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02120055dV OZz 0 &1;4 —, P 4 t M 0 0 AC FAQ 'R R5R CITY 0—IF CUPERTINO BUILDING DIVISION PEkivHT BUILDING ADDRESS: BATHROOMS BY HANS PERMIT NO. 101'21 PHAR LAP DR 0212Q0.5,5 OWNER'S NAME: 4986 TIFTON WAY APPLICATION SUB DATE ROD HOO 12/13/2002 PHONE: (408)978-3053 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under Chap 9 Job Description pro of (commencing with Section ) of ujvisio of theeftlitimm a rof sions; Co an my license is n c i full frr�X rBATHRM REMODEL C as License ic, Date Comracmir,,w 1L--1A1MrrEcrsDECM(RATI0N �understand my plans shall be used as public records Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area $ 18 UVeation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Occupancy Type not more than five hundred dollars ($500). 0 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License Law does to L U r �'J U III LAft VecvfuZed Inspections not apply an owner of 102 , - PIERS property who builds or improves thereon, and who doessuch work himself or through his own employees, provided that such improvements are not intended oroffered forsale, If, 103 - UFER however, the building or improvement is sold within one year of completion, the owner- 104 - REBAR builder will have the burden of proving that he did not build or improve for purpose of sale.). 105 - ANCHOR BOLTS E] 1, as owner of the property, am exclusively contracting with licensed contractors to 106 - SEWER & WATER construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and 202 - UNDERFLOOR PLUMBING who contracts for such projects with a contractor(s) licensed pursuant to the Contractries License Law. 203 °' UNDERFLOOR MECHANICAL 0 1 am exempt under Sec, B & P C for this reason 204 - UNDERFLOOR FRAME Owner Date 205 301 - UNDERFLOOR INSULATION - ROUGH PLUMBING WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 302 - TUB & OR SHOWER 0 1 have and will maintain aCerifficate of Consent to self-insure for Worker's Compen' sation, as provided for by Section 3700 of the Labor Code, for the performance of the 303 - ROUGH MECHANICAL work for which this permit is issued. 304 - ROUGH ELECTRICAL 0 1 have and will maintain Worker's Compensation Insurance, as required by Section 305 - FRAME 3700 of the La � Code, f the pe cc of the work for which this permit is issued. * My Worker's �Tpensatirm Insu ce d Pol 2- 72 cats 2 WCERTIFICAT n0FEX50N*;01*KTE J/V/ 306 307 - HOLDOWNS - INSULATION 1' COMPENSATION INSURANCE 308 - SHEETROCK (This section need not becompleted ifthe permit is forone hundred dollars ($tOO) 309 - EXTERIOR LATH orless.) 310 - INTERIOR LATH I certify that in the performance of the work for which this permit is issued. I shall not 311 - SCRATCH COAT employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date 313 501 - ROOF NAIL - FINAL ELECTRICAL ENERGY Applicant NOTICE TO APPLICANT. If. after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must 502 - FINAL PLUMBING ENERGY forthwith comply with such provisions or this permit shall be deemed revoked. 503 - FINAL MECHANICAL ENERGY CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of 504 - FINAL BUILDING ENERGY the work for which this permit is issued (See, 3097, Civ. C.) Lender's Name 505 506 - FINAL ELECTRICAL - GAS TEST Lender's Address I if at I hav re this application and state that the above information is 507 - FINAL PLUMBING comp correct. I agree t with I city and county ordinances and state laws relating to building construction, d he. uthorize representatives of this city to enter upon the 5 FINAL MECHANICAL o for above - mentioned for ins ction urposes. sa e)a C' rdem fy at h I ss the City of Cupertino against liabilities, judg nut, co and,'ex rise w i h ny way accrue against said City 509 5$- FI FIN N in consequence the . . . . . tin of is APPLICANT I LY WITH ALL NON-POINT Issued by5i WORKS Date SOU RE , Re-roofs Type of Roof Sig 9im of A It an mract, PV k Z Ir HA ARDOUS MATERIALS DIS LOSURE Will the licant or future building occupant sto or handle hazardous material asdefinedbythe uperlino Municipal Code, Chapter 9. and the Health and Safety Code, S action 25 )� (a), 0 Yes No No roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contammarip as defined by the Bay Area Air Quality Management all new materials for inspection. District, oy" XN. he h h I r ad the mtar�dms m terra is under Chapter 6.95 ofthe Califor- I if at y eL nia Heald y Sockins 5534. 