04020041 CITY OF COPERTINO �a`�"�p.� �'k"p .,st � '' °♦s•• *rte '`
BUILDING DIVISION PERw1 �4'1"Lf
BUILDINGADDRFSS: SARATOGA KITCHEN & BATH PERMITNO04020041
W NER'S NAME: PERMIT L55UE DATE
TnT-TN HERON 14n TpwTq Rn #jo /044004
ONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
p p LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 em licensed under provision of Chapter 9(commencing lob Description
nNCIPwith Section 70110)of Division Sof the Busimosand Profusion Code.and my license is � '��
LiZto full force rend effect 7 8 8 3 N D MS BATHROOM REMODEL
Licen I Lie.#
n— Dab� � Contractor (a[n �w� 200JARCHITECT' ECLARAT N SEP ?Z
yy! , 1 understand my plans shall he .pot
d o
OyU
s.;0: Licensed Professional BUI DING
3 OWNER-BUILDER DECLARATION BUILDING
g 1 herchy affirm that 1 am exempt from the Commctur's License Law for the
d n 0 following Tenon.(Scene.703 1.5,Business and Profcesions Code:Any city or county
K$�' which requires a permit to...Amer,alba improve,demolish,or repair my structure noo
prior to its issuance,also requires the applicant for such permit In File a signed statement
t— that he is licensed pursuant totheprovisionofthe Common'sLicense Law(Chapter 9 Sq.Ft.Floor Area Valuation
Fa (commencing with Section 7000)of Division 3 of the Businessmd Professions Code).,
that he is exempt thercfrom and the basis for the alleged exempdon.Any ViDlatban of 1a ri,nmA.
Section 7031.5 by any applicant for a perrnit subjects the applicant to a civil_Penalty of 3 ' HILs 5ysa71yesTQ Q Occupancy e
nut mars than five hundred delta.($500). P y `yp
1,as owner of the ppor y,or my employees with wages as their cele eampenndon,
will do the work end Ne swcturo is at intended or offered fo...1.(Sm.7044,Business
and Pmfesslans Code:The Cmum un',License Law does not apply to an owner of Required Inspections
propeny who but Ida or Improves thereon,and who dors suc h work himself or through his
own employees,provided that such improvements ere notinbnded annotated forses.If.
however,the building or improvement is sold within one year of completion,the owner.
builder will have Ne burden of proving that he did not build or Improve for purpose of
sale.).
❑1.as owner of the property,em exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li.
cense law dean not apply to an owner of properly who builds at Improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant in drc Contrecter's
Lt.n.Lew.
1 un exempt under Sec .B d:P C far Nis rowan
wner Deb
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the fallowing declarations:
❑I have and will maintain a Certificate of Consent to sciNnsure for WorkersCompen-
m0on,.provided for by Section 3700 of the labor Cade,for the Performance of the
work for which this permit is issued.
I have and will maintain Workers Compensation Insurance,n required by Section
3700 of the labor Codc,far Ne performance of the work for which this permit is issued.
My Worke'r'f1 Compensatio'n/hy�sur"ence c�ameerr.and Policy number am: l
Caner. roratip�yydgf�uolicy Na.:s`Ib9e0r3�3''1
CF#TIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This eomlan need nothecompleted if tib permit Is furore hundred dollars($100)
or less)
I certify that in Ne performance of the work far which this permit is issued,l shall Out
employ any person in any mmnerm as to become subject to Ne Wor ecia Compensation
Laws of California Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption.you should
became subject to the Workers ComPenation previsions of the Labor Code,you mum
QZ forthwith comply with such provision or this Permit shell W deemed revoked.
NDING AGENCY
z
CONSTRUCTION L.3W7,Civ.).)
[r I hereby alarm that do.iso eonuuciinn lcndingageny for the perfmmance of
W4 the work for which tbib pertnil is issued(Sec.303],Civ.C.)
WW A Lender'sNamc _�--
z Lender'sAddrcss
r,Q I certify that I have read this application and sub that the above information is
W,F coral.I agree to comply with all city and county ordinances and sum laws relating to
DU building construction.and hereby autharire representatives or this city to enter upon the
W above-mentioned Property for inspection purposes.
