05110152 CITY OF CUPERTINO *'a�wa,"�'''^'"
BUILDING DIVISION PERMIT CONTRA CTQWINk.�ORMATIQN
�� t?.-...h+.xtssp
BUILDING ADDREss: BATHROOMS BY REMODELING 'N1T NO05110152
11331 B PERMIT ISf/E DATE
OWNERS NAME:
RICHARD & BARBARA SCHUMACH7,R1422 SARATOGA AVE 11 /29/2005
NE SA ARY NO. CONTROL NO.
(408) 378-6700
BUILDING PERMR INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
t� 0
i00 LICENSED CONTRACTOR'S DECLARATION
F 1 bvcby affirm that I provldou of Cluper 9(mmmeodn{ Job Description
�ia`$ with Sa71oa R00W d0iHdan30rUh Bwtutn,ad Prorta[ba core.ana-m I;mntc i,
+�„ mmnramead p REPLACE BATHROOMS FIXTURES (2 1/2) ,
'p: IseUaeClav L"'" NON-STRUCTURAL
Fq Da¢ Cnnvarwf MAJ 31"
W7 ARC ITECI'SDEM 1
l f< I vWv[und my pWa+hall bei u public reca�6
�a LltUnted Prufeuianal
OWNER-BUIIDER DECLARATION
r 1 hucby IT,.on,I an,uenpt form tha Cote dor`,Litt°x Law f«de
d folbwin{.,(Sctdm 7031A,Buanau and pmfutiaa CUtde:My city or county
$ wt*h swim a permit to m�wale.Impo,e,acm,dlM.or mpair any I=t.
_iV pn«b D a °,.w w��dn,Ppl�, lr°rMhPmnitbrka,i{kaRm ml S Ft. Floor Area Valu &2131
E o Nat K ulkc pauun(bNtProvivms m Ude Comb"Litt.Law(Cbpc 9 q
(tnto.dn{with Smdm 70y0)Of Diaidon 3 or Ubc BatUUnt and Prafeubtn Cade)or
— that M u.,I Nctefmao and Ude baso for me dkrd aempinn My vW--of pJT�t�
Seabn M31.3 by any aPPllam for nn a Pesume b)nUa akin �b a l peaakp
y of beOccupancy Type
35623045 . 00
NUrn
Uta Mort Nov nw hmdmd d011an(25001
LoI w wOand Pmpa, I,,noroployce withtra{eauUdO(m.amnpcovtim,
wlBmuK,Od. UdO,Tr Cojoo+noti L— Larmmr wonafs«.roan.owri of Required Inspections
,td P y wt OW Cade:The nUt th t Ciente ovi na h am apply for
awmr a( - q P
progenylobo buildsor iUtt than tbamn.andlobo d«a auchwathimvlrarlhro°{b his
Owm emplo3w.wasWdmattutbwis Wkrnuart out lnetdea OraQuei far.nw U. �1 A
bownv,it buiNlo{m'vopro Ponying
tIwithinot yea Or ro p fr Ubemover-
bullas wig ba.e the Nvdm or T°vinC Nat he aid not bulla«impmw f«yrpoe of
❑1,u erase
of the pmperry.as Ud.only emodin{with Band avtMoe m
carutmet Uk Portae Wy n a x,Butinof ana PrafeW bo Code:)Tie Cmoacars nd
telae[mow aonnv hlw n,n virb c ofpotoil.) bWdtla«unpmo dten:on.am
who COr Law.rIX 3+e 11 p1O}CCLS with d CmVa[lar([)BSnSed PU!]WlLL b cite[anlrK'b�l
LQ�e�w. 6
�IOA rumps uncia Sec ,Bd:PC f«Nurutm
D,u
WORKERS COMPENSATION DECLARATION
I bertby&BBI otdar penalty a PNSaY om err Ube falbwin{n..r..�
I haw and will maittuiv a GnilL.,^err COUuem n xlf-lame r«WaAxf,Coropem
Iodm.v Pro "forby Seen.37 of Nr Mbar Code.far me Peff—N ttr
wort fm wMN tbu pcnoit is I
❑1 bate and will munaln Woh 'Com?".• an Ivarvtes.u ttal°in d by Sttdon .
