02060107 (3) CITY OF CUPERTINO ,•�arw..,,x€r.•r:..J... . ,a . .
BUILDING DIVISION PE T CONTR9GtTOR' ,.O UNc f
BUILDINGADDRESS: PERMIT NO.
22340 CUPERTINO RD CALIFORNIA BATHROO REMO ELERS 02060107
OWNER'S NAME: APP11 ATION SUB DATE
DAN & JUDITA AGULIAN 783 REGENT PARK DR 06/18/2002
i PHONE: SANITARY NO. CONTROL NO.
4083609706
ARCHn'ECTIENOINEER: BUILDING PERMIT INFO
m BLDG b'IPLT PLUNtB MECH
L u u u
o Sse LICENSED CONTRACTOR'S DECLARATION
4 hem y affirm that I un licensed under provisions or Chapter 9(commencing Job T Description
N r3 t. withsacd 00))of Divii n 3 of the Buslnasj Pmfessiom Cade,aaand my license BATHROOM RE }•+//�s77TT�a�((���+' ae 11��
G < tis n full( s and effect. Lic,a / 1 / �a•--v XLED
U m Conus UF,FN/.6
f9- ARCHCfECT'S DEC TION e_
y] I understand my plans shall be usd u public needs •y' ��tg. AUG 13 2002
:31 HEDA Licensed Professional
HOWNER-BUILDER DECLARATION on1 hereby air=that I•m eeasemp from the Contractors License Law for Use, BUILDING
$15000
h Z< following sson.(Section 70313,Business and Pmfessiom Code:My city or county
O which requires a permit to consumer,alter,improve,demolish,or repair any sometime.
3$ ,prior 0 its iuuooce.also regW(ea the applicant fa such permitto file°signedsaumem
trot pq Itti¢n{ed pursupnt too pamisjom of N°Conoume,Licsnse Law(Chap..9 �y L.,� 1 Valuation
(commengogwrth Sepuon7 )of Division7oFthe Busjnessrand prpfessiav Cdc) ;."-\ j t44%,
or Natt he k ffiempf sehTmm and the basis for the•ll4ed ekemptin.Any violation 1
a Secuon 7031.5 by any applicant for•Permit subjects the mre applicant to a civil penal ,
of not othan five hundred dol len(5500). 101 APN�3�,,,,7�.,.
PtYGi1tlY5ATION Occupancy Type
01,As owner of She property,or my employees with wages is theirsole compensation, 102 — PIERS '
will do the work,and rhe structure is not intended or offend for sale(sec.7044, - 1O 3 — UFER Required Inspections
Business And Prdfem ssioCode:The Commo mr'a License law doss not apply to an
owner Of property,Who builds or improves thereon,and who does such work himself 10 4 - _REBAR _
.,or through his own employees.po vidd that such improvements arc not intended or
c e of sale.if, owbven the will
hav the
improvement n sold he did one year of
'comyletion,the owner-Wilder will hove the budenofproving Nat he did not build or 105 — ANCHOR BOLTS
improve for parposeofmle.). 106 — SEWER & WATER
t71,•i owtia of in property,AN exclusively convecting wire littnud conGecmrs to'
_._ UNDERFLOOR"PLUMBTNG" -
omumttheprojat(Sec.7PAi8A'.eisend Prof -iNA Code:)The Contra or'a 203 - UNDERFLOOR MECHANICALit
License New dos
ma.w'
to an owner of property who buiw or improves sercon. '
' and who conuaas for Such ProJaa with o convumr(s)licensed pursuant m the. 204 UNDERFLOOR FRAME ---- --'---- -'- -"--- - — -
-
Commotion"
License Law. '
❑lam exemptuda see B&PCmrthlsrtason 205 - UNDERFLOOR-"INSULATION
Owner - live 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
thereby affirm under penalty ofperutyaneofinefollowing declararnns: 303 - ROUGH MECHANICAL
O I have And will maintain'a Ccrtiftcans of Consent to'selbinsure for Workar's 304 - ROUGH ELECTRICAL
Compewtion, u provided for by Section 3700 of the labor Code, for the
parrarmzaear me work for which this permit is ureal. 305 - FRAME
❑1 have and will maintain Waiter's Compensation Insumtce,AS required by Section 306 - HOLDOWNS
- 3700 of this labor Code,for Ne performance of tine weak for which this peanut is
' - Issued.M workeri Compensation wuranc`c�er ane Policy number are: 307 — INSULATION
.,;a_348._.._.._.SH{E�ETRO�CK........_L� ........ ............ - - , , , _ ...,.,_........_.__...
.. 'CERITFlCATIONOP EXEMP170N FROFf WOR1(ERS'; 1 l,r�'. :309. Lf�'�X'1�R1 C�iF:.LHs.FIlx'•:
COMPENSATION MSl7RA E"'' __ _
'.., . . 310.._7.-LN'Z'ERIOR LATH._ ._._... .___._. _.
