02040161 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10084 CONGRESS PL THE BATH ROOM INC 02040161
OWNER'S NAME: APPLICATION SUB DATE
! •ELEANOR TURMAN 1910 W EL CAMINO REAL 04/30/2002
HONE: SANITARY NO. CONTROL NO.
(650) 968-7666
z z ARCHITECTIENGINEER: BUILDING PERMIT INTO
m BLDG ELECT PLUMB MECH
L_7 I.1 U
ss.. 2 LICENSED CONTRACT'OR'S DECLARATION
O H 1 hereby itis,that I am licensed under provisions of Chapter 9(commencing Job Description
:M�: with Section 7000)of Division 3.0he Built, d ProfessionsCde,and my license L
O w7W is in full fn a std effect. 22
U Lpi�c�e`n�se Clv Lic.M
13 ua.
.,t", dp ° contrecmr Inti
.ib O d ARCHITECT'S DEC Aeco
-I I understand my plan,shall be used as public records
I i O Q Licensed ProfCsSlOnal
�i OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the —
y
tea 8 h.orrenyciyorcmtnty $12000
F O req pe p h,or repair any statement which uirtse rmit to�conswn, er.in,rove,de�molino nleasigned stmemem - _ --.-.-._-. -----. ------ -
following reason. anon . ,Business and m essions
dorto,scarocice,also arcs theapplicant for Such Permit
(comeccemW pSectionin the Provisions of the Contractor's License Low(Chapter 9 ,5f Valuation.
(commencingwith Sanestminanorhe basis3ofthe Business and Professions Code) (-( '%- tF32�'�'sF#,� h�r6a�E'tl 1`�'js3"ty
or that io is exempt therefrom and the basis for the alleged cicmant to Any violation V U l
of Section 7031.5 by any applicant fm a permit subjects the applicant to a civil penalty
of not momrhanfivehundrwao][.,($5o)). 10 I ' DATION Occupancy Type
0I,as owner of the property,an my employers with wages a their sole compensation,
will do the wirk,'acd'the structure is not intendedor offered far'sale'(Six,7044.
Business and Professions Code:The Convector's License Law does not apply to an 103 - UFER Required Inspections
owner of property Who builds in improve Hereon,and who does such work himself
or through his own employees.provided that such improvements sm not intended or _ __ 1.04 - REBAR _
offered for sell:If,however.the building or improvemem i5 sold within one year of '- - '-'- -""
completion,the owner-builder will have the burden of proving that he did not build or 105 - ANCHOR BOLTS
improve for purpose of sale.). 106 - SEWER & WATER
El asowmdolihepmpmiy,amasew sivdycontractingwith licewed dcan uatiarsie 202 UNDERFLOOR PLUMBING
Lonstruct the pmjcct(See.7044,Business and Profession,Code:)The Contractor's
icense law does not apply to an owner ofprolixity who Wilds orimproves themen, 203 - UNDERFLOOR MECHANICAL `
and who contncts.for such projeca.whin a cantracouns)licensed portion,to die
Contractor's License law. ... ". 2.04 -=- UNDERFLOOR,-FRAME
❑lam exempt under Sec. ,B&PCfor his reason 205 - UNDERFLOOR'" INSULATION
_= osmer Data 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
302 - TUB & OR SHOWER
I hereby admit under Penalty of Perjury one of the following damrarona: 303 - ROUGH MECHANICAL
❑ 1 have and will maintain a Certificate of Consent to self-insure for Worker's 3 04 - ROUGH ELECTRICAL
Compensation,-as Provided for by Section 3700 of the Labor Code, for the
_ performance of the work far which this Marl,is issued. 305 - FRAME
❑I have end will maintain Worker's Compensaiion Insurance,as required by Section 306 - HOLDOWNS
3700 of the labor Cade,far the performance of the work for which this permit is
3 0 7 - INSULATION
iss ed My Worker's Campensauon Insurance curter and Policy numbenre:
308 :: :,SHEETROCK- ;. s-
` ,(�eRrlExeMPcFRomw R""—d eas� F-'' T_ 309 `BXTEReIOR �LATI-I"
}1 n/n 'COMPENSATION 1.SURANCE - ., _ _,___ _
..,'iThii section nkd not W completed robe parmit is far one hundred dollarx 310 'INTERIOR LATH•___
(s10o)mlaaa) _ 311 - SCRATCH COAT
adiry tn..m the
p xa a ce pr me work rar mm�tai's p m r is i sed:a 313 ROOF NAIL _
shall stat employ any Parton in any manner so os m become subject to Ne Workers' 501 - FINAL ELECTRICAli 'BNERGV
Compensation Laws of California.`Dam
cam
-502- - FI'NAL PLUMBING ENERGY -
NOTICE -
_.
