04080108 CITY OF CUPERTINO 77,
a^"
BUILDING DIVISION PERO
NNT,"07T,0RJNF0kMA N,
BUILDING ADDRESS: PERMIT NO.
BATHROOMS BY HANS 04080108
ER'S NAME: PERMIT LSSUC OATH
T_TTTT_)MTT1r 492r TTTTQN WAY AA /I-n-12
PHONE: SANITARY N POMOL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
] 0 0 0 0
y00 LICENSED CONTRACTOR'S DECLARATION
us 1 hereby'from that I am licensed ander provisions of Chapter 9(commencing Job Description
i with Soctimn7 on 3 of me Businwa^m�gqfessmrm Code.and my lice.¢is
?may in Tau fort Jc iviai /'a 3g3 REMODEL SHOWER SURROUNDS (2 BATHS)
j�Z License Lic.M
Oete Cun DELL S
AR NI IN used
8 e RA
undersand my plans shall W used as Ptah' oNs
0 Licensed Profcssiaaal
OWNER-BUILDER DECLARATION
1 hereby m irm that I am uempt from the Commerce.License Law far the
n 0 following mason.(Section 703 I.S.Business and Professions Code:Any city or county
K m which requires 8 Permit to construct,alter,improve,demolish,or repair any Structure
ca pnormits ismancc.alturequiru the a,dbam forsuch perming rile a signed statement
s<
that he is licensed pursuant o the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area I ❑
c�m (commencing wire Section 7000)of Division 3 nrthe Business a ad Profusions Code)or
$ that he Is exempt therefrom and the basis for Ne alleged exemption.Any violation of
Section 7031,5 by any applicant for a permit subjects the applicant o a civil penalty of 3 6�I$ 0�flef 0 0 Occupancy Type
nm more Nan five hundred dollars(55007.
❑1.at owner of Ne property,m my employees with wages m their solo compensadon,
will do the work,and me swctum isnot intended or offered far sale(See.70u L Business
and Professions Code:The Conumus's License Law mora not apply It,an owner of Required Inspections
property who builds or Improves thereon,and who does such work himself.r through his
own employees.provided Our such improvements arc nos intended.,offered for sale.If.
however.Ne building or improvement Is sold within one year orcompletion,the owner-
builder will have rise burden of proving that he did not Wild or improve for puryose of
sale.),
❑1,u owner of the property,am exclusively contracting with Released centncmrs to
constmet Ne project(See.70as,Becomes,and Professions Code:)The Contractor's Li .
cense law Jou not apply to,an owner of property who Wilds or improves dsemon,and
who contracts for such pmjeets with a commeor(s)licensed pursuanno Ne Comeactoes
Lica se Law.
❑I an exempt under Sea. .B Ar P C for this mason
Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of me fallowing declarations:
I have and will maintain a Cenifcate of Consent to self-insure for Worker's Compete
sedan,u provided for by Sermon 3700 of the Labor Code,for IN performance of the
work for which this permft is issued.
❑1 have and will maintain Worker's Compensation Insurance,u required by Section
3700 of the Labor Code,for tha Performance of the work for which this permit is issued.
My Work Comps .n Ins nBe�cartfer and Policy number art: /
�1h7 Glee LNs P.... 011 i0 f
.JCI CERTIFICATE OF EXEM�OM WORKERS'
CTE OFE EM N RANGE
(Nisseethm.c.d not hecomplemJi permit is formal hundred dallars(5100)
less.)
1 certify that in the performance of the work for which this Permit u issued.I shall not
employ any Person in any manner su as to become subject m the Workers'Compensation
Laws of California Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Esemptien,you should
become subject to the Worker's Compensation provisions of me LaWr CDM%you mum
,J O fuMwith comply with such orniuma,or this Permit and]he d.,.ad revokmd.
Z CONSTRUCTION LENDING AGENCY
(~ .N-. I herehy as m that mere is a consuuctinn lending agency for Ne performance of
a ? the work for which this permit is issued(Sec.3(197.Civ.C.)
�W A Leal sName
,a z Lender's Address
U Q 1 certify met I have read this application and state mat me ahova information is
U, coned I agree in comply with all city and county cNinances and state laws mlaling to
QTJ building construction,and hereby auth.rra representslivuo s City 10 come upon me
ahovcies judge Property for inspection purposes.
ty (We)agree to save and keep me is
or Cupertino against
rL.i r/3 liabilities,)udgments,emsu IDntle nsca hichm Tony Weyaccrm againstsaidCity (/(/� / 1
(„) z or PPLRgare apt me tint f per t O
^' APPLI BUND A IL COMPLY WITH ALL N -P INT Issued by: Date r /
EGU N /
8 � y Re-roofs
S' m Ap rcanucontr r \ Dam
// HAZARDOUS MATER LS DI SURE Type of Roof
a Wi a applicant or future building eccupantstoro orhandlehnurdous material
az der by the Cupertino Munic� Come,Chapter 9.13,and the Health and Safety
de, uron3553260? All roofs shall be inspected prior to any roofing material being installed.
