03060051 ;ARCHT�F/ENGI�ER:
RTINO SION PERMI C,0NTRAGTORIN'E PERMIT NO.
THE BATH ROOM INC 03060051
PERMIT ISSUE DATE1910 W EL CAMINO REAL 06/06/2003
SANITARY NO. CONTROL NO.
(650) 968-7666
BLDGELECT PLUMB MUCH
BOO
LICENSED CONTRACTOR'5DECLAKATPUN Job Description
iJ F 1 hereby affirm that 1 em licensed under previsions of Chapter 9(commencing
with Scetio ] of Division?of the Bus�Ess end Prufasions Cnde,and my license is ��p�p ,gW p a®®
a in full force fIe /— L eA 2-�, AN®llRg�Al iii OlUlasO
3'y"4 License , ue.is BATHRM REMODEL
qqqq Dale C4W�ec r
'-a ARCHITECTS LAR PON JUL 31- 2004
understand my puns rhall be t mLes public accords
a�
a y Licensed Pmfcasionel
g OWNER-BUILDER
mptfrDECeContrON BUILDING
1 hereby maso affirm that 1 1. exempt from Ne Contractor's License Lew fou the tl'Y�I
pO following reason(Saito]0]L5,Business and Professions Code:Any city or county
which its iseS a permit a cnnawep epee,improve,demolish,or repair any structuremeet
Lzi• Matholufssrusedpaluanttoreslhevision nt forsuch ortheContrarmilmicensfile ae Law
S Ft.Floor Area $5��t tion
< that he is liccnxJ pursuammthe previsions of the Contractor's License Lvw(Chapter q•
[ es
(commencing with Settled 7000)of Division 3 of the Business and Professions Code)ser
y Net he is evempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant o a civil penalty of3 4� � e6 0 Occupancy Type
notlnote than five hundred dollen(g500). "
❑1,as owner of Ne property,or my employees with wages as their sole compensation,
will do the work.and the 6.CWre is not intended or offend for Sele(Sec.7044,Business 101 - FOUNDA'R��&fed Inspections
end P.M
sums Code:?fie ConlmdorY License Law docs out apply to an owner of
propmty who builds or improves Mention,and whodmssuch work himselfortrough his 102 - PIERS
own employees,provided that Such improvements are notinknded or offered furselo.If, lO3 — UFER
however,the building or improvement is sold within one year of completion.Ne owner-
bu0dee will have the burden of pmvmg that he did net build or improve for purpose of 104 — REBAR
Sale.).
E]1.as owner of Ne property,am exclusively contracting with licensed Contractors to 105 - ANCHOR BOLTS
construct the pmject(Se,70",Business and Professions Code:)The Contractors Li- 106 — SEWER & WATER
cense law does not apply to an owner of property,who builds or improves thexon.and, 'ZO2 — UNDERFLOOR PLUMBING
who contracts for such projeeu with a contractor(s)licensed pursuant to on Convectors
Lcenaal,mv 203 - UNDERFLOOR MECHANICAL
❑lam exe sunder sec. ,B&P C for this mason 204 - UNDERFLOOR FRAME
Ow r ORKER'BCOMPENSATION DEC L Arra 205 — UNDERFLOOR INSULATION
I heteb al0rm under penalty of perjury one of the fall ng declarations: 3 01 - ROUGH PLUMBING .
I have and will maintain a certificate of Consent mself-imum fm workers Compcn. 302 — TUB & OR SHOWER
.alien,as provided for by Section 37M of the labor Code,for the performance of the 303 — ROUGH MECHANICAL
work for which this permit is issued,
❑I ban and will maintain Worker's Compensation Insurance,es requited by Section 304 - ROUGH ELECTRICAL
37W of the labor Code,for the performance of the work for which this permit is issued. 30 -5 — FRAME
XMy mko Co eesavonInsurance cam erandPubesnumberram: r 306 - HOLDOWNS
'er: PolicyNo.: /'
ERTIFIGTE OF EXEMPnON woRKERS'Rs• 307 - INSULATION
COMPENSATION INSUR CE 308 - SHEETROCK
(Tru Section need not he completed if the permit is for one hundred dollars(5101) 309 - EXTERIOR LATH
or IcssJ
f coolly that in the performance of the work for which this permit is issued,I shall not 310 - INTERIOR LATH
employ any person in any mortician as to become subject to the Workers Compcnsallon 311 - SCRATCH COAT
Laws of California.Date
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT:If.after making this CeniOcam of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become Subject to the Worker's Compensation provisions Or the Labor Code.you meal
.J Z, forthwith comply with such provisions or this Permit shall be decmcd revoked. 502 — FINAL PLUMBING ENERGY
z� CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
(..r 1 hereby affirm that them is a construction lending agency borft performance of 504 - FINAL BUILDING ENERGY
Qi> Ne work far which This permit is issued(Sec.3097,Cih,C.)
