04110144 CITY OF CUPERTINO TT�3sa,,�g�� ��.r!<�e�♦,��c-. p'A•'"'< _''��s�♦` 1 - _--- .-- . .
BUILDING DIVISION PERMIT
Cot\J.1�1'1VTQ11.���YQ L�1�1rA���N .
RUILDINGADDRESS: BATHROOMS BY HANS PERMITNb4110144 - - -
2386 HARTMAN DR
NER'S NAME: PERMIT ISSUE DATE
LARRY & NADIA GERMAN 1758 JUNCTION 4
rHONE: ' SANITARY NO. - ._CONTROL NO.. _
(408) 436-8151
ARCHTIECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
li o p LICENSED CONTRACTOR'S DECLARATION Job DESCrIpIl00 -
uF 1 hamby affirm Net 1 am licensed ceder pmvisions or C'haprr 9(ammencing '
with Scction7")of Division 3afthc Busineuand Professions Code.andmylicenscis
Vii„ inrnnmaaneerca REVISION--IN HOUSE USE ONLY
License Class Lie.•
gra Dam Cnnlrmnor NO NEW PERMIT ISSUED ORIG. #04090224 - - - - - -
',]' ARCHITECTS DECLARATION
1 understand my pI.nS.hSll he used as public records
Licensed Professional
OWNER-BUILDER DECLARATION
0 0 I thereby alarm that I len exempt from the Connors License city
o for the
O O which ng ream..Permit
t 7031.5.construct.
Business and improve.
de oli Co dc:Any tiny or county
K m which require n pmno re eov=n,alkrampmw,dem sail t or a pair any amenum
u—m priors iucensede ormat 10 the de,
ovisio s Of for suchmenta' LiUmsaLaw(ned urmem -
=e
that he licensed SaturntotheofDislomofUraCammctahLi¢nrl�OnsCMICr9 Sq. F[. Floor Area Valua[i( 115
ER$ than he
veraiNSecuon]Bndheprvisionrorereged transition.
Any
Codc)of
'S Nu io u eumpn dnrtrrwn and or aper Ile the alleged exemption.Any violation of
Section 7031.5 by any applicant!ar+permit subjects the epplicanuoacivil penalty of ppN Number Occupancy Type
nor mom wn RK handled dollars(S50o). 32613133 . 00
0 1,as owner of the property,or my croployees with wages as their sole compensation,
will do the work.and the s=arum is not intended or offered for We(See.]844,Business Required Inspections
and Proda.mv Code:The Cro mnoes Littnse Law does Out apply In a owner,of q '
preparty who builds of impm.thereon,and who doeasucb workloirescif orewugh his
own employ..provided Nan Such improvements.not inended oroffered forsaks.IL
however,the building or improvement is Said within one year ofermpleuon.the owner- -
buiMer win have the burden of proving door W did not Isuld or improve for purpore or C'
aleJ.
muter of the roperty,am in=and con=ning with licensed contractors
nmV 3 m
conitmaN pnaa ( .man weer of andrrywhoons Code:)Tie[Domtar,rad �.
claveonu n t yman ownerofpmpeny who Wildsorimprov.human,and.
wM10 con=
L❑ia1 cwiaconutos)licensed pursuauthe Conisvartcammrns
me S .B Pcm
I la
J�\
u -1
P TI EC AT ON
1 he lab afro under Penalty of perjury ane of the following decla omms:
❑Thaw. ill maintain a Certificate Of Consent to self.insum rot Workers Compen.
sanion,as provided for by Section 37W of thS Labor Code,for the performance of the - ...
work for which this Permit is issued _
0 1 have and will maintain Worker's Compensation Insurance,le required by Scedon -
37n0 of the labor Code,for the performance of the wmk for which this permit is issued.
My Workers CnmpevNon Inmm e.carrier and Policy numh a am:
Carrier. Poli y No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed if the Permit is for one hundred dollus(SIM)
or less.)
