03070136 (2) CITY OF CUPERTINO / s•�.��+a(.>us 01
.� ,ID,��,mm,.� to�7,aaY �,•.
BUILDING DIVISION ISExiI C0NTRAC'�T01k�P *N Y,
Siff�:. •d S mob,..mck�r3z"'Sic ,1?f
BilCI)r G ADDRESS;
BATHROOMS BY REMODELING PERMIT NO03070136
OWNER'S NAME:
Mh,RrTjP.RTT7 T. 1422 SARATOGA AVE PERMmgUE DATE
NE:
(408) 378-6700 SANITARY NO, CONTROL NO.
ARCHITECPENGINEER:
BUILDING PERMIT INFO
BO ELECT PLUMB MEC"
sera. LICENSED CONTRACTOR'S DECLARATION Job Description
O O
F I hereby affirm anal 1 am linen cr provisions of CInpter 9(enmmeneing
E4 with Section] rf Division3of the6 nand Prufcssions Cotic,antl myliccnu is
—0 in full fottto t
^gi uttnaclasa it, Lm,n G7S�Od';3 REPLACE BATH FIXTURE & TILE
a °r
ARCHITE CLAR O
Az
U I undersand my plans shall M used u public records j
Sar. Ur.cnud Pmfcasmnal ��/
05 OWNER-BUILDER DECLARATION
ii E I hereby affirm that I am exempt fru.the Contractor's License Law for the Q�
S m wi
O fallong......(Section]1131.5,Business end PmfladOn,Code:Any city..county
—� hich requires•po r"to ennnmct,alter.impmw,demolish.or repair any Structure
Iraor O iB ex-nr.lso regmrta the applicant for such permit to Ere a signed Statement
e thatheislicenudPursuemmtheprovisionsoftheConnaur''sLicenseLaw(Chapter9 S Ft. Floor Area
leW (commencingwithSectionTIM)ofDivison3oftheBusincaxandProfessionsCMA)ser q' Valuation
Nat he u exempt thomtsom and the basis for the alleged exemption.Any violation of .t 32344027 . 00
Section 703 1.5 by any applicant for a permit subjects the applicant to a civil Penalty of
not more than Bin hundred dollars(SSW). APN Number Occupancy Type
0 1,but owner of one property,or my employees with wges as their Sole compensation,
will do the work,and theswchme is not intended or offered for Set.(Sec.7044,Business _ D
and Professions Code:The Contractor's License Law docs not apply to an owner of Inspections
propeny who Wide or improves thereon,and who does Such work himself.,through his 102 - PIERS
own employees,provided that Such improvements are not intended of offered for ASIA.If,
however,the building or improvement is cold within one year of completion,the owner. 103 — LIFER
builder will have the burden of proving that M did not build or improve for purpose of 104 — REBAR
sale.).
0 1,As owner of the property,am exclusively contracting with licensed comuctors to 105 — ANCHOR BOLTS
construct the project(Sec.7044,Business and Prorcesions Codeq The ConaacmrY u. 106 — SEWER Fie WATER
cera law it=not apply re an owner of propeny,who Milds of impreves IMaon,and
who contracts for such projects with a contnctor0)Licensed pleauant to lMCurtractora' 202 — UNDERFLOOR PLUMBING
License LAw.
I—
❑ exempt und
203 - UNDERFLOOR MECHANICAL
Am er Sec. ,B h P C for this rcuon
Own. Date 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
40I hereby On.under Penalty of perjury one of the following declarniun: 301 — ROUGH PLUMBING
Ibe.and will mainaim a Centre.,of Conant to aelf.ieaum for WmUra Co.Pen• 302 — TUB de OR SHOWER
anion,AS provided for by Section 3700 of the Ube,Code,for the porre mance of the
work 3 0 3 — ROUGH MECHANICAL
for which Nis paean it is issued. -
0 I have and will maintain Wurker'a Compensation Insurance,u required by Section 304 - ROUGH ELECTRICAL
37OO of the lwMr Cotle,to the pcnomance of ework for which this permit is issued. 305 — FRAME
My WArkcr'S Cnm sation Inau;rapge carticy Policy number Are
c�r: L/ �s��[. icyN.,; Odfzi DOS 2 306 - HOLDOWNS
`� CERTIFICATE OF FX ON FROMwORKERY 307 — INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
(Thisucann mend nm M completed irrM Permit is Toone hundred dnllan(SIM) 309 - EXTERIOR LATH _
for len.)
