04110069 CITY OF CUPER'I'INO '�s^-r-� 'ks%t�^"''%�'•%""''"` �' �' '' ''
BUILDING DIVISION PERMIT +`,CONa,
TRACs rORINEORMAMN '� - -
e'.571&. ?"� !,5� .
BUILDING ADDRESS: - PERMIT NO.BATHROOMS BY REMODELING 04110069
�ER'S NAME:
PERMIT ISSUE DATE
17
J SANITARY C OL NO.
PHONE:
ARCHITECT/ENGINEER: BUILDING PERMIT INFG
-. BLDG- ELECr PLUMB MECH
- uoo . LICENSEDCON1ItACDWSDECLARATION Job Description
MF 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing -
<n t^(h c�dn,OfX))Of0"sionJof Nc BsVmyx1(d Profcsi um Codc.anJ mylicensc is - - -. _ _
^t3i at License Class ,L kMd�174 4�� REPLACE 2 BATHRMS FIXTURES/TILING
Z-p Dav: Conlncwr
as ARCHriELTS DEC PN
1 undersand my plans:hell W used&a public r ds -
3yU
' 3p� Licensed Profess ionel --
3 OWNER-BUILDER DECLARATION
I hereby,(See Nat I1L exempt Wm tie Cssions 0s License Law for the
00 which
reason.(conn o eo LS.Business and Proon,de oli Calc:Any city m caumy
K$ which rmussu a e.also m Ui=the,a@e.improw,demolish,m repair any struaua
m�'^ that he it,issuance.e.almrequiree Novisiocam for Such Contrccaiuofiensee a signed(Cha mem
FFt?< w,Wlxfiamcdparstion7N)ofDivimtsof the,3orthemm�essanimnxlaw(sCode)9 Sq.FL Floor Area Valuation
G (commencing with Section 7")of DivixionJ or the Business and Professions C.de)or. -to
$ that he Is exempt therefrom and the buffs for IW alleged eumption Any violation of ,�-n1.hlvi,'.a,.f�
Smdon 9011.5 by any applionl for.permit s Hailes t e applicant be a Civil penalty of 3 6*6]Y1 L04rIO O Occupancy Type
not roam in.fim hundred Jolla.(5500).
0 1,u owner of the pmpeny.m my employees with wages as their sok mmpenution,
will do she work'and Ncawctum u not intended oeoffned forsalc(Sec.7B44,Business
and Profession:Cade:The Conuaclora License Law does ml apply m an owner of Required Inspections
property who buildaorid that welleimpromwbo sexual
ctende himself earNmughhis
awn a er.the building
that well impmszmcnu tie not intended of Completion.mpeemd forto ow.r. c
however,Ne buildingb r improvement is sold within one year of profr Ne owe of
builder will have the burden of proving Nn he did not Wild or improve far purpose of
ask.).
0 h as Owner of the promny,am Oxclusively contracting with licensed Contractors to
consumer the project(Sec 7814,Bainass and Professions Cade:)'Ihe Comosexc's Li.
cense law does not apply to an owner of property who builds or improves Nneoo,so .
who convacufor such projects with a contractar(e)Iicareted pursuant to the Contranafi - __ _ . -
License Law. O
0i
em exempt under Sec. .B At P C far this mason
per Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of Ne following declarations: ..
0 l ham and will mountain a Certificate of Contin to self-insure for WarYcr's Compcn-
smion,as provided far by Section 3700 of the labor Code,for the perfarmenm of the
.,it for which this permit is issued.
0 I have and will maintain Worker's COm,emsauon Insurance,a required by Section
3]00 the IaWr otic,for Ne pedarmance of work for which Nu permit is issued.
My CoketaC
Eco.,
1rq ?icy number aa:
a er.
L? — D/� yes .
CERnFIC •OF FXFMPnON'PR WORKERS'
COMPENSATION INSURANCE
(This section need not W completed!fine permit is forone Wndrtddollan(SWO)
or less)
I cenify Na in the performance of the work for which this permit is issued.I shall not
employ any person in any mannerso a to become subject to de,Workert Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making Nis Certificate of Exemption.you should
become subject to the Worker's Compensation provisions of she Labor Code,you must
.JO forthwith comply with such provisions or this permit shall he deemed revoked.