1 understand that if the building y does not tlyr aV' to I y to nt, t ibility to notify the occupant of the &.� imirm h he requiremen h be et Certificate oNccupan i gnature of Applicant Date \-A", All roof coverings to be Class "B" or better ,e rued agent Ow, r truth to cci 00 Cwe 5 ei Z S°owf C �3cD ygyPy3og e00 6Xm� w —r.. r_za SFo 4 Oz z y a> a� oz UO_ OF Fa UZ 4 CI'T'Y OF CUPERTINO C"' '- O% "s RM ATkyItr O r' N• „ O ; +. BUILDINC DIVISION PERMIT : BUILDING ADDRESS: BATHROOMS BY HANS PERMIT NO. 101'21 PHAR LAP DR NER :S NAME: 4986 TIFTON WAY APPLECA'I']ON SUB DATE ROD HOO 12/13/2002 PHONE: 408 T9 78 -3053 SANITARY NO CONTROL NO. ARCM ITCTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB KIM LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am berated under pan s of Chaptc 9 (cummcnoing :r ndnaca p wdn seemrn Buena Dsran rth snrssa r it my license is f�rty�a)nJ rBATHRM FINALE® in full t REMODEL Dam �.7 Contrae G A lI9TCTSDE RATION JAN 2 7 2003 mdcrnonJ my plans Snell he used as public rccnNa LicensJ Professional OWNER-BUILDER DECLARATION BUILDING I hereby affirm Thin 1 am exempt from the Contractor's License Law for the following reason. stein n 7113 I.S. Business and Professions Code: Any city or county which requires a Permit to Constmct, alter. improve, demolish, or repair any structure prior w its issuance, also requires the applicant for such Permit o Ii le a signed statement Sq. Ft. Floor Area Wiliha ion that he is licensed Vursuantln the provisions of the Contractor's License Law (Chapter 9 $18 (commencing with Section 7410) of Division 31 of the Business and Professions Cade) or that he is exempt therefrom and the Was for Be alleged exemption. Any violation of be Occupancy Type Section 703 L5 by any applicant Be a permit subjects the applicant to a civil penalty of not more Nan free hundred dollars (55110). I. as owner of Be pro,eny, or my employees with wages a their side compensation. equired Inspections will do the work, and the structure is not intended or offered for sale (Sec. 7(M. Business and Profession, Cade: The Contewhore License Law does not apply to an owner of 102 - PIERS pmperty who builds or improves Berens, and who does such work himself or through his employers, provided that such improvements are not intended m offered formic. If, 103 — UFER hown owever. me Building or improvement is sold within one year of completion, the owner. 104 — REBAR builder will have [be burden of proving Wt ha did not Wild or improve for protons, of sale_). 105 — ANCHOR BOLTS 1, as owner of the property. am exclusively contracting with licensed contractors to 106 - SEWER & WATER construct Ne project (See 70ta, Business and professions Csdc:) The Contractor's Li. cerise law does not apply to an owner of progeny who Wilds or improves thereon . and 202 - - UNDERFLOOR PLUMBING who contacts for such projects with a contratmor) licensed lop,mono the Contractor's' 203 — UNDERFLOOR MECHANICAL License law. I an exempt under Sec. ,B& P C for this reason 204 - UNDERFLOOR FRAME Date 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATIONDECIARATION 301 — ROUGH PLUMBING I herebyanLm under penalty of prrjm,umi or the following declarations: 302 — TUB & OR SHOWER 1 nave and will maintain a Cenificem of Consent m self irume fur Worker's Campmr 3 03 - ROUGH MECHANICAL sation. as provided for by Section 3700 of me Labor owe. for the performamr of the work for which NS Permiti.sianrd. 