02050175 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10398 WESTACRES DR BATHROOMS BY HANS
OWNER'S NAME: APPLICATION SUB DATE
vARY & SUSAN LONGDON 4986 TIFTON WAY 05/29/2002
PHONE: SANITARY NO. CONTROL NO.
` _ (408) 978-3053
GOO ARCHITEC`UENGINEEW BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
i E
8y=
LICENSED CONTRACTOR'S DECLARATION
� T therebyeFn nthat I am licensed under provisions of Chapter 9 kommen<ing Job Description -
O�-O with Secuit.70W)of Do'si Sof Ne Busines dPmfessions Code.and my license �n y� ® Imo®
�xF� is in BATH ROOM REMODEL �0V`�
z 2- License Lic.
Couacu
3L01LL ase I C E(madi.p TION `� Jf °I Q 2002
I understand mY place sM191 be used a public 1111 NovP1 1 O
O Licensed Professional
!Sa
OWNER-BUILDERDECLARATION
BUILDING v I hereby a(Sect on 1 1. exempt from the Contractor's s License law for she L \T
t?a following mason.(Semon]misma I,after, and Pronasions h,ac:Any city s county'
E F O which mgaim:a permit io eon:writ ager,impmvv,e<moRan,or repair my:uucwm
$8000
t°j30� priorits issuance.also regra the applicant rm such permit to Bk a signed statement, -
that L4,sliteressid porsanl to the provisions of the Contractors License Law(Chapter 9 ggq FI Floorpplea Valuation
(vo c g With Sean 7000) f D tion 3 of the qa mos and Prpilmor,Code) d.'t,Y 3.; 5 �5'9a141614+: O O.3 u'3 '$r`1"q'.
or that he ms exemPs therefrom aqd the basis far the allpgdd esemp,iah,Any vmlm on -
-of Scedon 703 L5 by any applmaqt for u Perron zubjnss the epPlicanuo a civil penvhy ��r3pm�nb�
of no,more than five hundred Jallars(S50% 101 APNFVUN'5ATION " Occupancy Type
❑I,as owner of the pmPcny,or my employees with wages as their sole compensation,
will do he work: d the Inotchim is nor intended or offered far san'(Sec 7014,- - -
Business hit Profisicorts Code The C ,mcmr's License Law does n d apply to an 103 - UFER Required Inspections
owner of progeny,Who builds or improves thereon,and who does such work himself
at through his own employees.provided that such improvements am not intended or 104 -. REBAR_
-'offered for saki:If,however:the building or impioov<mcnt is sold within o ._ne year of -
impletion,me owner-Wilder will have the When of proving that he did not build or 105 - ANCHOR BOLTS
impoe for ptormm af. l ). 10_6._.- _SEWER,.& WATER
of ae;oftncpro pods am exclusiv1y contracting wwSrirfeased conotation IF 202 - UNDERFLOOR PLUMBING
construct she project(Sec 7044.Business and Professions Code)The Contractor a t
- _ cansaLawdoesno,applymanownerofpmpene
ywhoWildsorimprovesd,reon, 203 - UNDERFLOOR MECHANICAL
❑Iamo contracts for such c a licensed pursvant.m the. .. .. ....... __.. _._.._._._. _
CamraemraLicenseLaw. . „ . 204 UNDERFLOOR.F,RAME .....
Add who Pmlccu w„ a c vsunogs)
semi,under See' B&PCfonhisfevon
205 - UNDERFLOOR INSULATION
ower Date 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penal!,ofr'ld n<of the meowing detlaations: 302 - TUB & OR SHOWER
v .ao,. 303 - ROUGH MECHANICAL
° f 1 O 1 have and will maint5ln a Cenificam of Consent to self-insure for Worker's
Cmipenmud.n. as provided for by Section 3700 of the Lala, Cade. for the 304 - ROUGH ELECTRICAL
-_ perms name of the work lo,whim thia pem,i,I:iaued.,.