ZN CONSTRUCTION LENDING AGENCY
(-+ -• 1 hereby alfrm Nal fm its Construed..lending apcny l'm the porfmmmce of
7 Ne work for which Nis permit is issued(Sec.3091,Civ.C.) -
IT]Q Lender's Name
z Lender's Address
(.),p I certify that I have rod this application and sue Nat the above information is
U.t" cancel.I agree to comply with all city and county ordinances and state laws relating to
DU Wilding coawction,and hereby authodrz.presmlatives of this city to enter upon thc
W above-mentioned property for inspection Purposes.
(We)agree to saw,indemnify and keep harmless the City Of Cupertino against
F-'N liabilities,judgments.costs and cape::which may in any way accmc against said City
U Zfnccof Negmming.filu"Cmil.
r-' NT UND ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
17((;1
REGU S. -1.
Re-roofs
Sqpgoal ofApplic HAZARDOUS MATERIALS DISCLOSURE ale Type of Roof
Will the applicant or future building Occupant store or handle hazardous material
a dclined by the Cupertino Municipal Code,Chapter 9,11,and the Health and Safety
Nc.Semon 255324)p All roofs shall be inspected prior to an roofing material bei. Installed.
❑Yes ,�a P P Y g
will the applicant or future building occupant use equipment or devices whim —If a roof is installed without first obtaining an inspection,I agree to remove- -
cmil harartlnux aimi
r conmna a JCIincJ by thA.c Bay AAir Quality Manm
ageent all new materials for inspection.
District?
0Yes NO
I have mad Ne hi a dons materials requirements under Chapter 6.95 of the Califon
nia Health A SalelyCode,Sections 255115.25533 and 25534.1 undersand than irtie Wilding
dans not cimoully hoc a¢ star it u my respomihiluy to notify IW occupanl of the
requirements which mu I prior to issuance of a Cenificam of Occupancy. Signature of Applicant Date
Calm,ur auNorircJ agcm Dam
All roof coverings to be Class "B"or better
Dam
CITY OF CUPERTINO '" +$. ' 2 t"-J
BUILDING DIVISION PE TCONTRACTOR INFOR1�i10N
BUILDING ADDRESS: PERMIT NO.
BATHROOMS BY REMODELING 04110069
n i TnunT
4ER'S NAME: PERMIT ISSUE DATE
PHONE: - SANITARY C OL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
neo LICENSED CONTRACTOR'S DECLARATION
y F I he,eby affirm that I am licensed under 9soo,em ms of Chapter 9(commencing Job Description
�Zu`j with 9gcdrn700tq of Oivisirnlof Ne Busiryru'YbE Professions Code,and my license is
_Ziniaand L +> 3 REPLACE 2 BATHRMS FIXTURES/TILING
z Liccenser.Class Lic,x _
DaWContractor
Y ARCHITECTS DEN
Y�� 1 understand my plans shall W public
used as puMic�ds
�aU
' ttnuJPmfi
cssone
0� Lil
g OWNER-BUILD I am exempt
ro DECLARATION
1 hereby affirm Nm 1 oat exempt tram Nc Contractor's License Law for me
o o following reason.(Section 703 1.5,Business and Pmfessinv Code:Any city O,county
K m EL which requites a permit t"construct,alter,impmm.demolish.Or repair any svuclum
v_y priormitsissuanec.a6o out ui,v lW applicant for such permilto file a signed statement
that W is licensed pursuant to the provisev of The Contractor's license Law(Chapter 9 Sq.Ft.Floor Area Valuation
5FG [commencing with Senion 7(100)of Division 3 orthe Business and Pro(eaiov COdC)or
'a =I he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by vry applicant for a permit subjects the applicant to a civil penally of 3 64��e10 0 Occupancy Type
not mom than five hundred dollars($500).
0 h as owner of the property,or my employees with wages as their sale compensation,
will do the work,and the swaua is not intended of offered for sale(See.7044,Business qqq /(�, Iy Required Inspections
and Professions Code:The Contractor's License Law dors not apply N an owner of {/ i1 q P
property who builds or improves themes,and whodoessuehwark hineselfor through his Milli (//''Y'l`�117�i
ED
Man employees,provided Nat such improvemenu are not intended Orolfered for sale.If.
