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03070136 (3) CITY OF CUPERTINO BUILDING DIVISION PPRMITCONTRACORINFOIZMATION BuiLo1NG ADDRESS: _ BATHROOMS BY REMODELING """'03070136owNER'S NAME: - 1422 SARATOGA AVE PERMIT ISSUE DATE (408) 378-6700 ONE: - SANITARY NO. CONTROL NO. i CHITECVENGINEER: BUILDING PERMIT INFO BLDG ELE PLUMB MECH Ira le CC'11 O D Y00 LICENSED CONTRACTOR'S DECLARATION �W-- U 1 hctehy arf,m that I em liwnac cr provision&of CWPmr 9(commencing Job Descri LIOD with Seccion7 fDivixi n3of thea sand ProrcssinnxC Je,end mylicensc is gOoO z'qi u«�1acl:a, .z Lie G7�0^cF.3 REPLACE BATH FIXTURE & TILE AUG 1 4 L J r m to ARCHI LAR OI BUILDING 1 ®Igtl Np�G D�u IunticrtunJ my plans shellWu&cJ as public¢cords H Licensed Professional 3 OWNER-BUILDER DECLARATION 1 hmoby affirm the,I em exempt from the Conusemfs License Law for the 0D following reame.(Section 7031.5,Business and Professions Corte:Any city m county I22 which requires s permit to ctmssmct,dmq improve,demnlish,in,repair any auctom ;- Poonnits issuance,ehu requimuhe applies for such permiuo file esigned,mument py¢< than he is licensed pursuant to the provisions of the Contractor's Ucenmlaw(Chapter 9 Sq. Ft. Floor Area Valuation yl-m (commencing with Section 7")of Division 3 of the Business and Professions Code)or i $ that he it exempt therefrom and the basis for the alleged exemption,Any violation of 32344027 . 00 Section 7031,5 by any applicant for a permit subjects the applicant to A civil Penalty of APN Number Occupancy Type not more then Bve hundred dollen(5500). I,as owner of the pmpeny,or my employees with wages As their Role compensation, (�7�T will do the work,and Nenrlu u[ m is not intended w offered for sale(Sec.7W,Business D y71Cd Inspections and Prefeulo^a Code:The Contractor's License Law does not apply to an owner of 102 — PIERS p propenywho builds or improves thereon,and who does such work himaelf or through his own employees,provided that such improvements are not intended or offered for sale.If. 1O3 - UFER however,the building or improvement is sold within one year of completion.the owner. , builder will have the burden of proving that he did not Wild or improve fat purpose of 104 - REBAR rale')' 105 - ANCHOR BOLTS ❑h as owner of the prolcny,am exclusively contracting with licensed convenors to construct the proper(See.7B4a.Business and Poefcoubma Carle:)The Contractor'&Li. 106 - SEWER & WATER come law docs not pply to an owner of property who Wilds or improves themon,and 202 - UNDERFLOOR PLUMBING who contracts fat such pmjece,with a conmanm(s)licensed pursuant to the Contractor'. Licenmtaw. 203 - UNDERFLOOR MECHANICAL ❑ 1 am exempt under Sec. B&P C fonhis..on 204 - UNDERFLOOR FRAME Owner WORKER'S COMPENSATIONDECLARATION205 - UNDERFLOOR INSULATION I hereby AfEnn under penalty or perjury o^e of the following declarations: 301 — ROUGH PLUMBING have And will maintain a Certificate of Consent to¢elf-insum for W^rkcri Compere 302 - TUB & OR SHOWER as pn,lded for by Section 37W of the Lebo,Code,for the performance of the 303 - ROUGH MECHANICAL for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,As required by Section 304 - ROUGH ELECTRICAL 27M of Ne lwWr Code,for the perfo ee or work for which this Noroi is issued. 305 — FRAME M(y�w/(],keraenm�naeli�nJnm&'sgg [,ni///e�� PaheynemhemA.J �7 306 - HOLDOWNS V _�•.uit.s!