❑Yu
Will the applicant or fuwm building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit Neardnus air contaminantsu cfioed by tW Bay Area Air Quality Management all new materials for inspection.
District?
t]Y.
(have mad thehvsNnus materiab rcyuirem or Charm,6.95 of the Califon
Tia Hcalm55afey Ce__ .35533 3553 .1 underardthatifthe Wilding
Jags not currently ga�i ¢nam.mar' umy ap.nsi ilymnodfy me.ccuP tort Ne
re wh' t et an C.AfnamoCSe�nncyO Signature of Applicant Date
oprlldhaedagent m All roof coverings to be Class "B" or better
Oathrooms by Hans
Contractor's License: 513838
Note: Existing condition is a tile shower
Brad Mailly with tiled in shower pan - 32" wide
Cell: (408) 431-0720 and 36" deep
Phone: (408) 26870682
Fax: (408) 268-0683
Client: Bath 2 - showe"f d'
i � tMCO
Vernon Hudnut.
19971 Lindenbrook Lane
Cupertino, CA � 32„�
(408) 996-3950
AUG 18 MN 36”
N� Sow ITY CUPS I IN
�r��1 S 1eca.��vc Vin L! E BUILDING PAC NT
Z�j—'.2
fD1'R��'aiJCE.g FSG Q'•t'3•,.,t••
SIGNEf), ���'S��' _V .,..ib.�.
fan af�1.V
thfs set of P` a 1°f,of o11 nl`Y () ur: ^r stter�r'
'Do V, ,•make enY 6han urmiaon
lawful
to without tNrilb.n r
on Sbu; UePt^ v,., a poen" ar
Idn „r to h
the s ,mPln�°l hBldpo Pn,n , aY Prn� 'i'",
h°idol°u0 or°�i n l ew
iDPrO 1 ,ry Ordmence
Bath 1 - bathtub
{$ I
t1 n
` ti`s'
r `
Bathrooms by Hans t
Contractor's License: 513838
Brad Mailly
Cell: (408) 431-0720
Phone: (408) 268-0682
Fax: (408) 268-0683
Client:
Vernon Hudnut
19971 Lindenbrook Lane
• Cupertino, CA
(408) 996-3950 nip
� q �111J
,��A,rq &2-RrUYVC5
Marble walls (34" + 60" + 34") x 64" RECOVEV
ani C�l re mue'r e—
�,2� 4I L( c&ow c.r L,OcA s
QbTY OF CUPERTINO�
aCITY0 PERMIT APPLICATION FORM
. CUPERTINO
APN# 3 / G L
2 Date:
Building AI(dx'e�s ( Mailing Address (i Yl
ifferen(fr&n buil mg address):
Owner's N Phone#:
Contractors • �y 7t yS License#:
Contact: D Phone: 003) 313-4072- Cupertino Business License#:
J cWOyL/ L' Fax: (got) o-'81.53
Building Permit Info: cctt,
Bld Elect& Plumb Mech ❑
Job Description- VP(sN11 2 RA-n4l al-,
Residential prL S'+n2 res Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: � Occupancy Group:
Type of Constructs Please check this box if the project is a
second-story addition: ❑
Project Size: Standard ❑ Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
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> 1.75M 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
`A BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
26 � � 1
1 of 3 ,--.
70s ' 0,13
i
*ITY OF CUPERTINO*
CITY O RM
CUPEI�TINO PERMIT APPLICATION FO
QuantityFee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
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
IN 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
BREMATRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFD:T Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Fumace> 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
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
2of3
OCITY OF CUPERTIN(JO
CUPEI�TINo PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BREMSIGNAD Rmdl Sips 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
BS WIM - 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 Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
•
3 of 3
CITY OF CUPERTINO +'�s '�% ^ � I. "
BUILDING DIVISION PERMIT ,.CON,''- RAC 'OR TNt)ItM"A"I'1'ON. ,
BUILDING ADDRESS: PERMIT NO.
