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03040126 CITY OF CUPERTINO BUILDING DIVISION PERTR�; ,TaR�INF �.tIVI - RVkgIN8YDR4sfILFORD DR THE BATH ROOM INC PERMIT NO.03040126 Ouge]kNPI�LZ JACK L AND JANET A 1910 W EL CAMINO REAL ErsMIT�DbD4'r28/2003 (650) 968-7666 SANITARY NO. CONTROL NO. BUIIDINO PERMIT INFO ARCH DIC(ENGINEER: BIRO EIEC' PLUMB MECH p LICENSED CONTRACTORS DECLARATION 1 hemby affirm the'1 see Ilwnsd under pee ons of Ch pacer 9(commencing Job Description wlNSectlon7 )or Divitlon3of the Budnoss 'rofesdons Coda.and mylkense i, ����® nmurmm.an Bea a 22 BATHRM REMODEL �� Llcen Lk.k Dau 7VEcuntracm S lusd rtend mypicudWlheuadupubticrecnd, JUN 0'3 202 Licensed Profctsknd OWNE. ecoDER DECLARATION BU'�NG 1 hereby.CS. Nu I am esnmpl from the fiamnnmors e:License c I.A.for the my o which re reu^n.(Salon 7031.5.Business ma Pmfea ell Cade:Any city s musty which requtra•permit rOn equires dor,improv,de ecell t fi mash any wrucore v �(� S^ pa"usItits uum Percent t to the theappnan fmsoch ant's file.I.. sukmem S Ft.Floor Area �4q5 V on < (thathe comm.cing wit punuad w1lM provisionslona theComment'sLicenselaw(chapter odo)or Q• Y (commencing Section 70nd the basis rof th the Business andon.Any vlosdo)m (hatSm he r exempt my applicant and or bur it the subjects the exemption.Any lineation of �1.� ca Won]than by any red doll for'permit wbjecu Iha applicant to•civil penally of 3�1 l�qrlY'dr 0 0 Occupancy Type rot mom than five hundred dollars(f5(10). ❑I,uawn"of Nepmpmy,amy pnployea with wgauthetr wk mmpewtim, wdnamlha.rorL ana thest^Imomrlwti^lelww«arcemd rarakfsec.lou.awllw Inspections and Professions Cade:The CannwM1 l^ Urenw law Encs not apply he N Owner or 10 2 — PIERS ptopeny,w ho bui Ids m i mptowa thermos,aa ou nd who doch work himself or Nmu fb hla ..employ=,pmvlded thatsuch lmpm,emenu WallU mulled orortenal for ale.If. 103 — UFER howen,the building or improwmen is sold wiNm ane year of compbon,the owner- bulkier win hew the bollen of peeving tin he did rot build or Improve for purpose of 104 — REBAR ale.), 105 - ANCHOR BOLTS 0 1,As own"or the property.am excludwly wnbactes with licensed eontneMM to wnuuct tin project(See.70".Business And Professions Cade:)The Conlrwim's U- '106 - SEWER & WATER rotes,Law does not poly man oweer or property who builm nrimllmns themen•A^d. 202 - UNDERFLOOR PLUMBING - who wnlraeu for such pmjecu with a Cortise u(s)licensed pmsum he the Conlruwrs License Law. 203 - UNDERFLOOR MECHANICAL 0 l am exempt under See .B Ae P C fm Nis recon 204 - UNDERFLOOR FRAME owlcr Dau 205 - UNDERFLOOR INSULATION WORKERS COMPENSATION DECLARATION I hereby affirm under penslty of perjury^ns of the following deelanllone 301 - ROUGH PLUMBING Its, and maintain will minn a Cenbcswof Column he sekf-Insure forWmkerl Compery 302 - TUB & OR SHOWER' .W.,M prm4dd for by source 3700 of the labor code,for the performance of ft303 — ROUGH MECHANICAL work for which lhrpermit isbuee 304 — ROUGH ELECTRICAL 0 I new and win maintain Wmaus ComlxnsNon Insurance,As required by Section 3700 d the Labor Cod,_for the perfmmarce of the w"k for which Nr permit Is lamed 305 — FRAME My Workers Compewtio c see ad"and Poheyrombu Am: 306 - HOLDOWNS Caden�_Ponry Na: -R t 307 - INSULATION CER FIGTE OF EXEMPTION FRO KERS' COMPENSATION INSUIDMI E 308 — SHEETROCK (Thio"den rued not Mcomplued lithe knoll is forms.hundma dollars(flIXn 309 - EXTERIOR LATH or lest`) 310 - INTERIOR LATH I cedfy ,sl In Ne performance of the we&fm which Nr Permit Is issued,I shall nm employ any person In my manner an As to become subject ee the wmken'Compewrm 311 — SCRATCH COAT Laws of Callfmnla Dam 313 - ROOF NAIL