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02100131 CITY OF CUPERTINO 0 BUILDING DIVISION PERMIT CONTRACTOR INFORMATION, Bu1Trg0212ESLONGDOWN RD THE BATH ROOM INC PERMIT N(02100131 11*3EAK WILLIAM G 2 AND PAMELA 1910 W EL CAMINO REAL APPLICATIIVI T`F'Y2002 PHONE: (650) 968-7666 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECLI 0 t� aa� r LICENSED IiD CONTsed and R'S DECLARATION of CON rc m P 1 herehy afhrm that 1 am licensed under d Miioras of Chapter 9(commencing Description �� with Scminn]aklpsf Divii on lofthe Ousine. JPndessionsCodc,and myiiccnse is BATHROOM REMO in full fnmcan�I of t 2-2 hnz— License Cl Ste L'c m oZ—^ Dam JVJj'j D2 Contractor_ _ II 00IL��B QQu� �/ ARCHITECT'S DI[ ATION 8 a ✓1 understand my plans shall eRused as lie records m^w edy0 OCT Licensed Professional 1 2 RHFwO OWNER-BUILDER DECLARATION ContrON I ZOO an COO hereby miro affirm that 1 I. exempt from the reuntmctor'a :Any c Law for the $6500 followinguires a(Section]IGL0.Business and improve. demolish, Code:Any city nrruture K$ which requires a permit m construct.elmr,improve,demolish,or repair any nrmwm 1 .� w prior hr its issuance,also requires the applicant for such permit to ftleasigned statement _ 1="i< Nat he is licensed pursuantto Ne provisions of the Contractor's License law(Chapter9 3A2F3J&Q7A10A Valuation �$ (mmmencing with Semion]Ikkpof Division 3 of the Business and Professions Code)or Nat he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of i JAPN-NWi;WL)ATiOccupancy e " not..or than five hundred dollars($500). 102 — PIERS p y Ty yp ❑I.o owwr of the pmpcny or my employms with wagu u their wle comNnution, willdothe work.and the svunum is not intended ninfrared fo radc(Sec.1061.Business 3:03 UFF and Professions Code:The Committees License Law dues not apply to an owner or 1 04 — REBAR Required Inspections pmpcny sono builds orimpmvcs Ncrcon,and wbadocssuch work himulf or through his own employees,provided that such improvements are not intended ornRemd for sole.If. 105 — ANCHOR BOLTS however,the building or improvement is sold within one year of completion.she owner builder will have the burden of proving Nal he did not build or improve for purpose of 10 6 - SEWER & WATER sa1e.). 202 - UNDERFLOOR PLUMBING E]1,as owner of the property,am exclusively contracting with licensed contractors to 203 - UNDERFLOOR MECHANICAL construct the project(Sec.TW,Business and Professions Code:)The Contractor's Li. cense law does not apply m an owner of property who builds or improves thereon.and 204 - UNDERFLOOR FRAME who contracts for such projects with a contortions)licensed pursuant to the Commerce's' License Lew. 205 — UNDERFLOOR INSULATION ❑I me exempt under Sec. .B&P C for this moon 301 - ROUGH PLUMBING er Dam 302 - TUB & OR SHOWER WORKER'S COMPENSATION DECLARATION 303 - ROUGH MECHANICAL I hereby of ndo under penalty of perjury one of the following decimations: 304 — ROUGH ELECTRICAL ❑Ihave and will mainmina CenifrcateofComem loref-insure for Workres Compere 305 — FRAME sation,as provided for by Section 3]00 of fee Labor Cole.for the performance of the work for which this permit is issued. 306 - HOLDOWNS ❑ 1 have and will maintain Worker's Compensation Insurance,as required by Section 3 07 - INSULATION 370)M Ne labor Code,for are perfmmanco of the work for which Nis pemail is issued. MyWorker's Compensation Insurance carrier and Policy number am: 308 — SHEETROCK *er:S.�. I. G Policy 113-PDO(AA 309 - EXTERIOR LATH ERTIF� ICA'Iti OP EXEMPn tJM WORKERS' COMPENSATION 1, ,NCE 310 - INTERIOR LATH (This section need nnl W completed hire permit is forma hundred dollars($IIM)) 311 - SCRATCH COAT 'Tess') 313 - ROOF NAIL I certify Not in the performance of the work fnr which this permit is issued,I shall ton 5 01 - FINAL ELECTRICAL ENERGY employ any person in any manner so so to become subject to the Workers'Compeuation Laws of California.Date 502 - FINAL PLUMBING ENERGY Applicant NOTICE TO APPLICANT:If after making this CenificamolExemption,you should 503 - FINAL MECHANICAL ENERGY become subject o the Workers Compensation provisions of the labor Code,you most 504 - FINAL BUILDING ENERGY oz forthwith comply with such provisions or this permit shall W decreed revoked. z505 505 - FINAL ELECTRICAL (—r rh. I hereby ofirm Nat Namisacnnsuucttnn[ending agency for the wrlormancoof 506 - GAS TEST a the work for which thisp mil isissued(Scc.lfyl],Civ.C.) 507 - FINAL PLUMBING W Q Ixddcr's No. 5 z Lender's Address 508 - FINAL MECHANICAL U O 1 certify that I have mad this application and state that the slave information is 509 - FINAL GRADE w F correct.I agree a comply with all city and county ordinances and State laws refining b, QW 5 FINAL PLANNING building con,nothmn,and hereby authnnsem,eentatives of Nm is city eaw,. nn the above-mentioned inspection purposes. 14 FIN LIW RKS (We)agree to save,indemnify and keep harmless the City of Cupertino against V) liabilities,judgments,frosts and expenses which may in any way came agatiral said City U Z APPLICeof the gnting of St ANTUN ERTANDSAND WILL COMPLY WITH ALL NON-PAINT Issued by. Date SOUWEGU AT S. 111IM aaL Re-roofs ;gnat r Appicam/Cm omctor a HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will she applicant or future building occupant store or handle ha�dous material na defined by the Cupenina Municipal Code.Chapter 9.12,and the IIcahn and Safety At.section 25532(.)? �xx,� - All roofs shall be inspected prior to any roofing material being installed. D Yea N't Will the applicant or future building ecculmt use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove emit halaNnov or r contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes 'Wn 1 have road the haeardous materials requirements under Chapter 6,95 of the Califon .is Heailh&Sid kly Colo,Sections 25505,25533 and 255341 understood that if Ne building does not currently have a tenant,that it is my respouibility to redly tbe txt.pant or the myuire rise ustbemclpnortnissuwccofaCcrdfca ofWcvP cy. Signature of Applicant Date ru woe, atom,iced agent wale V All roof coverings to be Class "B" or better