02060107 (2) OF
CI BUILDING DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22340 CUPERTINO RD CALIFORNIA BATHROOM REMO ELERS 02060107
owl NAME: APPLICATION SUB DATE
NEN & JUDITA AGULIAN 783 REGENT PARK DR 06/18/2002
PHONE: SANITARY NO. CONTROL NO.
4083609706
n O O L
ARCHmiC`UENGINEER: BUILDING PERMIT INTO
z w BLDG ELECT PLUMB MECH
o zy" LICENSED CONTRACTOR'S DECLARATION
y o 1 o=re y ercrrm that I am licensed under provisions of q-^.S'k� Job Description
p.n L:- wimsa6 ooB)nrDivis' n3pnne aaaineaa aQJ Pmr<safons cnaBATHROOM REMODELING
an.n Tour ane erc<n. .�`� /Li o C .` Lic.M XJF 'Atm ComrenSARCHITECTS DEC ATIONd2y 1 unaemand my plans shall be uud as public recordsd AUGq
w m p C Licensed Professional Ii V 1 2 ZO OZ
n'6 OWNER-BUILDER DECLARATION
I hereby affirm mar 1 am exempt from the Conuacmr's License Law for the
following reason.(Section 703 1.5.Business artd Pm(<xsions Code.:Any city or county BUILDING
$15000
Y which requites a Permit construct.alter,improve,demolish,or repair any sauu ,
ad 3x C .prior m its issuance,also rem quires the applicant for such petmlt to file a signed statement.
thsth<iylittnSed PunuPnttyyahe Povistotls of the Commuters License Law(Chapter 9 .. ♦ r earY 1 Valuation
(commencap mh Sc-hop,olibli fDi.vision J of the Busine{spnd Professions Code) i.SJ�1.i�3'2'§°b't�b,- s 1J 1a.1'),l�f'I�.t.): s ,
or ma�he Ik eicmpr tnerefrnm and the basis for the allEgcii ekempdrai.Any viclation - t
of Section 703 IS by any applicant for a permit subjects the applicant to a civil Penalty-
of not room than rive hundred dollars(S500). 10 l APNP�YP.I1tlUATI ON i'=.R?rr-'-- Occupancy Type
❑1 r he p p nY my ployccs with wages as thin,vole pen i n. 102 - P T F.Rq ;
-
will do can o k:and the votheme is nor intended Or Offered for sal (S ]DU- ---'— ---- -
'Bu .and Pfufessp Cal Th Contractor's License La does t apply t 103 - UFER Required Inspections) B D.1 -
owner of PuTeny Who builds or mproves hereon and who dos such work himself 104 - REBAR
or though his own however,d provided that such improvements arc not intended a _
6ffetcd"for"sale:owner-bolder
Der,dr,will
building er urden o'f proving
n sold within and ydu of --- -""-- - - —'----------------- ---- - --
4nmPlafnn,meown<r-nnmerwmnave me hardennrprnvine mm he die not nndd nr 105 �- ANCHOR BOLTS � .i
improve for purpose or sola). 106 - SEWER & WATER -
oi, ow«erg na-�:amex<m.i lr=nti - - -- 202—=-'UNDERFLOOR-PLUMB ING - ;cu—ir-:i=:-r;ii. +; -_.___.- ..
ce Y B with licensed cmGjtbd..to
- %i«oxw.doesno,a"i]m'anewallofand
whinnsildsm rprovehe mm<tnrd 203 - UNDERFLOOR MECHANICAL�:'.`::I
:. PPY Propertywhobuildstrd.pumusthto the
and-who coLicerveL such proiccis-rite a,coatrecmr(s)licensed.parsnam m.Ne...___.____._204_._-._.UNDERFLOOR--FRAME--___._________.._..._..-_..__. ....__.�._.._._....._
0 1ttmasis License Law.