I certify that in the performance of the work for which this permit is issued.l shall tat
employ any person in any manner not as u become Subject o the Workeri Compensation
Laws of Califomia.Dane —
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject at the Walker's Compensation Provisions of dm Labor Coda,you must
wJ Z forthwith comply with such provisions or this pc,ran Mall W deemed mvokcd.
ZO CONSTRUCTION LENDING AGENCY
(-. I hereby alRrm Nan then IS a consbVninn lending agency for the performan¢of
lYi> the work Por which this permit is issued(Sec.369'1,Co.Q
G Q canec'. Name
Landers Address
U[] 1 certify bur. have reed this application and sure than the Shout information is
0 f' .acct.1.glee m co ply with all city and county otdiives of and sole laws relating b
U building cons coon, dfor rums Ino repmaenmtira or this to enter the
r shout and pm y for ivpccuon P quses -
((WWc) gree Ip ,indemnif d cp hatmlev the City of Cupertino against
F'raq li.h ' ls.ju mtnta,c wan es of MIL may in any way same against mid City
U z int 9 no, offt no f PC
qP E T S D LL COMPLY WI N-POI Issued by: Date
S R E TL N
Re-roofs
Signau of ApplianlAgItacur ata
HAZARDOUS MA IS DISCLOSURE Type of Roof
III Nc applicam tar ruwm building ow mtsmm or handle hamNovs martial
u dot by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safety
r. tion 15531(a)? All roofs shall be inspected prior to any roofing material being installed.
0m
Will the applicant orIum building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit Int s it cmuminmu as dented by the Bay Arta Air Quality Management all new materials for inspection.
Diatrfcn
llhh wis the hmaNt s vials myvimmcnts under Chopur .95 of C+IIrOF
ni SIN S cn Code.See M533avJn534.lumlersun thatif Wilding
d not tly a u pet t my mapansihilitY m notify ala len of the
M tittle I fsmatrc acenivauor span . Signature of Applicant Date
o coraathnmm.gcnt ata All roof coverings to be Class "B"or better
CITY OF CUPERTINO TT�3sa,,�g�� ��.r!<�e�♦,��c-. p'A•'"'< _''��s�♦` 1 - _--- .-- . .
BUILDING DIVISION PERMIT
Cot\J.1�1'1VTQ11.���YQ L�1�1rA���N .
RUILDINGADDRESS: BATHROOMS BY HANS PERMITNb4110144 - - -
2386 HARTMAN DR
NER'S NAME: PERMIT ISSUE DATE
LARRY & NADIA GERMAN 1758 JUNCTION 4
rHONE: ' SANITARY NO. - ._CONTROL NO.. _
(408) 436-8151
ARCHTIECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
li o p LICENSED CONTRACTOR'S DECLARATION Job DESCrIpIl00 -
uF 1 hamby affirm Net 1 am licensed ceder pmvisions or C'haprr 9(ammencing '
with Scction7")of Division 3afthc Busineuand Professions Code.andmylicenscis
Vii„ inrnnmaaneerca REVISION--IN HOUSE USE ONLY
License Class Lie.•
gra Dam Cnnlrmnor NO NEW PERMIT ISSUED ORIG. #04090224 - - - - - -
',]' ARCHITECTS DECLARATION
1 understand my pI.nS.hSll he used as public records
Licensed Professional
OWNER-BUILDER DECLARATION
0 0 I thereby alarm that I len exempt from the Connors License city
o for the
O O which ng ream..Permit
t 7031.5.construct.
Business and improve.
de oli Co dc:Any tiny or county
K m which require n pmno re eov=n,alkrampmw,dem sail t or a pair any amenum
u—m priors iucensede ormat 10 the de,
ovisio s Of for suchmenta' LiUmsaLaw(ned urmem -
=e
that he licensed SaturntotheofDislomofUraCammctahLi¢nrl�OnsCMICr9 Sq. F[. Floor Area Valua[i( 115
ER$ than he
veraiNSecuon]Bndheprvisionrorereged transition.
