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04050045 CI'T'Y OF CUPERTINO ` a BUILDING mvlslory PERM _ CONTRACTOR INY'ORMA� 1N k4: RUI[.DING ADDRESS: PERMIT NB 4 0 5 0 0 4 5 CONIFER CONSTRUCTION PERMIT ISSUE OATE NrItS'Y4AML'_ T 11A R 17TpR SANITARYNO. CONTROL NO. 7F. ONS. BUILDING PERMIT INFO CHITECT/ENGINEER: BLDG ELECT PLUMB MRCfi 0 p0 0 0 LICENSED CONTRACI'ORSDE,imis f o lob Dr$UI'1p'�t0��(1 II D iw1 hereby affirm INS I am Boned under provisions of Chapmr Y(commencing IlttJfJ—IIip I\\Vp Illll�l l�� i with SeclionVIXg1)of Division JOf the Business enJ Pmfe¢ions Co@.and my liens is ❑❑❑ mmBmClear, rm" BATHROOM REMODEL j i License Cress Lire e Dme GnnlDECL ARCHITECTS DECLARATION DEC T- 2004 Yya C 1 understand my pians shall he used as public records Jto 30. 1-iccnscd l'mfessional t1 ❑ ttf��� tt S OWNER-BUILDERexemptO[Ce Conte ON LD) I 11 D Imo\II y 1 hereby al'rirm that I exempt from the DECLARATION License Law for the U IPO Ittl\\VI' zpo R11mving masnn.(Section 7031.5,Business and Professions Code:Any city or county D Le m fLi wta:h requires a permit to construct,alcor,improve,demolish,or mpao any Strictme y_N prior In its issuance also Inquires lW applicant for such permit to rile a signed statement that he is licensd pursuant to the provisions ofthe Contrenor's License Law(Chapter 9 Sq.FL. Fl oor Area Valuation - pFo (cow mmring with Seetion 7")of Division 3 of the a weress and Professions Code)or i rt3 chat he is exempt therefrom and tie basis for the alleged exemption.Any violidno of Scelion 7031.5 by any applicantfor a permit subjects the applicant m acivil penalty Of 36k1�61d6ir(3Je00 Occupancy Type not more than Ton hundred aallan(3500). I,esnwne,of the p.pcny.o my employaea with wages as their axle comp<nsminn, will do the work,and the suunuin is not intended or offered for sale(Sec.Allo,Business Required Inspections said Pmfcssfone Code:The Conuazmrs License Law does not apply to an owner of q p progeny who builds m improves thconw.and won dwm,co h work himself m through his - own employees,provided that such improvements arc not intended or offered for sale.If. however,the building or improvement isanld within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale). 1, s owner of Ne propeny,am exclusively contracting with licensed conwctms to con met the pmjeal(See.7W,Business and Professions Cade:)The Connectors Li. cense law does not apply to an owner of progeny who Wilds or improves Neuron,and who contracts for such pm?-cu with a comractor(s)licensed pursuant Ne Contractor s License law. C 1 em ,under See .B&P C for this reason OR C MPENSATION DECLARATION rcby affirm under penalty of pe Jury one of the following declarations: I hove and will maintain a Cenifewcof Consent to self-insure far WormelCompcn- silion,as provided far by Section 37M of the lahor Code,for the performmee of the work for which Nis permit is issued. C"1 have and will maintain Workeh Compensation Insurance,as rectified by Section 37M of the laWr Code,for the performance of the work for which Nis permit is issued. My Workeh Compensation insurance carrier and Policy number we: Caw", Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not hecompleted fire permit Is for one hundred dollars(E 100) S Icai.) 1 ccnify that in the performance of[tic work for which this permit is issued,1 shall nal employ any person in any manner sn as to become subject to the Workers Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If.a0cr making this Cenifcme of Exemption,you should become auhjen to the Worker's Compensation provisions of Ne Lar Code,you must .J 'oorthwilh comply with such provisions or this permit shall be deemed revoked. Z`-' CONSTRUCTION LENDING AGENCY E.4 I hereby affirm Nal there is a eonsuouinn lending agency for the perform once of g4 7 the work(tar which this permit Is issued(See.3097.Co,C.) W Q Uenilm's Name / 0. Lender's Address V UQ 1 certify that I have read this application and stale that the shave information is 1L F coven.1 agree to comply with all city and county ordinances and slate laws relating ie- CU building construction,and hereby authorise repremnmtives of his city to enter upon the W above-mentioned property for inspection purposes. Y' (We)agree to save,indemnify and 4ep harmless the City or Core against „Fy fp'q liabilities,judgments.costs and expcmes which may in anyway act.againsl laid City / U Z in consequence of the gowning of this permit. APP WC NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOUR C ZULATIONS y--1 -0 Re-roofs / igna r ifApplicarl Ja or Dam H ARDOUSMATERIALSDISCLOSURE Type of Roof Will the applicant or(mum building Occupant store or handle M1avardous material