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03100007 L"�,:,,'DING Y OF CUPERTINO ' 9 '! - nuu,DlNc DrvIs1oN PERMIT CONTRACTORiINFORMATION ,„ d ADDREss[ THE BATH' ROOM INC PERMIT Nil.03100007 R'S NAME: 1910 W EL CAMINO REAL PERMRISSUEDATE 70 ANNR mmRTnrx " )r) (650) 968-7666 SANITARYio'l CONTROLNO. AR CHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELELT PLUMB MP.CH 0 0 0 0 !00 LICENSED CONTRACTOR'S DECLARATION w❑ 1 herppby affirm that 1 am licensed under provisions of Chapter 9(commencing lob Description iiW inloll ftyf]WU)ofDivixian3ofthc9ys7ncaanJPrufcuinnxCnJc.anJmyliccnxis PINALED in full forte and effect. ✓ a $ Z Licenu CI s Lice p D 22 BATHROOM REMODEL DatcCuntracwr i ARCHITELTSD R TION OCT 2 0 2003 i�< I undcratanJ my planW u s shall sed as lie records tdU .off' LiccnuJ Pmfcsxionel OWNER-BUILDER DECLARATION BUILDING a I I Wmhy affirm Info I am exempt Brat the Contractor's :License,.,c Lew far the p O allowing rcama.(Section 7031.5.Business and vee demolish. Code:Any city lirrcounty tme m which rtyoircd a permit to construct.after,improve,demolish,lir repair any nrucmm dei prior to its issuance,2150 receptors the applicant for such Permit o file a signed statement ei< that he is lice medpursuant tnthe provisiomnrthe Contractor'9Licenxlsw(Chapter 9 Sq. Ft. Floor Area Valuation 21-' (commencing with Section 7(I(0)of Division tards,B usines and Professions Code)or Nat he is t mmpt therefrom and the basis for the alleged emmption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(550(1). I,as owner of the portion,in my employees with wages as their sale compensation, will do the work.and the swcwre is not intended iroffcred fo..all see.?W4,Business 101 — FOUNDPWce Qhid Inspections and Professions Cadc:The Committees License law does not apply w an owner of property who builch or improves thcwon,and who daessuch work himselfor through his 102 - PIERS own employees.provided that such improvements are not intended molferd forsale.If. 103 - UFER however,the building or impeoeemem is sold within one year of completion,the owner, but war will have the burden or pmvins that he did not wild or improve far on.or 104 — REBAR sole')' 105 - ANCHOR BOLTS ❑1,as owner of the property,am exclusively contrmti ng with licensed contractors w construct the pmjcct(Sec.7(Fn.Business and Professions Code:)The Contractor's Li. 10 6 - SEWER & WATER arse law dean not apply to an owner of property who wilds or improves thereon,and 202 - UNDERFLOOR PLUMBING who curttracta for such projects with a contractor(s)licenud pursuant to thh e Contractor Lkco ,law. 203 - UNDERFLOOR MECHANICAL ❑I am exempt under Sec. .B h P C for this reazon 204 - UNDERFLOOR FRAME Data205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION I hereby afnra under penahy of perjury ane or one following declarations: 301 — ROUGH PLUMBING I have and will maintain a Cenificam of Consent to xlGinsum for worker's ComNo. 302 - TUB & OR SHOWER sation,as provided for by Section 37W of the Labor Cock.for the perfmmamc of the 303 - ROUGH MECHANICAL work for which this permit is issued. 1 hale and will maintain Worker's Compensation Insurance,as reyuimd by Section 3 04 - ROUGH ELECTRICAL of ow Labor Cod,for the perrmmanec of the work for which this Permit is issued. 305 - FRAME My Worker' n na;Iys�¢.m. m earim and Policy number am: 306 - HOEDOWNS Carrier. - •M • ` Policy No.:—11 )•��a'S7K// C•KTIFICATE OF EXEMPTION FROM W°RKBR� 307 - INSULATION COMPENSATION INSURANCE 308 - SHEETROCK (This section recd not w completed if the pmnnir is for one hundred dollars(S 100) 309 - EXTERIOR LATH lir kis.) 1 certify that in the performance or the work for which this Permit is issued.I shall not 3 10 INTERIOR LATH employ any person in any manner w as w Wcomc subject to the Workers Compensation 311 - SCRATCH COAT Laws of California.Oma Applicant 313 - ROOF NAIL NOTICE TO APPLICANT.If.after making this Ccnincate of Exemption,you slmZ 501 - FINAL ELECTRICAL ENERGY become sunjcct to the Worker a Crmtsmolu on previsions of the labor Code,you mull �Z forthwith comply with such pnvisuns or this Nmilshall be deemed revoked. 