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040602334 CITY OF CUPERTINO�"` 9g'�;.+m, N '+ +• BUILDING DIVISION PERM xC®NTRA.CT,OOR1INFORM' BUILDING ADDRESS: 645 ASTER IN CALIFORNIA BATHROOM REMODE 'ngNO04060233 OWNER'S NAME: PERMITISSUEDATE GARY & SALLY LEHR NE: SANITARY NO. C ONTROL NO. 4083609706 ARCHITECT(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Chapin 9 (commencing Job Descri h Q P 1 hereby affirm Na 1 am licensed mater p visions of with on WB)of Division3ofthe Rusin?*, Professions COM, and my licevc is w L� EEP nALE in m^I rad erre��, ✓ ,R �, �,, iS RELACE BATH FIXTURE/.ELECT. GFI Li ' l^ � ARC.MC Da e`,'-(; Conroe CCfI ZO o4 SEP ID ARCHITECTS DE� r I untlerwnJ my plans shill he used az puM' rtcnrd,s BUOLDNG Licensed Proresu nal OWNER -BUILDER DECLARATION I hereon affirm that I oro exempt from the Convector's Law for the Any + Cmdc: Any city or county following mason. (Section 1831.5, Business and Professions Cook: : c deo ri repair any structure which mquira a re rnmsthe alter. improve, tle t. issuance. also Permit in IM theapplicantforsuch the Conpermiuo rile aicense signed moment that heor itssiensedp pursuant of the Connector's License Law sed pSuctio Sq. FL Floor Area Valuation 7000) of Division 3 the Cook) or he.commeirg t Suction ]BOB) of Grylc) of (cat exempts and Profiron. Any I Net he is exempt therefrom and the bazis far the alleged Gumption. Any violation of he is xempt basis the aged 3 6eTROffliffierO 0 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to acivil penalty of ...more thou five hundred dollars (S500). 1, as owner of the property, or my employees with wages as their sole compensation, Required Inspections will do the work and the structure is not amended or offered for sale (Sec. 7014. Business and Profusions Code: The Connector's License Law dose at apply to an owner or property who builds orimproves thereon, and who does such work himadfor through his own employees, provided that such improvements are not inended aroRcred frank. If, however, the building or improvement is sold within ane year of eampicdan, the owner - builder will have the burden of proving that he did not build or impose for puryoa of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed Contractors 10 contract the project (Sec. 7044. Business and Professions Cade:) The Convector's Li. came law docs not apply to an owner of property who Wilds or impmvo thereon, and who contracts for such projects wife a contrdefor(s) licensed pursuant m the Contractor's License Law. 0 l am exam pt under Sec ,B&PC for this mason Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under pemlty of perjury arc of the fallowing dededusions: I base and will maintain a Ccrdficae of Coam m eolt-insure tar Worker's Compen- sation, a provided for by Section 37M of the labor Code, for the pcdo... of the work for which this permit is issued. ❑ I basic and will maintain Worker's Compensation insurance, as required by Section 3700 of the labor Code. fa Neperformance of the work for which this permit is issued. ywarke"Ccoopeasame Ins. ruecarrier and Policy number art: Is I +76:,/=UN� Policy N9.QVI Z9 W . CERTIFICATE OF EXEMPnp� GM WORKERS' COMPENSATIONI ANCE mname,icm need nothecomphned if the permit is fm one hundred dollars (1100) or less.) I certify that in the performance or the work for which this permit is issued, 1 shall not employ any person in any manner an az to become subject o flat, Workers Compensation Laws or California. Data Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject m the Worker's Compensation provision of the labor Code, you must ' foMwith comply with such provisions or Nis permit shall W dcemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction [ending agency for the Performance of ' the work for which this permit is issued (Sea 3097, Civ, C.) Leader's Nauru Lenders Address _ j 1 certify that 1 have mad this application and state that the above information is + cones l agree to comply with all City and county ominences and suite laws relating to building concoction. and hereby authorize represcromins of this city in enter upon the above-menlioned pumurty for inspection purposes - (We) agree to save, indemnify and keep harmless the City of Cupertino against j limAlinex.judgmcroscams and experses which may m my wayaccmc againstsaid City inconsequencepct of the this mit. + APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURC . GULpE ATI. l -roofs f Type of Roof /Re .t/TfAp,lje gnu a ApplicanVContrscmr �ae HAZARDOUS MATERIALS DISCLOSURE Will the or future building occupant stem or handle ha�ou¢ material deRSee by a Cupertino Cupertino Municipal Code, Chapter 9.12, and