03100058 CITY OF CUPERTINO � '� `� •!
BUILDING DIVISION PERMIT CQNTItACTnR INFORMATION
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BUILDING ADDRESS: AMERICAN BATH IND, INC PERMIT No.03100058
a OWNER'S NAME: 30987 SAN BENITO ST. . PERMITISUEDATE
SUNNY VIEW MANOR
NE: (510) 475-8200 SANITARY NO. CONTROL N0,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
log LICENSED CONTRACTOR'S DECLARATION '
idF1 hereby affirmNat 1 am littnud under provisions of CTopnr 9(commencing Job Description
with SCcflon 70fA))of Division
inBNmreaanUerr L 7 of the Businessand Professions Cock.arW my license b rd REPLACE TUB TO SHOWER
r$Z License Clans Lk.N /
Data TS DEC
3
ARCHITECTS DECLARATION
is Iundaraland my plans
shall the used as public records
'0 Licensed Professional ,e1
OWNER-BUILDER DECLARATION
g I masaereby annum um 11. cacmpl from the Contractors o ;Any cense taw for IN
.D D following union.(Section 7 coon.Business and Rofmxinm Cade;Any city s county
$ whichitsissrequires a Permit to cnmWat.elnC Improve,h permits fi repair any auvauu
pda that he isiensedprsu,quires lhcapp Wof for uchpermiuu0ense Law
w(Cha mem
s O (commencingudpunlion7 )ofDivioion3of eBusContrinssancanuLaw(Coulk)9 Sq. Ft. Floor Area Valuation
i�
(commencing is cacwith Section IOW)the Division offhceueexeandon.Any
Code)Ar
$ Net he u cacmpl thertfrom and the bun for the alleged exemption.Any violation of 32615013 . 0
Section 7031.5 by any applicant for a permit subjects the applicanto a civil penally of AIAN Number Occupancy Type
mat an=than row hundred dollars($500).
0 1,As owner or the property,or my employees with wages As their sole compensation,
will do Ne work,and Neswctun is not intended or offend per sale(See 1014.Business 101 - p1{pd Inspections
and Professions Cade The Convectors License law does not apply to An Owner Of P
propcny who builds orimprom thereon,and who doessuch work himselforthrough his 102 — PIERS
own employees.provided 011H such Improvements Are not intended Cropland forule.If. 103 - UFER
however,the building or improvement is sold within one you of completion,the owner.
builder will have the burden of proving that he did not build or improve for purpose or 104 - REBAR
1i C') 105 - ANCHOR BOLTS
'I.as owner Maj
a pnpeny m esdmivdy convacli as with )licensed Contractor's Li.
m
omwm de proj cl(See.T Bminess and Profcvions Code:)TN Cwteunri Li. l06 — SEWER & WATER
terse law does Iapply loo nerorpmpeny whabuadsor improm thereon.and. 202 - UNDERFLOOR PLUMBING
whocontmcufor uc lrojec iNac0nvenor(q it, so 0.
rL1.da Canuacta/s
Licenan Law 203 - UNDERFLOOR MECHANICAL
❑Ism cm tun Sec. .B k P C far this noon 204 - UNDERFLOOR FRAME
Owner WORKERS C PENSA ECLA,RATION 205 - UNDERFLOOR INSULATION
1 hereby affrrtn under penally of perjury one of the fallowing declarations: 3 01 - ROUGH PLUMBING
I haw and will maintain a Ccrdliican of Consent to self-Usuu for worker's Compton. 302 - TUB & OR SHOWER
73700.fdm
on,u provided for by Section 3700 of the Labor Code,for the performance of the 303 - ROUGH MECHANICAL
rk for which this permit is issued.
flow and will maintain Workers Compensation Imuran,u required by Section 304 - ROUGH ELECTRICAL
labor Code,far Ne performance ofNe work for which this permit is issued. 305 - FRAME
Workers Compensation Insurance envier and Policy number an: 306 - HOLDOWNS
rtier: CERTIFICATE OF REMPTIOIV FROM WORKERS' 307 - INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
(Ibis tactics, ad not N completed if the permit is for one hundred dollars(5100) 309 - EXTERIOR LATH
ter leas.)