305 - FRAME
❑1 have and will maintain Worker's Compenaadon i enin,nce.as required by Section 306 - HOLDOWNS
37M of he'LaWr Cod. ftallhe perform neeof sh rk for which thisgirth t is
ias a MyW rkorsC p e I,sur c e and Pol y ne e 307 - INSULATION
/.9Te,l�/���1 308..- SHEETROCKk
cLkTIFICATIOC'OF ENtl1�T1oN FROM WORKERS
;UR NC S' l - 30'9'I-` EXTERI OR I LATH
COMPENSA' NINEs
... _ ,..._, -. .....- ......... . .. .. ... .—__._ ._.
- -..
.--......_.,- .._ __ E - - .. -..,._
r(Thiciienion fined not be mmpletea if the omni,is for one hundred dollars 310. INTERIOR LATH , ,,, m.,
cslno)anaaa.>. , 311 - SCRATCH COAT
- 1 nryinaimthePerrirtWconn okrar:n'mu,spe t,:,aaueai - -- � � 313 -� ROOF NAIL. � '. - - n �
shall not mployany persy an t becpm . bjett, ,hp Workers 501 - FINAL ELECTRICAL ENERGY
Compcnsa,on Laws cf C Pimm a.Doc
Appple , - - - - " - 502 � - 'FINAL PLUMBING ENERGY
.N(irICEfOAPPLICANI' If,him,rmk gth Cerfificme.fE,unrommu.yausou "
J
Z become subjett ,he Worker's compensation provisions of the LabrCode.youmust 503 - FINAL MECHANICAL ENERGY
ZO fonhwish rnmply with men pmvisians or chis permit shall W deemN mvokW.
_ _ ._._ _ -504- - FINAL BUILDING ENERGY --
"' " YONSereis a IONL&NDINGAGENCY
f" 505 - FINAL ELECTRICAL ,
� "' 'r lherebyaff affirm there : nmiwn,an lend'ngagency farshe pedorman2e
of she work for which th. pe ,'. anted smi.097 C,v C)
y.o - Lmder•sNam . 506 . - . GAS.. TEST...,-
D Z LandaraAddress 507 - FINAL PLUMBING
UOnirythalnvaredniaavvrea,ion state that the above inromatoia 508 - FINAL MECHANICAL
tIa. f^ correct.1 agree t core with ail city and county ordinances and ante laws reining 509 - FINAL GRADE
. (, ,o th Idln cons, e,inn, rid himb nntharin repreunativesofmi"o,memcrupon
W ,n oWv nenrhnea to try inape<' ngurposea... 510 - FINAL PLANNING
ly, ( c)sur to av indc ni(Y c hmmlcsstm Cityof Cupenuoagaim,
m Nabi ii ivag q,.rn,:aria a . ` n may in any way acerae agamx,sale 514 F NAL WORKS /j�
U"Z Ci Yin use c bf m c g n ng f h' i,.` s/ v
APPL : I ., RS 5 e\ COMPLY WITH ALL-NON ' Issued by:
Date
S U C I , - 'I
igna, of APPGcan muucmr '. el Re-roofs /
-HAZARDOUS MA IALS DISCLOSURE
nth apple tmrm- Wadingp t.,nmmnandl n aN,.
to
o ,maani Type of Roof
Will Be a Cupemn Mu 'pal Cad h pt 91 d th<Healthand Saf ry
Y 55320
,,
as e r
Cad , 2 t All roofs shall be Inspected-prior to any-roofing material being Installed.._
n
wpliiauto,itione If a roof is installed without first obtaining an inspection;I agree to remove
mit hvmdous air contaminants as defined by the Bay Area Air Quality Management
oia<t7 all new materials for inspection. Applicant understands and will comply.with .
ores „ all non=point source regulations,, „
1 have phij.odou
smmerils equircmcundeChnpmcr 6.95 of she
Callfomia eaSCodeS do 05,25533 and 25534.1 understand thatifthehui ngoendy .that i,is my responsibility to notify the..Pa of,hivt met Poor to issuance of a Cenificam of
'ay Signature of Applicant Date
ac Iarae n, „cZ All roof coverings to be Class "B" or better
.Ca
.,.. ..,- ...: ... - _ .. . . . . OFFICE -
CITY OF CUPERTINO
BUILDING DIVISION pE CONTRACTOR INFO ON:
BUILDING ADDRESS: PERMIT NO.
