07110154 CITY OF CUPERTINO �t �����*���'���;, :
BUILDING D;VISION PERMIT �'����'
;. .:
;; <. �; . < ,.:> .
pERM1T NO.
Bui���c�+�r�REs�RAKE CT BATHROOPIS BY REMODELING 0'7110154 .
pIItMIT ISSUE DATE
iNER'S NAME: .
THOMPSON CHARLES F AND KAY E 1422 SAItATOGA AVE 11/28/2007
SAMTARY NO. CONTROL NO.
PHONE: �4OH� 37�3
BUILDING PERMCI'INFO
ARCHI'IECClENGINEER: BLDG ELECT PLUMB MECH
� � 0 �
n p Q LICENSED CONTRAC7'OR'S DECLARA710N IOU DCSCi1�7t10R
,� V C I hcrcby sffirm Uu� I am licenscd undcr provisions of Chap�cr 9(commencing
Z Z � with Scc6on 70(xp of Di 'sion 3 oCthc Busincss and Protcssions Codc, and my lic� is HALL BA` ['H REMODE L
�� y in full force an d e f f ��� Q�
� � Z Licenac Clasa �n�racwr
= �,,, ❑ Dam
� � � ARCHII'ECI'S DECLARATION
I undcrsunJ my plans shall bc uscd u public rernrda
�yv
`a y Lir.ensed Pn�fcssional
OWNER-HUILDER DECLARATION
� `� �►krcby ulTirm thal 1 am cxcmpt Gum �hc Con�ractor's Liccnsc Law Cor thc
i p O following rcason. (SccGon 7031.5. Business and Profcssions Cak: Any ciry or county
.� ,°, Pi which mquires a pemiit to consuuc4 e��r. �P��. �molich. or repair any svucw�c
y Z y prior to i�s issuancc. also requires thc applican� for such permit to file a signcd sta�ement S Ft. Floor Area Valuation
< that hc is limnscd pursuant lo lhc �xovisions aC ihc ConUactor's Liccnse [ew (Chaptcr 9 $19 6 8 0
Y t z -� $(commcncing wi�h Section 7000) of Division 3 of thc Busincss and Profcasions Cadc) or
y�.. that Ae is ex�mpt the�e[rom and ihe bssis �or the sllcgcd exempuon. Any violatiun o[ Number Occupancy Type
Section 7031.3 by any applicant [or a pem�it subjecu the applicant to a civil penalty of 316 3 2 015 �
not mote �han five hundmd dollars (5500�
� I. u owner a[ tlie property. ac my employces with wsges u the'v solc compensadon,
wi11 do the wodc, and ihe swawe is not intended or oReeed for aak (See. 7044 susiness Required Inspections
and P�o[essions Code: The Conuacmr'a License Law dors not'PP�Y e��"ner of
property who builds or improves thercon, and who das such work himaelf or throngh hia
own emplayccs. Prmided that such improvemen�s ue not intended or ofCcred for sala I[.
however, ihe building � imp�uvement ia sold within one year oC compleuon. the ow��-
builder will have the barden o[ proving �hat he did not build or improvc Cor purpose of
sak.).
0 I, as owner o( the propeny, sm acclusively conuuting with Iicenaed rnntract�s to
consuuct the p�oject (Sec. 7044. Business and Pcofessions Code:)llie Coatnctor's Li-
cense Law does no� spply w m owner o( propeny who builds or improves U+enon, �nd .
who conuacu [or sucd projects with a conuactor(s) Iicenxd purswnt io ihe Convacars
Licente [.aw•
I am exempt under Sec. , B& P C for thia resson
wner Date
WORKER'S COMPENSATION DECLARA't'ION
I hereby aflirm under penalty o[ peryury one o[ the fo0owing dalaraGons:
❑ I hsre and will mainuin a Cenif cate o( Consent lo ulf-imwe for Worke�s Compen-
sation, as provided for by Secuon 3700 of the Iabor Code, for �he performancc of �hc
work (or which Ihis pertnit is issued.
have and will mainlain Worker's Campensation Insurana, as icquired 6y Scction ,
00 oC ihe Labor Codc, for �he pecformance o( work for which �his permi� is isued
My Workds Co Tpenau' esu cartier d Poli num ��
�Y �
�� ol'�cy No.: '�
CERTIFICA OF EXEMP'fION FROM WORKERS' .
