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03070022 CITY OF CUPEWrINO *"�` $" '.a°tw r�`��r✓'ee *`' r s"`a'L�,` *.'.��" BUILDING DIVISION PERMIT z CONTRACTOR INFORMATION , . BUIL DING ADDRESS: THE BATH ROOM INC PERMITN003070022 CICIA STANDING OAK CT OW NER'S NAME: 1910 W EL CAMINO REAL PERMIT ISSUE DATE IiT0T4NqQN THOMAS E. n'7Ln2 12001 SANITARY NO. CONTROL NO. (650) 968-7666 ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH I� Q io0 LICENSED CONTRACTOR'S DECLARATION u 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description with Section?0W)af Div1Aian3of Ne Buem,m.A Pmfeasums Cnde,andmylimnuia j qin fullfameandeffmI. ZZ BATH REMODEL Z License�CIX Ls� _ �Lit.X g� Dam__'71"Llll'C Cummcmr e ��f��f�A�R��Cf{f1ECl'SDECLARA 10 1� C U I understand my plans shall he used as public records rJUL 2 1. 2303 bGJ Licensed Professional g,� OWNER-BUILDER DECLARATION 2<F I hereby affirm that I am exempt from the Contractor's License Law for the O o following reason,ISeclon 11131.5,Business and Pmfeainu Code:Any city or county BUILDING 5$ which requires a permit to construct,alter,improve,demolish,or repair any structure gV -zi prionobs isvuarec.also requires the applicant forsuch Permit o file a signed.vetement ££ that heislicensedpursuanttotheprovisionsoftheContractorsLicenulaw(Chapter9 Sq. Ft. Floor Area Valuation d�$ (commencing with section 70101)of Division 3 of the Business and Profusions Code)or `i.. Nn be a caempt therefrom and the basis for Ne alleged exemption.Any violation of 34250009 . 00 Section 7031.5 by any applicantfor a permit subjects the applicant in a civil penalty of APN Number Occupancy Type not marc than five hundred dollars(SSW). ❑L an owner of the property,or my employees with wages a their sole compensation, will do the work.and the structum is not intended or offered for sale(See.3004,Business iui and Professions Code:The Contractor's Licerae law door not apply to an owner of 10 2 - PIERS d Inspections property who builds or Improves theron,and who de such work himselfor through his own employees,provided that such improvements rte not intended or offered for sale,If. 103 - UFER however,the building or improvement is sold within one you of completion,the owner builder will have the burden of proving that he did not Wild or improve for.purpose of 104 — REBAR am.). 105 - ANCHOR BOLTS ❑I,at wner the Project Impa(Sec. ,Bam usiness ely contrProfessors with Codd:)no Contactors to 106 - SEWER & WATER construct the pmjcct(Sec.)1104,Businca and Pmfusom Code:)The Contractor's Li. cense Law dues not apply to an owner of properly who Wilds or ire prowsthetcon,and 202 - UNDERFLOOR PLUMBING who contracts for such projects with a contractor(s)licensed pursuant to Ban Contractor's License Law. 203 - UNDERFLOOR MECHANICAL C]1 see exempt under Sec. .B k P C for this moon 204 - UNDERFLOOR FRAME arDa1a 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION I hereby aBirm under penalty of perjury ane of the fallowing declaatiomm: 301 - ROUGH PLUMBING (hoe u and will maintain a Certified.of Cmrseno self.baum for Warkefs Compete 302 - TUB & OR SHOWER nation,As provided for by Section 37M of the Labor Code,for the performaam of the 3 03 - ROUGH MECHANICAL work far which thisPertitisjamed. 304 - ROUGH ELECTRICAL I have and will maintain Workers Compensation luuramm,as required by Section 1W of the labor Code,for the Performance of the work for which this permit is lured. 