03060052 (4) CITY OF CUPERTINO �^'" `n'`«s"'a�a "' '"t' .�`" �` -'n.�-a• "•"tea` . '.
BUILDI NG DIVISION PERMIT CONTRACTOR IN 'UTtMATT , • .
BUILDING ADDRESS: PERMIT NO.
THE BATH ROOM INC 03060052
AM PERMITL'SUEDATE
1910 W EL CAMINO REAL 06/06/2003
6ii r'DwARID 14 Am; ;49Y—S— SANITARY NO. CONTROL NO.
(650) 968-7666
ARCH11LCf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMBMECH
roti
LICENSED CONTRACTORS DECLARATION Job Description
m I hmrchy affirm that 1 am Rnn, nder provisions of Chopter 9(commencing aa
�< with Seci )of Division3of�..ad Partial..Cntic,and my license is F'� 4� LED
is full fo dcffe / ./ Z� �R�,i�
-'� Liccn�Llc.k 1!T BATHRM REMODEL
Dab �CConuaxxryry �— II1a' C
ARCHfIECISDBCl.SRATION JULY 2 5 2003
4u 1 un and my plans shall W used as,mNi.rtcmtls
yU
k n
Licensed Pat onsl
aC OWNER-BUILDER DECLARATION BUILDING -
'<Y 1 hereby affirm that I am exempt from for,Comnctofs License Law for the
0o following mnnn.(Second 703 1.5,Business end Professiam Code:Any city ar county
which requires a Permit to construct,alter,improve,demolish,in repair any structure
-Z!^^ Prior 10 its issuance,also rtqu;ra the applicant for such froah to rile a signed sucomad
ec that he is licensed pursuant to the pmvidhof the Comracmr's License Law(Chapter 9 Sq.Ft.Floor Area 5Xy3llatlOn
n
Yst S (commencing with Scrimp 70D0)m(Division 3 of the Business and PmBssinm Core)or UV V UU
3 th.fhe Is exempt therefrom and the basis(or the alleged Caemption.Any violation of
Section 7031.5 by any applicant for a pemth subjects to applicant to a civil penalty of 3„aD,7vr,N�+.o6e6 0 Occupancy Type
not more than five handled dollars(SS00). LL''Cf�4!�Y18 LL''��'"'
❑Esc hewer work. cod pmpeny,a my omntendedwith wgu u ale(Sec.compenntion,
and dothensandtheawemmmitte hennaed or ave dataed a.,apply 1.an Business 101 - FOUNDARi pffed Inspections
and rixy wh Professions Code:The Coms¢ton,Licenseand
who Law data not apply to an owner Of
pmpenywhoss,provided that
improvements
doe amputated waisted fmughhis 102 — PIERS
save however,thees,ping or i Netaurman is vementsartnet ear ofidoroaercd for ale.IL 103 - UFER
however,the building or improvement Ire sold within one year of completion,the hwner-
buildm will have the burtlen of proving that M did not build or improve for purpose of 104 — REBAR
aalm.l.
Di.ave owner of the property,am exclusively contracting with licensed contractors to 105 - ANCHOR BOLTS
convect the pmjem(Sec.7044.Business and Pmfusons Code:)The Clinmeteri Li. 106 - SEWER & WATER
cone law does not pply to in owner of property who builds or impmvrs thereon.and, '2OZ - UNDERFLOOR PLUMBING
who comuaots for such projects with a eomncmr(s)licensed pursuant to the Contractor's
Lmanrtlaw, 2.03 - UNDERFLOOR MECHANICAL
0 1 and exempt under See. .B k P C fw this rteson
204 - UNDERFLOOR FRAME
Owner WORKER'S COMPENSATIONDECRAD
LATION 205 - UNDERFLOOR INSULATION
I hemby arms under penalty ofperjury ore of thC fallowing decl.ndmta: 301 - ROUGH PLUMBING
Ihswand will maintain.Cenifin¢of ConenuoselN....fmwmkcr's Compere- 302 TUB & OR SHOWER
7rT"00
tian,u provided for by Section 3700 of the labor Code.for the p promance of the 303 - ROUGH MECHANICAL
ork for which this permit is issued.