304 — ROUGH ELECTRICAL ❑ 1 have and will maintain workers Compensation Insurance. as required by Section 3 05 — FRAME 37(X1 of Ne V Code, for the pe yfree of me work for which this permit is issued. My Workers am =:dlofImm cerimirrandPo y -CO 306 - jlvl HOLDOWNS c,�f. ter M+s 22 307 - INSULATION ✓✓ CERTIFICATOP EXEM ON FROM KERS' COMPENSATION INSURANCE 308 — SHEETROCK (9Tissestionnced natWcnmplemdif the Nninitis Bob. hundred dollars 4100) 309 — EXTERIOR LATH 'alas'') 310 — INTERIOR LATH 1 ecnify that in the erforrource of the work for which this permit is issued, I shall not 311 — SCRATCH COAT employ any prrum in any manner m a to Wcome subject to the Workers' Compensation Laws of California. Date 313 - 501 — ROOF NAIL FINAL ELECTRICAL ENERGY NOTICE TO APPLICANC 11, after making this Ceti or Exemption, you NOTICE shoum Wcome subject m the Worker's Compensation provisions of the labor Cock. you muss 502 - FINAL PLUMBING ENERGY forthwith comply with such provisions or this permit stall he deemed revoked. 503 — FINAL MECHANICAL ENERGY CONSTRUCTION LENDING AGENCY I hereby unions Nat there is a construction lending agency for the Performance of 504 — FINAL BUILDING ENERGY the work Et which this Fermi ts issued (Sec.urn. Cit. C.) 505 - FINAL ELECTRICAL Name Lenders Na 506 — GAS TEST me Lender's 1 rentry that I bav all this applamom and shire that the above o.formmom ix 5 0 7 — FINAL PLUMBING correct. l agree to comp with I city and county ordinances andsu, laws relating ht 5 MECHANICAL huilJingconswcrion,atlWmb urhorisrcprescmariresofthis city tncnur upon the anoir.mentionrd n,pr y rot dos etion nmoxs. (We)a cost c. indent lya h I u the City of Cupertino against liabilitiex.judg place or and'ex rise w anrwayacemeagainussiJCHY "—AL 5 rj G in mnsequencen the min (oft is r APPLICANT A rL P \'1.1 A 'LY WITH ALL NON -POINT Issi b I s WORKS Date SOU •RE (2 Re -roofs Type of Roof Sig to rf AP I. sou rmmctor c HAZARDOUS MATERIALS DIS LOSURE Will use licantorfumm Wildingrccupantsm m ianikhrcdousmmerial s Jc OnrJ by the u,mino Municipal Code. Cbapmr 9. . and lbe Health and Safety de. Section 755 (a)'! All roofs shall be inspected prior to any roofing material being installed. DYCS ((�{Nn {ffutureeb If a roof is installed without first obtaining an inspection, 1 agree to remove Will the applicunlor building occupant use equipment or devices which emit hx.pum, air cornamman aJcfione by the Bay Area Air Quality Management all new materials for inspection. District? O Yr, No �\ \cores. I aJ NC varJnus mnu untCr Cnapmrfi95uftW Cali for pia HCalth cry Cr c. 3a ions �.' d 553 J. I UnMrstamJ Nal if NC la ding Jrcs nrn c dy W to nt, p sibility m no! the racupam of the myuimmcns n he el t cerd0ama eapancy. IgnalureofApplicant Date 2 1 All roof coverings to be Class "B" or better Own aurh Bard agcnr Dam CITY OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM 69 2-12- o Contact: Phone A oe -A #: M, omit I Building Permit Info: HE n Mech I a, -# 2 V Fee Description F Fee Group W O Other App lances MECHANICAL Construction Tax B BUILDING hid/Off/Comm/Quasi B BUILDING Con. Tax for BQ Zone Hotel and Motel B BUILDING Constax — Resi/Mobile BELEC1000 i ii E Elec 600V <-- I OOOA E ELECTRICAL BELEC1001 E Elec 600V > 1 OOOA E ELECTRICAL BELEC200 E Elec Svcs 600V <= 200A I I ELECTRICAL U11. I ! I a I ire E Energy BUILDING BENERGYADD--- E Energy Add Multi UT la. _ fee - BMITIGATC C _jnvestigation f -18 BMITIGATR R Res. Housing Mit Fee • e ew ulti-Family Res M MECHANICAL New Multi-famil i Res E ELECTRICAL- New Comm Electric E ELECTRICAL • N ew Co Mechanical 1 11 MECHANICAL New Comm Plumb a, -# 2 V i .�`" ' �' ,: . �� - �' , s ,�� ,� DIM I RIA5,4 3 3 A. A ioRD t- ,V C; a C. O t- ,V F €eEm3 I '333' M I s 1, 3 g M HVIEH nil q ml 01 t Dog 1--i g ^ �3 s A i I i S 5 u,u -'s 5 22 -a a all g ks -d ISa..— jig. Hm vis s;; 's !41 Y. Qi R H R S p -3 E;qH Et !f 7 a w Hi� Mi z ;C. u F €eEm3 I '333' M I s 1, 3 g M HVIEH nil q ml 01 t Dog 1--i g ^ �3 s A i I i S 5 u,u -'s 5 22 -a a all g ks -d ISa..— jig. Hm vis s;; 's !41 Y. Qi R H R S p -3 E;qH Et !f Hit S .,A a Hit S .,A