Appliant NOTICE TO APPLICANT:IL iflm making this Cuffiate of Exemption.you should 501 — FINAL ELECTRICAL ENERGY bumme subject to the Worker's Compensation pmvidon,of the labor Cone.you mud Z forthwith comply with such pmvednnsorthis puellmdlbedecmedrewdua 502 - FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hereby NUM Net Nem 129 construction lending agency for One performance or 504 - FINAL BUILDING ENERGY the work for which this Penn lAblamed(Sac.In",Ch.c.) 505 - FINAL ELECTRICAL C Lammers Name . z LemaersAdd•ess 506 - GAS TEST 1 certify that 1 haw read this appliance and sum that the'W"Inrom,Nw Is 507 — FINAL PLUMBING .cL 1 at=to comply with all city and county ordinances Ad sou laws re1Nng M rV^ Wilding Continuum.And hereby AuthOlins Of this City 10 on="pro fice FIN MEC CAL If7 shove-men i..d prop.uy,for Impecdon purposes. fy (we)as.N aro,InacmNy and keep harmless the City of Cupertino against 0 9 F I ,y liabilities,judgments,cau and expenses which may In any way a"rueAgainst aidCity 5 NG In consequence of Ne granting of this perm 1. Date APPLICANT U ERSTA Df AND WILL COMPLY WITH LL 1 ON-POINT Issued by:5 C WORKS SOURCE REO.) TIONS i y � �8 D� Re-roofs signwnm eek Contra or of Roof A3:ARDOUS MATERIALS DISCLOSURE Type . MI)the Applicant m four,Wilding oxupantdom"Ndk umaterW Ad dennd by du Cupertino Municipal Code.ChaNer 9.13,and the Hutth and Safety Code,Section 25533(.)1 All roofs shall be inspected prior to any roofing material being installed. Oyu use equipment or device OI e Wil the applicant m future building{occupant devices which If a roof is installed without first obtaining an inspection,I agree to remove Int headou,dr cenNmman,As&find by the Bay Ana Air Quality Management all new materials for i ection. District? OYa (p1e1a . Iban mdthe h'adwsmdeddsmgaimmcwunder Carrier 6.95orNeC,Rrm- .L 3H sl h @Sd"yCode,Swd=Y55o5.33533 sed i553a.Imdemwm thdlf es,building '(/ dm,not clown, haw a lananl haw It r my responsihkllly o turfy the Quepanl of the mgmmmnnts hmnsta tpdnr mrsCcrtirusmor Sign ureof plic Dae own"a mhos; e.eel Dau�� All roof coverings to be Class "B"or better -- RTY OF CUPERTINO CIT'ypF O � . CUPEI�TINO PERMIT APPLICATION FORM �i 0 3 ° �{ APN # � d Date: � r Building Address: Z�3� J 1 V►� I A- pn . Owner's Name: Phone #: v. a- rn, s. �3i No�Z 406-151 -in', Contractor: (N C License #: / oq j 7;7— Contact: 13 Ar\j CupF/ ertino Business License#: Build Permit Info: Id Elect [? Plumb jKj_ Mech .® Job Desc tion: Resid ial 0 �� m ci ❑ ft. Floor Area: o-� X11 $/Sq.Ft.: t"f Cost of Pr oje Occupancy G up: i Type of istr Quktity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100Kto500KBtu 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/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 Ener Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING � Z ( 7 � �' 1 of 3 _ E� CITY OF CUPERTINO CIT CUPTYOF 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 BNUSFD New Single Family Res BUILDING 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 BP NT Alt of Drain &Vent PLUMBING BPWATER InstalUAlter Water Pie 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 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> 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 2of3 CITY OF CUPERTIA CITY OF PERMIT APPLICATION FORM CUPERTINO 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 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 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING • 3 of 3 fig 66 Job Site: . " Mr.