I have and will maintain Worker's Compareadon hound,as Bertrand by Seaton 3 04 - ROUGH ELECTRICAL
of dm labor Code,for the performance of the work for which this permit is issued. 305 FRAME
ywmrkctsCompensationmatineeorisaneP ' numbertie: 3O6 — HOEDOWNS
.mer. -�. 1rC- Polity No.: "bt7' b
/�ERTIFICATEOFEXEMPr1ONF7iOh WORKERS' 307 INSULATION
/y COMPENSATION INSURANCE 308 - SHEETROCK
(This seel;on need not ho completed if the lsrmiUs for one hundred dollars is 100) 309 - EXTERIOR LATH
or lac)
I cortify that in the performance of the work for which this permit is issued,I shall not 310 - INTERIOR LATH
employ any person in any manner in as to become subject to the Workeri Comicuation 311 - SCRATCH COAT
Laws of California.DateAppl313 - ROOF NAIL
NOTICEafter
Ncame subject
APP fee WOI:IL COMproesamn provisions
of
Lahor code,You
501 - FINAL ELECTRICAL ENERGY
become auhject m it Workers Compcan;is pmvir shal of de hoer CMe,'ynu mut
�`� fonhwithcamply with each prnvisinnsm Nis permit shall Ec domed rtmkcd. SOZ - FINAL PLUMBING ENERGY
Z0 ' CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
4r 14 1himby.17Erm Nat then iso connmcdnn Lending agemy fon he perfurmana of
the work for which this permit is Word(See.3W7,Ch.C.) 504 _ FINAL BUILDING ENERGY
Ir�p Undoes Name 505 - FINAL ELECTRICAL
az Lcader.Addes 506 - GAS TEST
U O 1 comfy that I have read this application and stab Not the above harion mann is 5 0 7 - FINAL PLUMBING t
LL. correct.1 agree to comply with all city and county ordinances and snit laws misting to
0507
vy, building construction,and hereby authorize rtpresenulisrs of this city to cnmrupnn the %FINAAMECHAN CAL
shove- entioned property(or i.,do. urpses(Wc)agree to caw,indemnify and keep harmless the City of Cupertino againstINW lubllitiu,judgments,costs and esp..which may in any way anmc against said City G
U� in ehmequence of thIN
granting of this permit.RSTANDS AND WILL COMPLY WITH L NON-POINT Issued byWORKS Date
SOU REGULA .
Re-roofs
gna rc AppIm.HAORDOUSMATERIAISDISCLOSUR ale Type of Roof
Will the applicant at future building occupant store or handle hanam m,muerial
as defined by the Corcoran Municipal Code,Chaptar 9.11,and the Health and Safety
Code.Section 29531(07 All roofs shall be inspected prior to an roofing material beim Installed.
❑Yes _VNa P P Y g g
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
cmll harardaus air eontaminants as dc0ncd by the Bay Arta Air Quality Management all new materials for inspection.
charier?
❑Yes 3%No
I hew read Ne hauNnusmetariaH rtyuimments under Chapar6.95 of db Califor-
nia He.lth&Safety Ca ,Seedom 25505,25533 ave]5534.1 undersand Ihatifthc Wilding
dace not currently haw a tenant.that it h my msponsmilily m notify the Occupant of o m
rcyuimtswhic unbcmetp'orluissuance ohCcrdf¢ ran ver Signature of Applicant Date
ver a adxe eel Da e All roof coverings to be Class"B"or better
3 92 - Job Site:
Ed Okubo
3 E 10440 Stokes Ave
Cupertino,CA 95014
B g 408.446.0743
,,far
3LI
a
$'
APPROVE ) F�
^^' ORDANrE t"rM THE C!rY On �J
�'_ JR)IP AMES
Work performed by:
CUPEA�tNO (Y. " A J The Beth Room,Ina D
1glow.EI Camirro #JUN 0 6 2003
-)ATE �— -— = Aft.view,CA 94040
MGM- - — _ 650.9W7666 U
This set of plans yleltifit ati ns MUSZ _ License 604922
1f;f.pt on the r at all tim >a td itBy
4� sr a^✓
S;:,I b make any iisanges Dili. 2bratierla 1 T I 1
�� r
96
[rig without without written pe mw
.sion fMM LI nuT \
NMI line Dept, ( tY of Cl pe tlno.
Est Eaping of this Plan ant sl ecdiatlmra
z 8 r "OT be held to perlr t [to be an
s.§, at of the viol tion of 3n! provi
sion scope of work:
,. —
$�,..• ;w,r ^r?ITan te of St to w. 1.Replace tub and walls
a 2.Replace tubtshower valve
3.Reid tiller
a 4.Install GFG
5.Install Exhaust fen
OFFEE Copy
? Notes:
a 1.Tub/shower valve is
92 pressure balanced
pg gg 2.Toilet is 1.6 GPF
90
80' i
1
(,�v�'- (WY OF CUPERTINO
CUP TYOF NO PERMIT APPLICATION FORM
N#
Building Address:
I0ggD 5ia��S AYE
Owner's Name: Phone#:
Contractor: License#:
}1E gA1}1 '20ov�1 c.
Contact:-r Cupertino Business License#:
100 P-1�. 1 9-7 DIO
Building Permit In o:
Bldg .Er Elect Plumb 9 Mech �(
Job Description:
Residential 4 l}1 l6 \00£L Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: Occupancy Grou -
A 51000.
Type of Construction:
Np.00r^ Y�- rnoo
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> IOOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILERS Boiler> 1.75MBtu 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 <= IOOOA ELECTRICAL
BELEC1001 El cc 600V> IOOOA ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BR,VESTIGA Investigation fee— BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
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afiov�
ATY OF CUPERTINO
CUPERTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI Multifamily Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res PLUMBING
BNUSFD New Single Family Res BUILDING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE PbIg 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 rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIltHAN A/C Units<= 10,000 c8rm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMED{T Lighting Fixtures ELECTRICAL
BREMFURN Relocation ofFumace 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
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• CITY OF CUPERTIA
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BREMPOWER Power Device/Apparatus ELECTRICAL
13REMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Signs 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 Electfical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
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