02110064 (2) CITY OF CUPEWI'INO e P' " A,
BUILDING DIVISION pI 'CONTRACTORvINPOR ION*e
s, 1-ll� W111
Bre rti ' BELLA DR E G ' S VALLEY BUILDING PERMITN82110064
owr(ThoEI S JOHN A AND BARBARA H 1195 S DE ANZA BLV APPLICArTFgS Ips .2002
ONE: — SANITARY NO. CONTROL NO.
ARCHI ECI'/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MPRII
0 0 0 0
00 LICENSED CONT'RACTOR'S DECLARATION
ce F I hereby affirm that I am licensed under provisions of Chapter 9(commencing Joh Description
fit,« with Scohnn'Jxkgnf uie..,nn3nf me 13U no and Prnfesinns nwe.wd my rcenve is SHOWER REMODEL
in full ifisidjud effect,
_ I.ked"e GM C,L 1.1111t'
FyF,� Date zz—&—G.1 Come ser +^'C(
Y V mol, ARCIIIITcrs ' ARATION
Kms I d Ynd my plana shall he used as Pnblif records id/��
epa0 V
Fir"' Licensed Ped...ioal
S OWNER-BUILDER DECLARATION
<s 1 hereby alfirm mal i am exempt from the Cnmramors License Law for the $5000
i—p o following reason(Section 7031.5.Business and Prof scion Code:Any city of county
K$ which requires a permit m construct,alter,Improve,demolish,or repair any svuctum
w"^ prior in is issuance.also requires the applicant for such permit 1.file a signed Statement
p�pZ<
that he is licensed pursuant o the provisions of the Contractor's License Low(Chapter 9 A Valuation
khC (commencing with Section 7000)of Division 3 of the Business and Professions Cmle)or
a, $ mat he is exempt shcrefrum and the basis for me alleged exemption.Any violation of
Section 7031.5 by any applicant for a pamitsubjecu the applicant to a civil Penalty of 10 pNN S Occupancy Type
m re m
nmoan Five hundred dollars(SSW).
pI,as owner of the psapeny,or my employees with wages her their sole compensation, 193 UFBR
will do the work,and the structure is not intended or offered for sale(See.7004,E minces
and Profusions Code:The conuaaor's License Law revs not apply u,an owner of 104 - REBAR Required Inspections
property who bnildsnr improves thereon,and wbodu.esuch work himself.,through his 1O5 — ANCHOR BOLTS
�n employees,provided that such impmvemenu are not intended or offered for sale.IL
however,she building or improvement is sold within one year of completion.de"wner- 106 — SEWER & WATER
builder will have the burden of proving mat he did not build or improve for purpose of
sale.). 202 - UNDERFLOOR PLUMBING
0 I,as owner of me pr.,,ty,we escla ioel,contracting with licensed comracmrs to 2 03 - UNDERFLOOR MECHANICAL
Clmustan the prod.(Sec.7044.Business and Ismicssions Code:)Thc Conlsactm's Li
cense law does not apply it)an owner of progeny who Wilds or improves thereon.and 204 — UNDERFLOOR FRAME
who comrecks for such pmjeca wish a contranm(s)licensed pursuant to Me Convaewr's' 205 — UNDERFLOOR INSULATION
License Law.
El I am exempt under Sec. .B&P C for this reason 301 - ROUGH PLUMBING
owner Date 302 - TUB & OR SHOWER
WORKER'S COMPENSATION DECLARATION 303 - ROUGH MECHANICAL
l hereby affirm under penaltyof perjury one of the following declmationm 304 — ROUGH ELECTRICAL
have and will maintain a Certificate of Consent to self-insure for Worker's C.mpen- 305 — FRAME
nn,as provided for by Section 3]00 of the labor Code,for the performance of the
stock fo,which this punit isissued. 306 - HOLDOWNS
0 1 have and will maintain Worker's Compensation Insurance.as required by Section 307 - INSULATION
3700 of the labor Code,for me performance of me work for which this permit is issued.
My Worker's Com1pen'sation lnsumnce a/j trier and Policy number am: 308 — SHEETROCK
cit 621fo u""u Pofiey 309 - EXTERIOR LATH
CERT IFICATE OF EXEMPT OM WORKERS' 310 — INTERIOR LATH
COMPENSATION INSURANCE
(Thisseetinnnced not Meomplcted ifthe permit is union,hundred dmlars(SIRd 311 - SCRATCH COAT
orlc.$) 313 - ROOF NAIL
1 cenify that in the perrurnmece of the work for which this Permit is issued.I shall not 501 - FINAL ELECTRICAL ENERGY
employ any person in any rea nner so as to beC.me subject to the Workers'Compensation
Laws of California.Dino 502 - FINAL PLUMBING ENERGY
App 503 - FINAL MECHANICAL ENERGY
=ICE T'O APPLICANT:It,after making this Ccnilieate of Exemption,you shout)
become subject m the Worker',C"mpsmoomn provisions of the"No Cade.you all 504 - FINAL BUILDING ENERGY
OD fothwimeompgwith such prositinesOrthis Rmuninsmnhedecmedrevoked. 505 - FINAL ELECTRICAL
CONS them UCr10NLENDING AGENCY 506 - GAS TEST
9>" work(,it
which this
Redthemissued(See.construction agency for she performance of
Wa the wo',,Na chthis mitisissued(Sc.J09],Civ.CJ 507 - FINAL PLUMBING
W Q under',,Na 508 - FINAL MECHANICAL
G Icndcri Address
UO 1 certify mat 1 have read this application and sum that she above momwti"n is 509 - FINAL GRADE
ea p correct.I agree In comply with all city and County Ordinances and care laws relating to 5 FINAL PLANNING
O U building conm,uOKA.and hereby auNmirc repiesenatiwS of this city to enter spite the
Lu above-mcminnedproperty for insPecuonpurposes. 14 FIN PUBLIC
CL. WORKS
(We)agmen to save,indemnify and keep harmless the City of Cupertino against !� 1
F' h liahilhics,judgmcna,ensu and expm
expenses which may in any way aecc against City l/// •U�1(/////
U z in consequence of the grand ng of this permit.
