02070018 CITY OF CUPERTINO . I - - ,
BUILDING DIVISION PES, CO1V1'l2ACTOR'.INF,ORM'. ON:$'
BUILDWGADDRESS - PERMITN
21111 RAINBOW DR SARATOGA KITCHEN & BATH 82070018
D NNIADERSON 140 LEWIS RD. $#10 APPLICAT{OOLSIJV-j2002
i
HONE: (408) 281-9250 SANITARY NO. CONTROL NO.
Q-zo ARCNITECT/ENGINEER: BUILDING PERMIT INTO
&U BLDG ELECT _ PLUMB MEC_K—
<> Lem- X'.T .1
y_ LICENSED CONTRACTOR'S DECLARATION ] hh jp] SC IL.tI AA 11 tt
Z_O IherebyaffirmiviIs.of'heedDinerprovisionsofChapter.andmmendng MASTER BATH REMSDEg., pjI][ V La
EtO
Myty with Section]000)of Division the Business and Professions Code.and my license
rain fall fame de t ,��° OCT 1 5 2002
6 Licens Lic.a
0�u Dam Comma
uC G ARCHITECTS DELLA ATION
3 I urderomd my plans 1ha11 be used as Public records
r o o Licensed Professional WILDING
OWNER-BUILDER DECLARATION
usi C' 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
t. following reason(Section 7831.5,Business and Professions Code:Any city or county $33000
I F O which requires a permit m ronstmct,slier,improve,demolish,car repair any stmcture
u�3m prior to its issuance,also requirca the applicam for such potent to fileasignW sm¢mcm .- . ._ _ _
mot heia)iansTd purtuam In the proritions o(the GOalmLlola Licenx law(Chagcr9 36¢FO�'FID6r.F0'€h Valuation
(<Ommrncing with Section 7000)of Division 3 of the Business and Profcssions Code)
or that he is exempt therefrom and the basis for the alleged czempibn.Any violation
of Section 7031.5 by any applicant for a permit subjects;the applicant a civil penalty '
of not more than Iva hundred dollars 1s500). ttl O lYPN I t�Y> WDAT I ON Occupancy Type
°l,as owner of the property.ur my employees with wages as their sole compensation, 102 — PIERS
will do the work.and the structure is not intended or offered for sole(See.7044,
Business and Professions Code:The Contractor's License law does Imt apply to an 103 - U Required Inspections
owner of progeny Who builds or improves thereon,and who does such work himself 104 — REBAR
or through his own employees.provided that such improvements arc not intended or 105 — ANCHOR BOLTS
tio
offered for sale.IL however,the building or improvement is sold within one year of
complen,the owner-builder will have Ne burden of proving that he did not build or
improve for purpose at tme.)� 106 - SEWER & WATER
O1,ss a,of the property,am exclusively contracting with licensed cantnnors to 202 - 'UNDERFLOOR PLUMBING
construct the projttt(See.7(AL Basinats and Profo,tions Cada:)The Cam.,. 203 - UNDERFLOOR MECHANICAL
- _ License Law does not apply It an owner of property who builds or improve,thereon,
and who contracts for such pmjecm.with a ennmeata,fs)licensed pu.am,no that 204 — UNDERFLOOR FRAME _
El Is.exempt
License Law. 205 - UNDERFLOOR INSULATION
°Iamaem tender Sec: ,B&PCfor Nis mason
net Data '301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby affirm under Penalty of perjury one of the following declarations: 303 - ROUGH MECHANICAL
!° 1 have and will maintain a Certificate of Canaan to self-inmrc for Weal 304 — ROUGH ELECTRICAL
Compensation, as provided for by Section 3700 of the Labor Code, for the
�PeCrrn,manee nrtne wnrk rorwhich rasa permit it iaaaad. 305 - FRAME
LryyBeve end will meimun Worku's Compensation lnsumnce.et,ryuimd by Stttion 306 - HOLDOWNS
3900 of the Lobar Code,for the performance ofthe work for which this permit is 307 - INSULATION
er
issued.MyW 's Campo ' nlasu nce ear,iar and policy number are: �g 308 — SHEETROCK -
TIFlCATIONOFEXE oNP'RGM.woRKERs•• .309. - ' EXTERIOR LATH
COMPEhSATION_INSURAr?cE •' - ..310. 'INTERIOR LATH . -.... ...