I enmity that in the performance Of the work for which this Permit is issued.I shall not 310 — INTERIOR LATH
employamy Person loamy manner m AS to become subject 1.due workers Compensation
Laws of Ca311 — SCRATCH COAT
lifomla.Date
N TICS 313 - ROOF NAIL
NOTICE TO APPLICANT:If,otter making This CcniOc-to of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
y become Subject to the Worker's
Compensation provisions of the Labor ends,you must
.J,Z f.Mwith Comply with such pmviumas nr this permit Shall M deemed mmked. _
0 502 FINAL PLUMBING ENERGY
V) CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
'l therebywhich this
Netthere t11 Wid(See.30 lending agency l'nr me performanceof 504 - FINAL BUILDING ENERGY
Qi the work fur which this permit is issued(Sec.309],CO.C.)
WMq Leder'sNamc 505 - FINAL ELECTRICAL
5 Z Leader's Address 1
U O I ttnify Net I have mad this application and stale that the above infnrmuiunis 5 0 6 - GAS TEST '
u, P correct,I Agree to comply with all city and county ordinances and bible laws relating m 507 - FINAL PLUMBING
pU buildingcontmction,Andherebyauthoriurepresentativesofthiscitytoenteruponthe FIJaNW CAL'
�W aWvo-mentiuned property for inspection purposes.
,n g1a (We)agree m Save,indcmni fy and keep hsanldas the City of Cupenin.against 09 FI
V) liabilities.judgments,costs and expcues which may in any way¢crud against slid city 5 V z in coAPPLlseexidence ordbe Bcoming of this permit.SOURt1 NT UNDEIRST DS AND WILL COMPLY WITH ALL NON-POINT Issued bY:5 ORKS Dat
srgesttturaofAppincanVC.ntraclor7�< Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Detc Type of Roof
Will the applicill or fit[..building occupant store or bandium
t hardous aterial
as defined by Ne Cupertino Municipal Code,Chapter 9.13.and the Health and Safety
Code,Section 35533(e)?
Dyes All roofs shall be inspected prior to any roofing material being installed. '
'
will the aPpncanI or ruture wilding occupent use egalpmenl of devices which If a roof is installed without first obtaining an inspection,I agree to remove
tit hamrdous air contaminants AS defined by the Bay Area Air Quality Management all new materials for inspection.
latrict?
D Yes
I have read the hmardnusmattfuls requirements under Chapar 6.95 of the Caliror.
nib Hubh K Safetycodd,sections 25505,25533 and 35534,1 undersand thouif the wilding
does not currently hoe dant,that it is my responsibility m nndly the nccu t Of the
mentos whlel met Fnortuissuancenfa Cenipcaa.f cup" Signature ofAppl
C icant Date
nermpuihniredagrro D,1C All roof coverings to be Class "B" or better
BATHROOMS
by Remodeling Specialists
1422 SARATOGA AVE. • SANI JOSE, CA 95129
TELEPHONE (408) 378-6700 CONTRACTORS LIC. #674083 J-,I��� Date _ ������"
7/JK& ;v fZL TC ti;��aLC- i I 'a a�
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APPRAN E[
SIN 'ACCORDANCE W TH THI CITY
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thissetlar h c s e dEr.,ns dOST I � _ .._. - � I
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on;same without ba all me : ani' is un
y can@ is c amt on.,
yii the hmEdi g;Dept wrdten parr issi$n Ir
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City of Cup.
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SHALL befheld'toanf ill
IVcotlgns
The stamping} I ,
SIP; the violation i l..ar r .provialhnE
'd any City Ordinance or ,tate Law,
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CITY OF CUPERTINO* 03 o 7 (3 6
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
APN # J Date: 3
Buildino2g ADddress: ailing Address (if different from building address):
Owner's Na? c . � Phone#: ����� •-7� �fqy�
Contractor, ? �Z ��,Q�� License#: e� �;Yb/ P 3
Con pct: /] one: 7c-0 Cupertino Business License#:
X --C4 i. Fax: 3� O(✓?
Build ng P.e it Info:
B d Elect ❑ lum Mech ❑
J ption:
Residential c «�s'� j��� e.N Commercial
Sq.Ft. Floor ea: X i $/Sq.Ft.:
i
Cost of Project: 7- Cr O Occupancy Group:
Type of Construct/ pl 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<= 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
BMITIGATC Comm. Housing Mit. Fee BUILDING
4-
1 of3 �2
ITY OF CUPERTINOO
CUP TYOF O PERMIT APPLICATION FORM
QuantityFee 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
BOVERTWE 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 Repipe Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTl0P 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 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Fumace MECHANICAL
BREMFURNOV Relo Fumace> 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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ItITY OF CUPERTINO#
CITY OF PERMIT APPLICATION FORM
CUPEfIiTINO
Quantity Fee ID Fee Description WELECTRICAL
Group
BREMRECEPT Rc tl, Switch & Outlets BREMRELOCA Relocation of Hood BREMREPALT R air/Alter Heatin BREMRESAPP Remodel Res A liance BREMSIGNAD Rmdl Si s Add Branch
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
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
EPERNUTFEE Elec Permit Issuance ELECTRICAL
MPERMFEE 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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