&Mrs.Birk r 213911 rO dDr, cupe�ii e, ars56`aVED IN4o QK'4ngt WITH T14E CITY on P^fj QUPFRTINO DINANCE9 3L 36 DATE 0 ThisSIGset This set of ,ans and specifications MusT Oe kept on the job at all times and itis un lawful to make any changes or alterations the same o Without d e°rfor e�gBy: Permission from the 6'fne'Sai Noolririn6f Cupertino. The St'iii6WPEi Cerf'ino Rade speCifiCati0R9 3HALL Qt I&a4,CA.94 jrmlt or to be an ExNAvsT �tarJ IPPra1A650-9%7, e6ti®n of any PraV13,019 M any Lice nsa�# WITH u SYHte l8gle 132 ' F(.VOt2E5GE2')T 132 LI(AHT f , l e Scope of work: a I , 1.Replace shower pan and walls 2.Replace shower valve . • 3.Install shower enclosure '� . I❑( 4.Replace vanity,top,faucet S.Install 6.Replapla Replace exhaust fan t� 7.Reinstall toilet II 1 ' Notes: 1.Shower pan and walla,cultured t ill,, 2.Shower valve Is pressure balanced PR283.OFCI at vanity Shower enclosure ie safety glace S�puor cent light exhaust fan combo tFi Itch is to euorescertt light 6 o is 1.6 OPF 3 T T44 1) nc All dlmensloro 8 Wee designations This la an odBlnal design entl must BIRKHOL2 Scale:112'=1' Design: 04=10 C given aro subject to vedficaWn on not bs roleaasd or cooled unless Dara : 04/23/103 job site and adjustment to Bt job applicable fee has been peld or job condItlone. order placed. Designer CITY OF CUPERTINO "S.wxM� ,i.td ,i%+"z". °"` "p ♦ .�r ar x' BUILDING DIVISION PERMIT C� �` Tl/R���1�Mt#.TIy =,gid BuZLlpNyBgDRgBgILFORD DR THE BATH ROOM INC PERMITNO.030040126 0 FMOLZ JACK L AND JANET A 1910 W EL CAMINO REAL �IT`SS'8Try28/2003 P (650) 968-7666 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO ARCNf1EC(ENGINEER: BLDG ELECT PLUMB MECH 0 0 0 0 �orpo LICENSED CONTRACTOR'S DECLARATION Job Descriptio iy I bureby efrom that I am licensed under pro along or Chapter 9(commencing with SCoOon7 )of Divlslon3ofd¢Bueinesae rofculons Code,and my license ie 1V a Ott r Z �n cfmrcean frau » (y. <f'y2. BATHRM REMODEL Da¢at Canlncwr 9 st d ARCHrIECrS DEC ATION JUN O 3 20033 1 undersand my plane Mall he used n public rueords 3 u. Licensed Prior cnbnal - �U1L®��� 3D OWNER-BUILDER DECLARATION 1 he eby affirm M that I nm exempt room ,Contractor's License Law for the 0 0 following rcuon.(Section 70313,Business and Rofeuiung Code:Any city or County 29 which requires a permit to COWMWL arm.improve,demolish.or repair any slru<lure Fel^ prim m iB)uuance.aIgo requires the applicant for such permit to Rte A signed statement rig < thathelslicensedpurauant to tho pmvisiongnfdM Contractors License law(Chapter9 Sq.Ft.Floor Area $y0 fti n i � (commencing with Section 70W)of Divinlon 3 Alto,BuSlnestand Profcuinna Cndc)Ar M Mal he Is exempt MCMUnM and she buts for the alleged exemption.Any violallon A( Semon 7031.5 by arty applicant for a permit subjects Me applicant 10 A civil penglty of 3AIN NQEftT 00 Occupancy Type not more than fn hundred dollen($500). ❑1,As Owna of the property.m my employed with wages u their tole compew0on, ,7,r' will do the work and MM the It Ant lnmed 14 ma«ered for We(Sec.7° ,eusimu — OUND?RT+fiW Inspections And pmfetMo A Cade:The Contractor',License Law don not apply to an owner of 10 2 - PIERS property w ho builds or Improv,,thereon,and who does Such work him set f Ar thmugh his own employees,provided Matsuch lmpowments arc not Intended moRemd for sale If. 103 — UFER however,the building or Improvement 1,Sold within one you Of completion,the Manor- Wilde,will have the burden of proving that he did not bund AT iMpfow for Purpose Or 104 — REBAR ASIA.). 