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04070093 (2) CITY OF CUPERTINO �'-rt"' BUILDING DIVISION PER �`�+� .pa�L'�`-'A3u i.a BUILDING ADDRESS:, PERMIT NO04070093 ' 10295 SCENIC BLVD OWNER'S NAME: PERMR ISSUE DATE PAPO MICHAEL A AND DOROTHY E: SANITARY N0. CONTROL NO.JW . ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 u00 LICENSED CONTRACTOR'S DECLARATION Job Description t�❑ I hcrcby affirm Nu 1 am licensed it p visions of Chapxr 9(Commencing t� with Sem 7 uf0iviMcm3of Bm Buri s Pmfeasiurts Code.anJ my license is wo mmnmreea from. p Lth g f5 �S�Gfp SHOWER STALL UPGRADE Zp DarcnscC yyL�Conuulor a �p7�Jf+lly• Ak nECTB DEL - — undersmn p�, n ,eA 7/16/04 LEGEND CONSTRUCTION PD BL 1y'�r Licensed Pnsfcssinnel Oat 1 4.aUILDER DECLARATION 0 0 1 rmiao affirm that 11. cx,mpl from the Cantmctm'e e:A n C Law for the / L p O following reason.(Section 1 IIco q Business and ve a moll Cad,:Any tiny or county / x which myuixs a permit ne arms the alter imprave,demolish,nr repair any avumum y'r^ that hepoor its issuance, sed puralso ntto the previsiappons o for such Compactors Reesrile ae ned awtemeto 9 �=< (co heincing with Section"")of Division of theContractorsBuacmr'anittnxlsw(ChaptersCode)or Sq. Ft.F]oor Area Val 10❑ zF$ '(commencing with Section7")of Division3 of the Business and PrafMyvii Cnde)or 1500 that he u exempt therefrom and the basin for the alleged exemption.My violation of Section 7031.5 by any applicant for a perntitsubjects the Applicant o a civil penally of APN Number - Occupancy Type not mare Nan Bve hundred delta.(S500). v. a❑I,as owner of Ne property,or my employees with wages as their sole compensation, will do the work,and the suamum is not intended or offered for sale(Sec.7U44,Busineu and Professions Code:The Convenor's Licen a Law docs not apply to an owner or Required Inspections property who builds or impracts thereon,and who does such work himself or through his own employes,provided than such improvements are not intended oraffered formle.If. ' however,Ne building or improvement is sold within one year of completion,the owner. builder will have the burden of proving But he did not build or improve for purpose of sale.). ❑1.as owner of the properly.am exclusively contracting with licensed convectors to convect the project(See.70".Business and Professions Code:)The Contractor's LI- cense law does not apply to an owner of property who builds or improves themon,And, the convects for such projects with a Contractors)licensed pursuant m the Contractor's ex Law. /a+ p,mrs S.C. .B&P C far this reason Owner ! Date ORKER'S COMPENSATION DECLARATION I hereby aRrm under penalty or perjury one of the fallowing declarations: I have and will maintain a Cerdllcate of Consent to self-intim for Workers Camper- sation,as provided for by Section 37W of the Labor Code,for the performance of she work for which this permit is imu ed. ❑I have and will maintain Worker's CDmpensalion Insurance,as required by Section 3700 of the labor Cade,far the performance of the work far which this permit is issued. My Workers Compensation Insurance carrier and Policy number am: Carriee Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not he complemd Irma permit 13 omorm hundred dollars($1001 or less.) I certify than in the performance or the work for which this permit is issued,I shall nut employ any person inany man cr sn bc< nc subjectmthe Workers'Cmairmoa6on Laws of Califd .D c Applinm H IC TO APPLICA :If,after making this ani foam of Exemption,you should objets to the Workers Compensation provisions of she LAW,Cndc,you must ,JO fo th comply with such provisions or this permit shall be deemed mvoked. z,~�. CONSTRUCTION LENDING AGENCY r . F l hereby affirm des them is a Constantino lending agency for the performance of ai> Ne work far which Nis permit is iuucd(Sec.3097,Ci,C.) W Q Lenders Name z Lender's Address U 1 canary that I have read this application and sum that the above information is VT (✓ correct-1 agree to comply with all city and county ordinances and store laws relating to O V building convection,and hereby auWmim representatives of this city to enter upon me ,r fA ahova-mentioned properly for inspection purposes. gy (We)agree to save,indemnify and keep harmless the City of Cupertino against u) liabilities,judgments,costs and expenses which may in any way aces,against mid City t L)Z in consequence of the groaning afthis Permit ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: - Dat 50ATI S. /� 71 % 10 7111Z/0 11 Re-roofs i woe of ApplicanVCanlm or D te s HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material