02030022 (3) CIBt OF
c DIVIiSiONVD ]PFRMIIT CONTRACTOR INFORMATI
BUILDING ADDRESS: PERMIT NO.
10084 CONGRESS PL BATH ROOM INC, THE 02030022
OWNER'S NAME: ,APPLICATION SUB DATE
BONNIE TURMAN 1910 W EL CAMINO REAL 03/06/2002
SANITARY NO. CONTROL NO.
PHONE:
(415) 968-7666
0=4 ARCHITECTIENGINEER:
sO O BUILDING PERMIT INFO
U BLDG ELECT PLUMB MECH
GaE I I CJ , J L i
6 s it LICENSED CONTRACTOR'S DECLARATION Job Description
5z m O 1 hereby alrrm that 1 am licensed under provisions of Chapter 9(commencing
.mh5� Dwith Section 70W)of Division J of the Businessand Professions Code.wWmy license BATHRM REMODEL.
1 in full force and ellen
. mi
N License Cls Lic.OnuDe CoOr
wmr
LLrn
�������
ATDECLARATION
O g 1 understand my plans shall be used as public records
Q APR
119 2002
l 6 0 Licensed Ptnlbesumal APR
a� HOWNER-BUILDER DECLARATION
1 hereby orrrm that I um exempt from the Contractor's License Law for the
?< following reason.(Section 7031.5.Business and Professions Cada Any city w county 1 '
Y E O which requires a permit to construct,alter,improve.demolish,or repair any structure B V'LDING $2 6 0 0
3m priono lieciuco punta tt16 the provisions
for Compactor's Teens Law(Cetemem _
that he is carred pSectiono the provisions of the Contractor's and Pr law(Chapter Y
(commencing wird t therefrom a of Division J of the alleged
x mrd ion.An vi Code) 3�� �� .��,., Valuation
or that he is exempt therefrom and the basis for the subjects
texempnt to Any l pennon
? of Section]031.5 by any opplicamfor apermit subjects the applicant to acivil penalty
Of not more man five hundred dollars(SSW). 10:`PN DATION ' • Occupancy Type
O 1,as matured the progeny,or my employees with wages a their wlc compensation,
will do the work:and the structure is not intended or offered for sale(Sec.]004, 102 —
, Business and Profession.Code:Thc Contractor's License Law docs not apply to en 10 3 - UFER Required Inspections
owner of progeny Who builds or improves thereon,and who does such work himself
or through his own employees,provided that such improvements oto not inlandea or _ 104 — REBAR
or
for sale,Jr.however,the buildingImprovement is sold within one ""- _.. -
ar impro year of --. .... .._.-..
compinion,the owner-Wilder will have the burden of proving that he did not butte or 105 - ANCHOR BOLTS
improve for purpose of sale.). 106 - SEWER & WATER
_.. . ._ .
❑L.as owner Panne p(Sec 7 am Business and contracting 202 - UNDERFLOOR PLUMBING
ntta contractors w -.
conshucl the projat(Sec.70a.,Buvncxs and Prefemons Cade.)The Canuaaor's - '
Lcrn LwaaanotappI toenowner ofproperty who wadsorImprove.thereon. 203 - UNDERFLOOR MECHANICAL
me me eonwns f inch project with a commnort.)licensed prrsmm m.he '2 04-' L 'UNDERFLOOR FRAME
Conttunors License la .. .-.. ..... .. .. .... .. _.
❑lam exempt under Sea. B&PC15orthitireason Data 205 - UNDERFLOOR' INSULATION
Orncr . WORKER'S COMPENSATION DECLARATION 301 — ROUGH PLUMBING
I harshy.from under penalty Of perjury Dna of following declarations: 302 - TUB & OR SHOWER
303 - ROUGH MECHANICAL
�C 1Fena and will rovided a cby Scti of Consent to sd Loons me workers 3 04 - ROUGH ELECTRICAL
Com action, he provided for b Section J700 of the Lebon Code, for the
pctramwnce Of work for which this perms i.issued.