COMPENSATlONINSURANCfi
(ILis section need not bc completed if t4e pecmit is for anc hunNed �ilus (S I00) .
nr Icss)
I cenify that in thc performance o( �hc work for which �his pertnit is issued, I shall not
unploy any person in any manner so as m become subject to ihe Worlcen' Compensation
Laws of Califamia. Da�c
Applicant
N077CE TO APPL.ICAM: If, aticr making �his Ccrtificatc of Exemp6on, you shoulJ
become subject to the Worlcer'a Compensetion provisiona of �he Labor Code, you muu
� O foMwilh comply with such provisions or this permil shall6c dcemcd revoked.
z �"� CONSIRUCfION LENDWG AGENCY
[...� �-�+ I hero6y �rtn Uut �here is a constcuction knding agency Cor the performance uf
a, � tlu work (ar which �his permit is iu�rcd (Scc. 3097� Civ. C.) .
W Q I.endets Namc
� z L.enders Address
V � 1 certify ihat 1 have resd ihis applicuion and statc thu thc abow infamauun is
w F cortec� I zgrce w comply wi�h all city and counry oniinentts and sute laws relaGng w
0 U buildins consuuction, and hereby authori�e represenuGvcs of this ci�y to cnter upon ihc
� W aAove-mentioncd propeny (or inspection purposes
a (�ye) agree w save, indcmnify and kecp f�am�less ihe City a( Cupertino against
�,H„� � liabilitiu,judgmcnls, cosu and expenscs which may in any wey accruc against seid Cily ���
V z in consequence oC U�e granting of ihis permiG Date ` �
� APPLICANT UNDERSTAND WILL COMPLY WITH ALL NON-POINT Issued b:r
SOURCE REGULATfO
�� � Re-roof; � . _-
Signaturo of A canUConuactor ��� T of Koof
HAZARDOUS MATERIALS D[SCLOSURE YP
w11 the applicant rn futurc building occupant storc or handle harardous matcrial
:fincd by thc Cupenino Municipal Codc. Chaptcr 9.12. and thc Hcalth and Sal'cty
.�. Scction 25532(a)? All roof,� shall be inspected prior to any roofing material being installed.
� �"° If a roof is installed without first obtaining an inspection, I agree to remove
Wil� the applicant or Culurc building occupant use equipment or devices which
cmit harardous air con�aminanu u dcfincd by thc Bay Area Air Qualiry Managcmcnt all new ; naterials for inspection.
�����
�y� No
I havc rcad �he hv matcrials requi�cmcnu unJcr Chap�cr 6.95 of tlu Califor-
nia Hcal�h & Safcty Codc, 'oaa ZSSDS, 25533 anJ 25534.1 undcrsl�nd ihet �C �hc b���ding
docs no� curtcn�ly ha an4 ��� �s mY �P�^�hiliry m noufy thc � �� � Date
rcyuircmcn�s wh�c bc mei pcior to issuancc ot a ccnirua�c otj�cu � Signatur e of Applicant
�� All roof coverings to be Class "B" or better
Owncr of author'ved agcm ���
�: � _
. � .
� �o. � - t
+ y�s� � � e � �
�
!1 �^ � � a #
. - �. . .
�. , . .,.- _..
'L < , _ . _ � _.
CUPE TlNO
Assessor's Parcel Number:
Name of owner.
���� � ��, � ��
Project address. �
/� � � � °���-���� �� �
�/ �x� �^- ne. °-� � `� �� �� ��` U�
Contact person./�e� v Pho
Fax.
Net square footage of lot.