/s-G / Wry No.: 0/70-" 0 05 CERTIFICATEOF FJ( ONFAOMWORKERS' 307 - INSULATION COMPENSATION INSURANCE 306 - SHEETROCK (Ibis ectitm nm eed^ be,completed if the permit is fm one hundred dollars IS 100) 309 - EXTERIOR LATH ( less) 310 - INTERIOR LATH employ that in the performance of ted work for which chis the W is issued,I etull nm Law.of in any manner an as to become abject in the Woheri Compensation 311 SCRATCH COAT Laws of Cdifornia.Date Applicant 313 - ROOF NAIL NOTICE TO APPLICANT:IL after making this 0mifce1,of Exemption,you should 501 - FINAL ELECTRICAL ENERGY become subject to the Worker's Compensation provisions of the labor Code,you must .J Z, forthwith comply with such provisions or this permit anal l he deemed revoked. SO2 - FINAL PLUMBING ENERGY ?( CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY 'Fr IhembyAffirmthattherei&econatmim.lendingagencylnnhepctfotmenceof 504 - FINAL BUILDING ENERGY LYi ti the work for which this permit is issued(See.3097,ON,C.) W z Lendcr'AName 505 - FINAL ELECTRICAL U0Lnder1cnifyAddress 506 - GAS TEST UO Ieereetocmplywmot I have udthcityandcounAndtyodtaucesandthat the surelawsotionon to 507 - FINAL PLUMBING U bonding I agree Io comply with all city end cepres ordimnces end sou bras reining to pU building construction,and hereby euthome representatives thiscitymcnterupon the MEC CAL r 4 ah^ve-mentioned property for inspection purposes. Wo)agree m rave,indemnify and keep harmless the City of CuNnino against %FIN FIh Juddlitles.judgmcne,,core,and cxperves which may in any way crom.g.iut said City NG /sUZ in consequence of the granting of this permit. xRE ULD DS ANO WILL COMPLY WITH ALL NON-POINT Issued by: C WORKS Dat (J SODUR![�-/p REGULATE ?4;F Re-roofs Sigeatorc of APPIinHAZARDOUS MATERIALS DISCLOSURE Oam Type of Roof WIII the applicant or future building occupant Store or handle hanardous material as defined by the Cupeninn Municipal,Code,Chapter 9.12.end the Health and Safety eWe,Sams.2553X.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will the applicenw,fit Wilding occupant usccyuipmem m Jcvices which If a roof is installed without first obtaining an inspection,I agree to remove I ho,ardnm air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. int ❑Ye¢ 1 have mad the prombn s materials requirements under Chapter 6.95of the C&bfim- ealth&SafetyCode,Secdmu 25505.25533 and 25534.1 understand thatif hu Wilding oat[urtcnrly has nk Net it u my msomihility m nndfy dm rc[u tof Nc amswhic mel poororissuancc.faeenidcetoof upon Signature of Applicant Date e,M uihodsd agent Dale All roof coverings to be Class "B" or better r7 CITY OF CUPERTINO (3 CITY OF PERMIT APPLICATION FORM CUPEIITINO PN # ;✓ J44 --- CO=ate: Date: 7/17/0 3 Buildin02g A.ddress: ailing Address (if different from building address): O-S' /� ��Z �.�acc • Owner's Na? /] Phone#: / �7� 9� Contractor//w�/ oa�i.� : License#: Con one: ��70'p Cupertino Business License#: moi, Fax: 37 0 6 3 Building Ee it Info: B d Elect ❑ ]um Mech ❑ J option: Residential o'er �a ¢.N Commercial ( - Sq.Ft. Floor ea: 3 X > i $/Sq.Ft.: - Cost of Project: 9" 7, gb Occupancy Group: � Type of Construct' Please check this box if the project is a second-story addition: ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1 M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu 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 <= 1600A ELECTRICAL BELEC1001 Elec 600V > 1000A 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 4- 1 of3 �• ��a . �� r -44 air CITY OF CUPERTINO C�TY0 PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. HousingMit Fee BUILDING BMNEWMULTI New Multi-FamilyRes MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI MultifamilyRes ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pipe PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 clip MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL 2 of 3 C - CITY OF CUPERTINO 00 CIR OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERIVIFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 1 3 of 3