As defined by the Cupenum Murici a1 Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes No Will the applicant or future building occupant tax equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants az it fined by the Bay Arca Air Quality Management all new materials for inspection. District Yes I have mad the hmardousmaterials requirements under Chapter 6.95 of the Califor- nia Health A,Sec yCade,Secdons 25M5,25533 and25534.l understand tha f the building does not currently have a tenant that it is my responsibility to ratify the occupant of the rcyuimmc mut metp miaanane,ora ,NficamorOc,aancy. Signature of Applicant Date Dwn,`nm axed' aF�nt ✓' - 771& a V All roof coverings to be Class"B"or better �ITY OF CUPERTINO* CUPEIZr PERMIT APPLICATION FORM qWPN# ©g Date: 7 / Building Addres `D 2n�s�� G �j✓� Mailing Address (if different from building address): Owner's Namo f 7 Phone#: d oro 1�a a 3/7 y�` 8 O Contractor:. License#: 60 5-^7 D8 Contact: / Ph e. 99 - y979 Cupertino Business License#: /Po F Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job DescripEior} s kow"- Si-� l ( r� f Residential V 1� Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: / Please check this boxct is a second-storyaddition: ❑ ole ro'ect Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M BtuMECHANICAL 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<= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BMVESTIGA Investigation fee BUILDING 1 of WITY OF CUPERTINO* CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g 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 Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREAkRUI4N A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l 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 BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 4kITY OF CUPERTIN(* CUPE�TiNo PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMS.IGNAD 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 Insection 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 MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mecb Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbin Fees foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 fI� 5142 AAJre55 Bw ,, M Lkv, +;V O j CA MGLStCfk &A.roow. St,ower G4%dl Scope of work; Re.w.ove SAawee- Sfm// � /^G�rr cln� tM-4 v- Wo. ,&5C are4SJRePIACR drywaJI W'44^^" Shower iu.w 714t-ej/aff S�ov,*Cr• Q,,.,a1,0% ..e e_, APPR ED RJAG V;DANC I TM CM _.QAGdc , o �4ows. SI 'der f . _ ,LUPE DATE SIGNEDs spaoi{�atwns d MUST be 1� set Is un l lawfu This at all ttimes end c ,- on th changes or alterations on same 1 c make any _-;t written PM nnission from the Building • .,:;, L ity of Cu It an rtino.�d s�ltications R� am„ng of this P rmft or to be an 1 " r ti stE2 B ec1 f ' . F.GT be Hold to Po of f violation of any Provisions ince of State Law. i I i ON O� O PART ENT ae to��tdG DF I a; i i I 3G.x 36 3�'1nWGf (,,nc la Svr� SARATOGn PLUG 14009969101 P- 1 FLORESTONE MODEL 2PG36-3W • FIBERGLASS SHOWER 36"x 35'x 73" Weight 101 lbs. Architect's Specifications Furnish and install two piece shower unit iMOdd 2PG36-3V7 as mannfacturcd by Florestune Products _'--- Company. Unit to be manulucrured of gel-coated a fiherglass meeting Class C Flamc Retardants and to be mpplied will,siip-tesistant[lour laminated far cstra rigiciiry.Color will he white (unless Otherwise specified).Unit to he supplied with r�t �mM 1' 2 rNC non-o�R drain. �.IU`•I 11 it i r1 t1 �v S''undard'Chlor. 'hire. 36— Optional Colors IW Colors matching most major manu&cturers'colors lG�p ) are available. Ifizza RtCEIVEL) 15 JUL 16 2184 Standards ITV Of CUPERT;1Z IA.Pli.O Listed File 0687 Rill r)J oFpaar T ANSI-Z-124.2 y,�.1• � Qct,(ry Sdmnrr.xn�Hrsrb Pr..am Rina 1947. Z851 Falcon 1)e Madera,GA 93637-92V Dimensions map vary s '�1 inch. 11:559-661-4171 Fax 559-061-2 07u Please cheek unit before installation, w w w . f 1 o r e s t u a e , c o m 777717777 77777W CITYBUILDING DIVISION NO PERMIT ( Witii.C�RAGTQR�NT+O t1V,�,ATIQN BUILDING ADDRESS:' PERMIT NO04070093 102 OWNER'S NAME: PERMIT ISSUE DATE . PAPO MICHAEL A AND DOROTHY VE: SEP Zt 2004 SANITARY N0. CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH DINIa y O pLICENSED CONTRACTOR'S DECLARATION 1 hereby Art,.Oat I am licensed under p viurns of Chapter 9(commencing Job Description with Sat Division3offec Buu Professions Code.and my license is v, mmumme react A65704' SHOWER STALL UPGRADE jZ_ License 1 Lie.d � Dale Commit., ��p A TECTS DEC�4�N — undc. ,nae be d ypyb 7/16/04 LEGEND CONSTRUCTION PD BL �gu / %1 3 m G< Licensed Professional s h0J OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from On Contractors License Law for the 00 following reason.