07030015 ,CITY0F CUPERTINO
BUILDING DIVISION
PERMIT NFlYITI�N,
BUILDING ADDRESS: PERMIT NO.
10290 DENISON AV CHRISTOPHER SHARMAN 07030015
OWNER'S NAME: PERMIT ISSUE DATE
CHRISTOPHER SHARMAN 7
ONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB IAECH
o p LICENSED CONTRACTOR'S DECLARATION O O
U p I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is
in full Come and effect CHANGE BATHROOM DOOR TO WINDOW
y
Z License Class Lic.8
E m Date Contractor
ARCHITECTS DECLARATION
wU I understand my plans shall be used as public records
a
G y Licensed Professional
y OWNER-BUILDER DECLARATION
< I hereby affirm that 1 am exempt from the Contractor's License Law for the
00 following reason.(Section 7031.5,Business and Professions Code:Any city ar county
�i which requires a permit to construct,alter,improve,demolish,or repair any structure
Z y prior to its issuance,also requires the applicant for such permit to file a signed statement
_< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
t, (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $1500
L R§ that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Number Occupancy Type
not more than five hundred dollars($51W). 31629062 Vl l P Y YP
❑1,as owner of the property,or my employees with wages as thew sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.IL
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 build or improve for purpose of
sale.).
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's u.
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such pro' i a contractor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt un .__ B-&.PCforthjs.reason
Owner Date _
WORIM'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations;
j I have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is Cor one hundred dollars($100)
or less.)
I certify Etat in the perfa wort for which this permit is issued,I shall not
employ any person in an o a�t aubitt a Workers Compensation
Laws of California. a
Applicant
NOTICE TO APPI.ItAtllf,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z~ CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
(Yi the work for which this permit is issued(See.3097,Civ.C.)
OWr Q Lender's Name
a z Lender's Address
U C) I certify that I have read this application and stale that the above information is
ly correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction.and hereby authorize representatives of this city to enter upon the
aabove-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
rF",y In liabilities,judgmen and expenses which may in any way accrue against said City
U Z in consequence ting of this permit.
APPLICA STANDS AND WILL COMPLY WITH ALL ON-POINT Issued by: Date
SOURCE ONA�l
3 Z
Signature of pplicanNContractor Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes R<
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
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new maerials for inspection.
District?
❑Yes Nu
1 have re e a ous materials requirements under Chapter 6.95 of the Califor-
nia Health&S C coons 25505,25533 and 25534.1 understand that iC the building
does not cu d tenant,that it is my responsibility to notify the occupant of the
require must t pri r w issuance of a Certificate of Occ aney Signature of Applicant Date
637 All roof coverings to be Class"B"or better
Owner or authorized agent I late
r
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 31629062 . 00
DATE ISSUED. . . . . . . : 03/ 2/2007
RECEIPT #. . . . . . . . . . BSOD0000594
REFERENCE ID # . . . : 07030015
SITE ADDRESS . . . . . : 10290 DENISON AV
SUBDIVISION
CITY CUPERTINO
IMPACT AREA
OWNER. . . . . . . . . . . . : CHRISTOPHER SHARMAN
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . :
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY CHRISTOPHER SHARMAN
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . :
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY PMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ------
BENERGY PERMIT FEE 83 .16 39 .92 0. 00 39 .92 0. 00
BPERMFEE VALUATION 1, 500. 00 83 .16 0. 00 83 .16 0. 00
BSEISMICRE VALUATION 1, 500. 00 0.50 0. 00 0.50 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 123 .58 0. 00 123 .58 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 123 .58 992
---------------
TOTAL RECEIPT 123 .58
,. CITE' OF C UPERTINO
015006
7 CUPE�iNo PERMIT APPLICATION FORM
_-PN# 3 t _ 2.9-- O(02r Date: ��✓�'/2 �` 2-007-
Building
007'Building Address• Mailing Address (if different from building address):
d�qo DIeN I Som► A-V162rvvE, E-k'7? 0 cA- so �
Owner's Name: Phone
CWg,cS + (,-iLb 873 —T? S I
Contractor: License#:
4 0-rw e,
Contact: Phone:44$8 2 -Z7�,i Cupertino Business License#:
C h6C'IS �4 P(e1Ymi°q,-�i Fax: cf-o3 - S- l J'7
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description• R E^^0 VE LX IST,�T �-RA0rH/'R.oO� 0✓TS)D E -boo 4 ��
Residential V ,,?V= Lr}C, " i tj Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: r oa Occupancy Groouup�5
Type of Construction: Please check this box if the project is a
- second-story addition:
eroject Size: Standard Large ❑ Majcr ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boil--r<= 100,000 Btu MECHANICAL
BBOILER2 Boiler > 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX C instruction Tax BUILDING
BCONSTAX Ind/Off/Conun/Quasi BUILDING
BCONSTAXBQ Con Tax for BQ Zone BUILDING
BCONSTAXH F-otel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC 1000 Elec. 600V<= 1000A ELECTRICAL
BELEC1001 Elec 600V> IOOOA ELECTRICAL
BELEC200 Elec ',vcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 oe3
lsCITY OF C'UPERTINO
CIT'OF PERMIT APPL [CATION FORM
CUPEkTINO
Quantity Fee ID :Fee Description Fee Group
BREMSIGNAD Riudl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS VE ntilation 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 Tamporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING.
ELECTRIC l;lectrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanical sq. foot MECHANICAL
MPERMITFEE Meeh Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Ph.mbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHGkddress Change BUILDING
3 )f 3
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family ;parent,spouse or child) will perform
A. _ All the work authorized by this permit
B. _ A portion of the we r�
C. NI one of the work
If B or C is checked,c:)nlplete 2 or 3 below.
I j
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. _ portion of the we r� (complete section below)
I
Contractor Address/City Phone # State License # Type of work to
I � I
3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
erformed
.....................................................................................................................................................................................
I I I
I declare under penalty of perjury that the ab,)ve is true and correct. I have read and understand the
Owner-Builder Information(rever e).
Property IOwner's Signature: J ` Date: 2 ��b !�
Job Address: f o2,�7b beyv'c3a�k t-ue ( � `� ^ ��C(f � j( Permit#
Any changes to the.information provided on :his form shall be submitted to the City of Cupertino Build
Department.
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APPROVE
I N t DANCE �°rM TP# GIT u;
CQ PYO CODE ,D Q ICE!
TUB/S W
ATE —2rc7 w
M
0
SIGN *PiVs
This s and specific 3andi-,s
US O
De ke t tip; job at a! time trr O ANITY
0
lawful v ake -ply cf�i�ges UNIT
on sa a ithcut wrifzon pe- r_: �
The bt Irn ng(it th- p?n f:n�i p P,CiiifaCi n• I C"'
gin/-ILL JVtZ be he d tc, Pe::-iliir to be + f �v
Tp(vv J the viola. en of an ;rAd;h!r
EXISTING BATHROOM DOOR PROPOSED BATHROOM WINDOW
PROJECT:
WORK NEEDED TO BE DONE; BATHROOM REMODEL
STAGE 1: STAGE 2;
1) Remove door, frame trim do sheetrock. 1) Replace sheetrock, tape k mud C k L SHARMAN 10290 DENISON AV CUPERTINO
95014 CA (408) 879 9991
2) Install frame k flashing for window 2) Fill empty space outside with stucco DRAWN BY:
9) Install window trim inside, sand sheetrock L.S
Cali for inspection and apply topcoat of mud SHEET NO.:
Call for inspection DATE: 1 of 1
��r C (3 C Z 60 oa i �J F=RA 02/23/07