the Health and Safely CoJc, Sccdon 25532(x)? Seeman ❑Ya E3 10. All roofs shall be ins ectad prior to an roofing material beim P P� Y g g installed. Will the applicant or once, Wilding attupant use equipment or devices which Lit If a roof is installed without first obtaining an agree to remove inspection, I P hanrdous air com mommas az defined by the Bay Area Air Quality Management all new materials for inspection. Diurin7 ❑Yes l(/ I have mad the havard,ws materials rcquim ardaunderChapter6.95oftWCalifs- ,isHealth&Safety Cade, Secdoa 25505, 25533 and 25534.1 underhand that iftM Wilding docs not cmrendy have a emus. that it 4 my responsibility an notify the occupant of m req ins ¢which nun be me, 'dormitmana of a Cemifiae of Oceepancy. Signature of Applicant Date _ _ z . ELI— All roof coverings to be Class "B'+ or better O r or amhori'mol agcm �,] Date w. I MY OF CUPEkTINO Assessor's Parcel Number: Name of owner.�'MR `h rn RS, G� V, S F}L 4,V t f- k fR M A ,J] Project address. //- q s t} S T -E G2 I - A iL1 E C U?C- (R T I ND Contact person -I To Phone n - Fax. Net square footage of lot. Existine Square footage: First floor:.. Second floor: _ Garage: TOTAL: MEET Proposed 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? On what floor(s) is work being done? Brief description of work. � Me -6L ,t., rye tJFT ALL AoeS Fo CCViPcy wt rW CEDES. Code editions: 2001 CBC (Y - N)2001 CFC (Y - N)2001 CMC. . (Y- N) 2001 CPC (Y - N)2001 NEC (Y - N) Effective 11/1/02 19 CITY OF CUPERTINO (W-PARTMENT Plan Review Process Work Book Page -8-Revised 4/28/04 ' From Plonnin 1BATHRCJM & ��ITCHEN �� , 26, • �EMODELERS (41 I 1 � ULI sign to Detailed & Quality Craftmunship ense No. 698718 HIC Ave., #204 • San Jose, CA 95125 1-9700 • Fax: (408) 360-9797 I I DF I I IN f - - _.. APP �� V�i✓T7r(. ��. rCSsQO If -C \.._.._�.9' L.�/ W�.T l t -; r IN-ACCOR AN "��T�'� E -y--� - — ---- -- - Dr r - _ 1Lr_ I I I - -- -F - and Wb MUST Bd k pt on the at d itm8 �_ 2 fr c rz r�� t, make any -C99 r1% stam m f bis- 'plat En8 J nartment Cdy of -- - .--r i--- P✓t _j-1 v,�c e- 1LN Ca440T9o he tWd_to_0=a?SD.fs� [C4x2A___ ... VA L ✓ e C r;rov_al of the vroldOn Of aM IGI i y I I r State — -_'7 - I j__ �7/a 7 Ti I I UR . � I I - I i �io� I -- i • I � __T ._ �`„�J /i�'i l._. /sem / /� C� ✓c'_ �/J.t11 I A210 1 ' - I I I - .• . r y )ng�. A" -6 s 6,6zzJ��a Ll Sly K- e; of d� W/° llBk d!g WS OsQ4°ul.k,�Y lob91 F sd a�, envy BM�St •/ /m'r9 010, hs/d 10/71? wine U/oho? o` is :a°Y oot �p fO l hO°s ZIA CITY OF CUPERTINO r` L *ITY OF CUPERTINO 0 PERMIT APPLICATION FORM N # i S Date: 6/O3 I BAPPLOTHER ilding Address: Maung Address (if different from building address): MECHANICAL Owner's Name: one #: 14.a8 973- /3a3 n a or: Lice se #: G N8 74 F (bd/ > oa onta t: Phone:Co ) 36p, Plop Cupertino Business License#: m— Fax:(�yb�f Abp MECHANICAL Building Permit Info: Bldg ❑ Elect ❑ Plumb Mech ❑ Job Description: Resi ¢. Commercial ❑ .Ft. Floor Arta: $/Sq.Ft.: Cos;�f Pr�� :�I / i%nstruction. Occupancy Group: T Please check this box ► project s a 4i second-storyaddition: ❑ ro'ect Size: Standard Large ❑ Major ❑ Hotel and Motel 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 1 M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler>1.75MBtu 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 Cl 1 of 3 J, CITY OF CUPEIiaTINO WITY OF CUPERTINO* PERMIT APPLICATION FORM Quanti 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 Inspection Overtime BUILDING BPBACKFLOW Atmospheric 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 Cbeck 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 > 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 Rept], Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO *CITY OF CUPERTIN40 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 Inection 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 MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG J. Address Change BUILDING 3 of 3 • • Loa �R DMc €� �Sma ;aU +Ot; pM 0z z 0 a>_ Jz U_O OF U Fy U CITY OF CUPERTINO a;°�+ �' �•` -' - BUILDING DIVISION PERMIT ucoNTRACTOR INFURMM�TION- 3�2,u..-'.. PWNBU1,1.DING ADDRESS: CALIFORNIA BATHROOM REMODEPmt §NO04060233 ER'S NAME: PERMIT ISSUE DATE GARY & SALLY LEHRMAN 783 REGENT PARK nR nrL29/20n4 NE: SANITARY NO. CONTROL N0. 