���� �
E�istin� Proposed
Square footage: First floor: f�-.�c----
Second floor: _�
Garage: _,�.— ,
TOTAL:
Are there at 1
east two 10 foot by 20 foot clear spaces inside the garage? � N
Is privacy protection planting reQuired for the �►roject? N
On wha.t floor(s) is work being done? rp ,.—
��
� � ` �� `-� `�� C �� � `���`'c�Z
Brief description of work. , � �� , �
n �' �,� �,
� �
Zooi cFC ��2ooi cMC ��
Code editions: 2001 CBC ��2001 NF C �'�
200I CPC � �
Effective 11/1/02 � -
� ,�
s
� � ,�
so ,;
�
�� .
,o�
Plan Review Process Work Book Page -8-Revised 8/22/OS
_ iA ��•..�" �r � l.✓.
' • �tx
�'3��'�'-Y'�t��1l�S � ���.. � - � �����
rr.r.-- a
, b b� R�mode�i� Spec;ic�iists IO -• /�— n�
142Z SARATOGA AVE. • SAN JOSE, CA 95129 � r �— C��
TELEPHONE (4O8) 378-6700 CON"FRACTORS LLC. R�674083 :��, Date
-,.-..�..,_ �---�v—.. .a,.� �..��..�--�:�_� �,.._... ,�. .�-- # -� a -�
` � ;� ��"�;��io �" ' _�, � ��... ' �t A ` /
–�►t ---�----?–�-.T.� � i
� ��'�� i r , F .� �
� i � u i , � # „ 3 � ,., ��
-r--- -;����--- �� -� � j , �
� � F � Y
{/� _r_... .l� ' - � ...3
_�� ,., - �i ��-� ; -�--.��•°�� ' . i 0
m� '" % ���5p....�" - .. �e e �.-- �--� -�-�•- °- •.�,� �= 3�. `�� - - � . � � I
w � F �_m...� t ' tl r � ! � � `
; ^ t f i $ > �,�.,�-.._,_" e...�.... _.. �_� '�- -�
_ . _ • n _
� ! �� s � �� } , E � ` _—_ _ _ ` '_. _ _ _ __ j� ' � - �
� � ; t � � .
�_�_� _ _ _�____�- - _-� --�_ �--.. �_�. .�._� � .�.... _�
i � � ; ` i - �... .�_._..i__. � ` � _ �.._. ..�.._ " � � � ! i ' �
, � , _
1 S l ` ��� --� i � � � .._.f
� 1 / • ` : . . . . _ . .. �.
f •��� � ; � �" � � 1 « �� 1 + i � � • '1 `
.,�.�..�.�. .��_._ _.�y..... .�—' �---+��.—..i—. rt'�!+•..�.—�—�.�hi�� ' �.. �.�._.{
— T' �.�`- � i 3 •� +� �-� ! � y
' � ' .., v�..�...�� . +�-`�.r.-� t _ _ .,. _. ` F ' r `�
._.....�.s..- � . �- .. '-- -- � F �.� "'¢""_.! �
�._�...._.:.. � r t ` �
� � 4
; � � � ,,.� _ ' _ p �
,. _.� ..��,.� �, .z �_�_....,,�t. �.�,. E ° `�_ s � I
� ,� , °
; �
-- � �--m-
., � � � } a
' E
" ' i j , �e � ' _ _ . _,�-
{ t � { _ �...
� � � � 3 k � � ! 1 ,,,�,�., � .�._- � -i- - �
�. ,—}-,--. _. f � � , � s� j I � �
� - s :.
i ��.
' _�.,_..e: � � ..�.�.-_.__.�_.._ k � � �
�+ ? u i i � � �
1 � � i � ,�� ' ~ � 2 E � ; � �
�= LL ; � � _�, 3 .... . ���� . } t � i �•�
! � e — �� j �� �� _ � � �
.�...�.. . i ` _
_ i , i � " '
' � t� �' � —� ? � ---- , _.�.�. � ..
, �. .
_ . i ( [
' C � F � � ]
� � ��" ��
� ' � -�
� ' t � '
� j 1
� t „ . . � y 3 � t �
�__._.�_.� , �---�
� � .� . , „_� � ,
_ � , �;
i .S f '. , � 1 ^ } A ��
� f 6 ' — �—
; �• ; � 4 — �
��..�. ��
�_._, �� � i ....._.�.:� 4 � � �.
i---�-- f �' _�'._�
__;_. , �
3 � � ;
� _� � .� - _ s,.:.� -g
'°",�""'�"� ^ � + � � � �� 1 = 1 �! __
� � � t j � � � a � .