W
(We)agree to save,indemnify and keep harmless the City of Cupertino against
h liebilitiea.judgmenu,costa and expenses which may in any way accmc against said City
tJ7 in consequence Nc gmmin of crmiL .
r"i APPLICA DRS A WILL MPLNWITH ALL/NONI-fPSOINT Issued by: Date
SOU CE 2! �/K
Re-roofs
HAZAR OU
Signature of ApplinData
HA2A(or=b MATERIALS DISCLOSURE Type of Roof
Will the applicant or future bribing Occupant,Chapter
or handle Health and
as deFined by the Cupertino Municipal Coda Chapmr 9.12,and the Health and Safely
Codc,Section 25532(a)? J/ All roofs shall be inspected prior to any roofing material being installed,
0Vn [A
Will the applicant or future building occupant use equipment art devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit han dnus air remmminanu as defard by he Bay Area Air Quality Managcmem all new materials for inspection.
Disoict7
❑Yes
1 have mad the ha.uhrus materials M,theoentsurde,Chapter 6.95 of the Califor-
nia HeelN ffi Safety Code,Section 25505.25533 and 25534.1 undersand Net if the building
does not cmremly knenL tAat it' my responi,`hiliry to notify the occuPml of the
mquircmenmw ban P mceaiycanBabnramp er. Signature of Applicant Date
a��/PTI
owrcre aumorind agent a Dare All roof coverings to be Class"B" or better
Cry
APPROVED,
IN ACCORDANCE P4ITH THE GtTY OH
cUPERTINa C'JES `.ND ORDIfVAI�C59
,i�1ee••••e% J
- i i\� �J $
OA 3 € 0 42094
SIMED
MtI i j °
itis set ofzand specify tiom�
oe f, t :,e job at all times and A is 10
L,rrf F e any changes or: alteratir iF
on _Yna out written permission fr n1® J
the Qtilding Dept., City of Cupertino.
The o2mping of this plan and specificati�n, I
;jj<<_. MOT be held to permit or to be t
pp oval of the violation of any prov€s�ar�r-
t anv City ordinance or State Law- ? j
i \
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f —UR
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INUIP
i -102
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o - n
Saaraatona Kitchen & Bath Design Heron�tAaster Bath A --�-- Floorplan m
U=1 Version 3.Room 3 Cavern oerg N*v»,2aos _.-Scale:Nn -
4 r �'�
L�d ITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
:UPER,TINO
APN # Z Date:
Building Address:
a 2 q5-1 R a
Owner's Nam Phone#:
zS 5 -40X3
Contractor: 0.„c a, �., �D License#:
Contact: \y Phone #:Z
9 sb
Applicant/C�ut� r: .N• � Fax #:
—�
Building Permit Info:
.Bldg Elect Plumb Mech
Job Des ri tion: Q
Residential: Commercial:
Nq.l,t. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation:
�e of Construction: Occupancy roup:
Quanti Fee ID Fee Descri tion Fee Grou
BAPPLOTHER Other A liances MECHANICAL
BBLDGFEE Bldg Permit s . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to IM Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Corn Quasi BUILDING
BCONSTAY,BQ 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 Ener BUILDING
BENERGYADD Ener Add Multi BUILDING
BINVESTIGA Investi ation fee BUILDING
BMITIGATC Comm. Housin Mit. Fee BUILDING
a� a
1 of3
CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM - - -
•CUPEVINO
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 PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pb1g 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
Lp BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain&Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT 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
2 of 3
CITY OF CUPERTINO
CUP TYOF PERMIT APPLICATION FORM
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
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 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
ti.
•
3 of 3
r7777
CITY OF CUPERTINO a.r^ 777 '�
BUILDING DIVISION PERMIT ` �+ z�°� ��xA� ATI ��L�a
r. u?.. ,w�n�`, �. H.
BUILDINGADDRESS: SARATOGA KITCHEN & BATH PERMITNo04020041
R'S NAME: - - PERMITISSUE DATE
0
]NE: SANITARY 90. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
+�Op LICENSED CONTRACTOR'S DECLARATION Job Description
n� 1 thereby affirm that I am licensed under provisions or Chapter 9(commencing
with Sttuan 70lllq o(Diviaian 3af the BuainessandPro(cuianx Code,and myliccase la t� p�p �7, p p�
� ymmnmmeandercoet� uex 7883yo MS BATHROOM REMODEL ' rf 0® atidbiLsL��
z_ Lkenq�aId�
DaIC /'a.'/�COntranmr
vil- ARCH
CI' ECLARAT N
SEP 23 2004
I understand my plans sh II W asp n P
U
3 Licensed Pnrfessi...I _
OWNER-BUILDER DECLARATION
i f I hereby affirm that I am exempt from the Contractors License taw for the -' BUILDING.Up�A ®'��
a o following reason.(Section 7031.5,Business and Profassions Code:Any city at county B1(�
K$6! which requires a pori(t.construct.altar,improve,dcmolim,or repair any atmemm
`'t'°' prior in its ismmae.,alm requires thcapplicam forsuch permit a File.signed.to ment
x�x< that he is licensed pursuant to the proviaiaaof the Carl.,..License Law(Ch.,,,9 Sq.Ft.Floor Area Valuation
F� (commencing with Section 700(d)of Division 3 ofthe Business and Professions Carl or
Nat he te exempt lbemfrom and de basis for Ute alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant io a civil penalty of 3 41�$IQ'll�l$Cr0 0 - Occupancy Type
not mom than five hundred dollars(SSW). ..