Any
Codc)of
'S Nu io u eumpn dnrtrrwn and or aper Ile the alleged exemption.Any violation of
Section 7031.5 by any applicant!ar+permit subjects the epplicanuoacivil penalty of ppN Number Occupancy Type
nor mom wn RK handled dollars(S50o). 32613133 . 00
0 1,as owner of the property,or my croployees with wages as their sole compensation,
will do the work.and the s=arum is not intended or offered for We(See.]844,Business Required Inspections
and Proda.mv Code:The Cro mnoes Littnse Law does Out apply In a owner,of q '
preparty who builds of impm.thereon,and who doeasucb workloirescif orewugh his
own employ..provided Nan Such improvements.not inended oroffered forsaks.IL
however,the building or improvement is Said within one year ofermpleuon.the owner- -
buiMer win have the burden of proving door W did not Isuld or improve for purpore or C'
aleJ.
muter of the roperty,am in=and con=ning with licensed contractors
nmV 3 m
conitmaN pnaa ( .man weer of andrrywhoons Code:)Tie[Domtar,rad �.
claveonu n t yman ownerofpmpeny who Wildsorimprov.human,and.
wM10 con=
L❑ia1 cwiaconutos)licensed pursuauthe Conisvartcammrns
me S .B Pcm
I la
J�\
u -1
P TI EC AT ON
1 he lab afro under Penalty of perjury ane of the following decla omms:
❑Thaw. ill maintain a Certificate Of Consent to self.insum rot Workers Compen.
sanion,as provided for by Section 37W of thS Labor Code,for the performance of the - ...
work for which this Permit is issued _
0 1 have and will maintain Worker's Compensation Insurance,le required by Scedon -
37n0 of the labor Code,for the performance of the wmk for which this permit is issued.
My Workers CnmpevNon Inmm e.carrier and Policy numh a am:
Carrier. Poli y No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed if the Permit is for one hundred dollus(SIM)
or less.)
I certify that in the performance of the work for which this permit is issued.l shall tat
employ any person in any manner not as u become Subject o the Workeri Compensation
Laws of Califomia.Dane —
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject at the Walker's Compensation Provisions of dm Labor Coda,you must
wJ Z forthwith comply with such provisions or this pc,ran Mall W deemed mvokcd.
ZO CONSTRUCTION LENDING AGENCY
(-. I hereby alRrm Nan then IS a consbVninn lending agency for the performan¢of
lYi> the work Por which this permit is issued(Sec.369'1,Co.Q
G Q canec'. Name
Landers Address
U[] 1 certify bur. have reed this application and sure than the Shout information is
0 f' .acct.1.glee m co ply with all city and county otdiives of and sole laws relating b
U building cons coon, dfor rums Ino repmaenmtira or this to enter the
r shout and pm y for ivpccuon P quses -
((WWc) gree Ip ,indemnif d cp hatmlev the City of Cupertino against
F'raq li.h ' ls.ju mtnta,c wan es of MIL may in any way same against mid City
U z int 9 no, offt no f PC
qP E T S D LL COMPLY WI N-POI Issued by: Date
S R E TL N
Re-roofs
Signau of ApplianlAgItacur ata
HAZARDOUS MA IS DISCLOSURE Type of Roof
III Nc applicam tar ruwm building ow mtsmm or handle hamNovs martial
u dot by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safety
r. tion 15531(a)? All roofs shall be inspected prior to any roofing material being installed.
0m
Will the applicant orIum building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit Int s it cmuminmu as dented by the Bay Arta Air Quality Management all new materials for inspection.
Diatrfcn
llhh wis the hmaNt s vials myvimmcnts under Chopur .95 of C+IIrOF
ni SIN S cn Code.See M533avJn534.lumlersun thatif Wilding
d not tly a u pet t my mapansihilitY m notify ala len of the
M tittle I fsmatrc acenivauor span . Signature of Applicant Date
o coraathnmm.gcnt ata All roof coverings to be Class "B"or better