02030036 CITY OF CUPERTINO "' "" "' •'.
BUILDING DIVISION PdjJ` YT ; ':CO .' CTQRs.INFORMt� OY '�
BUILDING ADDRESS: PERMIT NO.
10432 NOEL AV 02030036
OWNER'S NAME: APPLICATION SUB DATE
STAHARA STEPHEN S AND JACQUE I 03/11/2002
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT(ENGINEER: BUILDING PERMIT INFO
s w BLDG ELECT PLUMB MECH
< ' u E.—) L:.i u
yi LICENSED CONTRACTOR'S DECLARATION lobDescription
z=ci Ihcrtbyefncr that 1 am licensed order provisionof Chapter 9lcommcncing
;yta. w'd`,s 100) )Of DI\'IIIo030f111eBYiln[SSandPlOf[SSInnSCOde.endmyhCenSt REPLACE BATHRM CABINET/TILE SHOWER.
of 5 JJ< is in ran r ria rBeef;
lac < License s Lie�SL•,.7 FINALE
3 u G Com
ARCHITECT'S D LARA 10
'a O<j 1 un rsmnd my pions nhall be usetl as public rccoNs q
dpO Linnxcd Professional APR 2 0 ZOOZ
OWNER-BUILDER DECLARATION
1 hereby affurn that 1 am exempt from the Contractor's License Low for the p�
h?� following e
requires m
reason, 7031.5.Business and Protrusions Code:Any city or county. BUILDING 4000
�F,3 ❑ which uires a permit construct,alter,intpemolish,rove,dor repair an nu
struu
a3= 'Fri° to its issmimgalsa nx,dosatsti,rdicetn farmch pennino fleasignednemmem
:halhelich., itpursnaMiotheprovisionsofthetheBuctariLicenseLaw(Chapter) Valuation
(commencing with Se therefrom
and the basis o t the l Business samor Professions Cotle) :3 2� �/ °��.�ff f. t
or Chef he is exempt thertlrom�and the basic for the alleged nempibn.Any violation
rof Section 70313 by ar,yapplicant for o permit subjects the applicant to s civil penalty
ofnatmomthanfivehandrwdoll.($30o). 1014PN'�'�DATION " Occupancy Type
111.as owner of the pmpaht,or my employees with wages as their sole compensation,
will"do'the work: ad the atmmurc is not intended of offered for able(Sec:70 set, -'Business and Professions Code:The Contractors License Lew does not apply to on 10 3 — UFER Required Inspections
owner of property Who builds or improves themon,and who does such work himself
or through his own employees.providedthatsuch Improvements are not intended f REBAR
nded or ., 1 04 --
-
olfiud(or sole V,ho ver,the building or improvement is sold within one-year o
edtnplefon,the ownerbuilder will have the burin of proving that he did not build or 105 - ANCHOR BOLTS
improve for purpose of vole.). 106 - SEWER & WATER _
^- '• OhosownerofNepropeny,amexdusivelycontractingwithlicensedcontractorsto 202 - UNDERFLOOR PLUMBING -
construct the pmject(Sec.70W.Business and Professions Code:)The Contractor's
License law docs not apply to an owner of Property who wilds or improves thereon, 203 — UNDERFLOOR MECHANICAL
t " .aad.wh.commucts.fs,such prajw..with a commemr(s)Bcemed pursuant to the _
contractursLicavan,Law, 204 - UNDERFLOOR' FRAME'
.: ❑lamuemptun&r,Sec. B&PCforaiisreawn 205 - UNDERFLOOR' INSULATION
`r Dae 301 - ROUGH PLUMBING
'
WORKER'S COMPENSATION DECLARATION
302 - TUB & OR SHOWER
(hereby aRnn under penalty of perjury.one of the fol lowing declarations: 303 - ROUGH MECHANICAL
')A' 'have and will provided!
a Cenifiecti of 37M of the f bar for Worker's 304 - ROUGH ELECTRICAL
timpani he provided for by Section 3Bas of the "bar Cade, for the
crformentt of the work fm which this parody is issued.. 305 - FRAME
_ ❑I heJa and will mnSnuin Worker's Corhpemnd..1niurutce:m required by Section 3 06 - HOLDOWNS
3700 of tM law code far flue lirlimansince of Ne work far which N's peardt is 307 - INSULATION
tsiued My Woh n C mpensauon Insurame c Mu Ind Pol y n mbar au. .
. 308 : - .3SHEETROCK
i CERTIFlCATIONOF PTIONFROM WOR
KERS - t r3O9 ' -`"•EXTERIOR 'LATH,'
COM ATION INSURANCE-t" `
..,.... ..., -�..,.,._.. _. ._....__. .t. . .._._..._.._.....
Ohm seNi6n deednatwcompleted ihhe permit is for one hundred dollen 311 - SCRATCH COAT
ISI00)or IessJ
...,r_ _.: ..... ....
1
can,fy th t in the perform n o(the ark for which this perm t is Issued,I 313 -' ROOF NAIL'"' '--
rhos t employ any person in any manner w m to beconat.subject,to the,WorketY 501 FINAL ELECTRI CAL ENERGY
Comnn
pebon Laws of California Date
C C Applicator - '' " "" " - " 502 --FINAL PLUMBING- ENERGY-
NOTICE TO APPLICANT:If, ranking aking this CeniRnteo Exemption,you should
7, amesubjecttothe Wormes Compensation provisions ofthe taborCod..youmust 503 - FINAL MECHANICAL ENERGY
thwith comply with such provisions or this permit shall be deem ed revoked. .504 ---. FINAL- BUILDING ENERGY(, .