D I,as owner ofthe property,or my employees with wages as their sole compensation,
will do the work.and Ne awctum is nal intended m offereed for sale(Sec.7011,Business
and professions Cade:The Comnclm'a License Law data at apply to an owner of Required Inspections
properly who Wilds or improves thereon.and who does such work himse If or through his
..,.play=,provided that such improvements are not intended in offered forule.if,
however.Ne building or improvement is sold within one year of completion,the owner-
builder will lave the burden of proving that he did not build or improve for purpose of
sale.).
D I,as Owner of the property,am exclusively contracting with licensed euntrcmaa m
construct the project(Sec.7044.Business and Professions Code:)Tim Counselors U-
conse law dots not apply b an owner of property who Wilds or improves therean,and,
who contracts for Inch projects with a conmecmr(s)licensed pursuant to the Contractor'
License Law.
❑1 am exempt under Sec. ,B&P C for this mason
er Data
WORKER'S COMPENSATION DECLARATION
1 hereby spire under penalty of perjury can ofthe following decimations:
1 have and will maintain aCenificnte of Consent iosel6insum fm Worker'aCompen-
nation,a provided far by Section 3700 of dm Iabm Cade.for Ne pmformmce of Ne
work for which this permit is issued.
I have and will maintain Workers Compensation Insurance,an required by Section
3700 of the Labor Code,far Ne performance of the work for which this permit is lamed.
My Worker)Compensation 1 mese carticnnd Policy number am:
carrier.��licy No.:s`I b 9 GP l•39 S'4
C 1 LATE OF EKEM ON FROM WORKERS'
COMPENSATION INSURANCE
(ThleseNuo need not W camplemd if the Permit is forma hundred dollars(SIM)
of leas.)
I coolly that in the performance of the work for which this permit is issued.I shall not
employ any person in any mannerm a in become subject a the Worker'Compensatian
Laws of California.Data
Application
NOTICE TO APPLICANT:If.after making this Coulleata of Exemption,you should
become subject m the Worker'Compensation previsions of the labor Code,you must
�O (o thwith comply with such provisions or this permit shall W deemed revoked.
„z„ CONSTRUCTION LENDING AGENCY
[-i 1tormy.ffrm that Nor is a construction Imilingagam,for the performance of
lYa> lie work(m which no.permit is issued(Sec.3097,Co.C.)
WQ Leaders Name
CL.D M Lenders Address
U J Q 1 certify that 1 have read this application and sum that the above information is -
n.F correct.l agree to comply with all city and county ordinances and sum laws misting to
C)U building conawction.and herebyauthodn reprraentativcn of this city to enter upon the
W .hove-rocntiooad property for inspection purposes.
(We)agree m ave,indemnify and keep hamiess the City of Cupertino against
va r4iq liabilities,judgments,costs and expenses which may in my way acerae against aid City
(„)7 in consequence the gnomon of nnLL
G APPLICA DRS WILL' MPL1wWITHA�LZL,Na%INT Issued by: Date.
SOU CE /T
Re-roofs
Signature of Applicanl/Contramor -Dale
HAZARDOUS MATERIALS DISCLOSURE 't.,' Type of ROOF
Will the applicant or future Wilding occupant sem or handle hazardous niman l
defined byNe Cupertino Municipal Code,Chapter 9.11,and Ne Health and Safety -
e:ss32(a),
Cyc5K All roofs shall be inspected prior to any roofing material being installed.
cc Yes
Will the applicant or future building occupant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hazardous air centurions;a defncd by Ne Bay Arca Air Quality Management all new materials for inspection.
District,
Dyes gPu
1 have mad the hazaMausmatarialsmquimmenb under Chapter6.95 ofthe Califon.
ria HcaIN&Safcty Code,Sections TiM5,25533 and 25534.1 undersand thatif the Wilding
does not curently ave a moan.Net it' my rcsponi hility m notify 1W occupant Of Ne
requlhe On w must be p' ssuancca "'PRY. Signature of Applicant Date
owner m auNo seed agent Data All roof coverings to be Class"B"or better