305 - FRAME My Workce Cc an maormce carrier and Policy,number aeryyy,,Q 306 — HOLDOWNS Carrier. g- Policy No: 11��Ws^4/fJ RTIFICATE OF EXEMPTION FROM WORKERS' 307 - INSULATION COMPENSATION INSURANCE 308 - SHEETROCK Ilea)fTlmis sect. al cm n{oc reed notnpincdfirm le.it is far one hundred do][.n 1011) 309 - EXTERIOR LATH 310 - INTERIOR LATH employ thus in on in any monec of the1w�rk for which this permit is issued.1 shall not employ enyt I in any m!!Wjpsylulwcome subject to the Workers Compensation 311 - SCRATCH COAT Lawsof Cali i (/[-+�1 Applicant L �� 313 - ROOF NAIL NOTICE TOAPPLICANT: f.after making this CeniBcam of Exemption,you should 501 - FINAL ELECTRICAL ENERGY - hecome Subject to the Worker's Compensatino provisions of IW labor Code,you must ' .J`[ forthwith Comply with such prnviaionaorthis Permit shall Mdminedmvoted. 502 - FINAL PLUMBING ENERGY zo CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY t=. Ihereby Affirm met thenissconstruction leading agencyfar thtptrreare col 504 - FINAL BUILDING ENERGY a > Lcwork sNamewhich this p mit isiaucdlScc.J9T,Civ.CJ Leaders 505 . - FINAL ELECTRICAL W Q = z <nder'sAddmsa 506 - GAS TEST U p I really that I have read this application and sum that the above information is 507 - FINAL PLUMBING roared.I agree to comply with all city and county ordinances and state laws relating m oU Wilding construction,and hereby authorise repgsenmirca of this city to enter upon the FIN MECFN7G CAL 7 W abovmmemioned property far inspection purposes. i gy (We)agree to ave,indemnify and keep harmless the City of Cupertino against 0 9 FI fq liabilitiu,judgmcnta,cote and experuca which may in Anyway accrue against mid City 5 of the of C) zAPPLIC NT"UNDERSnhngOSIhis Permit.AND WILL COMPLY WI AL NONPOINT Issued by:5 ORKS Dat SOURCE ULATIO ON Re-roofs Signawrt fAp anU mratmr Data HAZARDOUS MATERIALS DISCLOS RE Type of Roof Will the applicant or future Wilding occupant nom or handle hanNous material As defined by the Culmina Municipal Code,Chapter 9.12,and the Health and Safety CMA,Section 2ss3zm)? ❑Yee l��yaaNu All roofs shall be inspected prior to any roofing material being installed. Will the applicant I future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hazardous air contaminants ss defined by the Bay Area Air Quality Management all new materials for inspection. Is n? ❑Yes j4YNo 1 have read the WaaNnm materials requimmcnts untk:r Chapter 6.95 atria Califon Ala Health k Safety Cook,Smarm,255115,75533 and 25530.1 undo this if the Wilding dans not c ntly here a to en4 thea it is my reiremenhiloy to adfy occupant of Ne mquim c which pdonn issuance iris CcniOca of cuDp . Signature of Applicant Date Owners , od,edagtar Date All roof coverings to be Class"B"or better CITY OF CUPER'CINpw'zx�,�C=+cO�nINcFERC®NTRBUILDING olvlsloN kk°R3�M*-' 3eATlaIt�� WITO BUILDINGADDRMS: THE BATH ROOM INC PERMITNO03070022 9q4 2TANDINa OAK OWNER'S NAME: 1910 W EL CAMINO REAL PERMIT[SUE DATE NEt (650) 968-7666 SANITARY NO. n CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH uop LICENSED CONTRACTOR'S DECLARATION C I hereby affirm mm I am mmosed under provisions of Chapter 9(commencing Job Description U wilh SenionTri))of Division3of NC Business and Professions Cndc,end mylicense is in full fnue and cGoet. ZZ BATH REMODEL �p q, p r� Licenu L4 ss La.g UNAPv20 't Dam Cummcwr N/`^ SS ARCHiIECrS DECLARATION IrlIundcrtonJmyplamsh&IlWuudupuM1licrccnN- JUL 2 12003 yo Licensed Professional OWNER-BUILDER DECLARATION BUILDING w <F I hereby arrant that 1 am exempt from the Contractor's License Law for the �I pL.DIAg^ m 00 following reason.(Section 7131.3,Business and Probations Cade:Any city or county aur/ 1 NG which acquires,a permit to construct,alter,improve,demolish,or repair any structure 5z< '6to its issuaw.,alsu requires theapplicant forsuch Permit to flu saigned:momcm m that he is licensed pursuant luthe provisions ofthe Commnur'sLicense Law(Chapter y Sq. Ft.Floor Area Valuation 9�a (commencing with Section 7M)of Division Sof the Business and Proftssiam Cmk)ur I that rte Is exempt th.mfrom and tic basic for the alleged exemption.Any violation of 34250009 . 