� �� a � �. � .
9 � �Ss.� � � � � ? ..�..��
i � � -
/ �
; � � � .��. �. �' � , � ' ,
� , . � 1 __ I � , � , t
L���_� t 3 ; 3
� �..._.�.,� �- ' -�--- � .--�-----� , - E
t� 1 � f j�� � a t
+, _ � � f
��
. ° � F �
E c ;. !
i i t ' "�,�„'_ ` _ . .
F '
� � 4 -- — � �
• � C � �
�- �
� -
.� � � , �
, _ �. ,
.. _ . >
���� � � �I, ° , � . , ., ;�
� , ,
_: _,� y , H :��
.
. � ;. .
,. � �. '� =
- �, . .
CUPEf�TlNO
Assessor's Parcel Number:
�,G',�,�.� �► ��� � ..�
Name of owner.
Project address. /�
/� � � � ���-����e�-e �� �
�/ �x� �- one. °-� �S �� �� [ S� U�
Contact person. j��� v Ph
Fax.
Net square footage of lot.
���-��� �
E� istin� Proposed
Square footage: First floor: �
Second floor: _��' �
Garage: �.- ,
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces inside the garage? N
Is privacy protection planting required for the ��roj ect? N
On what floor(s) is work being done? c ���� 1 � - ,��/-��
�� ��.��c� �'``J � l i�
Brief description of work. � ��� , �
� �� ' �
,-
Zooi cFC ��2ooi cMC �� "�
Code editions: 2001 CBC �� 2001 NE C �'�
2001 CPC � � T'
, .:: :� �Z�� �� �"'�
hy � a �;�� CI�CY OP�
, � ��CE `NI�1 �yCE9 �
Effective 11/1/02 � ,;� F�CG�`'�� � Q���t�a
�tfP�.��ltd�J ' �OD�S A
��-2�� �
�r,�E�'���____��� s
�� ,...._-..—°" ""— tll�y;iS `
k .�--� �t - ,�.c�,;ca� u
�-1 ' r i�-. Jj ' ur ,y �t �Q 1
��,. � c.et �! �, rl' - ` f ' �it'��: �`� ,. �'''"�4:
_ � .' �, . r� ` �;• `� ,�.� �er aiA�er�:ii�r, � �,�
= �r,e �� , , <, Y � } t .,. -sion tro ,�■,�;
� t•�� ���� � _
^;ENEI) 1 �' ; 't"' y 1 ,�til`�'
�@ Ka.l. • � �.r (;; l:'::��� �
•. � :��K` �. , t�1•.� :�ru ICut
,<, f l,uXl�. , � �� if
G , y �",l�< <� ' r` '.h�S ir:.�.R t� �;� b� dC
L�ir;�� ��t:+ ` �:1i;4�. i7C
t!l�� � t�i:.(� +- �" *pVlSl�n�
{ ` � �� la tiL� �i �n� �'
�.�r` ��� 5.ti� Vt`"'r c C;� �—��� I.�V�
,`i?ii? � � � 1l,I�i� ,..�
Plan Review Process Work Book Page -8-Revised 8/22/OS
- ' ..,� - �r � 1.�.
. .
���`������ �����+-- �.� G
,.—`—„ ` ,
.d b� Remo�te�i� Spec�iatists !a y' �� �� -
I422 SARATOGA AVE. • SAN SOSE, CA 9512�� rf � � Q�
TELEPHONE (4Q8) 878-6700 CON'FRAC"fORS LLC. #674083 ��� Date A`` r
.