as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety Code,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed. p Yes t his. If Will the appliaanl Orfunm building occupant us equipment or devices which a roof is installed without first obtaining an inspection,I agree to remove emit haiallous air contaminants as defined by die Bay Area Air Quality Management all new materials for inspection. District? CYcso I have read the moard ems mamrials requimmenu under Chwpmr 6.95Of the Califon nice ficalth&Safety Cndc,Sections 255B5.255JJ anJ 25514.1 untkrsuntl Nmirthc Willing J ties not eurtendy here a anan�thnl it is my responsibility m notify the rccupanl of the requcmen hichmustW tpdorni,suanecofa CcNficaw Of Occupancy. Signature of Applicant Date Owne dXmP rim as cal Dale All roof coverings to be Class"B" or better FUR OUT WALL TO SK ALIGN W/EDGE OF TILE 13 SIM. CERAMIC TILE I MIRROR, ALIGN W/ TILE EDGES WALL LIGHT .-G EQ. EQ. -I— a I –J 13 - CORNER MOUNTED TOWEL HOOK @ +/_2'-11", _3"=-- -3'= SOAP HOLDERS w CTR. ON TILE T.P. HOLDER @ +/- 1'-7" - 4 Z CTR. ON TILE t' a+ f � L, I �.. i R 3 .? O `m � •�_ G T JWATER SUPPLY FOR W.C. 2 SK ,,THIS SIDE jW.C. BRUSH 12 ALIGN EDGE OF TILE W/ TOP + SIDE OF SHOWER RECEPTOR SK EAST ELEVATION 9 SCALE 0' 1' 2' 4' 6' 8' FUR OUT WALLS � _y, CERAMIC TILE GYP. BD. J GRAB BAR TOWEL HOOK @ 5'-D" SK 14 ALIGN ------------ TOWEL RAIL U 1/2"PTD.WD. BASE SK WEST ELEVATION 112"=1' 10 SCALE 0' 1' 2' GYP. BD. CLG. (3)RECESSED LIGHTS, F14 WALL LIGHT, F13 GFI I i I - i ` E EQ. o 0 SEE SK-9 FOR OF LIGHTS ,(�;OF FAN CENTERED c- W/W:C. N - I-0 r - '.3:S.FAN c? 0 0 SK BATHROOM RCP / LIGHTING PLAN / ELEC. PLAN 1/2°=1'-0° 8 SCALE 0' 1' 2' 4' 6' 8' ,SN� COITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO APN# /r� Date: —Q Building Address: Mailing Address (if different from building address): Z Owner's Name: Ph ne #: - 2S�- 63;G Contractor: License #: Contact: Phone: Cupertino Business License#: Fax: Building Permit Info: Bld Elect Plum Me Job escripti . Res identi (� c Sq.Ft. F or Area: Ft.: Cost of Occupancy Grou Type of Constructionf Please check thi ❑e project is a second-story addition: Project Size: =BAPPLOT Large ❑ Major ❑ Quanti ,.-fee Description Fee Group OtherAppliances MECHANICAL BBLDGFEE Bldg Permit sq. foot 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 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 <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 't / � 4 4�3a - )f aLL6_155A �TY OF CUPERTINO cm OF CUPE TTINO PERMIT APPLICATION FORM Quanti Fee ID Fee Descri tion Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housin Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTM4E Ins ection Overtime BUILDING BPBACKFLOW Atmos heric Vacuum PLUMBING BPCESSPOOL Cess -- PLUMBING BPERMFEE Bld Permit Fees BUILDING BPFIXTURE Pbl Fixture PLUMBING BPGAS Gas P;-;-- System Fee PLUMBING BPINTERCEP Ind Waste Interce for PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Re eat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewa a Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Tra PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT D-;-----tion Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI A Bance Install MECHANICAL BREMBUSWAY Remodel Buswa s ELECTRICAL 13RENMIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BRE HOOD Installation of Hood MECHANICAL BREMMISC Misc Annnrqtiiq ELECTRICAL BREMNRAPP Rem Non-Res Ap Bance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/A aratus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BRENIREPALT Repair/1 .1 --eating MECHANICAL 2 of 3 �I'Qll�r® CITY OF CUPERTINCO CITY OF PERMIT APPLICATION FORM CUPEkTINO uantit Fee ID Fee Description MELECTRICAL BREMRESAPP Remodel Res A liance BREMSIGNAD Rmdl Signs Add Branch BREMSIGNS Remodel Sips, Mar uee 13RF-MTHEATR Theatrical Li kiting Fix 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 TemporaEy Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Tem Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electricals foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicalso. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbin Permit Issue PLUMBING PPLBG Plumbin Fee s foot PLUMBING ZADDCHG Address Change BUILDING 3 of 3 c>BUI DIN UDPEROONNo PERMIT CONTRACTOR INFORMATI6 `,r' BUILDING ADDRESS: CONIFER CONSTRUCTION PERMIT NB4050045 S Apz I ell PE PERMITISBUE DATL SANITARYNO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0/� - u00 LICENSED CONTRACTOR'SDECLARATION Job pli u\NA D C 1 hereby affirm that I am IittnscJ under provisions of Chapter 9(commencing VU/,-\U t� with Section 7001 of Division 3 of the Business and Professions Code,and my license is o L0neClaand erm"' BATHROOM REMODEL S License Class Ln. F p Dam T'S DECLARATION As shot hCTS DECLARATION t DEC D- 2004 di 1 untlemrenJ my plans shall he used as public meoNs DyU n u h Licensed Pmfessinnel O 11 D t� n OWNER-BUILDER DECLARATION U IILII� I\\\YVII II I hereby off rte thin 1 am exempt from Jin Contractor's License Law for the 1111 H 0 following mason.