'tThistectiohnee,nota completed it the Perot is for one hundred dollars 311 — SCRATCH COAT
nlo0)a.1e,fy 313 .- -ROOF NAIL
I certify that in the performance arms work for which this ct to the
issued,l 501 - FINAL ELECTRICAL ENERGY
shelf hot employ any person in any meaner sat as to become wbjtts to the Workers
Compcnmtion Lows of California.Data
Applicant 502 - FINAL PLUMBING ENERGY
NOTICE To APPLICANT:IT, full making this Canifiesreof Exemption,you should 503 - FINAL MECHANICAL ENERGY
z beaomesubjeamthe Workees Compensetionprovisiomofma Libor Codgyoumust
ZC .7onnw'vneomprywith,aehp,omaion:o,miap mhthaib desmdrcakd. 504 - FINAL BUILDING ENERGY':
CONSTRUCIONLENDING AGENCY 505 — FINAL ELECTRICAL
na by athm mat mprc is a eantwatmn lancing agency rat that p an.neem 506 - GAS TEST
r� of Ne work for which this Permit is issued(Sat.309],Civ.C.)
a, z ,Lander'tNamc . 507 - FINAL PLUMBING
p x LenLer't Aaarett 508 - FINAL MECHANICAL
L) O ' 1 certify Nat 1 hove read mss application ens sum that the above info..in.is 5 0 9 - FINAL GRADE
kL';: correct.I agrtt to comply with all city and county ordinances sacristan,lewd relating
O.V to the aboWildingronstmctiogandhembyeumon.opreuntativesofhiscitytoenterupon 510 - FINAL PLANNING
W ve-mentioned property for inspection purposes.
Oa gr
(We)-Fee to save,mdernnify and keep hamarCupertino
aess me City of against 514 —
FINAL PUBLIC WOJIDV] liabilities,judgroanu,costs end expenses which may in any way acerae against sed
City in consequence of the gzaming of this pc,mit.
SOURCEREGU ATIONS.NDS,afi�B,IYfLLCO ,sW/THPLLNOy/POAPPLI ANTUND8RSTA. \s X NO' Issued by: Dale Z V v
SignamrCmApphcaoUL0n1mCI0r I Data Re-roofs '
HAZARDOUS MA ERIALS DISCLOSURE
Will the applicant or future Wilding occupant came or haMle hazardous materia Type of Roof %
as defined the Cupertino Municipal Code.Chapter 9.17,and the Heath and Safety
Cada,Section 25532(e)?
°Ve u.
All roofs shall be.inspected prior to,any roofing material.being installed.
Will the applicator orfumm Wilding occupant use equipmensa'devices which If a roof is installed without first obtainingan inspection,I agree to remove
tit hazardous air ronmminams as defined by the Bay Arta Air Quality Management P g
stha" all new materials for inspection. Applicant understands and will comply with
�(( °Yes .' all non-point source regulations.
`sat' 1 have read the hazardous materials requiremems antler Chapter 6.95 0(me
California Health&Safety Code.Sections 75505,25533 and 25534.1 understand that
if them building doos oro currently have a¢malt,that it is my responsibility to notify the
occupam of "re is which must met prior m issuance of a Ce '¢ e of
O<u
7 ,L Signature of Applicant Date
owner or euthonu gem
old All roof coverings to be Class "B" or better
_ .. . . ..: . . rIFFICF
f
06/30/2002 21:58 14082618893 CABINET CRAFT �` PAGE 02/02
Saratoga Kjtchan & Bath
• 140 Lewis Rd, #10
San Jose, CA 86111
-IN — 648 14I
� I
I- v
k( —�24 481 -2
\ Bench W )r'2,deepilnhig
IN ACCORDANCE WITH THE CITY Of
CUPERTINO CODES AND ORDINANCES
V-. DATE 7'
L —vt
f.—t= Chip' SIGNED
2 N This set of planr�nd specifications MUST
be kept on the job at ail times and it is un
lawful to make any changes or alterations
to on same without written permission from
w
the building Dept., City of Cupertino.
