03070136 CITY OF CUPERTINO
BUILDING DIVISION PPRMITCONTRACORINFOIZMATION
BuiLo1NG ADDRESS: _ BATHROOMS BY REMODELING """'03070136owNER'S NAME: - 1422 SARATOGA AVE PERMIT ISSUE DATE
(408) 378-6700
ONE: - SANITARY NO. CONTROL NO.
i
CHITECVENGINEER: BUILDING PERMIT INFO
BLDG ELE PLUMB MECH
Ira le CC'11 O D
Y00 LICENSED CONTRACTOR'S DECLARATION �W--
U 1 hctehy arf,m that I em liwnac cr provision&of CWPmr 9(commencing Job Descri LIOD
with Seccion7 fDivixi n3of thea sand ProrcssinnxC Je,end mylicensc is gOoO
z'qi u«�1acl:a, .z Lie G7�0^cF.3 REPLACE BATH FIXTURE & TILE AUG 1 4 L J
r m to
ARCHI LAR OI
BUILDING
1 ®Igtl Np�G
D�u IunticrtunJ my plans shellWu&cJ as public¢cords
H Licensed Professional
3 OWNER-BUILDER DECLARATION
1 hmoby affirm the,I em exempt from the Conusemfs License Law for the
0D following reame.(Section 7031.5,Business and Professions Corte:Any city m county
I22 which requires s permit to ctmssmct,dmq improve,demnlish,in,repair any auctom
;- Poonnits issuance,ehu requimuhe applies for such permiuo file esigned,mument
py¢< than he is licensed pursuant to the provisions of the Contractor's Ucenmlaw(Chapter 9 Sq. Ft. Floor Area Valuation
yl-m (commencing with Section 7")of Division 3 of the Business and Professions Code)or
i $ that he it exempt therefrom and the basis for the alleged exemption,Any violation of 32344027 . 00
Section 7031,5 by any applicant for a permit subjects the applicant to A civil Penalty of APN Number Occupancy Type
not more then Bve hundred dollen(5500).
I,as owner of the pmpeny,or my employees with wages As their Role compensation, (�7�T
will do the work,and Nenrlu
u[ m is not intended w offered for sale(Sec.7W,Business D y71Cd Inspections
and Prefeulo^a Code:The Contractor's License Law does not apply to an owner of 102 — PIERS p
propenywho builds or improves thereon,and who does such work himaelf or through his
own employees,provided that such improvements are not intended or offered for sale.If. 1O3 - UFER
however,the building or improvement is sold within one year of completion.the owner. ,
builder will have the burden of proving that he did not Wild or improve fat purpose of 104 - REBAR
rale')' 105 - ANCHOR BOLTS
❑h as owner of the prolcny,am exclusively contracting with licensed convenors to
construct the proper(See.7B4a.Business and Poefcoubma Carle:)The Contractor'&Li. 106 - SEWER & WATER
come law docs not pply to an owner of property who Wilds or improves themon,and 202 - UNDERFLOOR PLUMBING
who contracts fat such pmjece,with a conmanm(s)licensed pursuant to the Contractor'.
Licenmtaw. 203 - UNDERFLOOR MECHANICAL
❑ 1 am exempt under Sec. B&P C fonhis..on
204 - UNDERFLOOR FRAME
Owner WORKER'S COMPENSATIONDECLARATION205 - UNDERFLOOR INSULATION
I hereby AfEnn under penalty or perjury o^e of the following declarations: 301 — ROUGH PLUMBING
have And will maintain a Certificate of Consent to¢elf-insum for W^rkcri Compere 302 - TUB & OR SHOWER
as pn,lded for by Section 37W of the Lebo,Code,for the performance of the 303 - ROUGH MECHANICAL
for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,As required by Section 304 - ROUGH ELECTRICAL
27M of Ne lwWr Code,for the perfo ee or work for which this Noroi is issued. 305 — FRAME
M(y�w/(],keraenm�naeli�nJnm&'sgg [,ni///e��� PaheynemhemA.J �7 306 - HOLDOWNS
V _�•.uit.s!/s-G / Wry
No.: 0/70-" 0 05
CERTIFICATEOF FJ( ONFAOMWORKERS' 307 - INSULATION
COMPENSATION INSURANCE 306 - SHEETROCK
(Ibis ectitm nm eed^ be,completed if the permit is fm one hundred dollars IS 100) 309 - EXTERIOR LATH
(
less) 310 - INTERIOR LATH
employ that in the performance of ted work for which chis the W is issued,I etull nm
Law.of
in any manner an as to become abject in the Woheri Compensation 311 SCRATCH COAT
Laws of Cdifornia.Date
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT:IL after making this 0mifce1,of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation provisions of the labor Code,you must
.J Z, forthwith comply with such provisions or this permit anal l he deemed revoked. SO2 - FINAL PLUMBING ENERGY
?( CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
'Fr IhembyAffirmthattherei&econatmim.lendingagencylnnhepctfotmenceof 504 - FINAL BUILDING ENERGY
LYi ti the work for which this permit is issued(See.3097,ON,C.)