502 - FINAL PLUMBING ENERGY z� CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hereby affirm that there is a contraction lending agency for the performance of 504 - FINAL BUILDING ENERGY Y> dm work for which this permit is issued(Sce.309?.Civ.C.) n p under'aNamc 505 - FINAL ELECTRICAL Lender's Add. � Z 506 - GAS TEST p nee to 1have with thirty and Counanddictason me.ure laws information in 507 - FINAL PLUMBING o� y (•" cornet 1 gree m comply wire all city and county oNinanees and sum laws relating m �U amovengentioned mtand forebysuthon purrocscnutivuofNis city to crustupon the FI&jgVNG"CAL shove-mentioned re to ertysave findmnifyan Purposes. (We)agree la save,indemnify reed keep narmlcu the City of Cupcnit a sti er, M�4w N liabili' ,judgmcnts,co o penes which may in any way accmea indt said Ciry JZ in co tarn.of me gra mg o chis pefmir.APP 1 ANT URGERS ANDS AND ILL COMPLY WITH ALL N-POINT Issued by: WORKS Date • SOU EREGUL 10 . Js� I lo (/ Re-roofs ign are A plicanVC tract Dam HA RDOUSMATERIALS DISCLOSUqq Type of Roof Wil capplicam orfuwswiWiogmcupamdwremhSretch mardausmamria as implied y the Cement a Municipal Code,Chapter 9.11.and lW Health and Safety I s.Section 15532(a)? All roofs shall be inspected prior to any roofing material being installed. Cy. U Will the apPlicanlor future building occupant tax equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove hazardous air contaminants an defined by the Bay Arca Air Quality Management all new aterials spection.ko? /p/��//�p Yes d"1N0shave mad the hamNop tarsals requirements under Chapter 6.95 of the Cali fon /n /1)cal Safcoy COM,ff 5.25577 and 25532.1 understan if the WillingL/ (/n rtcml have aNa it is m responsihilitym nouly c cupant of thcnow r. musypdo mi vanes.(.conow.w 'cu cR Sign tur fAp li nt Date Ownwma rcdagcDate All roof coverings to be Class "B"or better CITY OF CUPEWFINO BUILDING DIVISION PFRMI* CONTRACTOR INFORMAW rf€' 3ru =,p+a0'Y s �°Fs+ )zft`>%�'a.�'.rz�las: �7d."'k BUILDING ADDRESS: THE BATH ROOM INC PERMIT NO.03100007 12220 J40MR2TRAM RID 4 310 WNER'S NAME: 1910 W EL CAMINO REAL PERMIT ISSUE DATE "E (650) 968-7666 SANITARY NO. CONTROL NO, ARCHI7FLTIENGINEER: BUILDING PERMTTINFO BLDG ELECT PLUMB MICH oo LICENSED CONTRACTOR'S DECLARATION - lob DescrlD(�p I P 1 herpphy affirm that l ma licensed under Prnvl.dons of Chap¢,'9(commencing umw with Scc,V7CW)af Division 3Rfthe By6nessmlProfessions Code,and my license is YB` I(aaiy�4ty in full Orce nd effect ✓ Da Z BATHROOM REMODEL Liccnsc clp3aI g D. It Da Gpnlrer OCT 250 2003 Sq ARCHITECTS D PR TION i K a 1 understand my plans shall M used as-p tic records tan or, IAl �a yywA.�s °ity Licensed Professional ��tlrra®'l�VI g OWNER-BUILDER DECLARATION aY 1 hereby affirm Ihm 1 am exempt frum the Contractor's License Law for the D o following reason.(Section 703 LS,Business and Professions Code:Any city or county f$ yvf ch rcyuir a pcpro on construct.alcor,improve,demolish,or repair any structure prior to its issuance.also poRircs the applicant for such permit to file a signed numment S Ft. Floor Area 4590 mat he is licensed pursuant the pro visions of the Contract.,',License Law(Chapter 9 q. Valuation �FG (commencing with Scctioo Mail of Divlslao J of the Business and Professions Code)or that W is eacmpt therefrom sod The basis for m,alleged eti mption.Any viomuon of Section 7031.5 by any applimot for a permit subjects the APPlicaot to a civil Penalty of APN Number Occupancy Type not more than five hundred dollars(SSW). 1]1,As owner of the property,or my employees with wages as their.mte compensation, will do the work,and Ne swcmm is not intended or offered fpmate(Sec.7044.Business 101 - FOUNDA eJQ19d Inspections and Professions Code:The Contractor's Licence Law docs not apply to an owner of ".Pert,who builds orimproves thereon,and who does such work himself or through his 102 - PIERS own employees,provided Nat such improvements are not intended or offeree for sale.If. 103 - UFER however.the building or improvement i,sold within one year or completion.the owner builder will brae the burden of proving that he did not Wild or improve for purpose of 104 - REBAR sale.). 