F,,,-4 ; . coNsmurnoNLENDINcnGENcr" 505 - FINAL ELECTRICAL
�.' .. .,mawat._. `rmingagmryforrhe`knormara
� lider'.N me tmh hthis Pmcr�mli`iii:�uM(sus°io97,civ._°:),'... ... . 506 - GAS TEST
U.o <naer'cn^aarym _-' • 507 - FINAL PLUMBING- ,
�+ at l have reed this application and state that Ne above information is 508 - FINAL MECHANICAL
ir^`rr bbiicci:I agree tq comply wnh all city dad county ordinances end amts laws nehtin¢
509 - - FINAL GRADE
�sf) to building const ruction;acid hereby authorize"famenotivesofthis city to enter upon
��xt tgj the above-mentioned.property for inspection purpoies., 510 — FINAL PLANNING
L.W (We)agree to save,indemnify and keep hmmless the f Cupertino yeinn
LL VJ liabilities,jud¢mrts,emu and expenses whuth may is y acerae against said 514 - FINAL PU IC WORKS
G:'Z Cirj in konuquenc fthe granting ofthis'pe '
APPLICANTU STANDS AND WI ALE NON-POINT
souac o Issued by: Date
nature Afppplicshuc n r. S Re-IOOIS /
HAZARDOUS MATERMDISCLOSURE e r .
,: will the applicant or fust a bolding acupmt tout or hendle hemdous nwadal Type Of ROOF ....
asdi,Bncd by,he Cupertino Municipal Code,Chapter 9,12,and the Health and Safety
Code,Smile.25532(.)+
oya,
All, shall be inspected prior to any.rpofing.material being installed.
,I,- Will me.pppcent u'f tun wilding occurparit use equipment or devices which If a roof is installed:Without first obtaining an inspectiOri;I agree f0 remove
ern harsadours air communism;as defncd by the Bay Area Air Quality Management
District?tee .t tL•Ifa all newmaterialsfor inspection. Applicant understands and will comply,with.
all non-point source regulations..
I have read the heucdous materials regoircmenu onder'Chsptv.6.95'of the '
dif erne.Health&Sefery Cade.gecdons 25505,25533 and 25530.1 urdessuM Chet '
if thewiNingdoeaaotcurtenOY haveatenanCthni 2, rytespmsibility to notify the -
O eliant of Nem "¢menu which mi mpg issuance of a Certifca¢of
pe yS': g cantI. D
= ' Si n
afore of Apple A t
i tar IhonZetlag ;;.,- X51D/��n 11 roof coverings to be Class"B"or better
OFFICE... _ .... .. _
l i'k.i :.'l` i 'rJ?1>`-'1 F,t . .,T'. t .., ,•.'.r,. I .. ,. , .• !.': )a A":r'.1 '•:. •
��� �� - BVI r • �2':.� [( ..� 3 Q
MAR 0 9 2002
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BEDRI�I ��4 BEDRI� �3
OUBMITTAL 9 s II x 12
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fuFFEE COPY 7sc,
IIIASTER BEDRIA BEQRIA2
IS@x u2 ire it 1
APPROVED --
IN ACCORDANCES ANDTDRDINANOEs
it
CUPERTINO CDD I I SEC O M D F L 0 0 R .P L AM
OATE•�_ '
• SIG - - + cations MUS)
This >et of Pia 'c�at aq times an r is•`
_ ya t on th I• _„o� or alteration=
latN'. -{u , , w, tten Permissto •
m me wtt D U t C,ty of CUUPer ino. ons
sPeci � an
1i�L ADT be by y 4 ii o Vol slona
t the vrotat3n of Y
rcrateLBW.
• hill
KITCNEUx DINING R�I�
9_x lo? (2°x 14? 134 x lo ?
UTILITY B STOI?AGE ,r' -, I�-
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GARAGE STUDY LIVING RIA
19tx20 lea 68K7' it /s° x 175
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IAASTER BEDRIA , BEDRIA t2
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SECOMD FLOOR 'PLAM
MAR 0 9 2002
FAIAM RIALy
1HBRE T KITCREM „ bmmr Ra
9exiol I2°x141 131x 101
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. GARAGE STUDY ENTRY 11 LIVIMeT RIA
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CTY" OF CUPERTINO
cuPEr�Tirvo PERMIT APPLICATION FORM
APN# � L6 Date:
® 3 a N L ( ,j C;4 iso ,
Owner' Name: Pho�}e #:
Contractor: License#: / p
1 WI1J S
00"S—) eve—)U.,n,
Contact: ',I I 11 Phone#:
Applicant/Contractor:
wild* Permit Info:
BldgI Elect P1 Mech
escripti yyW��,
Residential: C� -►}Q� (`g�, T, C Sir Commercial:
Sq.Ft. Floor Area:. . $/Sq.Ft.:
Architect/Erigineer: Valuation: ;
" Type of Construction: Occupancy Grout:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE BldgPermits . foot BUILDING
BBOILER1 Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M 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
13ELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
ENERGY Ener BUILDING
TBBENERGYADD
Ener Add Multi BUILDING
INVESTIGA Investi ation fee BUILDING
MITIGATC Comm. Housin Mit. Fee BUILDING
lof3 ` 7 s3
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