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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
,CONTRA-C�'TnRx,NFO.�tMt1TI(J:1V,.
BUILDING ADDRESS:
BADGER CONSTRUCITON
""'06040082
OWNER'S NAME:
PERMIT IESUE DATE
ROB & LAURA TSUK
300 RIVERSIDE
SANITARY NO. CONTROL NO.
831)336-1778
ARCHITECTIENGINEER: a
BUILDING PERMIT INFO
BLDG o "0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 bunchy &firm that 1 am thousand under provisions of Chapter 9 (commencing
with Section 701%) of Division 3 of Me Bus race sed Prarcuium Cade, and my license is
infullro and from 7
BATHROOM REMODEL, NO RELOCATING OF FIXTURES
License , Lm.g
Dam - - CommamNONralm-STRUCTURAL
A CHITECrS DEC" ATI N
1 understand my plam Nall he used u public tench
Licensed Pmfamm al
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from Ne CmuenoYs License law far the
following mason. (Section 703 LS. Business and Pmfcatium Code: My city or aunty
which mquires a permit m ennsweL altar, improve, demnlim, a repair any suunue
prior W its issuance, also requires Ne applicant for each permit to Ole aslgneA nammem
Sq. Ft. Floor Area
Valua*6500
that he is licensed Pursuant as Me provisionof Ne Connector's L3onse Law (chapter 9
(commencing with Section HIM) a Division 3 of the Business and Professions Code) or
AndM k so mpt Nmefraro and the hear fm the WegW esemp0on. My Halation of
APN Number
Occupancy Type
Section 7031.5 by any applicam for a permit subjects Ne applicant m a civil penalty of
and, moa Am aw hundred dollars (SM
32641068.00
❑ I,uawaa drum property,'myeroploym with cagesu Meh sole comppwtiro,
e ns
Required cations
dne
dforo(Sx.7044,Buss
willdothewarLandtheincomismaintmandoroneesal
and Pmrevianf carie: The ComaecWh Llama law doer ant apply to an owner ter
q P
property who buildamimprows Hereon, and whodassuch work himse forNeagh his
ownemplaym,provided dolsuchimproaemmtteene ear cdcmlated for axle U.
hawevea. the buildingde rmpmvemtm timid withal one year of completion, the owner.
builder will have Ne Nudes of proving that he did rat bW m or improve for purpose of
'�j
Ads.).
❑ 1, as owner or ct Sec.70interparty. . B Inesiwly cmuxMng with ) Tim Canuacme U.
connect Ne project (See. rope Profuolom Cade:) pr Coosa LI-
'1
p�
son.
cepa Law dm notapplyje ts owe of proper( who m Improves theean, and,
n an owner of
sed P
who for such Projects with a conlncmrtU licensed Dumuanl W Na Conuxmrs
m Lath
License law.
❑lam uempt under Be, .6 A PCfar N4 rasion
O
l�
Owner Data
WORKERS COMPENSATION DECLARATION
1 bceby affirm under penalty of Injury one of the following declarations
SA
NITARy
l hare and will ammudo aCemficam of Come[ W self -Insure far Workers Compm-
sed rn, a provided fa by Section 37M of the Labor Code. far de performarmca of rise
work for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Inver', as required by Section
37M of the labs Cade, for the performance of the weak for which his permit is issued
My Workers Conspentstion Insurexe artier and Policy number are; �j 1111
coma: 5'r`TTE FL)mD Policy No.: I�9 l`ilda / -0T
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
emu mita need notbecanPkmd i(the pewit Is fmonc hundeddallan ($I00)
or Ion.)
I certify Mut in the perforromed of As wart fa which this permit is traded, l Nall am
employ any person in any manners' as W become subject to Ne Worker' Compensation
Law% of Glifomia. Dam
Applicant
NOTICE TO APPLICANT: If, after making this Coronae of Frampton, you Nwld
become subject W Ne Workers Compensation provisions of Ne Lahr Copes, you mon
rortbwith comply with such Presidents a this Permit Nall be domed revalued.
CONSTRUCTION LENDING AGENCY
1 hereby an'um that Nee its commucdnn lending agency for the performance of
dm work ren which this permit is issued (Sec. 3197, civ. C)
Landers Name
Leaders Addreaa
I certify that I haw ead this application and aisle Best the above Information is
coracle I ager W comply with all city and county ordinances and auto laws elating no
Wilding conrouctioo, and hereby auNome eprcxntatim alibis city to enter upon MI
above-mentioned property for inspection purposes
(We) agnea to taw, indemnify tad keep harmlee the City of Cupertino against
liabilitie, judgment, costs and expenm which may in my my accrue against mid City
In consequence of Ne granting of this permit.
I APPLICANT UNDER All AND WILL COMPLY WITH ALL NON -POINT
— J�
Issued by: Date I ,:
SOUP peGUL�'IONS.
Re -roofs
Type of Roof
/ (//XrAO /[�lA.2{�l �FY
Sig tie of Appicaud/Cohment, Data
HAZARDOUS MAT21RIALS DISCLOSURE
Will Me applicant ortomem bWlding eecup rm rare Or handle hmNau material
as darned by the Cupertino Municipal Cade. Chapter 9.12. and the Health and Safety
Cade. Section 25532(a)?
All roofs shall be inspected to any roofing material being installed.
❑Ym Nu
prior
OWIII
If a roof is installed without first obtaining an inspection, I agree to remove
Nc applicant or fustic building occupant tax equipment or dcvim which
IL hearmus sir conumlmarts as de0ood by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Ym Nu
I have mad the haurdim aerials requirements under LTapmr 6.95 of Mm Califar-
niaHcalNhSNctyCade,Sodau25505,25533md25534.lundceundthnifde building
dm Incm1Y haw a umanL II u my espowmlitY m notify Ura accupmt of Uve
Meal hichon at Ise rWirm ora Ceflific It occupancy.
Signature Uf Applicant Date
�i �� ���'�`�
All roof coverings to be Class "B" or better
Owner or tat an cd a cm am