TOAPotheWoT.ILCompeer sats this Carinate of Labor ode,you mind '
Z become hwithc unply hthsuchprCoionsorthisprovisionsLlthe
eemedrode,youmun 503 - FINAL MECHANICAL ENERGY
Q Q forthwith comply with such provisions m this permit ahvll he deemed revoked.
— - 504._ -. FINAL _BUILDING ENERGY-. ..-
'CONSTRUCTION LENDING AGENCY
"I�heseby eRrm Nat Nere is a conswnion lending agrncy for the perfommnce' SOS - FINAL ELECTRICAL '
, tin work for which this Permit is issued(Sec.3097,Civ.C.)
50.6.-.- GAS TEST
y'p La
'S 507 - FINAL PLUMBING _. . ._.._.... ^ _.... .. . .
i1. z Lcudc Address .� / I
U'0 Icertfy that lh ercadthi' mic.. and...tetharthe oboe information is 508 - FINAL MECHANICAL
�0 U toWil Berg trcomply dheall ctyand coemyordmivesaand natelaws relating 509 - FINAL GRADE
.V to budding construction,and hemby euthonre rtpresematives of miscity to corer upon
r� the abase-menumbed.property for inspection purposes.: 510 — FINAL PLANNING
y (We)agree to save;indemnify and keep harmless the City of Canadian against
V!) liabilities,judgmems,costs and expenses which may in any way auction against said 514 - FINAL PU IC WORKS
U z City in consequence of the granting of this permit.
APPLICp NTUNDEgqNDSAND WILLCOMPLY WITHALL NON-POINT Issuedb r v (�
S u f i REG AlT IN.: - t _ Y Date
'Pina.biffid hood ontra r '' . '• Data Re-roofs
HAZARDOUS MATERIALS DISCLOSU '
W11 th applicant in futumbuilding occupant store oShandl haaerdobs metenal _ ,Type Of ROOF._.as defired by Ne Cupertino Municipal Code Ch Pte 9.12,and the Health and Safety l:
Code Satin 25532(U? - s..i ' \ r t I ' ' ^ t - ..
El Yes "° x..t All roofs,shall be inspected.ii to any roofing material being installed._
Will Nem,ficamarm building occupant use wuipmcntordevices whim If a roof is installed without first obtaining an inspection;I agree'toremove
air hi aanta
rdous an canitsZ es deflawl by the Bay Are Air Quality Management
'Smc 1 hire recta all new materials for inspection. Applicant understands and will comply with
pupa , : No - all non-point source regulations;,,, .
the Safety
Conus materials 2 rc 5,25533 under 4,1 mu h.95 of tale
iftheCalifornia ni,du,Safety Cody,aveSection,mount,
that
it
and 25534,I undesamnd that
`ilthe building does not currently haveutenvnh that it is my rcsponsihility to notify the - '--
acope f Ne obluire nu which uns, prior to issuance of.Cal ificam of
Signature.of Applicant Date
woe earn ua em " Date All roof coverings to be Class"B"or better
OFFICE