03080124 CITY OF CUPERTINO ' *r``^ ,p?-•rtAS'nr ' -` r
BUILDINGDIVISION PERMIT CONTRAC�`TnMF0RMATI0N A'
,»� . rte•� � .?z #�
BUILDING ADDRESS: AMERICAN BATH IND, INC PERMIT No 03080124
944c; (-TTPPPTTNr) RD 4 41
OWNER'S NAME: 30987 SAN BENITO ST. . PERMIT ISSUE DATE
SUNNY VTRW MANOR nR /?I; /2i)n-A
NE' (510) 475-8200 SANITARY NO, CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB M[CH
0 0 0 0
100 LICENSED CONTRACTOR'S DECLARATION
IC ' I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
U with Section 701rt))of Division 3aflhe BusineuuMPmfesdam Code,and mylicenacis
n m full tape and effect. REPLACE TUB TO. SHOWER
a J� License ClassLk.0
Dow Contractor
ARCHITECT'S DECLARATION
f 1 undersand my'Unsalted Mused as public records SEP 2 2003
)yu
c tad Lixtead Professional
-HS OWNER-BUILDER DECLARATION
BUILDING
q I hereby affirm N 1 am exempt from the Convenor's License Law for IM
00 fallowing mason.(Section 71131.3,Business and PmfeCtion Cade:Any city ar county
3$ which requires a Permit in Canaria,altar,improve,demolish,or repair any someone
prior to its issuance,also mquins the applicant forsuch Permit to file a signed sutcmcat
22s�s< that be is licensed pursuant to Ne provisions of the Contractors License Law(Chapter 9 Sq.Ft. Floor Area Valuation
2F� (commencing with section 7")of Division 3 of the Business and Profession.Crude)or
Net he is'exerept tMmfrom and Ne basis for the alleged sump fart.Any violation of 32615013 . 00
Section 7031.5 by airy applicant fon Permit subjects the epplicantto a civil penalty of APN Number Occupancy Type
not more Nan five hundred dollar.($500).
1,as or of the property,ear my emplayces with wages as door sale Compensation,
will do Ne work and theatractup Is not intended or offered fonele(S.C.7W,Business — d Inspections
end Prefessm a Code:The Contrumrs License Law does not apply to an owner of 10 2 - PIERS IERS P
property who builds or improves themon.and who,oc.such work Interaction through his
own employees,provided Net such improvements are not Intended or offered for mle.If. 103 — UFER
however,Ne building or improvement Is veld within one year of completion.the owner.
builder will have the burden of proving that he did not baud of improve for purpose of 104 — REBAR
'1c'' 105 - ANCHOR BOLTS
kruownerofthe Property,am unwind convening wile:)The
eCeontruwasi- 106 - SEWER & WATER
c nswcnbe projec Sec.70W,Business and Pmfeasiom Coda)The Convector',Li-
ceMelawdoesn applyt nowner ofpmpanywho Wilds orimproo ,wambo,and. 202 - UNDERFLOOR PLUMBING
whoconwctsfor chpmj Uwithaconvanor(Qlicemedpunuanttothe Conv¢toes
Lkense L.w. 203 - UNDERFLOOR MECHANICAL
❑Iota esempt S .B&PCror this an 204 - UNDERFLOOR FRAME
o ate Z� 1� 205 - UNDERFLOOR INSULATION
OR 'S COMPENSATION DEC TION
IMreby affirm under Knotty of Perjury ane alum following deelanOm S: 301 — ROUGH PLUMBING
I have anti will maintain a Cenifiam of Conant to ulr-insure for Worker's Camper. 302 — TUB & OR SHOWER
minor,as provided for by Section 3700 of IM labor Cade,for the performance or the 303 - ROUGH MECHANICAL
work for which this permit is Iniad. 304 - ROUGH ELECTRICAL
❑I haw end will maintain Workers Compewtnn
ion htsuce,as respired by Section
37Wofthe Labor Coca.for MepoformanceorMework for which this pcmilisissued. 305 - FRAME
My Workers Compensation Insurance terrier and Policy number art: 306 — HOLDOWNS
Cartier: Policy No.:
CERTIFICATE OF EKEMPI'ION FROM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
(This section uad not the completed if the Permit Is far one hundred dollars IS 100) 309 - EXTERIOR LATH
tae"`)certify Net in aO performance of the work for which thin permit is issued.l shall not 310 - INTERIOR LATH
employ
Lawsoenyperson i Data manneranaswbecome wbjecl mlM warten'Compcnmtion 311 — SCRATCH COAT
Law.ca Celifomie.Daa 313 - ROOF NAIL
ApPlicanl