105 - ANCHOR BOLTS ❑1,as owner of the propeny,am exclusively contracting with Licutsed contractors to construct the pmject(Sec.70",Business and Predations Ced,:)The Contractors U. 106 — SEWER & WATER Come Law does not apply m an Am of property who builds or Improves thereon,And 202 — UNDERFLOOR PLUMBING who contracts for such projects with a contractor(s)licensed pursuant to the Conuanmrs License Law, 203 - UNDERFLOOR MECHANICAL ❑I xm eaempl under Sec .B A P C f."hi.Munn 204 - UNDERFLOOR FRAME °r ° WORKER'S COMPENSATION DFiCLA0.ATateIO 205 - UNDERFLOOR INSULATION I hereby alllmt under penalty of perjury one of the following declarations: 301 — ROUGH PLUMBING ❑Thaw and win malnWna CeArum OfConsenuo sel6ingurt for WorkehCompon• 302 — TUB & OR SHOWER cation,As pmvldcd for by Section 3700 of the labor Code,for the performance of dm 303 - ROUGH MECHANICAL Aorta for which this pmmltlaimeed. 304 - ROUGH ELECTRICAL ❑I have and will maintain Sooners Compensation lognomce,As required by Section 3700 of We Labor cora far M,performance or arc work for whim this permit is tutted. 305 — FRAME My Worker's CAmpensaliot late lreAce eemmr and Policy number am: 306 — HOLDOWNS Carder. Policy NA.-J, )3.J1 307 - INSULATION CERTIFICATE OFMEMPIUN FROM yrO KERS COMPENSATION INSU101NCCE 308 - SHEETROCK (Missectlon need not Wcomplemdlflhe permit is furon,hundreddollm(SIM) 309 — EXTERIOR LATH m teas.) I certify that in the performance of the work for which this permit is issued,I shall not 310 INTERIOR LATH employ any person In any mannerw AS in become subject to the WArken''Compensation 311 — SCRATCH COAT laws O(Califomla.Dere' Appliunl 313 - ROOF NAIL NOTICE TO APPLICANT:If.after making this Certificate of Exemption.you Mould 501 - FINAL ELECTRICAL ENERGY become Subject to Me workers compensation pmvtuons of Me labor Code,you most .,'Z fore.ilhcomply with such pmvt,)onsn,this purnitMail Wdcemedmvoked. 502 — FINAL PLUMBING ENERGY zo CONSTRUCTION LENDING AOENCY 503 - FINAL MECHANICAL ENERGY [-t I hereby Affirm that there is.construction lending a;cncy for the Performance or 504 — FINAL BUILDING ENERGY a> the work for which this permit is iumd(Sm.3097.Mr.Cd W q Leader,Name 505 - FINAL ELECTRICAL = z Lend,raAdd., 506 - GAS TEST U OI unify that 1 haw Toed Mis application and sou Mat the above information Is507 - FINAL PLUMBING Iy coned.1 agree to comply with all city and county ordinances and state laws relating to O SH building construction,and hereby suthorior represenlaliwt of this city to cmm upon the FIN MEC CAL w Move-mentioned prop any for inspection purpoaes. (Wc)grime to sew,indemnify and keep hsrreleu(he City of Cupertino against 09 F I fn IIMIIinu,judgmenW costs and expenses which may in anyway ans7oe against told City 5 NG U in consequence of the rimming of this permil. �••� APPLICANT U ERSTA)DS AND WILL COMPLY WITH LL ON-POINT Issued by:5 C WORKS Date SOURCE REGU TIONS u� Re-roofs Signature qtl aComm.tm AZARDOUS MATERIALS DISCLOSURE Type of Roof WIIl dm applicvntm(calmOccupant ,bullJingtoM or handle rardousk mamdal AS defined by the Cupertino Municipal Code.Chapter 9.11,and Me Health and Safety ' ode.Section 23531(e)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes O NA Will the applicant Or fOm'we building Occupant use equipment or device,which If a roof is installed without first obtaining an inspection,I agree to remove emit haurdnus air contaminants AS corned by the Bay Arta Air Quality Management all new materials for i ectlon. District? Oyu ON. I haw mad the hxurdtmt materials requirements under Chapter 6.95 of the Califnr. '/X nix Health A Safety COM.Secdons 15505,15533 and 15534.1 understand thin if the Wilding dura not currensl haw a mnanL that h h my mepongihlllty m notify Soon aaupanl of Mc Mquimmcnu hmuubu et pdar nuance Ada CertiOcem of cupan $ig0 ser4ofp1i C Da e X01 All roof coverings to be Class"B"or better Owner o mhodr d agem Dam