APPLICANT UN DER S'rANOS AND WILL COMPLY WInI ALL NON POINT Issued by: Date
SOURC Rf:G 1. IONS.
& Re-roofs
one nl Applicamucom actor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupam.store or handle h r/ard"us material
as defined by the Cupec ono Municipal Code.Chapter 9.12,and the Health and Safety
Code.Section 2553200.1 All roofs shall be inspected prior to any roofing material being installed.
❑res
Will thcapuicamorfumre Noldingoccspantuse esImImcntor&Vice,whieh If a roof is installed without first obtaining an inspection, I agree to remove
tit ha a dous air contaminants as 10mcd by the Bay Area Air Quality Management all new materials for inspection.
ict!
❑Yes W¢ "
I have read the bwardo..mamrials requimmena under Chapter 6.95 of the C.Il"r-
nia Ilcelth&Safety Crate,Sections 23505.25533 mid 25534.1 undersand Mw if the building
dscs not currently hast a tenant,that it's my reapou lbility to noufy fixil anI of me
uiremcuOuts' u.themelenireatet,ra,:n `y. Signature of Applicant Date
�� All roof coverings to be Class"B" or better
cr nr aumuriveJ.gem Date
l �
CITY OF CUPERTIN#
� ba G
cuP TYdl o PERMIT APPLICATION FORM
N#
�fe Date: t„ // - 8-- 82
Building Address:
//�2_ T
Owner's Name: Phone#:
yrs (W 9) aSZ - /95Y '
Contractor: / License#:
Ec+f rct cii� 30 /0.6
Contact: I Phone #:
�� 4168 996 - 7_/06
Applicant/Contractor: Fax #:
Id ng Permit Info:
Bldg Elect Plumb Mech
_Jzescription:
Residential: Commercial:
Sq.Ft. Floor Area: /.� $/Sq.Ft.:
Arch itect/Engineer: to Valuation:
Type of Co st cti .�� / Occupancy Group:
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 > IOOOA 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 Plumb PLUMBING
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BUILDING INSPECTION DIVISION
TO: CONTRACTORS & HOMEOWNERS STANDARD OPERATIONAL PROCEDURES
FIELD INSPECTION #11:1
' SEPTEMBER 16, 1991
SUBJECT: Shower receptors, walls of shower stalls and bath tub/shower walls.
1. Tile directly on gypsum wallboard is not permitted.
2. Water resistant gypboard (Greenboard) is required under lath.
3. One layer of grade "D" paper moisture barrier over gypboard is required.
4. Lap,ja�r minimum 2" horizontal and 6" vertical with long dimension horizontal.
S. Metal lath to be not less than 1" Off GA woven wire. Zo G A r
6. Metal lath or woven wire lath to be applied horizontally (long dimension
perpendicular to studs.)
7. Metal lath to be lapped one mesh at sides and ends (minimum 1:)
a. Fasten lath wire with 1/4" furring nails 6' oc on supports (studs)
9. Self furring lath may be used provided:
a. It Is Installed with red marked wires closest to moisture barrier.
b. Staple 6"oc with #16 GA. 7/16 x 7/8�staples on red marked wires only.
C. Wire must be embedded in plaster in both directions.
• 10. ALTERNATE TO WIRE
APPROVED CONSTRUCTION OF FABRICATED AND PORTL•+.ND
TILE LINED SHOWER RECEPTORS CEMENT PLASTER:
1/2" wonderboard or durrock
'r-F7,(1 glass mesh mortar units.
Gceenb°asdl er ! �J u LJUI
L 1. No silicone
���yre b nn 2. Fasten with 2" galvanized
• C o+edP � � l� � roofing nails 8" oc.
( ,r. ieth y Ij iAll joints and corners to be
( ice �. Nov '0 $ loped & filled/covered with thin
N 1002 Al or portland cement mixed
wi h acrylic additive.
°= 4. Grade"D" building paper
moisture barrier beneath glass
mesh mortar units.
5. Installation o1 moisture barrier
_�• .Y between framing and greenboard
.RUT aw.mw
not allowed.
Tn1 Ta Dara i Toro
CODE REFERENCES:
UBC 4711, 4705 & TABLES 47-
w,,,,W�yM� B-C ICBG RPT#2444, 1254
racoTan ua.o
Shower Notes:
rrTr..nono ' ..nn r a".H
Threshold shall be wide enough
�O"`•rOO�^rm�� to accommodate a minimum 22"
Y ti YrYIT YTW1m I�Oar
r.rnu.,atan Rwwmw w�wru 'wu,`u' wide door (909-C, UPC)
,1 oua rcpt°men name°a arnewm oorw�T"aorral rrTu1 TOR
cert ra..waorm e°Il/•U ifnlYOrYlm a1111taaal ro n�tara Ol
!t/Mw®YT61 TARr1 n.cnT ler'R 11r1M Y .errnYO a01r1 Yr I�aa4®
v® nao�wrr arwc rRr•rumryn.n arinanr
iraa ons°ern To corer aur nae wofaao wr
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