105 - ANCHOR BOLTS ❑1,as owner of the property em emli sively cenlraning with licensed contractors m construct the project(Sec.7tM4,Business and Pmressions Code:)The Conisclor's Li 106 - SEWER & WATER cerise law docs not Apply to an owner or property who builds or improves thereon,antl 202 - UNDERFLOOR PLUMBING who contracts for such projects with a contractor(s)licensed pursuam to the Comracmr's Lieenr<Lb- 203 - UNDERFLOOR MECHANICAL 0 I am c.emp,under Sec. .B d P C for this msson 204 - UNDERFLOOR FRAME wnefDate 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty or Perjury one of the following decimations: 301 — ROUGH PLUMBING I have a oil will maimain a Cenif sm of Consent to selbinsere for work„',Comp,. 302 - TUB & OR SHOWER motor,m provided for by Section 3700 of Ne Labor Code,for the pefmmamc of the 3 03 — ROUGH MECHANICAL work tar which this Permit is issued. 304 — ROUGH ELECTRICAL I have and will maintain Worker's Compemstien Insurance,As myuired by Section 1100 of the Labor Code,for the perform race of the work for which Nis permit is issued. 305 - FRAME My Worker' Co sans nce carrier and Pulley Rumba A. 306 - HOLDOWNS Cartier. - •—� Polio I S•OCC(SJ,r[y'f —L C R— CAT TIFIEOFEXEM—PnONFROMWORKER—S' r 307 — INSULATION COMPENSATION INSURANCE 308 - SHEETROCK (Tbissectinn need wtbecomplemaifthe fcrmili,fincine hundmddollms(SIM) 309 — EXTERIOR LATH nrless.) i certify that in the performance of the work for which this Permit is imued.I shall not 310 INTERIOR LATH employ any person in any manner an aa to become subject o the Workers Compensation 311 — SCRATCH COAT Laws Ap,fieof maCalifornia,Dam 313 — ROOF NAIL NOTICE m NOTICETO APPLICANT:Worker's r' after Compensation this real.the Eabor on.yaushmuW 501 — FINAL ELECTRICAL ENERGY forthwith comply with such COmpCM1LhOaermit Om of deemed Revoked. QN0.you mum 502 — FINAL PLUMBING ENERGY �7 ronhwim comply wit.moan"mammos lir this pc,mBanan heaccmca mynted. z0 CONSTRUCfIONLENDING AGENCY 503 — FINAL MECHANICAL ENERGY 01 I hereby affirm that there is s eomtmnina lendinga,cm,for performance of 504 — FINAL BUILDING ENERGY Ya:y the work for which this pem,it is issued(Sec.3097.Civ.Cd 505 - FINAL ELECTRICAL L Q Lender's Name Lana,rsAddress 506 — GAS TEST �z 7p 1certify that Ihave read this ty ancounanesummat the above information relating 1. 507 - FINAL PLUMBING L (•-' emeeet.l agree m comply with all city and county ordinances and ream laws relating to �U buileing connunion.antl hereby sudmim rcprescnmtives of this city 10 enter upon the FIN MEC ICAL NU abovemcntioned properly ror inspection purposes. (we)agree to save,indemnify and hep harmless the City or Cupertino against 09 FI fq liabili ,judgmenm,co n penises which may inany way accrue a Am said City NG r Jz in ca veno of the gm ing u this permit. 'S Date r/ ^m APP 1 ANT UNDERS ANDS AND WILL COMPLY WITH ALL N-POINT Issued by:5 C WORKS SOU EREGUL TIO Re-roofs ign tum A ph,ma/C «act Date Type of Roof HA RDOUS MATERIALS DISCLOSE Wil a applicant Or fmure building mcupu,tvore or andleharud..A material as defined y the Cupertino Municipal,Code.Chapter 9.11,and the Health and Safety Code,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. CYm u If a roof is installed without first obtaining an inspection,I agree to remove Will the aPP onto or future building by the Bt sex co Air Qu or mama ement ch ,R naeamms air,onmmmmu as mmfiRea by me Bay Area Air Quality Management all new aterials k � . bon 0Ycx itA Nu 'y fpt-7 I haverenJ me hurmdop. ¢rials requirements under Chapter 6,95 of the Cali for /n //) nice Heal Safety CoM.Sccut 2 )5.25533and25534.1under,mn tha Ethc building (LI V / Jmsn rrtnll have'JJ¢cc��r� ma it ism rmpomibdy 1.nosily cuPml of he red At msw a mus r/MMLismtoi cameonccrdneam ,r. Sign turcofAp lDale ownmma horireJagcnt ca Damoverings to be Class "B” or better THE BATH ROOKIt. JOB �OY�Aqj-6c 1910 West El Camino Real Unit E SHEET NO. OF MOUNTAIN VIEW, CALIFORNIA 94040 16501968,7666 CALCULATED BY DATE FAX (650) 968-2151 www.thebathroominc.com CHECKED BY DATE SCALE C) �t4�e- . ........... ............ ------- .... j...... c .... ........ .... .......... A .......... . ........ rAf- Vlt ............ ................. _J L ........... .......... .......... L4� ...........1".." ..1- i 1 -11 , - -i.-_--; i 1 , . ......... .......... ................. MAS ............ ..........J ........... i vur,w"I"'5 ....... ....... ........... . ..................... Lli(F , LAtt' VlAfl.) ...... ........... ........ ............. ..J.......... .......... ................ .................... ................ ............ ...... ......................... ....... .... . ..... ........... ...... . ....... ........ .... ........... .......... ... ................. ........................... .. ......... ...... Pkr POP NPOR6 . ............. CCQ�DAPIQE WITH!THE C 0 6 MINA C T UP D .... . ... ...... ......... . ........ ........................ .......... . ..... AT, SI NEIa .............. 1. .......... . . ........ ........ ......... MUS7 TH's sel iii spomcgion! .......... it isun .......... hmv-i u.I ill tmov and lawful jo m I'd jnj d nn,s I `eratilW ........... on, same ............ ........... ........... peci icati ns Tl�, topil of this in nd 111peci ......... . .............. ....... J t w,'iBIT. i-be ar, T or v a__411.xly,-D oxkej b .......................... ...... . ..................... .......... t _j ....... .............. ....... .......... ......... ....... .......... T . ........ THE BATH R00M,9C. jos 14AtL OW44 1910 West El Camino Real Unit SHEET NO. OF MOUNTAIN VIEW, CALIFORNIA 94040 (650) 968-7666 CALCULATED BY DATE FAX (650) 968-2151 www.thebathroomine.com CHECKED BY DATE SCALE :S-0 f5!. .. ......... ........... ................ .................. ------ 722-330 �O Ja tpf�lool cdPE�ip D, CA 15b?LI Vim, ----------- .......... ...I........ ......... .................... ........... ............. .......... 4' ............ ........ ,............. .................... ............ 4...... .. .........- r -rk4 b,q J........... ................................... .... .... ....... ....................... ....... T A A4 ....... 1 I/A ............. ........ W51ALt Fc. ........... .......... ............ .......-. ......... .......... ............. .... ................. .......... .......... ...................... ........... ........ .......... ............ ............ --------...... .... .......... .......... V6. I.- . ......... L., wo. . ......... . ...... ...... ............ ......... ............... ..................... .......... .......... . ....... ... ------- .. ----- .......... ................ ........... ........... ........... -------........... ........... . ........... .......... ............ ........... .......... - ........... ........... ......- ............ ........... . ........ - ............ ............ ................. - ........... ...... ............ ...... ....... ........... .......... . -cffillf ............ ........... ........... .........................1............ ............ ............... .......... ... ........ ......... ......... ------ ............. .......4............ .......... Ti 2-1 .... ...... ......... ......... ...... ............ ------- .......... ...... ...... ........... ....... ........... ........ ...... ................ . ........ ....... ZU WITY OF CUPERTINO* CITY OF PERMIT APPLICATION FORM CUPEPTINO N # 2/ �. Date: t) 0 3 Building Address: 2233 \OMv -R, 3 1 D Owner's Name: Phone#: S �00f— �)TASTocK_ g0b-'133- 5MI Contractor: License #: THE 61)LI l2ti Contact: Cupertino Business License#: �o Building Permit fo: Bldg ®- Elect 1. Plumb I� Mech ❑ Job Description: Residential ~ �/ merc 6 1 Sq.Ft. Floor Area: $/Sq.R.: Cost of Proje Occupancy Group X300, Type of Co truction: g 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 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 <= IOOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BF-LEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING v3 3 1 of 3 *CITY OF CUPERTINOP CITY 0 CUPEkTINO PERMIT APPLICATION FORM 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 BNUSFD New Single Family Res BUILDING 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 Re i e 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 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFDCT 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 2of3 sa�(jza - CITY *CITY OF CUPERTINOO OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL 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 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 3 of 3