The stamping of this plan snd specifications
SHALL NOT be held to paimit or to be ac
ipproval of the violation of any provi<f,`^
i.. _ ny City Ordinance or Smhr I nw
W) JUL 0 2 2002
BY:—
1 CV
CV
I
I 45 109 64 `\
E0 3�yd DIJ1 S30IAJ35 1I1483d ' E99LEZGL04 ET:Ot Z00Z/I0/40
CITY DIGDP I
BUILDING ISN PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMITN82070018
21111 RAINBOW DR SARATOGA KITCHEN & BATH
1iN%kDERSON 140 LEWIS RD. #10 APPLICATff/Ibn72002
(408) 281-9250
.BONE: SANITARY NO. CONTROL NO.
t<
O O ARCHITEC(ENGINEER: BUILDING PERMIT INFO
z m❑ 1 Lia
BLDG ELECT__ PLUMB MF.Cn_-
iZa I LJ k .7 _I
v i LICENSED CONTRACTOR'S DECLARATION 1 pI
1 hereby ufhrm that I am licensed under,provisions of Cha 9(commends 1CrFt=IR� ��
i =o P1er g MASTER BATH RE lf-0
j with Seninn]fNkq of Divismn3of the Business nnJ Profession,Code,and on,
in full force nal a ea.
w re ueenm I Lie"a n 3'EO
LLCQ Dna ARCHITECT'SDECLA A][ON OCT 15 2002
I undersand my plans shall W used as Public«enols
i z e O Licensed Prefewi...I Ipa.k{1 {� ^
K ce�y OWNER-BUILDER DECLARATION W�k/�LDYCN
w=m I hereby affirm mal 1 am exempt tram be Comraaor's Liana Law for me $33000
following reason(Section 7031.5,Business and Professions Code:Any city or county
E O which requires a permit to construct.alter,improve,demolish,or repair any structure
a3� pnan 'tane Iurepor m applicant fattish ,all w fl aem
-gel sit - ---- -- - — -
c.
tMth I'a ,idprsalr mil i .r fl C..,a ,s L'tt. In (Chep«9 ,_ 36A E1Q���p �,�s _,_ , Valuation
(nommnc'ngwlM1 Secl nRlIHlltfOvsionJof the Busmen{ dP..reasuns Code)
or that he is exempt th[«frain and the basis for the allfged exemptibn.Any violation
-of Section 7031.5 by any applicant for a permit objects the applicant to a civil penalty
^fa.,more than five handed dollars(xsm). 103NPNNbMWDATION Occupancy Type
❑1,as owner of fire prepertr.ormycmpmymsisith wages as their sole compensation. 102 - PIERS
will do the work.and the structure is not intended or ofi'cred for sale(sea.mea, 103 - U Required Inspections
Business and Professions Code The Contractor's License Law does not apply to an Q ns p
owner or property whe builds or improves thereon.and who des such work himself 104 - REBAR
or rough his own employee,,presided that such improvements are con intended or
,afered for ale.If,however.the Wilding or improvement is sold within one year of 105 — ANCHOR BOLTS - - --"
inmpletion,the imism-builder will have the burden of proving that he did not build or 106 — SEWER & WATER
mprove rcr purpose of sale.).
Diva.owner of inep-liry.am ascluociy camanteling wdtih eeenue h,ovesna m 202 — -UNDERFLOOR PLUMBING —
_ ^mrswct the pmjen(Sec.70114.Business and Professions Covi The Contractor's 203 — UNDERFLOOR MECHANICAL
License Law does not apply to an owner M Property who builds or improves them..,
and who contracts for such pmjects.wdn a contorisj licensed pursuant le.the 204, — UNDERFLOOR FRAME
Dimcsscm�hth`eremunderSee B&PCwimason 205 — UNDERFLOOR INSULATION
owner Date' 301 — ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER
I hereby affirm under Penalty of perjury one ohne following declarations: 303 - ROUGH MECHANICAL
(�0 I have and will maintain a Certificate of Consent to sell-insure for workers 3 04 — ROUGH ELECTRICAL
Compensation, is province! for by Section 370 of the Labor Code, for the 305 - FRAME
performance orthe work for which this permit is issued.
