t
NOTICETOAPPLICANl If,afternarkin, his Ceraficate.f Escalator, you :h did
- .EXTERIOR
310 - INTERIOR- LATH '
beet 1, a d Worker's Compensation P ,salt) Labor Cade, you n
railroad nemnplywilh such . ormnpcmiishllbddeerumvrked
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311 ° SCRATCH ,COAT:
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CONS'T'RUCTION LENDING AGENCY
, - . 1, 3 ROOF NAIL y' '
1 III air rtell little is a construction lending ageuey for the ptrl'ornwnee
of work for which this retail, is issued e9ed. 3097, Ci¢ C.)
501 - -FINAL ELECTRICAL ENERGY' '
Leadc', Address'
502 — FINAL 'PLUMBING ENERGY "
'1 cruily ihe I have read this vp head I t t that the blechaffora, I r
s -5.03 — FINAL 'MECHANICAL ENERGY•
correct. l g ply all p city i county e state - fir g
'504. FIAAI._ BUIL DING' ENERGY
m s a t dl m p fi r m city t p
dr .i .
't
me b t Iproper, r t I t Fl
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. 505 - FINAL' ELECTRICAL-. - '• "
- I'ahltc,,m I J pe Jk lh4 n wy ICUp n' slid.
jJ8 r' t J x�ws with )m r,Ywy 'gninsf 'd
.'�jOE '- GAS ���•.
city et ce of lit g unOng a ra t this
.TEST „ - ��
'.FINAL
WIL
APPI,�A''M INDERSTANDS DWILLC MPLY WITH ALI NON -POINT
so tic R .D Ns. 1 5•. �,
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':�512f`7 PI_UIYIB'I NG
b Dale . .
Signnlum nfApplimnVQndmcmr - Do
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- Re- roofs' ,_, . r ''
' HAZARD MATERIALS DISCI )SURC
Will the upPl cat f f t Id' g p' t.t handle h -d 'rat 1
defined
-s: 509 — FINAL .GRADE - t
Type of Roof
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as by the Cupertino Municipal Code. Chapter 9.12, and the lleallhme'5ay
.. ! ..71.0 — ;FINIAL hLANNI
Cud S f n 25532(a)
DY: 'D(Nn • •,jr -
"All lro0fs,shallbfddOpecte"FIT brr"ioal f�ngni'PPNSBeinginstalled.:�
Will mad applicant or buture building 1 f use equipubleloor d - 'i which :
If a'roof Is installed without first obtaining an inspection; I agree to remove
endfM1 Jus:,r cool niaboo Jef,ed by fhc Nay Area A Qnlity MUnegc tem`
- Distsmt^ _
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all new materials` for inspection:' Applicant understands and will comply with
Cl ye, ❑Nil
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al_I'non -point source regulations. -
1I d rN h J matter -' I 4 1' d Chapter f 95' I the
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at calm ,& ul ty Code S.1ion,25505,25533har,25534. 1 andrommal n
it b'Id' gd ut fl h - f tit 1 Y. y Fl blfyt rly tit
[ tit r rc t which be of r m to issuance l a Cenilaat r
ccu p.tt
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Signature of Applicant Date
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All roof coverings to belClass "B" or better ,
" v OFFICE