❑lam en=mV•t uriadr sect" "'1 , ",B&P C for this rtaeon 205 - UNDERFLOOR01I�NSULATSON
owner lime''-' n " : 301 - ROUGH PLUMBING
- 1 hereby WORKER'S COMPENSATION DECLARATION
affirm underpah r ` 302 - TUB & OR SHOWER
np ogeor,mgrnnnwingde=lamdnn::- 303 - ROUGH MECHANICAL
❑ I have and will maintain'a'CertificateofConsent io'self mance rot Worker's
304 - ROUGH ELECTRICAL
4_ Z Compensation; as; pmvidW for-by smian-3]00 of me Labor Code. for the
perfnrmam«nim=wn,k rnr wmm�rota Perron is cran=e. 305 - FRAME
❑Ill �e 'Iain ta wdm C ' rte 1 n as rcq ad by section 306 - HOLDOWNS
3700 of in Lnv Cod f m peri rte f me work r Which this perurit is 307 - INSULATION
iss d eMy Worker's C mce i Inaum c� T 'nit Policy tolls e '
am,S)'4�t'�M�rr �•tPol c�' 2z�i of tl 100129' 17,ff.*
CERTIFICATION OF EXEMPTION FROM WORKERS k.,<t1 .3 0 9: _q)EXTERPORS.yIHTH ,
310 -,,- INTE
'` (Th s -i 5i n<ed not be completed rm<cern t is fnr one hundrcJ annars --�
313 '--ROOF
COAT
COMPENSATION INSURANCE
li t
1 nfyml m - - a� _ -NAIL -._: ___. .-.
per as rte rkr note. pennt 501 - FINAL ELECTRICAL ENERGl
•W II a
Or PI Y Y M to yL rye/� t t Illi W rk rs' -�' '
Comce t jtaw;gG¢1 f rtes qaf/ b/ Y f 'L
=--FINAL. PLUMBING..ENERGY. _._.... -.
NOTIC� PPLICANT It r Taking 2 ----
ion Certificate pin you should - 503 - FINAL MECHANICAL"ENERGY
Z become s bj cai the Wok Comps ation provisions of m Lobo Cad you mol -
O fhnn to oro lywhn hp i.nm.ao m pe thallbeaee m mmd. 504 - FINAL.,_BUILDING_ENERGY_
Z p
CONSTRUCT] LENDING AGENCY -.1
.j' 505 - FINAL ELECTRICAL
1 hereby rcrm rh t the omnionction lending age cy for me cerfonnanc< I r t
'i aam pName
n<nt-1" t . ..t cl 506 - GAS TEST '
D'Z Lena r Add, -
507 -----FINAL PLUMBING - ---
V - tl certify that 1 have read this application and state that the above in mountion is 508 - FINAL MECHP.NI CAL'i"
W eE. coriect:I agree to=ompy with all city and county ordinances and state laws relining 509 - FINAL GRADE
mbu ld grnn--to andh by authr 'pr<.e it es fth -yt enter upon
y nb b e et -p,p peri i p p p 510 - FINAL PLANNING
Es,1 (w( b to vote:indemnify indkeep harml. daeCtY TC pen `tea 'nst
t/) liabilities.judgment,< a a psmaes which may any y « gine, is 514 - FINAL UBL C WORKS
U City seg c ce of th 6 t g of ill p 't } /
APPLICANT UNDE STANDS A11 m.ndi-nandconND WILL MM PLY WITH ALC\OM1 POMi'9 Issued by:0 BJ
Datealum or
HAZARDOUS MATERIALS DISCLOSURE Mde Re-roofs
Nll the ppl camofumre bu'Id'hg ac<up t".In handle usmt 1 .,-.Type of Roof .
u def dby theC pen Municipal Cc, Ch Pt .912 and t a hh ands I ry - ^-�• •. -^^--------- -- ---�
Cdde 5 a 2533.(a) 3 r t •, s f s? S ) 'Yf ♦ r �- r 'C. t!I' (I'I- -`•
❑Ya s Y �,Iqo F ski ('t �.s.�_ • 4 .t - 3 S lx 'E�t,i N 1`t..i'14� Y,
,_„ All roofs sball be inspected prior to any roofing.material being Installed. _
W 11th applicant future b 'IJ gOccupant_ nseequp 1 or devices which If a roof is insialled without first obtaining an inspection; pagri remove
cal t h and e r cone ¢ni dcOned by'he Bay Am.A O 1 iy M...g cot
Mound, all new materials for inspection._ Applicant understands and will com I with
l _ ' 1. pP p,y _
oY all non=poinCsource regulations ...f.
I he rwJ itis hemotions materials requirements under Chapter 6.95 of the
Cal toms Hcahh&'Safety C.dn:Silti.nl 25505:25533 and 25534 1 understand that
-tf dm bm[diug docs n urrently have a tenant,that it is my responsibility to notify the -' - ---- '- -
o'n.la nt or m rt 'h must be nib.ptioi w usoxnce of a Ccnificate f
Occupancy.'" •. v
`Signature of Applicant Date
" tin ea, m All roof coverings to be Class "B"oe better '
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