W z Lendcr'AName 505 - FINAL ELECTRICAL
U0Lnder1cnifyAddress 506 - GAS TEST
UO Ieereetocmplywmot I have udthcityandcounAndtyodtaucesandthat the surelawsotionon to 507 - FINAL PLUMBING
U bonding I agree Io comply with all city end cepres ordimnces end sou bras reining to
pU building construction,and hereby euthome representatives thiscitymcnterupon the MEC CAL
r 4 ah^ve-mentioned property for inspection purposes.
Wo)agree m rave,indemnify and keep harmless the City of CuNnino against %FIN
FIh Juddlitles.judgmcne,,core,and cxperves which may in any way crom.g.iut said City NG /sUZ in consequence of the granting of this permit. xRE ULD DS ANO WILL COMPLY WITH ALL NON-POINT Issued by: C WORKS Dat (J
SODUR![�-/p
REGULATE ?4;F
Re-roofs
Sigeatorc of APPIinHAZARDOUS MATERIALS DISCLOSURE Oam Type of Roof
WIII the applicant or future building occupant Store or handle hanardous material
as defined by the Cupeninn Municipal,Code,Chapter 9.12.end the Health and Safety
eWe,Sams.2553X.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicenw,fit
Wilding occupant usccyuipmem m Jcvices which If a roof is installed without first obtaining an inspection,I agree to remove
I ho,ardnm air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
int
❑Ye¢
1 have mad the prombn s materials requirements under Chapter 6.95of the C&bfim-
ealth&SafetyCode,Secdmu 25505.25533 and 25534.1 understand thatif hu Wilding
oat[urtcnrly has nk Net it u my msomihility m nndfy dm rc[u tof Nc
amswhic mel poororissuancc.faeenidcetoof upon Signature of Applicant Date
e,M uihodsd agent Dale All roof coverings to be Class "B" or better
r7
CITY OF CUPERTINO (3
CITY OF PERMIT APPLICATION FORM
CUPEIITINO
PN # ;✓ J44 --- CO=ate:
Date: 7/17/0 3
Buildin02g A.ddress: ailing Address (if different from building address):
O-S' /� ��Z �.�acc •
Owner's Na? /] Phone#: / �7� 9�
Contractor//w�/ oa�i.� : License#:
Con one: ��70'p Cupertino Business License#:
moi, Fax: 37 0 6 3
Building Ee it Info:
B d Elect ❑ ]um Mech ❑
J option:
Residential o'er �a ¢.N Commercial ( -
Sq.Ft. Floor ea: 3 X
> i $/Sq.Ft.:
-
Cost of Project: 9" 7, gb Occupancy Group: �
Type of Construct' Please check this box if the project is a
second-story addition: ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1 M 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 <= 1600A ELECTRICAL
BELEC1001 Elec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
4-
1 of3 �• ��a . ��
�r
-44 air
CITY OF CUPERTINO
C�TY0 PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BMITIGATR Res. HousingMit Fee BUILDING
BMNEWMULTI New Multi-FamilyRes MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI MultifamilyRes ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res 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 rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pipe 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 clip MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> I 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
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C - CITY OF CUPERTINO 00
CIR OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, 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 Inspection 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
MPERIVIFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
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