��_ ��.-.�._.,--...�. R---_�-v--�,4 �� �� "`� } ! _ /
�� jc� ���� ��-,���-� � � � �1�1�,4 ` .�
1 ; � � �----� , � f � s ` � F �S �
� ��.. � ��
...�_ ._ . � _
, � � �-� , �a -a-�-. � F � � i . �
-� ... .. _ � , i � .' •
k
.. . .l� ....�.. . .�:...fq-+W� �f'.� �. ' - .� ` -- 3
� � ; �_� j � � : �� t €
' �._�e--.�" .. � e,�.- �?---�. �b.��• -.• i � t e � �
- [ �� t i l � � 1. � j �
��._ `� I � � � ; r i e 9 � r �
. .
� � �._�C. -._ .._.�._ _._.�.,,.._...�.� �
� ,. _
_ �. .. _.. o _ t
� ; `�°. _ ` ` "
� � E � i i I R + 5
�,� - � � � � _-_ _ _ _ _ _ - — . ' , o
a F
+ � i
.. . . _. ._ . . _,.�.1— _. --. ._ � +.m.-
i �
� , ` _ _ � �� . .�T�. . _. .i... L '
` � '� F
,.. ` � - _ �--.�_�_�__.._ � __�._..��..-_ " _ � � t � � , �
' � � t _ �-�---�- -•-�- s —�----�--�--�- �-f
.� ' � � �
�..�.
: r 1 � '
� i f �
�� ..�. � .....�� .�.,,� � � . e�..e�.: ' _ .. . _ . . .
' i � , -5�- �� , � �
__.�._. _.�._ �.. � ..�.. _ ---�... -�
� � � .W�.�. - � . �----�. ---� �-
�. � � .�.�._. � � .._..�
� } �.
----.-�-r- _ _ _ , E �_ t� , !
.��.._�: ..�-.-.� . �.
� .--_. , r �-�-�.--
; _. � �.. _.� a�..- � ,.z :_ � _.��. �. �- .—�.,,�-- � ,+ —1,,,,� � �,
` ' ` � ' �-�-�—�
- -� �-'�' � j � , ! ' 1 y ° �
{ � € � p � � , - t'--' -� - �
� � � � ' k � � i 3 ' -- �—�� � � �....
�.� � . � 3 � �
� ' , _� e 1 t -.... a l 1 �
M ' _ i ..-�--,. -�l-� d � � ra ,
! � � � `� ~ � � � t � � � �
y« .. i �. � _,.�., '� .... . }.�t . � � ^�
--'-�. . � -- ; -+ �- "^ ; ; _ J� �.,� : � i
f i � �
_ _ � , `� � x
� ' �� ^ I j
�� 1 ' 1
( ' f i ` � _.,� f . �
__��� ...
i
. _ , --�-----�--�—�-'-
�. � � � } � -
R t .. . �._._l_.r p ' ' � � � —
. �� � �
d � � ; � _ ,
; — -� �, ;
f , 1 . �
. ! .� . � '..�� � �.�W � � � � � i �
�� � ' ..`�'�,. � � .�-' �
° � - ' �. �
� � � �r
� - " - Y - �
E � -�-�ti �- - . � � - f S � � i � �. �.e..-g
�� � �{ i� i �s � � � ! F
i " � _ � D � '_� � __•
�
�� � � 1 ` � ` ° ' � i � a . ,
� 4 s � 1 t ,_... �,. " � .�- � � �"'..
a
i% �.._...�..� i J a I.� : )
- � „e _ .��, �, � �.,. ._t-�. �-�--�
� , ,. ' � � � � � � i
� , 3 i �
� � � S � • ..�... t ' �"� w�-�v �
t---~ f - � � i , - t i �
� � �. �
_.� L��� �.
� � � � � � #
� . � c :. .
i 1 F - ..�.r._ '
��� _ _ _ � : F , -
� �
� - , � y � '
_� . �
�� i/oi�-y
CITY OF ��UPERTINO
;� ����` ADDITIOrJ/REMODEL
.�.�
CUPE�TINO PERMIT APPI,ICATION FORM
APN # .3 ! � ,3 02� � `J . � Q Date: f/ ���/d �
Buildin Ad�ess� � �-
� «�� �� �
Mailing Address (if different from building address):
Ow�er' �I'�1 � ��. ��� � Phone # � � ) � �
� /' , ��„� � �/
Contractor: Phone #: �� p�� J��6 � 6
��l-Cd/``,�'�-8-�-r� � �C � ���r,' F . Fax #:
Contractor License #: � � � U��
Cupertino Business License #: v`1 0� � 3
Contact: � Phone #: ('� �� J � �,��j � �
/� l� " QL� ��'`'�— Fax #;
Building Perniit Info:
Bldg. Elect Plumb. ]_ Me . Hillside ❑
Job ription: '
What is being added?