'(Thiel ser nneed not be completed if the permit is for one hundred dollars 311 — SCRATCH COAT . . '
($100)0,1...)
I unity that in the pe}(ormonce or the work for whish silpertnir is issued,1 313 — ROOF NAIL
'a" 0rrtui^Noy am pe_a
l(m,•nsvnaAner w m tp ory�s�ea�t`ro me waders' 501 - FINAL ELECTR I CAli -"ENERGY '
Appbamt / D�(' Ea// ! 502 - FINAL PLUMBING ENERGY .
NOTICI"r1r0 APPLICANT: ;Cuxma A., this Ceni6cma of Exemption,you should 503 - FINAL MECHANICAL ENERGY
z Obecome subject m rhe Workefs Compenseuan previsions of Ne Tabor Code,you must
mrtnwitheamplywimananproviaionSmobisp m",hallb chain vekeE. 504 - FINAL BUILDING ENERGY
'CONSTRUCTION LENDING AOENCY
�-^1 I nertby.Flsm that mare i.•eanawefian lending agency rex fits perramana 505 - FINAL ELECTRICAL
�.Qof the wodfar which this permit is issued(Sec:3W7,Civ.C.) 506 - GAS TEST
Leder%Name 507 - FINAL' PLUMBING
Lander:Addresa
O 508 - FINAL MECHANICAL
I certify ren I ply read thls application and ion and sou oras the above information is
w.F
to building
I•gree to coon,and he hallereby
city and county ordinances and state lows enter
509 - FINAL GRADE
V the almye-mennruc[ion;antlh fq btopectum representatives of this city upon
ygp) the•hoveO).g.nedpopnymrifyNdkeperypus 510 - FINAL PLANNING
Da es,iNgra°tosave.indemnifyandwhihamayinanywa acon,anoursaid 514 - FINAL UBL C WORKS
st
W liabilities,judgments.costo and expenses which may in any way acorea againa said
City in Consequence Of the granting of this Lenoir.
APPLICANT UNDE STANDS AND WILL COMPLY 0.TfH ALL'NON�POM'
oug�F;yyp(n.7NKt ,��,.� Issued by: Date
�• �� JZ
signature of pp mHAZARDOU — Ds[=) Re-roofs
Haat m low. MATERIALS DISCLOSURE
Wall the applicant or Ihrurt building occupant start .handle harardoua Shfaty Type of Roof
defined the Cuartiro Municipal Lotle,Chapter 9.lY.end the Health and safety
Code;section 25b2(a)?.
❑Yea All roofs shall be inspected prior.to any roofing material being installed.
Will the Applicant or futu/re`buiQd9a lding acupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazvdous•,r contaminants AS defined by the Bay Ain.Air Quality Management
Disvict? all new materials for inspection. Applicant understands and will comply with
❑v<a 960 all-non-point source regulations.
I have read the hasardous materials requirements under Chapter 6.95 of the
California Health&Safety Code.Sections 25505,25533 and 25534.1 undershoot that
zo�7
ntly have a tenant,that it u my responsibility to notify the -
hich must be met prior to issuance of a Certificate f
Occupancy. Signature of Applicant Date
,te All roof coverings to be Class "B"or better
-. OFFICE
• APPROVE®
IN
ACC WITH 714E City 08
CU1N0 IAN ORDINANCES
• ff CGL v COPY PERTDES
nAZJ ndL N ( /� DA7E IDE
V SIGNED ——
_ set of plan_ and specifications UST
M
-1,72, 7 4 C ✓ r�?i T be N n kept on the job at all times and it at un
lawful to make any changes or alterations
���Lfl 7 /�, on same without verity Of Cupertino
from
the building Dept., City
The stampin/1jh Pla/ nd specifications
V rd T (�
SHALL NOT be ne.0 t� �c'"" t�ovisioo<
approval of the violation of any P
a Inv City Ordinance or State Law
I1 8 2002 '' �
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SUBMITTAL
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f( - CITY OF CUPERTINO o 2 o,
CUPERTINO PERMIT APPLICATION FORM
I PAPN# 32 / sdOZ / Date:
Build' A dress:
o G u ✓1/o
Owner's Name: OA-/-/ } ��q T7[♦ Phone#:
VCI /d�
-7,S-Z-- 716q
Contractor: License#: {�p y
1 IgOgIVIA 9Tpnoa✓i oONL�t�f . /D 710
Contact: ��y✓
?4
one
v1) 76 a—
Applicant/Contractor: Fax #:
Y797
( Buil ' g Permit Info:
Bld Elect Plumb Mech
j�*bescription:
Residential: QZp Uct (yeq ,� F 1 , ifq� �ti v Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation: `
I
Type of Construction: Occupancy Gr up:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances 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> I OOOA 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
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 P-lamb PLUMBING
, 874�,
1 of