4083609706 ARCHITELT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 LICENSED CONTRACTOR'S DECLARATION Chapter Y Job DOSCTIptIOn I Mmby affirm Nal I am licensed under provisions Of (commencing with SCOM oivisi✓ on3oftheBusin!s W,PmfcuiumCade.andmylicenseis RELACE BATH FIXTURE/.ELECT[PON ��IL �® Li n rss Lic. p ll—'9Gt,�� _t.bL�1,l _ Ount ARCHITECTS DEC spmordsIundclwnJ my SEP 2004 planssM1illbeuseJa Licensed Professional OWNER -BUILDER DECLARATION I henhy. Nm 1 em exempt from the Conlna taw for the BUILDING Co s: Any c Sec cssiom Cods: Any city or county following reason. (Section 9831.5,Business and improve. nr .,.it any, awctum alar. Sol which requires a Permit In C.chew formen the n Perlia that wits issuance. also mqo the sheapplicant for suchpermit sacrile a,Law statement Licenselaw(Chapur9 Sq. Ft. Floor Area Valuation (comma cingwdpuuuam7000)ofDivisio 3the the (commencing with Section 70W) of Division 3 of fire Business and Profesioe Code) of Nal M1c is exempt Ncmfrom and the baso for the illcgcd Gumption. Any violation of Section 7031.5 by my applicant for a permit ubjects the appliCWL to a Civil penalty of 3 6*242iliffithet0 0 Occupancy Type P Y not mote Nan five hundred dollars ($500). YP 1. far owner of Ne property, or my employees with wagers their sole comhroad it, will do the work. and NesumN ctum is not unclad or offered for We (Sec. Mad. Business Required Inspections and Profcsfamns Code: The Contraetur's License law does not apply w an owner or property who WiIdsorimproves Lemon, and who doessuch workhimseIforthrough his Own employees, provided Nm such improvementsam not intended oroffered hermit. If. h.Cm,. the building or improvement is sold with. 0. year of rompl)tion, Ne owhoo, builder will have Ru burden of proving that he did not build or improve, for purpose of sale.). ❑ h as owner of the property, em exclusively contracting with licensed ronuuwn to consumer the project (Sec. 7044, Business and Professions Code:) The Can"Cloff Li. come law docs not apply to an owner of property who Wilds or impmms Nemon, and . who concocts for such projects with a com acwKs) licensed pursuant of the Contramofa License Law. 1 am exempt under Sec. B & P C for Nis won Owns Dau WORKER'S COMPENSATION DECLARATION 1 hereby of con under penalty of perjury arc of the following declantimu: I have and will maintain a Certificate of Consent to self -inseam for Workm cr't Comp) noon. u provided for by Section 3700 of the Labor Code. for Ne perfonnarue of the weak for which Nis permit is issued. ❑ 1 have and will maintain Workcr's Compensation Insurance, az requimd by Section 371 oft) laWr Code, for Ne performance of Ne work forwhich Nis Permit is issued. y Workers Compensatia Ins u artier and Policy number are: Policy NOQQ12998' ., CERTIFICATE OF EXEMPI7Q[�j 9M, WORKERS' COMPENSATIONI ANCE Mutt it. need not PC completed if the Per mit is for ane hunted dollars(SI M or loss) I certify that in the performance of the work for which this Permit In issued, l still not employ any person in any manner u u in become subject in 0W Worions Compensation ' lawsof C.ffi min. Date Applicant NOTICE TO APPLICANT: IL ager making this Cenificate of Exemption, you abmw become subject no the Worker's Compensation provisions of Nc labor Code, you must forthwith comply with such powaiors or this pmmi0 m.11 W dc)mcd revoke. CONSTRUCTION LENDING AGENCY I hereby affirm Net then is a construction lending agency for the Performance of the, .,it for which this permit Is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Addmas I cenify Net I lues read this application and sum Nat that mass i.f xtro tion is carve)) I agree to comply with all city and county ordinances and sum laws relating to building Construction, and hereby authame reprcunutive Of this city 0o enter upon theaton Pur s (We) agree to save, imh moi ry and kap harmless the City of Cupertino against ertypad liabilities, judgments, costs and expenses which may in any way accrue against said City Sof m in Con equenceo the in this of the padding Of this permit. ermit. PLICAace APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NNL ON -P in SOURC GULATIONS. Applrc �u Issued by: Date V Re -roofs e eZ o HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding occupant stare or handle harm ours material defined by lie Cupeninu Municipal Code. Chap cr 9.13, and tM Health and Safety Code. Section 15532(a)? ED Y. t9� All roofs shall be inspected nor to an roofing material bei. P P Y g g installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove It havardout air Commii.a.0 .d red by IW Bay Amo Air Quality Management all new materials for inspection. Diuricl? ❑Yes u I have hand the hv:relousmamrialsmquimments underCltap erb.95 Of Jm Califor- .isHell&Sammy Cade, Sodom 15505.25533 and 75534.1 undemund Natifthc Wilding does not Commit, it, bast a W..L that it is my map nobility m notify du occupant Of Nc hagi ma whichrm3Lbemelprior70kssuanecofaCertirmaut (Oc Signature of Applicant Date 0 All roof coverings to be Class "B" or better P*rk2 r of automed agent Date