3700 of do Labor Cade,rar the pof«roanee of tht wort ra which Ubu pumit u y^rA
My Wo,k ,C.prmati,a�f000,na tonic and Policy number a m:
Cattle'.. 7//A.;e loJ�• L� `Policy No_ <05.w1s9�e c>n 7J.z/O/
CERTIFICATE OF EKEMFTION FROM WORKERS
COMPENSATION INSURANCE
(Tbl,sealoa mW mtbcmnUpu If Ne permLL Is fora lb d doBaa(5100)
or leu)
1 mti(y tbm In the perform,a Of dic,wort for which this I it Is Iuvd.I+hall ml
wptty,ttp permn in any vtaorcr.as to become vbim to ft W.1hU,1' ;='=•�^
Lewy of Califarma.Dau
AppOa.I
NOTICE TO A"UCANT:B.afmr matin{this Ccnifkae Of E.¢mPlbn.ym tbooW
bmane aubfcct
On tha Won&,COOUPct non p Wore a Nc L+b«Cock,you mue
,JO ronhwidn comply wlm toe Ptarions or thit«niL"I be deemed mated
z CONSTRUCTION LENDING AGENCY
I y afEn lost loam is a matrvdm leading alit yfnrU4 perfanarUm of
a� Ube wort for which this pemtit u it IS".3097,Civ.C)
W� Q Lando,Name
=Z LrndeM1 Addma ..
C.7 1 mdfy Nat 1 bac tcad colt.'Iwaiim and tum au,the abort ioramatan 4
cot l agree to comply with all city and county ordl et And 3=law,mlatia{b
W iMia{cmtuatim,ad hereby aathon,e rcprumtaii ei Of Nu ORY In tenet UP"the
[fl ,bore-rntouorca V.Ptrty for tupecdm pv7..
(We)ansae to ave iod unify and keep batolev Ube City of Cepcmro a6vmt
jai Ilabilidea.}d{mrnucosts
and c,yctuu which may N airy way aecr gaInd,laid City Ty
UZ, intornaxi a°rNe{apupcm
un{ofthit. Date 2- rc6-e
APPLICANT UNDEEEEEE99P$998��ST'T�ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: �I
SOURCE -
Re-roofs
Sipvturt
HAZARDOUS
AZA NAppliaRDO DDae
FLVAU5 MATERIALS DL9 UI h-RE Type of Roof
WIIy teCoIcntorfM bonding Occupantr9,1or handle harudaasd WCLl
u dc0md by NO Cupenim MUtrticiryl Codc.Oapbr 9.11,and Uhe HedN and Safety
coa.s«dm ssmz(o' All roofs shall be inspected prior to any roofing material being installed.
❑Yn ONO
mwnmb If roof is installed without first obtaining an inspection,I agree to remove
Wiu de aPpllt,n,Or mmm bulldin{omupaM.ltlpmt ordtvm
emit ha, d air cmIaonN u dcftmd by UM Bay Arc,Air Quliry Man iiit..t all new materials for inspection.
