03060051 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ;5CONTRACTOR INFORMATION
BUIMING ADDRESS: PERMIT NO.
THE BATH ROOM INC 03060051
AM PERMIT ISSUE DATE
1910 W EL CAMINO REAL 06/06/2003
(650) 968-7666 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: - BUILDING PERMIT INFO
' BLDG ELECT PLUMB MECH
3oii LICENSED CONIRACTOWSDECLARATION JobDescri tion
1 hereby aRna Nn 1 am licensed under provisions of Chapter 9(commencing P
with Sectio 7 of Divi"Or thea and No(cuinm Cotle.end mylicenseh �..�rrA it /n1 p ��
° in full tone If Y Ia1�FNN 6�'4v L
gz License I' Uc.g 2Z BATHRM REMODEL
Dam
ARCHTIECTS[jECLARATION JUL 3 12003
undcntand my plans shell W uuLLu puhlic records
J
Licenced Pmfcstional
` 3 OWNER-BUILDER DECLARATION BUILDING
I I hachy s1Erm that 1 am exempt from the Camnctors License Lew for IM
-o o following mason.(Section 711713.Business and Professioes Cade:Any city or county
5$ which¢quina a Permit to convect,elm.impmw,demolixh.a repair any structure
fen prior in its issuance,also requires the applicant for such permit to rile a signed statement
SS< thatW is licensed pursuant to the previsions nr the common's License Law(chapter 9 Sq. Ft. Floor Area
FD nie
tion
(comm5
that heeu exempt therefrom and the buts for the alleged exemption.Any violation of
Section 703 I.7 by any applicant for a permit subjeda the applicant to•civil penalty of CCUParaCY Type
not mon Nan low hundred dollars(M). 34'Lp 'y CpL0
0 1.a owner or the properly,may employees with wages as their sole compensation,
willdotheworl,andtheawnurtis not lalondW moRertd tressle(Sec.TD11,Buiineu 101 - FOUNDA'RiE.�9fed Inspections
and Pmfessimn Cade:The grammes License law does not apply to an owner of
Property who In iicaor improves therton.and whodoessuch work himself orthrough his 102 - PIERS
own employees,provided that such improvements ma not Intended or offered fault.If, lO3 — UFER
however,the building or improvement is sold within one you or compledon,It comer-
builder .will have the burden of proving that he did net baud or improve for purpose of 104 — RE BAR
sale.).
(]I.as owner of de property,am exokalwly camomile,with licensed am.[..he 105 — ANCHOR BOLTS
ronswd the project(Sec.7(N,Business and Profusion Code:)The Conu.cmr'.Li. 106 — SEWER & WATER
cove law does not apply to an owner of property who Wilds ar improves themon.end,
who contacts for such projects with a conusstar(s)licensed pursuant to the Commem's 202 - UNDERFLOOR PLUMBING
L)cevelaw. 203 - UNDERFLOOR MECHANICAL
❑tem axe funder Bee .B&PC for this ancnn
204 - UNDERFLOOR FRAME
Ow r ORKERBCOMPENSATIONDECL.t A a 205 - UNDERFLOOR INSULATION
Ihereb AIII
under perdlyorpeduryoneordefoll gdalarathom: 301 — ROUGH PLUMBING
INve.nd Mll meimm�.CcniOwa of Cotuem to sel6iesurt fm Workers Camper 302 — TUB & OR SHOWER
cation,As pmvidcd for by Section 7700 of the Isar Code,for the performance of she 303 - ROUGH MECHANICAL
work for which this permit Is issued.
❑1 ban and will maintain Worker's Compensation Insurance,as required by Section 304 - ROUGH ELECTRICAL
3700ar do,labor Cade.for the perfarmunear the work for which this Permit is Wood. 305 — FRAME
My aster Co nssOf lwnnce carsim tad Polirynumherart:
er. C ' Pol¢yNo.: 3' 000b 306 - HOEDOWNS
ERTIRIMTEOFEKEMPToli WORKERS' 307 — INSULATION
COMPENSATION INSUR CE 308 - SHEETROCK
Cfhis«dlon need not W campined if de Permit is far arc hundred anions lS lisp) 309 — EXTERIOR LATH
nrless.)
1 certify Net in the p ufarsnance of the work for which Nis permit Is imucd,I shell nm 310 - INTERIOR LATH
employ any pawn in any manncrm As At barren subject Or the Workers'Compcesation 311 — SCRATCH COAT
Laws of California.Dam
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT'.If.after making this Certificate of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
became subject to the Worker's Coarmrsaaan provisions of the tabor Cade,you mug
.JZ. forthwith comply with such provisions or this permit$hall be deemed revoked. 502 — FINAL PLUMBING ENERGY
'ZOCONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I Wmhy affirm that them Is a mnnructinn lending agency for the parformanc of 504 - FINAL BUILDING ENERGY
lYi the work for which this permit is issued(Sec.7097.Civ,C.)
W p Landers N. 505 - FINAL ELECTRICAL
= LcnaeraAadeu
z 506 - GAS TEST
U O 1«oily that I hew mad this applintion and sme that the above inforeatioa is 507 — FINAL PLUMBING
rom at I Agra to comply caNws comply with all city and county ordin.ns d m larelating a
0�" Wilding convection,and hereby authorize Mpruenotiwa ser this city to color Ora,Me FI NA MECHAN CAL
Liz show-mentioned property for hareeam putposn
(We)egme to save,indemnify and kap harmless Om City or Cupertino against 9 F I N
Vi liabilities,jogmenu,emu and expenses which may to any way aarue Against sod City 51 — G
U 7 to consequcnee of the ranting of this permit.
•7
AP PL ANT UNDER DS AND WILL COMPLY WITH A N N-POINT Issued by5 WORKS Date
SOU EREGULATIO . 03
Re-roofs
ho of ApplicanUConu.nmate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant a future Wilding occupant gore or handic huardow aalorig
As derated by the Captain.Municipal Cade.Chapter 9.12,and time Ninth and Safety
Coue,Saubm 27772(.)7 All roofs shall be inspected prior to any roofing material being installed.
C3 Y. WNa
Will the applic I or future building usurper six cquipmcat or devivs which If a roof is installed without first obtaining an inspection,I agree to remove
cels henNnus air canuminam u darned by the Nay Aru Air Quality Managcmcm all new materials for inspection.
7District?
❑Yee QNu
I hew mad Ne hu�rdmsmaloaals rtquirtmcau under Chaparb.97of the Glifon
uHulN&SefdyCade.SMimg257o7,73577.rm25771.1 udersand thuif Wildingors not co medy sew.same.that it u my rsp inability to ratify tie a opsit of tie
qu' mals hw ugbc.1poormiuuawcor9Ccnireamof a Signature of Applicant Date
wn a atho ze .g t �3 All roof coverings to be Class"B"or better