I certify that In the performanco of the work for which this permit is issued.I shall not 310 - INTERIOR LATH
employ any person In my manner an As On Ncome subject to IN Woskari Compensation 311 - SCRATCH COAT
Lawsorcalimrm..Data
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT.If.After making this COniEate of Eaempflon,you should 501 - FINAL ELECTRICAL ENERGY
become subject u the Worker's Compensetion previsions of IN Labor Cade,you must
�z forthwith comply with saehprovisions Crthis permit&haRlcdeemed mvelmd. 502 - FINAL PLUMBING ENERGY
M CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I Nreby Affirm dot dere isa construction lending agency for de performan of 504 - FINAL BUILDING ENERGY
3i r�.r the work for which this pemit is issued(Sec.7097,Civ.C.)
z]Q Landers Name 505 - FINAL ELECTRICAL
?
z Lenders Add. 506 - GAS TEST
J p 1 cenify that I have read this application and sun that the above Information is 507 - FINAL PLUMBING
icorrect.I agree to comply with all city and county ordinances and state laws totaling to
Ubuilding conkroction.an herebyaunhorimrepnuntatimofthis city toOmer upon de FIN MEC CAL
4 above-men ed prole for inspection puryosea
L (W arts to u indemnify and keep harmless the City of Cupertino against 0 9 FI
rq liabilities, enu.co aMdaaparnsacs which may in any way accrue against said City S NG
;)7 in conseq c of the gr ling of Ibis permit.
'^• APPLIC NDERS NDS AND WIL MPLY WITH AL POINT Issued by:55% C WORKS Date A",r
SOURC R LATI S. 'i-^'I\/
Re-roofs
Signartul olWmanuConulkion 1 Claw
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle havudous material
as defined by the CupeninnMu pal Code.Chapter 9.12,and the Health and Safety
C
ode.Section 25532A)?� All roofs shall be inspected prior to any roofing material being installed.
Y. Nu
Will the applicant or future building ocsupanl use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
Ir
WUMn s air contaminants efined by the Bay Area Air Quality Management all new materials for inspection.
❑Y o
Lha the hm materials requirements under Chapter 6.95 or the Califon
nit HealthI arm Code. 25505,27533uW2553e.ludcrsuMth if de building
does not cu fly aw a un 'I' re ihility n notify the up I of the -
requiremcns hic moslNm tpn rur's�Ceni0cauyf(�cu �� Signature of Applicant Dale
Owner ora nand Agent Il tau D n All roof coverings to be Class"B" or better
C CITY OF CUPERTINO 03
CITY° PERMIT APPLICATION FORM
CUPERTINO
PN# DY Q
Building Address: Mailing Address (if diff(rentm building address):
22 `/ / S� CL, PeycT7i-U itO L t�n7-(o J /C-
Owner's Name: Phone#:
S �-j Y O t E="2,.i Yus
Contractor: License#:
it A,max(C. Arj ;} Afk-�
Contact: Phone: Cupertino Business License#: .
'-fv& 15-3-Y300 Fax:
Buil ' ermit Info:
Id Elect Pum Mech
Job Des ion: f _
tial ❑ I 7 Commercial El
Sq.Ft. Floor ea: $/Sq.Ft.:
Cost of P oject* j �6 Occupancy Group:
Type of onstruction: Please check this liproject is a
C o,v icS/U -/ o ^ (,,4> Tz, f, a second-story addition: ❑
,J
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to IM Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILERS 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<= I OOOA ELECTRICAL
BELEC1001 Elec 600V > IOOOA 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
z3CH9
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(C CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee 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
BNUCOMME 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
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 Repipe Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo 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 cfrn MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Ligbting LightingFixtures ELECTRICAL
BREMFURN Relocation of Fumace MECHANICAL
BREMFURNOV Relo Fumace> 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
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aftmz-o: CITY OF CUPERTINO
PERMIT APPLICATION FORM
CUPE(�TINO
Quantity Fee 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 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 Inspection 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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