305 - FRAME
❑1 have end will'maimain Workar's Compensation Insurance,as required by Section 306 - HOLDOWNS
3700 of the Labor Code.for the performance of the work for which this permit is
sree.My Worker's Compensation Insurance carrier and Policy numberars: 307 - INSULATION
.. :.-: :rte:. %.c mer eoEey No.: 3 0.8 : SHEETROCK
CERTIFICATION OF EXEMPTION FROM WORKERS': - •
. .. COMPEf4SATIONINSURANCE. . .: 309 - EXTERIOR LATH
. INTERIOR -LATH.. ---.. ... .
_. ._ _.
3'10 .
"(ris la .ealuna«a not be LoroPlnea rine gerroui.for one nrtwrda dollars; 311 - SCRATCH COAT
(5100) rlcss.)
Icertify hat n the performance ofth oekf hhtbspennnrs Worse:' 313 "ROOF NAIL-.=. . .. -
Compoll t t employ _Y person Laws of t h subject mthe Worsen' 501 - FINAL ELECTRICAL ENERGY
Com . California.ff Date
Applicant502FINAL PLUMBING ENERGY
NOTICE TO APPLICANT If after making th Cm f t of E pt on.you should
Z becL subjectt theWorke c x t provisions of thLabotCode,you must 503 - FINAL MECHANICAL ENERGY
sZO O ronh-nn comply with suchp .ton.Lim petmlanmlxa ere�Lkea. 504. - .FINAL.. BUILDING ENERGY . . .
Iti' .. ....b .. .
'5: „ ' CONSTRUCTI
ON LENDING AGENCY
" 505 — FINAL ELECTRICAL
,� I hereby.rich that mere rs s conatus d lending agency forthe performance ..,
�.Q Lime Lkfo wmenthWp mW t.¢.ree(sea3097.C..e) 506. - GAS TEST
a.La Londe Name..: � ..: .. ...._ . �..,.�..
M Z L<na nagrt.a 507 - FINAL PLUMBING
V..O Ian'fythat Ihave readthis application and statethe,the shave information 1. 508 - FINAL MECHANICAL
w'[� connect 1 agree to comply with all city and county ordinances and state laws realm
O:.r_3 to building construction.and hereby authorizerepmsennowal fmiscity toenter upon 509 - FINAL GRADE
}} W ma abovem,eattuned propeny'a'Iaspec"On purposes. 510 - FINAL PLANNING
Ft CL. 'We
)agma to se ver mi-xis ertino agai
and keep I—I.-the City of Cupnst
V1 liabilities,judgmrnts.costa ane expense:winch may in any way accrue egaimt aid 514 — F INA P I C WORKS
U,v City in cbnsc9uence of the gm holt of this pen"it
SOUHCE REGULATIONS.DS AND LL
COMPLY U LTH ALL NOY-POINT Issued by: &
Date
Signature of APPbcam/Commcmr - Ga. Re-roofs
HAZARDOUS MATERIALS DISCLOSURE - -
Willde,applicants wfuture building occupanlatorewhimiluzardousmaterial Type of Roof. ..
a defined by the Cupenino Municipal Code.Chapter 9.12,and the Health and Safety
Code.Sauon 255321¢) .. .,
El es ❑No'.. .. .. ...
All roofs shall be.inspected prior to any roofing.material,being installed.
Will the applicant or future budding Occupant use equipment devices which If a roof is installed without fust obtaining an inspection,I agree to remove
-mit hazardous air contaminants as defined by the Bay Area Air Quality Management
oisiden.❑Yesall new materials for inspection. Applicant understands and will comply with
. . .: . ❑No ...
all non-point source regulations.
I have read the hazirdoua materials requiremcnW under Chapmr 6.95 of the -
Califomia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that
if the building does not currently have a tenant,that it is my responsibility to notify the
Vupapancyto or the requiremen W which must be met prior to issuance of a�Certificate of
Occ .. -
Signature of Applicant Date
Owner or amhonme a gent Dae All roof coverings to be Class "B" or better
... .. ... OFFICE
The Beth Room, Inc.
1 Kitchen & Bath Remodeling Showroom
1 1910 W. EI Camino Real #E • Mountain View, CA 94040
Since 1979 (650) 968-7666 FAX (650) 968-2151 Lic. #604922
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p design erM mus[ Dnteglvnn oro:..ibjnct to vedtlaatlon on 03/05/102
r enpletl unlelljb clic and adju.acgat b fit jab baan pald or jobconditions. Deslgner