01010077 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDIESS: PERMIT NU.
20154 NORTHWIND SO THE BATH ROOM INC 01010077
OWNER S NAME: APPLICATION SUB DATH
LLOYD ELIZABETH E 1910 W EL CAMINO REAL 01/19/2001
]ONE: SANITARY NO. CON NO,
(650) 968-7666
an
paz ARCHITECT11INGINHER: BUILDING PERMIT INFO
O CO HLM: ELECT' PLUM({ MliCll
�6Pan
=1 J
m i LIQ3NSIiD COM'RACI'OR'S DECLARATION cen Job Descrip 'on
7`= 1 hereby aRrm that 1 xm licensed under Pmviziunz of Chapter 9(m, sing
SIC one.7000).f Dlvision3ofthe lhnirav,ml fcs.inm Code.mm my license
�xs infmluaeeamlef f C��}ao2 BATH REMODEL
as [.I've Ca 1dr.p �
,�3 )utc Cuntmam •��u
ARCHITECT'S DECLARATION
C LLLLy I understand my plans shall be used as public meords
W 6 p O I;n'uncrd Prnrenrivaal
a OWNER-BUILDER OECIARA'1'[ON O
e �—'n I hereby affion that 1 am excmin farm the Contractor's Licence U.for the
t:L¢ following mann,.(Section 7031.5,Rosincs%and Prolev,ioto Code:Any city Lir county
5 x❑ which requites a proton a,comma,a ller,in,prnvc.Acnu,lish,Lir repair unY....a.
1a6d 3� prion t '' 'I t y lh I pl t t I I 't t la ''g d,t l acro
bar he is lircawdp t thepct).........A the Confetti Ir (Chapter 9 Sq. Fl:Floor Area _ Val rn
(commencing with Section 7000) f D J f th B es J I f :' Code) I
or that hesempt therein n and the bass Inr the alleged exemption.Any violation >�z V3000
of Section 7031.5 by any applicant for a penult subjects die applicant It,a civil peorhy -
ofnot more than live mtodealdollars(5500), APN Number 0cctTp¢w 7Ype
01.a:owmer eflhe pml,eny,.r my Candoyeed with waged as their-le eompemtaim. 31638050. 00
will Jn the work,and the%acture is not intended Lir offered for sale(Sec.7144,
Bootie.,and nofev,ion.codo'na,Commaorx License Low does not apply to an Required Inspections
Lirr of propclty whir M1tild%or improecx thereon.ani who does duelt work mm.olf FOUNDATION
ihmugh his own amploycespmrided that such hopmscmmns arc Lia intended ur
offcml for sale.If,ho neve,the building or improvement is sold within one year of —
rnnpletion,the revoccholder will have the burden of moving that he did not build or •102 PIERS
mpnoc orpurpoicor.ale). 103 — UFER
❑I.adownerorthe Cartoon,ran of,ift,velycommaingwith rnm.wdrroo,wa,to 104 — REBAR
construct the project(Seo.7BI Business.and Professions CII The Contractor's
Linen.eLawJrcsnotamlyoranowneroformenywhobuilJsorimprove,thereon. 105 — ANCHOR BOLTS
toldCaf who cataract, for such Far,with u eonmrctons) licvmcd pursuant m the
c„nva,etor,d ldaa,^e l-aw+ 106 — SEWER $ WATER '
❑I am emmpt code,See .It N 11 for thi%mroon
202 — UNDERFLOOR PLUMBING
owner Date
WORKER'S COMPENSAr[ON DECLARA1[ON 203 — UNDERFLOOR MECHANICAL
I hereby afim m,der pmmltyo]),crjurr are or he roll—ing decmmrcoo.: 204 — UNDERFLOOR FRAME
I 1 hrvc aced will �,aiCrain a Certificate m
of Consent to.elr. .am for worker. 205 — UNDERFLOOR INSULATION
ontp°oceait
ns. a. pro. lea for by .union 37x1 or he L.nnor Code ror m.' 3@1 — ROUGH PLUMBING
w1lo :nate I the wodk Iba which mix , nit L.n urs.