BATHROOMS BY HANS 04080108
OWNER'S NAME: PERMIT ISSUE DATE
E:
SANITARYN 0 OLNO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p 0 0 0 0
ar00 LICENSED CONTRACTOR'S DECLARATION a cri non
i�+�r� w 1 hereby moth
m Nat I am IicomM under provisions of Chapter 9(commencing
with Sectio ] ivision Sof the Business en Lesion Code.and mylittnu is (�1
i n G■Wf
iqz ima, a contnxtor 3 REMODEL SHOWER SU
p� I ARCHITECTS DEC
Ky understand my plans shall he used as Pu nrds NOV 9 2004
G Licensed Professional
Oat I a.cm.DER DECLARATION BUILDING�I
K O O hereby.(firm e. 1 am eBuire from Pr Contractors n:Any c Law far the
p o following reason.(Section]1131.5,Business and Pro(essium Code:Any city ar county
$� which requires a Permit to comuucL alar,improve,demolish,or repair any structure
Prior to its is mnce,aim requirer the applicant forsuch Permit to file a signed statement
Ihet he is licensed pursuant m the prevision of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuate 0
(commencing with Section 7000)of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the bub for the alleged exemption.My violation of HH1�sfg..yyssii 1.Q
Section 7031.5 by atry applicant for a Permit the applicant to a civil penalty of 3 B+Jad sJ`®r9 I 0 0 P Y TYP
not more Nan lve hundred dollars($50[d. - Occupancy e
❑I,at copper of the Property,or my cmployus with wags an then We compensation,
willdotheworkandduswctumisnotimmntledar.ff, Aforule(Sce.70U,Buineu
ssi
and Prefeos Code:The Contractors Licens u c Law donot apply an owner of Required Inspections
property whe bu Ilds er improves thereon.and who does such work himulf or through his
own employees,provided that such improvements art not intended arc@red for We.If.
however.Ne building or improvement is sold within one year of completion,lie owner.
builder will have the burden of proving that M did aot build or improve for purpose of
tile.).
❑1,u comer of the property am exclusively contracting with licensed contractors to
construct the project(Sec.7014,Business and Professions Code:)The Co^tracur's LL
cense Taw docs not apply to in owner of property who builds or improves thereon,and
who contracts for such projecu with a contnmtar(q licensed pursuant in the Contractors
LKCRQ Law.
❑I amesempt under Sec. ,B k PC for this mason
t37M
r Data
WORKERS COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury one of the fallowing declarations:
ave and will maintain a Certificate of Coment to xlGinsum for WorkersCompm-
,r phich Win
fpe mi Section 3700 of the I�bor Code.far tie performance of Ne
for which Nis permit is iuucd. '
ave and will mainuin Wmkcri Compeuatien Insurance.u required by Section
of tie Labor Code,for due performance of the work for which this permit is issued.
or ggT nwlntstyleetyfi canisand Policy nmithe,.: 2/O,/r.eC.Jr'(•f•T7 I•NJ (Tjn^'Y� Polley .: `T-
CERTIFlCATEOFE%�AN WORKERS'
CTE OF E ATI N RANGE
Olds auction need not Ise ..ted Penufhiforms.hundrcdd.lims(SIM,
or ms)
1 certify that in the performance of the work for which this Permit is ismd,I shall not
employ any person in any mannerso at to become subject o the Workcrt'Compensation
laws of California.Dam
Applicant
NOTICE TO APPLICANT.IL after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Code,you must
0 O foMwith comply with such provisions or this Permitsem
hall he deed sent
Z" CONSTRUCTION LENDING AGENCY
[r��+ 1 hereby.f irm that there I..c...troctirm lending.gamy Int the furmmamee of
C > the work for whim this permit la issued(see.3097,Co.Ca
Ca Lenders Name
.'I. Z Lenders Address
U Q 1 certify Nn 1 have read thio application and sum that the them inform Warn b ,
11.F coned 1 ague to comply with all city and county colossuses and sum laws relating to
DU building construction,and bereby ande.ce mprexenutiveso is city to enter upon the
(ll alem-memioned property for iupenion pu=c.
F (We)agree u an and keep the sty e(Cupertino against
Tap liabditis,judgmencs,costa a roes hichm many ysmue agwut said City eol
J 7 in conseque f the i f perAPPLI i ND A COM Y WITH ALL NONPOINT Issued by: Date '
EGU
b' Re-roofs
S' re AP nem"Cantr r Dem
HAZARDOUS MA DI SURE Type of Roof
WE applicantorfutme building occupantmon orhandle haallommateriai
u tic0 by the Cupertino Munic' Code.Chapter 9.12,and the Health and Safety
nae, ecuon25532ta37 All roofs shall be inspected prior to any roofing material being installed.
❑Yea n
Will the mplicam or future bu'hung occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ha am us air conunnomis a fined by the Bay Arca Air Quality Management all new materials for Inspection.
et?
E03'
Yet u
I have mml the hscW"u...imalsrcquircm kr Ch aprer6.95ofd¢Califor,
7nijaHmt"Safclyco�dc,5 'om25 .25533 255 'not..nerdysonans thatjf is my spumy ty to nodry the ocup t of the
t(wn , Qel 6 Ra ce eeNBcitte ye�3 Signature of Applicant Date
arm 'red age^t 4 m All roof coverings to be Class"B" or better