(Section 7191.5,Business and Professions Code:Any city or county K$ which mquires a permit to cnnsmon.sIter.impro e,demolish,m repair any structure 80 m—'^ prior in its issuance,also requires the applicant for such Permit to Rlc a signed statement that he is lrearaed pursuant,,the pmvisim.of the Comractoh License Law(Chapter 9 Sq.Ft. Floor Area Valuation 'lz—$ (commencing with Section 70NI)of Division 3 of the Business and Professions Code)or that he is exempt th.mfrom and the basis for the alleged exemption.Any vi,,lmion of Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of 3 69"I6 fro 0 Occupancy Type not more Nan five hundred dollars($500). ❑I,as owner of the property,or my employees with wages a their sole compensation, will do But work,and the stuclure is not intended or offered for sale(Sec.7W,Business and Professions Code:no Contractor's License Law docs not apply to an owner of Required Inspections property who builds or improves the con,and who does such work himself or through his own employees,provided Not such improvements are not intended or offered for sale.IL however,the building or improvement is sold within one year of completion,Ne owner. builder will have the burden of proving Thal he did not build at improve for purpose of sale.). 1. s owner of Ne property,am exclusively contracting with licensed contactors to con met the project(Sec.7044.Business and Professions Cade:)no Conoacmr'a Li se law does not apply loan owner of property who builds or improves Hereon,and who contracts for such projeem with a eontmemr(s)licensed punuam m the Contreetora Licen se law. eae tticr sec. ,B&PC for Nis masonOR MPENSATION DECf.A TION r.hyaffirm under Penalty of perjury one of the following dedmtions:e and will maintain a Cerdfera of Consent to self-insure far Worker's Campen- provided for by Section 3700 of the labor Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Workers Compensation Insurance,a squired by Section 37W of the labor Code.for Ne performance of Be work for which this Permit is issued. My Workers Compensation Insurance carrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not he completed if the permit is for onchundred dollen($I00) or less.) 1 certify that in the performance of the work for which this permit is issued,I shall nut employ any person in any manner so as to become subject to the Workers'Compcnsmion Laws of California.Date Applicant NOTICE TO APPLICANT:IL after making this Ceti ficam of Exemption,you should become suhjea m the Workers Compensation provisions of the labor Code,you mum J O foMwith comply with such provisions or this permit shall be deemed revoked. ' CONSTRUCTION LENDING AGENCY F"14 l hereby affirm that there is a constmninn lending agency for the Performance of (Yi> the work far which this permit is issued(Sea.3097,Civ.C.) W� Q Under Nam. D Z Lender's Addmsx V Q 1 certify that 1 have reed Nisty and county and stem that and shove infuriation relating is to 0U coding lagrcemcomply and herebyall eityand eounty,,Ndvar of and stemla ntreupon me pU building construction,and h.mbyatthorimreprescnntiwsaf this city to enter upon Nc abovomemioncd property far inspection a Purposes (Wc)ogme to cast,indemnify and keep harmless the City accrue Cupertino id City / nF.t VI liabilities,judgmcnm,cosh and expenses which may in any way accmc against said City Uz in eonuyucnec of the greening of this Permit. I APPLIC NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURC ULATIONS J _1 ,0 4 Re-roofs (57 Igna ofAPPlicaHti ARDOUS MATERIALS DISCLOSURE Date Type of Roof Will the applicant or future building occupant store or handle h rcurdoa material defined by Ne Cupertino Municipal Code.Chapter 9.13,and the Health and Safety a,Section 35532NO1. All roofs shall be inspected prior to any roofing material being installed. ❑Yes ,trio Will the aPPlicam nr future building occupant vu equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District' ❑Yesu 1 hove read the brardous materials requirements under Chapter 6.95 of the Califon Pia HcalthS Safely Code Seed,,a 255(15.25573 and355}q.l undersmnd Nm if the building does not currency haw a tenant,that it is my responsibility be notify the occupant of me ba Qn hreh meat be rpt;ar to iaaaance or a cerdfice,arOccapart Signature of Applicant Date Owner mm rile fit Data All roof coverings to be Class "B" or better