00 Sc6lon 7031.5 by any applicant for a permit subjects the applicant to s civil penury of APN Number Occupancy Type not more than five hundred dollars(5500). I,as owner of the property,or my employees with wages at their sale comPemsallon, will do Ne work.and Ne struclum is not intended or offered for sale(Sec.7044,Business iUl — d Inspections aqd Professions Cade:The Contnetoes License law does not apply to an owner of 102 — PIERS p Property who builds m innorwas thereon,and who does such work himself or through his own employ...provided thin such Improvements ase not intended in fremd for sale.If, 103 — UFER however,the building or improvement is sold within one year or completion,the owner builder will have the burden of proving that M did no,Wild or Improve for purpose of 104 - REBAR .t`')' - 105 - ANCHOR BOLTS ❑L as owner of the property,am amlinwely romancing with licensed convectors la 106 - SEWER & WATER continue,the project(Sec.7014,Basin.end Prof axions Cade:)The Carmichael Li- cense Law data not pply to an owner of property who Wilds or Improve lhemon,and 202 - UNDERFLOOR PLUMBING who transept for such pmjeco with a contractor(s)licensed pursuant to the Commences Lt...Law. 203 - UNDERFLOOR MECHANICAL C3 am exempt and.,See. ,B&PC far Nb season 204 - UNDERFLOOR FRAME' Owner Dam 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury rote of the following declarations: 301 — ROUGH PLUMBING 401 I has and will ammonia a CertificateoFCmi to ulbm faCorrosion-imur Wallace-Wallace-Cpcn- 302 — TUB & OR SHOWER salion,u provided for by Sm,wn 3700 of the labor Code.for the perfoonance,of the 303 - ROUGH MECHANICAL work for which this Permit is issued. 304 - ROUGH ELECTRICAL kI have and will maintain Worker'-Compensation Insurance,as required by Section 700ofthe labor Code,for the performance or the work for which this permit is ree.wL 305 — FRAME My Wmkce Co on lmunnce Cartier and Policy number am G� 306 - HOLDOWNS Cart9- Policy Na.;J.t_]_22 u=1- 307 - INSULATION RTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 308 - SHEETROCK (This section need not be completed ifate permit is fm one hundred dollen($100) 309 - EXTERIOR LATH orless.) 310 - INTERIOR LATH I certify that in the performance of IW work for which This permit Is issued,I shall not tmployany persoa in any momtsobjuOomc Wmken'ComFams.1a, 311 — SCRATCH COAT Laweof Celi is �jxLb" Applianl TWn< 313 - ROOF NAIL NOTICE TO APPLICANT: f.,Me making this Certificate or Exemption,you should 501 - FINAL ELECTRICAL ENERGY become subject to the Worker's Compensation provisions of the Labor Code,you must .J,Z forthwith comply with such prnvitionsmthisPermit shall bedeemcdmv.ked. 502 — FINAL PLUMBING ENERGY zo503 - FINAL MECHANICAL ENERGY CONSTRUCTION LENDING AGENCY y-t I hereby alram Nal Vert is construction lending agency ror the performance of 504 - FINAL BUILDING ENERGY x > the work Or which this permit 13ssmd(Sec.3M.Civ.C.) Lendc's N505 - FINAL ELECTRICAL {a1 Q rame FL Lcad.r Addmss 506 - GAS TEST U p 1 certify Inas I have read this application and sow that the above information is 507 — FINAL PLUMBING Pcored.i agree to comply with all city and county ordinances and stale laws relating to OU build ingConstruction,and hereby au,horimrepresentatives Ofthis City toenter upon the FIN MEC CAL ahov-mentioned properly for inspection purposes. (We)agree to save,indemnify and keep harmless the City or Cupertino against 0 9 FI Hfn liabilities,judgments,costs and expenses which may in anyway seem.