NOTICE TOAPPLICANT:IL after making this Ccaificatc of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject m the Worker,ComPemation provisions of the Labor Code,you must
�2 rorthwithComply with sochprovisions urOf,Permit Aillbe Warned!pwkatl. 502 - FINAL PLUMBING ENERGY
z 0 CONSTRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY
FE` Ithereby trim Oat them isacomtrunionlending agency for theperformanceof '504 — FINAL BUILDING ENERGY
FG> the work for which this Penni,Is imued(so.3097,Civ.CA
04p Lemice.Awe 505 - FINAL ELECTRICAL /[�
Z)Z L ndersadde, 506 - GAS TEST /vJ R-
U O 1 cenify that 1 haw read this application too mm that the above information is 507 - FINAL PLUMBING
D. F correct.I agree m comply with all city and county ordinances and state laws plating to
O U Wilding construction,and hereby authorim tripmeatmativas ofthis city R,Omar upon Me, FIN MEC CAL
[27 above. nntianed pmpeny for inspection publicists.
(WO).ge_<5
ree o tape.indemnify and keep harmless the City of Cupeni.against 09 FI
req Ilabi ,Iudgmo .ensu and expenses which may in any wayaccme,gehutmidCity 5 NG
ire eequenec o'the granting of this Permit.
^ AP LICAN7 U RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 C WORKS Date
S RCE REOkIL 0
I 63 Re-roofs
Sig tar ofA icaroUComncmr Dal.
HAZARDOUS MATERIALS DISCLO E Type of Roof
III
the applicant or future building Occupant nom or handle harardout must
as Bncd by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
Code.Section25532(.)7 . All roofs shall be inspected prior to any roofing material being installed.
❑Yallo
will the applicam or future building occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
It h.zardnes air contsmimans as defined by the Bay Area Air Quality Management all new materials for inspection.
Rine"
❑Yes �No
I haw the lueardmiss materials requiremenuundk,Chaper6.93afacCalifor-
niaHeaiadr ray ode, trns 23N)5.25533 and 25534.1 undenaand thin ftbe MiWing
does not cu dy eve ,ere Met it u my nespandMility In redly theqOcup n,of Me
ppitrcmcn hic in be taimimiceofecenificatao6occah Signatu re of Applicant Date
Cir
0 rauth.nO.dagcm •✓JV�G' Dataf OI All roof coverings to be Class "B"or better
. Ca
CITY OF CUPERTINO.
GUP TYOF O PERMIT APPLICATION FORM
PN# 34 G,, r3 O Date:
Building Address: Mailing Address (if different from building address):
go 4W
Owner's Name: Phone#:
SLItiN V1 Ez✓ MJ A✓b Y,>9 2l'3 Y 3
Contractor: License#:
.u�iu cam 3.4r�
Contact: Phone: yo9 2S3-V)ejc Cupertino Business License#:
U N Z L/7T Fax:
Building Permit Info:
Bld El ctPl Me ❑
Job esc 'ption: t4NI
Residential El 0 41rd (2,I��,t00 0-( u - 1 << Cotmmerci
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project Occupancy Group:
Type of Construction: Please check this box if the project is a
zo/J�2
second-story addition: ❑
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
BELE 200 Elec Svcs 600V<= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
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CITY OF CUPERTINO
CUPEf�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
BNUCONDAE New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
13PCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees' BUILDING
BPFIXTURE PbIg 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 Pie PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfin MECHANICAL
BREMAIRHAN A/C Units<= 10,000 cf n 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
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CITY OF CUPERTINO
CUP TYOF O PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL
BREMSIGNS Remodel Sips, 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 Insection 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 Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
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