however.the building or improvement is sold within one year of completion,lie owner-
Wilder'will have Use burden of proving Nat he did oat Wild or improve for purpose of M1
reale.). = Z��J
0 h as Owner of the property.am exclusively contracting with licensed contractors to
construct the es not (Sec.to a4,Business and Profusions Coale)The Convenor's Lid BUILD
-¢n,p p p q
cove Law alms not apply c an owns of property who Wildsp or improves Neuron,and Itrt[lri•G71Ypg gp�iVl{pB5 Reit ILpg11]
who contracts for such pmjecu with a crntnaor(s)licensed pursuant w the COnvacmh
License
I am exempt
ezcmpt under Sec. .B h P C for this reason
mer Date
WORKER'S COMPENSATION DECLARATION
1 hereby Orion under penalty of perjury one of the following declarations:
0 1 have and will maintain a Ccnificam of Consent to self-insure for Worker's Compcn-
Major,as provided for by Scnion 37W of the Lahr Code,for the pnfmmance of the
work far which this permit is issued.
0 I have and will maintain Workers Compensation Insurance.as required by Section
37W fOr labor Code.for use performance of work for which this Permit is issued.
My/µ+gorkcts/C/ryq�eaW+/oIr{iwrasll c�am�u.,f�r Va`.lLicy numberUare:
a�er`�S C✓LC. �{XEMPT1 licY 1,�f�: ✓J � " C��T r
CERTIFICA COF OMPENSATION
MWORKERS'
COMPENSATION INSURANCE
(This section need not be completed ifthe Permit is(crone hundred dollars($100)
or less.)
1 eatify that in the performance Of the work for which this permit is issued,l shall not ..
employ any person in any manner s"as W become subject to the WOrkSri CempevaUOn
Lawlor California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate Of Exemption,you should
become subject to the Workers Compensation provisions of Ne Ulm,Code.you most
.JO forthwith comply with such provisions or this permit shall he deemed mvnked.
Z CONSTRUCTION LENDING AGENCY
F.� I hereby affirm that there is a conswction lending agency for the performance of
G' the work fur which this permit is issued(Sec.3097,Civ,CA
W Q :coda's Name
Ilenders Address
()Q 1 anjfy that I ham mad This application and SLOW Nn the above information is
(y (~ coned 1 agree to comply with all city and county Ordinances and sta¢laws relating to
� building construction.and hereby authnn representatives Of this city W enter upon the
Uabove mentioned pmpcny for Inspection purposes.
(We)ogre.to sive,indemnify and keep harmless the Ci 1,or Cupertino agaimt I /)
Ir to inchaseSnonce orthe
cossand Of this Permit.
may in anyway eccmc againstsaid City 1/"_�/ai/s+ �` Ib
Uz
inchaseorthegr TANDfNis permit.
^' APPLICANT UNDE ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO RCE REGU S. 1.
Re-roofs
gnaw efAPpl'=am/Contractor
HAZARDOUS MATERIALS DISCLOSURE aW Type of Roof
Will the applicant ser future balding ocmpnt store or handle ha urdrus material
s defined by the Cupertino Municipal Code.Chapter 9.13,and Ne Hcahh and Safety
ode,Section 25532(x)? All roofs shall be inspected prior to an roofing material being installed.
_ ❑YeM Ntr P P Y g g
Will he applicant or mare building.,.,am am equipment or devices whim If a roof is installed without first obtaining an inspection,I agree to remove
emit Walnut air mnmmina s as defined by the Bay Area Air Quality Management all new materials for inspection.
Dklnl,?
