02060103 CITY OF CUPERTINO -� "• " •""' . •- -
BUILDING DIVISION PERMIT• CONTRACTOR 6&0"'" ATI
BUILDING ADDRESS: PERMIT NO.
10189 TANTAU AVE BATHROOMS BY REMODELING EPEC 02060103
OWNER'S NAME: APPLICATION SUB DATE
ICHARD FREEMAN 1422 SARATOGA AVE 06/17/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 328-6700
C z z ARCHITECr7ENGINEER: BUILDING PERMIT INFO
P,O O_ BLDG ELECT PLUMB MUCH
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5hLICENSED CONTRACTOR'S DECLARATION Job Description
cz`a —o I hereby off=that 1 am licensed under provisions of Chapter 9(commencing BATHROOM REMODEL
with Section 701li Division 3oftha Business and Professions Code.and my license FINAL
�®
x i is in full farce and ret .e G 9 OA3 Y ,
z z 6 License Clazx Lic.0
ja O a O Oatn Contactor
m3 u.�, ARCHITECT'S DECLARA ON NOVO 7 OooO
=O I understand my plans shall Ne used as public records I'1 V L LL
S� Y�
to 6o O
Licensed Professional
LL
OWNER
-BUDER DECLARATION BU I LDI I }��
e vi I 1 hffirm
ereby ain.,1 am exempt from the Contractor's License Law for the /'�
1—z>• following mason.(Section 7031.5.Business and Professions Cade:Any city or coumY lD J 31
{ o which requires a permit to consmict alter,improve,demolish,or repair any structure.
3 m prior to its issuance,also requires the applicant for such pimi to file a signed statement
— [hot h{i9licmadpursuanitolhpppro'p,misof the ConractoraLicense Law(Chapter 9 ; 0 �.,. Valuation
(commencing with section"12)of Division 3 of the Business and Prppf"sians code) FO 's'l( ,.,,
or Ihai tic is exempt thsoirnO d and me basis for the allijeS a}amptkh.Any violation
of Section 7031.5 by any applicator for a Permit subjects the applicant to u civil penalty A N Occupancy Type
ad not moa than five hundred dollars(ssoo). 101 P } AT I ON
C1,as owner of the property.or my employees with wages as their sole compensation. 102 — PTFRS
-
will do he work,and the Omicron,is not intended or offered for sale(Sec.7044. "-
Business end Professions Code:The Conuacmr's License Law does not apply In an 103 - UFER Required Inspecti6ns
owner of property 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
;co ped'fun sme.ow Roweveq theiWildinglavt or improvement rs sold he did one year of 10 5 - ANCHOR BOLTS
icompletion,for Rus ose of ale.).will have the burden of proving that h,did not build or
mproves for prrpaaa of sale.). 106 - SEWER & WATER
pl.as owner ol'bar propany,xsm eulusively comar-Gng with licensed contractors to 202 - — UNDERFLOOR PLUMBING ' •'
consumer the pmjoct(Sec.1044,Business and Professions Code:)The Contractors 203 - UNDERFLOOR MECHANICAL
t License Law does not apply to an ownar of propeny who builds of improve mareem.
and.whp cdo"cla for sucb.proiats with a.mrummair(a)licensed puaranLlo.the .... -2 04 UNDERFLOOR.-.FRAME._ .-. . .-_ . . . . . .. _. .. ._ _.
Conractor'z License Law. .
Cl am exempt under Sec.' .B&P C fm,hix mazon 205 - UNDERFLOORINSULATION
owner Dale 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 — TUB Sc OR SHOWER
Ihereby affirm under Penalty oflierjuryaneofthe following declarations: 303 - ROUGH MECHANICAL
C 1 have and will maintain b Canmeam of Consent to self-irOmd for Worker's 304 - ROUGH ELECTRICAL
s " Compenzmim, az provided for by Section 37W of me Labor Cede: for the
perfmmmum of the work for which this permit is issued. 3 05 — FRAME
1 have and will maims i Workers Compensation Insurance,az required by Section 306 - HOLDOWN S
37W of the Mbar Code,for the perfam ranee of me work for which this permit is 307 - INSULATION
issued.MY Worker's Compensation Insurance carrier and Policy number are: ...
.....
..._ .....
bSFb _SO Jc
c 6t�:>dCwCa 1oliry N : 3 0 8" SHEET
CERfIM;ATIONOFE)(EMPTION FROM WORKW',, r '305- -''EXx'FERIOR`--LA7`H'
COMPENSATION INSURANCE' , • 310' -INTERIOR--LATH-
(This section need not xcompleted if the permiais for one hundred dollars 311 - SCRATCH COAT
(slOB)m less.)