M
IQ Lenders Name 505 - FINAL ELECTRICAL
g" Lenders Addreas 506 - GAS TEST
V p I certify that f hrvc read this application and stale that the above information is 5 0 7 - FINAL NAL PLUMBING
F corded.1 agree to comply with all city and county ordinm¢es and auk laws telating to ---
pU building Conswction,and hereby authorim representatives of this city to an upon the FINA MECHANICAL
Dd aM1ovc-( ei od agree 1.ertySave for inspection footrests.ha. �-
U
(We)agree to save,indemnify and keep harmless the City of Cupertino against FIN
to liabilities.judgments,costs and expenses which may In any way accme against said City - 551 - G
U inconsequence of the granting of this Permit. _ D3I0
APPL AM UNDER T DS AND WILL COMPLY WITH AL N POINT Issued bYWORKS.
SOU EREOULATIO D3
t Re-roofs
net col'Applicant/Conlracor
.to
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle harardeus material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the BOOM and Safety
Code,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes WN.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
until bavardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
DiNic
L
Yes ®Nu
ave mad the haramous materials mquiremena under Chapter 6.95 of the Califor.
&Safcty Code,S cimas255(15,25533und25534.1 understand ouif c lailding
curtomly ave a tenant that it is my responsibility to notifythe upsetOl'nuwhicmunhcmdprionuiuuanccofaCcniOcekof ap ar. Signature of Applicant Date
�13All roof coverings to be Class"B"or better
Wood. eg I este
Job Sft.
$ Le
962 Nmroy
Cardley
3 g 10186 pones Haoh
Cupedhro,CA 86014
Jeri • \ 408.287-8606
rt
if
WOrk Pmft nred by:
The Bath Room.hx.
r�nnnr?r 1810 W.El CmMra Real
G., :... . - • -� hfi.View.CA 94040
'pi" -_l' :t4E CITY (A e5Ds 79W
1 i= R arlw�WP
r . 1 .,• ;�"e �1AAD E ,st J License#eD4W
101
t 101
fita&a , n.s,d n ��'�; �' a�I timeLlkUtrs on i Scope of work
g (.n n, i„ rP�Y' icy cringes or al'laratlon`( FE CUP
1•RePleOedrawerpenandwdb
y a , :,{ n. err r.1en Pe'mIssi�n from 7 Replace si er Valve
g $ 0 ri r,.. Ciiy of �aPeftIO0. B.Replace w"
ell 4.hwW exhaust 4n
$ -- ;, r,� �h s Plan antl specification: 6.hufafl tip
Proviso',
-pp'iic to permit or to be w, 8.prolan 4 recessed can flglds
f. olation of
-,' lei. pnv rovislom
J
i(1y t D ince or S1OD aw
r
62003
N :
i aas
g6 &rower v&*"Is ssu
Prere balanced BY
p TOM is 1.8 GPF
[ Exhaust fan with fluorsserd UgM
§ L-�PZCESSCo c�eqN uaur-�,
ss
i -- &Y OF CUPERTINO 0 /
4��
CITY F PERMIT APPLICATION FORM /
CUPE TINO
Ask
qWPN#
Building Address:
D I�5 porl-[�2s I-�I�TC
Owner's Name: Phone
Contractor: License #:
1-�� llmrly NC. 0oy9Z1_
Contact: T Cupertino Business License#:
Building Permit InU:
Bldg Elect _C& Plumb Mech ❑
Job Description:
Residential X BQ LEN' OLS_ Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
X0-7
Cost of Project: 5 Occupancy Group:
Type of Construction:
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 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
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
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ATY OF CUPERTINO
n o
CUPEI�TINO PERMIT APPLICATION FORM
Quantity Fee 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 Pb1g Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BP1NTERCEP 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 rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pipe 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 Furnace MECHANICAL
BREMFURNOV Relo Furnace> 10K btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res A2pliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
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y CITY OF CUPERTINP
Cur`ITYOF PERMIT APPLICATION FORM
QuantityFee 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 Sips Add Branch ELECTRICAL
BREMSIGNS Remodel Signs,Marquee ELECTRICAL
BREMTHEATR Theatrical Ligbting 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 '
BSWMI 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 Plumbin
Fee sq foot PLUMBING
ZADDCHG Address.Chane BUILDING
j
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