&gains,said City C, NG V `,G in consequence or the granting of this permit. ^' APPLIC NT UNDERS DS AND WILL COMPLY WI AL NON.POINT Issued by:5 C WORKS Datd SOURCE ULATIO O 1-11 Re-roofs Signawrc Ap aDate HAZARDOUS US MATERIALS DISCLOS RE Type of Roof Will Om applicant ser fume.building e.Chapter err and m Health and as defined by the Cupertino Municipal Code.Chapmr 9.11.end,W Health anJ Safety Code,Section 25532(x)7pppAll roofs shall be inspected prior to any roofing material being installed. ssf ❑Yes I(N- Ox" till the applicant orfuture building oceupantuse equipment ordtvietawhich If a roof is installed without first obtaining an inspection,I agree to remove h ,hara,dous air contaminants ate defined by the Bay Arca Air Quality Management all new materials for inspection. ❑Yes .WfNu I have read no hanali ms materials requirements under Charter 6.95 of the Califon hie Health&Safety C.dc;Secuom 25505,25533 and 25534.londersmn not fthe but as docs note curly he r'1 -n1,thinum yresan sihila w tiny c,tecupanl at um rcyuirc c which pdonuissuanccofeccrtifica of "M Signature of Applicant Date owners , on,<dagtm 6 Data All roof coverings to be Class "B"or better 60 Job Site: Mr.&Mrs.Johnson 22994 Standing Oak Ct. $a L Cupertino,CA 95014 409257-8965SUBMITTAL xf JUL 02 2003 #1 By - Wdrk Performed By: The Bath Room,Inc. 1910 W.EI Camino Real Mt.View,CA 94040 650-968-7666 lJoense A 604922 0OV ICE COPT o 9s 120 .Ejc}yj✓jr ffvJ 120 Irls �wmt Scope of work: Fit 1.Replace shower pan 2.Replace shower valve fit Fu�oafs�er/r 3.%placetullet APPROVED $ o �ppr 4.Replace exhaust fan IN•ACCORDANCEWITH $ 0 5.Install GFCI THe CITY,oR CUP 0,�,an$ AN ' IIIA110 0 DATE SIGNED Ttiissetpecifications; MUSTbeleptllifimes;andi it it.urt, a motes: lawful tb'make any Changesr or, alterations. Shower valve Is pressure 6alariced Without Written, permissibnr ftOm, Toilet is 1.6 GPF the!building Dept.,.City of CuperbMA First switch to fluorescein 1igM ming of this a Shower enclosure is set ey NOT be held n and Sp[xifp GFCI at vanity 091IMIt or to be alt 6PProvaf of the 6ididfidtl of any ProvWM 60 Of any City dt_dlfl%Of State Lary gg S� ao "0 1, as CNY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM N # 3L S1 c� Date: 7 I Building Address: ZZQa I STAN01* OAL CT. Owner's Name: I I I Phone#: MR.a Yv\ile,. Tp OrJ �I 'ZSR. Contractor: License#: rta�rn rJ� bo�I�ZZ Contact: Cupertino Business License#: Building Permit Info: dldg V Elect IL Plumb EA Mech I& Job Description: Residential f'_�TP U DA-r� e[Moopl , Commercial ❑ Sq.Ft. Floor Area: 5 $/Sq.Ft.: Cost of Project: Occupancy Group i q Type of Construction: T -lam 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> IM 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 1 of 3 / AY LiraOF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO 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 BNUCOMNM 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 07 BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP 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 rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM 3USWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Fumace> IOKbtu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREN20LE Pole/Platform Fixture ELECTRICAL 2 of 3 CITY OF CUPERTI00 a110 PERMIT APPLICATION FORM CUPEkTINO Quantity Fee 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 Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs,Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BLUDING BSEISMICOM Seismic Commercial BUILDING k BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Ternp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL 44 EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fees foot PLUMBING ZADDCHG Address Chane BUILDING • 3 of 3