• ..1 cerlfY that in the performance of the weak for which oris Permit is issued.) .. 313 — -ROOF- NAIL
•-. ..: .. .' .:". _.. -_ _.
shall not employ any parson in any manner so in to become subject to me Workesi 5 O l - FINAL ELECTRICAL 'ENERGY'
Cangatha.tion Lawasfcelifirmn Do" 502 -..FINAL PLUMBING_. ENERGY.. .
Applicant
NOTICE TO APPLICANT:If,after making this Cenificote of Exemption,yourWould 503 - FINAL MECHANICAL' ENERGY
sbecome subject m the Worker's Compensation pmvisions or the Labor Code,you must
zOfonhwithcomply with suehprovisions orthis pemnitsh.ubadeemed invoked.
504 - FINAL BULLDING .ENERGY: ., - .-
'Vi CONSTRU CTONLENDING'AGENCY 505 - FINAL ELECTRICAL
1 hereby affirm in.,there is a construction lending agency far the pedomance —
afthewark for which this permit isissued(Sec.3091,Cmc.) 506 GAS TEST
y'G Lard01'sNatr'a'' 507 - FINAL PLUMBING
�fZ Lender's Address
U'p 1 certify mat I have read this application and state that the above information is
508 - FINAL MECHANI CA
gT. Pcowat.1 agree to complyy with.11 city.rad county ordinances and sate laws rising 509 - FINAL GRADE
-O.0 tabuildingcousmiafon.hrdhereby authorizatepresetnmivesofthis city toenter uPon 510 - FINAL PLANNIN
W1 the above mentioned property for inspection purposes. _
.0. (We)efireco, ,m.indemnify andkeep hornless the City of Cupenlno against —
fA' liabilities,judgments.cola and empasm which may in any way same against zaid 514 FINAL UB C
U,z City in consequewl of the granting of this pemrit r
^ AP'P'''L''I'C'�'T UNDERSTANDS AND WILL COMPLY WITH A N N:Po1NT'' Issued by: Date
SO EGL'LATIONS i;�/,
r$'Ignmure 7Appll NAZA DOU ' , Dae Re-roofs
nAURDOUS MATERIALS DISCLOSURE
W11they,,heC snafu-miIP-1. ade.Chaptuoaorhandle andthhealthaneiiiinliven mvoiil Type of Roof .. .... . ._. .. -. ...-. .. .. .. .
C de0nad lis the Cupenioo Municipal Code Chapter 9.12.end me Health and Safety
Code,SCecY sn 25 is
tI
All roofs shall be.inspected prior Jo any;roofing mater al being installed.
Will me applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hazaedous air contaminants as defined by the Bay Arca Air Quality Management
Dbthct? Yes �Na _ . , all new materials for inspection. Applicant,understands and will comply with
all non-point source regulations.
1 have mad the haaordouz materials requirements under Chapter 695 of the
California Health&Safety Code.Sections 25505,25533 and 25534.1 understand that _ .. ..
if me building does not currently have a tenet that it is my responsibility to notify the
occupant or me quircments which must be met prix,In u uana of a Cenificate of
asrpmey. Signature of Applicant Date .
ige�5 7
OwnEr or authorized agent Date All roof coverings to be Class`B"or better
.- .. OFFICE --. .. _ .. .
(�C CITY OF CUPERTINO
• CUPTYOF O PERMIT APPLICATION FORM �� 0
APN # 3 C) — O Z Date:
Building Address:
Owner's Name: l Phone#:
'Pe
�yA
Col_ntractor: Mo176/i',/B License#:
Contact Phone#:
Applicayj/ tr S r: Fax#:
ding Permit Info:
B lect Plumb Me_chh"
cription: 4-Cf- — Am
Residential: Commercial:
Sq.Ft. Floor Area: 3 6 ,l $/Sq.Ft.:
Architect/Engineer: Valuation: 7-D
ype ofCons cti / Occupancy Group:
�,Qivv.o oc-C�C
Q
uantity Fee ID Fee Dcscri tion Fee Grou
THER Other A liances MECHANICAL
AX Construction Tax BUILDING
TAX Ind/Off/Comm/ uasi BUILDING
TAXB Con. Tax for B Zone BUILDING
TAXH Hotel and Motel BUILDING
TAXR Constax—Resi/Mobile BUILDING
1000 Elec 600V <= 1000A ELECTRICAL
1001 Elec 600V> 1000AELECTRICAL
00 Elec Svcs 600V <=200A ELECTRICAL
GY Ener BUILDING
GYADD Ener Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BNEWMULTI New Multi-family Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
lof3 _W 10o737
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