10398 WESTACRES DR BATHROOMS BY HANS 02050175
OWNER'S NAME:
APPLICATION SUB DATE
GARY & SUSAN LONGDON 4986 TIFTON WAY 05/29/2002
PHONE: SANITARY NO. CONTROL NO.
I
(408) 978-3053
w 0 OC ARCHITEC(ENGINEER: BUILDING PERMIT INFO
W U BLDG ELECT PLUMB MECH
<i E-- l L=J C-:3 I_J
y i LICENSED CONTRACTOR'S DECLARATION
Z
O z-0 1 hereby af& Job Description
p
m that 1 am licensed under provisions of Chapter 9(commencing
with Se lm.7001H. Divisi Sof the Business dProfcssions Code.andm license
i is int
To Tor e a �" BATH ROOM REMODEL p�� ,{�
6 L Lamme Lia. �e��LE®
C.
u O " A CT-S DEC TION `✓ P f
S I understand my plans shall be used as public records 2002
Y
w p O Licensed Professinml NOV 18
OWNER BUILDER DECLARATION
m 1 hereby,a.(S m that 1 em exempt from the Cssions m's License Law for the ��' ®���
F Z< following..,an.(Section 7031.5.Business and Professions Code:Any cry or county'
D which requires a permit a comaruct,alter,improve,demolish,or repair my structure
63,a Prior m its isssmee,also requireslut.,11icant foamch pcmdlm fdcasigmed soomor
Nm rte h,foamed pursurato the praNsas of be Contractors License Law(Chapter 9 cy� EIhh-FJoor Area,., Valuation
(cortwewin8 with Section]000)of Division 3 of the qusNess,and Pro4uions Code) v } 5`7 4'V 1'4'-Q O _ s. "i s`
or Out he is exempt thertfmm and the basis far the illegdd Atimbo(oh.Any violation - '
-of Se anon 7031.5 by any upphca o for a Permit subjects the applican to a civil Penalty N1tmb
of not mote than five hundred d=($5BB). 101 APN F VLJN�ATZ ON Occupancy Type
❑1,as owner of the Property,or my employees with wages m their sole compensation.
will do the work:and the awnure is not intended or offeree for In(Sec.7044, - -
Busincu and Prefessiom Code:The C.M.I i s License law does ma apply to sm 10 3 - UF
Required Inspections'
awn ro
I owner of pperty Who builds or improves thereon,and who does such work himself
or through his own employees,provided not such improvement
see not intended or 104. — REBAR..
offered for rule.IL ndwuilde the l have
the urge ofprot n sold within one year of
completion,the owner-builder will have the burden of proving then he did nm build or 105 - ANCHOR BOLTS "
improveforparposeofsale.). 106 - SEWER & WATER
"O hzioaoai of me prcpcny.an exclusively contracting with licensed contractors to 202 - UNDERFLOOR PLUMBING
consumer the projat(Sec.]OCG.Business and Professions Code:)The Comnictora
LicroselawdoesnotapplytoanownerofprapenywhoWildsorimpromthereon. 203 - UNDERFLOOR MECHANICAL
and who canonical far such pail with-e ommore oral licensed pursuant to me.
Contractors Licerse Law. 204 — UNDERFLOOR- FRAME
❑I am e.cmpo under See ,B&P C for this reason 205 - UNDERFLOORINSULATION
Owner WO-Data RKER'SCOMPENSATION DECLARATION 301 - ROUGH PLUMBING
I hereby affirm under Penalty of perjury one of the following declarations: 302 - TUB & OR SHOWER
C 1 have and will maimmin a Cenificae of Conxcm to self-insure for Worker's 303 — ROUGH MECHANICAL
Compensation, as provided for by section 3700 of the Labor Code, for the 304 — ROUGH ELECTRICAL
performance of the work for which,this pcmdt is issued. 305 - FRAME-,
❑1 have and will maintain Worker's Compensation Insurance,as tequircA by Section 306 - HOLDOWNS
37W of the labor Code;for the pciformance ofthe work for which this permit is
i.ea.MyWorker's,Co. ma ion Insurance earneraneP0cynumberare: 307 - - INSULATION
he No.l -02— 3.08
fE'1�T����y]�R� —.,SHE,ETROCK. ,
CERTIFICA(ngmpFSSATANWURANCEOR l 3' " 3'09' '= EXTERIOR`LATH "
anis:ecdo,need nor hecompleted ifthe Permit isfor am,hundred donaa 310 — INTERIOR LATH .