❑I have and will maintain worker,CmnpenUdnn Insurance as requited by Section 302 — TUB & OR SHOWER
37IX1 of the Uttar Code,for the performance of the work for which this permit id 30� — ROUGH MECHANICAL
i..no 1.M workers Compen.a .,ananee card d rro,Ee nrr:n, �,
CRi PoIicy No.:�J✓� 304 — ROUGH ELECTRICAL
ERI( ICAIION OF EXEMPTION FRONI WORKERS' 305 — FRAME
COMPENSATION INSURANCE _ v
fIhis v,11 I need not la,contrleted ism:pd ..I i.ror one combed dollar.', 306 — HOLDOWNS
(SlaBorle".) 307 — INSULATION
I cenify hat in he parfommnce of he work foe which this pemm is issued.1 308 — SHEET ROCK
dealt m,(nnploy any person in any net to,so a u,biome.object m the workers'
Cmnpnrsatioa,laws of Cdi'"r"i'iDi1a
Applicant 309 — EXTERIOR LATH
NoneF:TO APPLICANT H.atter making flus caddicare or Edrmptmm you xoom° 310 — INTERIOR LATH
Z beeline.abjmI to the workers Coml,ensabon pro . ofthe La]mr Celle.you most
O O ]om,with d.nyy aim Inch ma i,ioa,.or mix perni,sLid hall bedcemed mooned. 311 — SCRATCH COAT
F n
CONS'IRUCI'[ONLENDING AGENCY 313 — ROOF NAIL
> I hereby alrmat m
them i,.v.mucron]coding agetay fur the performance
orthe work In,which his permit i.haocd(See.3197.Ci,C.) 501 — FINAL ELECTRICAL ENERGY
aq L,.derdNnc
Z to let, mAdobes. 502 —' FINAL PLUMBING ENERGY
.7.
UO
1 certify that I haes,mad this application and%Ctue that the above information is 503 — L MECH ICRL ENERGY
fz F.
correct.1 a,me to comply with all city and county ordinances and state laws refining
O v t„bud,rmgeo..tmetion,iloarcnyaudmrimovoexcnmaoe.,Ifde,city,,ente'."a 5 — FIN L BU I ING ENERGY
W me ahn"t .eadoned,excny bn a„q,eetion,ampn.ed.
y GVe)agme I, ace.indemnify and keep hannless the Cipro]Camara,againm 05 — FI L E TRICAL
F m Iiab lines.' eons and e.pa,.e,whim pray in any way term,against sato p
U Z eitr in nx'gaenee n me grandn• f mid pear. 506 — T '/
z I'I'I CANTON iR5'I' ) (LLC MI'LY WITIYAIOa'�1 ISstledb atCSit Y• INID”Si...I ppecarmConfact Dte Re-roofs 50 — FI AL MECHANICAL
IIA]ARD S NIAI'E
wan mo appbeam o,f am h,dldi.g oeemool Iran.or handle hoar.loux anacdal Type of Roof 9 — FINAL G RADE
CndernwbydmCnpenimnMmdei]lalco.a.Chapter 9,12.amldmBrlin,andSarny 10 — FINAL PLANNING
ala Section 355321,1:'
❑Ye. ❑No All roofs shall a iy5 jl4tedp�MILy F�J@IgjlVt%JPJFl;l installed.
Will theappiano..rrnmmhandling oeroo I, ve,idpn,,nordcvi,exwhich If a roof is in. alled without first obtaining an inspection, I agree to remove
snail ouardu.s it aea:nnimml,as Jelined by the Bay Arc.Air Quality Mtnogcmmnt
Ahola^ all new materials for inspection. Applicant understands and will comply with
°Ya' [],No all non-point source regulations.
rate read he hamMnus nlnarials mcuiren,e.0 antler Chapter 6095 of lire ,
Cul' ,ran lleaBn& 'afely Code,Sections15505,25533 and 25.934,l unft,dland flea
if I,building does not emmilly In , cnantthdt it is my
bill
ty to notify the
I of the uifcen I,. -m ton rebi }f Cent araf
e"pa" ' • f Signature of Applicant Date
uantoriAdagcnt Dalc All roof coverings to be Class "B"or better
OFFICE