0Y. N"
I have real the W.Wous WoOd.ls regwmmensunder Chapmr6.95 Of the Cold.,
not Hcalmffi Safety Code,Seedons 35505.25533 and 25534.1 understand mot if N=Wilding
does not eumcndy have a te �{,titer it is my Marone ihiloy W nohry the occupant of thc
requiremcnm hiMhmo jlpoor toissuance Ora CeNfeWOfOeepancy. Signature of Applicant Date
G�r—raaNnriy<dagent Date All roof coverings to be Class "B" or better
® CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng : Sub: Blk: Lot :
APN . . . . . . . . : 36923006 . 00
DATE ISSUED. . . . . . . : 11/12/2004
RECEIPT # . . . . . . . . . : 27731
REFERENCE ID # . . . : 04110069
SITE ADDRESS . . . . . : 6708 JOHN DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HOSHIZAKI JON A AND MADELEINE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4563
RECEIVED FROM . . . . : BATHROOMS BY REMODEL
CONTRACTOR . . . . . . . : JOZO CARAN LIC # 24223
COMPANY . . . . . . . . . . : BATHROOMS BY REMODELING
ADDRESS . . . . . . . . . . : 1422 SARATOGA AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95129
TELEPHONE . . . . . . . . : (408) 378-6700
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-- -------- ------------- - - --- ---- ---- --- -- --- ----
BPERMFEE VALUATION 32 , 581 . 00 393 . 12 0 . 00 393 . 12 0 . 00
BPFIXTURE UNITS 6 . 00 54 . 00 0 . 00 54 . 00 0 . 00
BPLANCHK PERMIT FEE 393 . 12 524 . 62 0 . 00 524 . 62 0 . 00
BPREPIPE NO OF FIXTURE 6 . 00 54 . 00 0 . 00 54 . 00 0 . 00
BPSEWER SEWER SYSTEM 1 . 00 21 . 58 0 . 00 21 . 58 0 . 00
BPSTORM PER DRAIN 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00
BPVENT UNITS 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00
BPWATER UNIT 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00
BENERGY PERMIT FEE 393 . 12 188 . 70 0 . 00 188 . 70 0 . 00
BREMFIXT NO. FIXTURES 4 . 00 4 . 80 0 . 00 4 . 80 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BREMPOLE NO. FIXTURES 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
BREMPOWER POWER UNITS 2 . 00 65 . 95 0 . 00 65 . 95 0 . 00
BREMRECEPT NO. OUTLETS 2 . 00 2 . 40 0 . 00 2 . 40 0 . 00
BREMREPALT NO UNITS 1 . 00 14 . 31 0 . 00 14 . 31 0 . 00
BREMVENFAN NO UNITS 2 . 00 52 . 41 0 . 00 52 . 41 0 . 00
BREMVENSYS NO UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00
13SEISMICRE VALUATION 32 , 581 . 00 3 . 30 0 . 00 3 . 30 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
-- -------- ---------- --- ------- ----------
TOTAL PERMIT 1534 . 55 0 . 00 1534 . 55 0 . 00
MOOD OF PAYMENT AMOUNT NUMBER
------- ---------- ------------ ------ ------
CHECK 1534 . 55 4731
TOTAL RECEIPT 1534 . 55
Zia, • CITY OF CUPERTINR
A CUPEf-TING PERMIT APPLICATION FORM
APN #� / / Date:
() GG -Ej /
Building Address: /
G coq /o f/.✓ 1�.�'%dam
Owner's Name: Phone#:
AeaJ
CIactorE�IoyEL/iV4Z License#:
2,v V,
Contact: Phone#:
Applicant/Contractor: X6,4Va;P&Li/UG Fax #:
Building ' ermit Info: \
Bldg Elect Plumh Mech .
Description:
esidential: q/ ,,, Commercial:
-Szq. oor Area: $/Sq.Ft.: —�
Architect/Engineer: Va ation:
.��
Typeeof Con stryctipn: � � ancy Grou
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances 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> 1 OOOA ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BEN'ERGY — Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BNEWMULTI New Multi-family Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
ti7232- 2,7 7 -3 )
1 of 3
CITY OF CUPERTINO
S CUPEYOF PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BNUMULTI New Multi-family Res PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
/ BPCESSPOOL 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 Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
PTRAP 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 A liance 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
/�JBREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
iBREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
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 Signs, Marquee_ ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
2 of 3
E - 11�ITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEVINO
nti Fee ID Fee Description Fee Group
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSF&2FAM Single &2 Family BUILDING
BSFNA Single Family New Add BUILDING
BSPECIAL Special Insection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Ternp 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 Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane 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> 1.75 M Btu MECHANICAL
•
3 of 3
..dROOS
C by Remodeling Specialists
W1422 SAPA'I'OGA AVE. • SAN JOSE, CA 95129
PRONE (408) 378-6700 CONTRACTORS LIC. #674083
�jo D12-41'r
' r C
5/
SPARK ARRES I ER REQUIRE®
2 20
=mac . 1
04
l
w
l
_ ilU
AF',DRO
N ACCOf2D i
CE.WITH THE MY 01 --
CUPERTINO '
cS AND r ,D) A
• of plans and spe dication�U
Ile kept on the job at all times and it is un
lawful to make an
y ch— . on same- without w ittao eS or alteratim
: .
Permission f=
he buiiding Dept.; City
an
Cupertino
fhe Stam in _
P g of this plan and speaflcatiorsss -
- HALL NOT be held to pe mit or to be a'
1pproval of the violation of eny pruvlsrnm
i . .
9V t:If4 D /1i nanCe nr �,raTa l a.• ._ .. _ _ -