_ 't v and will maintain Worker's Compensation Insurance,as rryvirtd by Section 306 — HOLDOWNS
37W of the La W:Code,fur the perfomana of me work for which this permit is 3 07 - INSULATION
issued.Mrw it Pat number are: 308 — SHEETROCK -
cr'a Co pc Intern
Cam": N,,005-Od — 6(70 30,9; '—,'EXTERI,OR LATH
TEPICATION OF E%E MON FROMWORKERS'I s
COMPENSATION INSURANCE, ... .310— "'INTERIOR .LATH...
'(This section need nm be completed from permit is for one handled dollars 311 — SCRATCH COAT -
(sloBlmless.) . , 313 - ROOF.. NAIL _ , . . .. .
1 terify that in the performance of the work for which this permit is issued.( 5 01 - FINAL ELECTRI CAL' ENERGY
shall not employ any Person in any manner sir as to become subject to the Workers'
Compenkahon Unwin!CaBfomm.Date 502 — FINAL PLUMBING ENERGY
Applicant
NOTICE TO APPLICANT.If,after making Ibis Certificate of Exemption.you should 503 — FINAL MECHANICAL ENERGY -
become subject to the Workers Compensation provisions of the"We Code,you must
zorthwitheomplywithsuchprovision,orthisPermitsh:llbedeemedrevaked. 504 _ FINAL BUILDING ENERGY
F I
CONSTRUCTIONLENDINGAGENCY 505 FINAL ELECTRICAL
-
> I hereby affair that there is a coiasnnction lending agency for the toomm once 506 — GAS TEST
ofine work forwhichthis permit is issued(Sec.309].Civ.C.)
y `q Inder,Name . ' "" 507 — FINAL PLUMBING
V z Len amaAddrenn 508 — FINAL MECHANICAL
V O I anBy to comply with ails ity and co my ordisome ances the
an sve information rfon n 509 — FINAL GRADE
fila U tobuilding
I agree to comply d he all city and county ordinances of
state lawn relating
O.f� theaildie-menstmetion;andhercbyapectionpurposenmtivesofNis'city mcn¢rupon 510 - FINAL PLANNING _
the above-mentioned,me t.Propend for inspection purposes..>. i (Wejergmet,costandepenseskeep hiharmless
mayinlanyhe waacmeagainstagainst 514 — FINAL PUBLIC WORE2S
Z City ins joJgments,cosec and expenses which may in any way same against said V
C:) 'L Cityinconse UNDERSTANDS
the NDS of VILLCO
APPLICANT UNDERSTAND���S ¢¢¢'''rtrtrt"���s'ILI:COMPLY WITH ALL NO.'p O/I�pJtT Issuedb r� ' 1 / Date
SOURCE REGULATIONS. 7�2/c y• /
Sighmturwl'ApPlicamesConmactor Dal— Re-roofs j
HAZARDOUS MA TRIALS DISCLOSURE
Will the applicant or future building occupant store or handle huivdous material Type of Roof
as defined by The Cupertino Municipal Code,Chapter 9.1:,and the Health and Safety
code. 0Yes 259na)] ';'; ,, ,- .t' .m _ All roofs.shall be-inspected l ,
❑Yen '. • F3!ee-' prior to.any.rooting material.being installed..-
Will the applicant mfuture building oaupamuse equipment ordevices which If a roof is installed without first obtaining an inspection, I agree to remove
Jemit musical air contaminants as defined by the Bay Arca Air Quality M...gcmced
Dow? all new materials for inspection. Applicant understands and will comply with
�![0� °Yes K"f all non-point source regulations.
:�c,
I base read the hazardous materials,requirements under Chapter 6.95 of the
limmin Health'
&Safety Code:Sections 25505,25533 and 25534.1 understand that
the Wilding does not currently have a tenant,that it is my responsibility to notify the
cupdm of 'd is xhi<h man tact prior to issuance of a Ce ¢ e of
`! c 7 Signature of Applicant Date
arauthem. gem Dm ./L All roof coverings to be Class"B"or better
OFFICE