(sloB)aness.) 311 — SCRATCH COAT _
I cenlfy that in me perfnrmsnce ohne wori for which this .it is isaned,I 313 - ROOF NAIL. . .
shall not employ any person in may manner so m to become iubjen to the Workcri 5 01 — FINAL ELECTRICAL ENERGY
Compensation laws of California.Date
Apphaa"` 502 — 'FINAL PLUMBING ENERGY
NOTICE TO APPLICANT:If,ager makin8!his Ccnificee of Exemption,you xhoula
z b omeaanjeatotheworke.'acbmpnsaiampraai:ianaortheumrcoae.yoamma 503 — FINAL MECHANICAL ENERGY
0 0 foMwith enmplY with such provisions m mix permit shall be denmcd rtroked.
— —' IO - 504- — FINAL BUILDING ENERGY(,
(~ CONSemisacONLENDING AGENCY 505 — FINAL ELECTRICAL -
I hereby ansm that then is s conewetion lending agency for the performance
Lea a work for which this permit is issued(Sec.J09].Civ.C.)
x � 506 ..— GAS TEST .,
y 0 Lender's Name - -
y z Lende,sAddrea< 507 — FINAL PLUMBING
QrI 1earthythaInvrear.1 tram 508 - FINAL MECHANICAL
0 z[. COIreCL 1 Bgrte t Co. c with ail city end county ordinances noes end sae laws ofling5 0 9 — FINAL GRADE
U to buildin const nion rad hdrtb ad mirertpmrenalivesofmiscitymcmcrupon
them. emu red v nye I" eeU=C 510 — FINAL PLANNING
�.a. ( e).g a a� .nae afy a naamleaathecayhrcnpeaidaagainst 514 - FINAL WORKS
VI Iiabilif judg nt,cc is and exp e h may,n any way accrue against said
U'Z City in n c oft g n ng f h io, m ,
APULC se IS SA COMPLY WITH ALL NON-POINT Issued by: r Date V v
qms ofA,licanLiRtimilln.r Re roofs It
HA]ARDOUS MA L c DISCLOSURE
11 the applkmt or tuna,Will cupant atop or naame mai dont tmtcdd Type Of.ROOF . . . ..
m de c by the Cuppenino Municipal Code. aper 9.13,and the Health and Safety
Code, mon 35532( : i ' ` I i.IN
Yea' o All roofs shall be inspected prior to' any' roofing.material being.installed.
Will thc applicant or Pomrt building occupant use equipment or devices which If a roof is installed Without first obtaining an inspection, I agree to remove
emit hazvdous dr contaminants as defined by the Bay Area Air Quality Management
Dishict? all new materials for inspection. ,Applicant understands and will comply,with
❑Yea KNo all non-point source regulations. .
1 have rc the azerdous mammals quircmcnta under Chapter 6.95 of the
Cdifomi call S. y Cod.'S do 05,25533 and 35534.1 undersand that
if me bui ngd of Trendy ,that it is my responsibility to notify the
coca of the q in emu wh v t met prior.
is
of a Certifies.of
op It. Signature of Applicant Date
a o ere nit ate. All roof coverings to be Class "B"or better
OFFICE '- - '
copy
• THIS PLAN SHALL REMAIN ON
Y ,.g
f-ONSTRt1CTION.
MAY 2 M2 lUl
By—
APPROVED
IN ACCORDANCE WITH
AN THE CITY CES
SUBMITTAL
CUPERTINO C ES AND�t1RDC� •\
SATE
#1
SIGNED et of la. end specific
be kept on the 100 at all
times 0 and alterations i
lav+fua
l to make ally g _ I
on same without writtecf Cupertino.pelmission from
City T
• he building Oap.., , —
The stamping of th s p'.an nd specifications _
SHALL NOT be had t0 pe.mit or to be an
n of any provision•
pproval o ,he .- — :
'ale I.aw
,r anv Citi � rl rar,..e Or
•