What is being remodeled? �
/�� r� l ���`��� .
/ �/
Residential
Remodel Includes Re-Roof Yes ❑ No ❑ If yes list number of squares
Remodel Includes Structural: Yes ❑ No ❑
Square Footage:
Addition: Remodel � � � � Garage:
Porch: Deck: Other:
Type of Construction (Usage Class): Occupancy Type:
1 FR, 11FR ❑ 11, 111, V-1HR ❑ 1 l, 111, 1�� V-N �
Valuation: � Please check this box if the project is a
�_�?��� �/, � �� • � second-sto addition ❑
Green Building Check list must be completed an�3 Green Building Points Achieved:
attached to the plans.
***For Office Use Only***
Over-the-Counter ❑
CITY OF C UPERTINO
ADDITON/REMODEL
FEE SC]E3EDULE
Quantity if
A licable Fee ID Fee Descri tion Fee Grou Permit T e
PATMOBF Atmospheric Vacuum PLUMBING �
PCESS Cesspool PLUMBING
PPRSEWG Ea. Private Sewage PLUMBING
Disposal System
PRSEWER Sewers PLUMBING
' BPSPRINK Lawn PLUMBING
SprinklerBackflow
BPWSVCS Main Water Service PLUMBING
BSEISMICRE Seismic Residential BUILDING
DECKWOOD Each BUILDING
DECKRAIL Each BUILDING �
GARDTW<=1K Wood Frame up to BUILDING
1,000 SF
GARDTM<=1K Masonry up to 1,000 BUILDING
SF
PATIOWOOD Wood Frame up to 30 � BUILDING .
SF
PATIOMETAL Metal Frame up to 30�) BUILDING.
� SF
PATIOOTHER Other Frame up to 30() BUILDING
SF �
Additional Patio Each BUILDING
300 SF
PATIOENCLW Enclosed Wood up to BUILDING
300 SF �
PATIOENCLM Enclosed Metal up to BUILDING
300 SF
PATIOENCLO Other Enclosed Patio BUILDING
up to 300 5F
• Additional Enclosed BUILDING
Each 300 SF
REROOFRES Residential Re-roof BUILDING
Each 100 SF
REMRESKITN Kitchen Remodel up to BUILDING
300 SF
REMRESBATH Bath Remodel up to BUILDING
2 of 3
CITY OF CUPERTINO
2 ITEMS OF 2 PERMI'� RECEIPT OPER�ITOR: patq
COPY # : 1
5ec: Twp: Rng: Sub: Bl:c: Lot:
APN ......... 31�32015.00
DATE ISSUED.......: 11/28/2007
RECEIPT #.......... BS)00003344
REFERENCE ID # ...: 07L10154
SITE ADDRESS .....: 19742 DRAKE CT
SUBDIVISION .......
CITY .............. CUPERTINO
IMPACT AREA .......
OWNER ............: TH�MPSON CHARLES F AND KAY E
ADDRESS ..........: 19742 DRAKE CT
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-2432
RECEIVED FROM ....: BOL�TIFACIO ALCANICES
CONTR.ACTOR .......: JOZO CAR.AN LIC # 24223
COMPANY ..........: BATHROOMS BY REMODELING
ADDRESS ..........: 1422 SAR.ATOGA AVE
CITY/STATE/ZIP ...: SAI�T JOSE, CA 95129
TELEPHONE ........: (408)378
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ---------- ------
1BSEISMICR VALUATION 19,680.00 2.00 0.00 2.00 0.00
1REMRESBAT SQ FEET 45.00 551.00 0.00 551.00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT : 553.00 0.00 553.00 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ------------------
CHECK 553.00 #5598
---------------
TOTAL RECEIPT : 553.00