(Section 7131.5,Business and Professions Cade:Any city or county 2 f. which requires a permit to conswcl,ether,improve,demolish,or repair any structure prior to its issuance,else requires the applicant forsuch Pamir to file a signed statement i�G that he is licensed pursuant to the previsions of the Contractors License Low(Chapter 9 Sq.Ft.Floor Area Valuation ar $ (commmscing with Section 7000)of Division 3 of the Business and Professions Code)ser thtl he it exempt d mefrom and Ne him for the alleged mempuon.Any violation of $1500 Section 7831,5 by any applicant for a permit subjects me applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5580). r. ❑L ss owner of me proper,or my employees with wagesas t1mrmle compensstlon, will do the work.and the structure isrunmu soled oroReud forsale(Sec.7044,Buuness 25702006 . 00 and Professiem Corp.The Contractor's License Low does not apply in an Owner of Required Inspections property he boolds orimprows;therms,and who doessuch work Mmolforthrough his Own employees,provided that such improvements arc not intended reoffered formic.if, however,the building or improvement is sold within one year of completion,me Owmr- builder will hive me burden of proving that he did not build or improve for puryose of role.). ❑1,as Owner of the property,am exclusively contracting with licensed eonuacton to conswct me pmjeci(Sec.7044,Business and Professions Code:)The Contractor's Li. ccnu Law dose not apply m an Owner of property who builds or improves thereon,and �kho tomato for such projects with a contractor(s)licensed pursuant o the Contractors C cu Law. H l em/es5@�µ�andeygee. .B&P C for this rcmon Owner ! Dau 'WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury am of the fallowing declarations: 1 have and will maintain aCenificam of Continuo self-innm for Wm1mesCompen- moon,m provided for by Section 37011 of the Labor Code,for me performance of the work for which this permit is issued. 0 I have and will maintain Workers Compensation Insurance,as required by Section 3700 of me Labor Cade.for me perfmmantt Of du work for which this pormitls issued. My Worker's Compensation Insurance carrier and Policy number Are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Otis ucOm rued mtbecomplemd]film permit isforow hundred dollars($100) or less.) 1 Comfy that in me performance of the woik for which thia permit is issued.l shall net employ any person in any man ezm obec cu/b'j�eccl in the WWriters*Comparedon Laws o(Calif 'des�C Applicant �.� f NQ�T7'IC��TO APPLICANT.If,after making this enificam of Exemption,you should br}pma/wM1ject m the Wohm'a Compcnmion provisions Of to Isom Code,you Most - Q`� fo tit comply with such provisions or this permit shall be deemed revoked. „Z,rO CONSTRUCTION LENDING AGENCY [r► (hereby air.Out mere iso construction lending agency for me perfermanaof ai > the work for which this Permit is issued(gee.3037,Civ.C.) A Lender's Name = z Under's Address U Q 1 cutify mat I have read Nis application end sou for On about information is H.L~ correct 1 agree to comply with all city and county ordinances and sum laws relating to QO building construction,and hereby authodm representatives of this city to enter upon the Shove-mentioned pto for inspection purposes. save (We)Agree to save,indemnify and keep harmless On wyacofc Maininoagainst U T/1 incoiseq judgments,costs gratsmdof this Permit. MAY in any way accrue ageinatmid City V Z Aconsequence of UNDERSTANDS this per mit. �+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: fDat (; so 72x 07�f�w, / .71L1�� Re-roofs mrc ofApplic HAZARDOUS MATERIALS DISCLOSURE —D��`� Type of Roof Will the applicant or future building occupant sort orhandlc hamrdous material as defined by the Cupertino Munici I Code,Chapter 9.12,and the Health and Safety Code.Schon 15532(a)7 ❑yeaAll roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building Occupant use equipment or dcvims which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminant u d fined by the Bay Arca Air Quality Management all new materials for inspection. District, ❑yes I have read the hazardousmateroals requirements under Chepter6.95 of me Califon. ria Helm A Safely Cedc.Sections 25505,25533 and 25534.1 undcrsund funif the building ,�� does not currently haw a Want,Oat It h my responsibility u Amity the w:cupam of me requiremc metp' rissuancc ole cnificate ofQct,racy. s Signature of Applicant Date 7 le, Owner authorized agent All roof coverings to be Class "B"or better Orae