Dinr3m9
❑Yet 0 N
1 hae mad du IUvardorttmaUcialt mgoiremenu Order CLapter695 O(ft Caliror-
nuHralNkSafmy .Sec*ioru U50.S,15573 arv12t5N.lurdetauod thairde huildm{
doer mtanrL aUmatUt.m�n�my mapmtiMlityomufy Uh acttpvterr ort
m9aimmcw m,xnetpn«nummaraCrnifkamor Signature of Applicant Date
All roof coverings to be Class "B"or better
Owru a,utlwmca,{ort _ - Dam
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35623045 . 00
DATE ISSUED. . . . . . . : 11/29/2005
RECEIPT # . . . . . . . . . : 32133
REFERENCE ID # . . . : 05110152
SITE ADDRESS . . . . . : 11331 BUBB RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER RICHARD & BARBARA SCHUMACHER
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4941
RECEIVED FROM . . . . : BONIFACIO ALCANICES
CONTRACTOR . . . . . . . : JOZO CARAN LIC # 24223
COMPANY . . . . . . . . . . : BATHROOMS BY REMODELING
ADDRESS . . . . . .. . . . . : 1422 SARATOGA AVE
CITY/STATE/ZIP. . . . : SAN JOSE, CA 95129
TELEPHONE . . . . . . . . : (408) 378-6700
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- --------- - --------- - ---------- ----------
BPERMFEE VALUATION 32 , 131 . 00 393 . 12 0 . 00 393 . 12 0 . 00
BPFIXTURE UNITS 9 . 00 81 . 00 0 . 00 81 . 00 0 . 00
BPLANCHK PERMIT FEE 393 . 12 524 . 62 0 . 00 524 . 62 0 . 00
BENERGY PERMIT FEE 393 . 12 188 . 70 0 . 00 188 . 70 0 . 00
BREMRECEPT NO. OUTLETS 8 . 00 9 . 60 0 . 00 9 . 60 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BSEISMICRE VALUATION 32, 131 . 00 3 . 30 0 . 00 3 . 30 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 1315 . 45 0 . 00 1315 . 45 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ---=-------- -- ----------------
CHECK 1315 . 45 5076
------------
TOTAL RECEIPT 1315 .45
•
= 3 CITY OF CUPERTINO -
CUPITY0 O PERMIT APPLICATION FORM � 5��� �S"Z
N # f / 2-3
Bui��g Add Q� Mailing Address (if different from building address):
I3/
O'Aer's Name: Phones# -7
Contractor: License #:
A�y� gy
67X83
Cont Phone: �S/p�J Cupertino Business License#:
Z/ / V'/Pw Fax ;W6, ,00 'r 1,0
Building Permit Info:
Bldg ❑ Elect Plumb Mech ❑
Job Description: // Q^; c% S1 —no
nS1w c
Residential El �'L / o=ercial LJ �/
Sq Ft. Floor Area: / q.Ft.:
Cost of Proiect: Occupancy Grouu:
T e o ons tion: i /I Please check this box if the project is a
second-sto addition: ❑
ro'ect Size: Standard �' Lar e ❑ Ma'or ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERl Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> IM to 1-.757x1 Btu MECHANICAL
BBOILER-5 Boiler> 1.75MBtu MECHANTICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX IndJOfVComm/ uasi 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
BINVESTIGA Investigation fee BUILDING
] of3 �
1 � ' J
CITY OF CUPERTINO
IF
CUPE{�TINO PERMIT APPLICATION FORM
.Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOI IIvIE New Comm Electric ELECTRICAL
13NUCOMN114 New Comm Mechanical MECHANICAL
BNUMDI 2 New Comm Plumb PLUADING
BOVERTIDIE Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum . PLUMBING
BPCESSPOOL Cesspool PLUMBII-TG
BPER 1FEE Bldg Permit Fees BUILDING
BPFIXTURE Pbl Fixture PLU7l�IN'G
BPGAS Gas PipiDg System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUI TG
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Re eat Fee BUIL DING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLU NIEBING
BPSEVVER Sewers PLUM BIN'G
BPSPRINK Lawn S rinUer/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitcben Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pipe PLUMBING
BPIVHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reins ection Fee BUILDING
BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
BREMAM ANTT A/C Units <= 10,000 cfm MECHANICAL
BRENIAPPLI Appliance Install 1`UEECHANICAL
BREI`6BUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREI f URN Relocation of Furnace MECHANICAL
BREAgURNOV Relo Furnace> l OK btu MECHANICAL
BREN AT Heater Installation MECHANICAL
BREATINHOOD Installation of Hood MECHANICAL
BREM IISC Misc A2paratus ELECTRICAL
BREI NTRAPP Rem Non-Res Appfiance ELECTRICAL
BREW POLE Pole/Platform Fixture ELECTRICAL
BREMTON'VER Power Device/Apparatus ELECTRICAL
BREVIRECEPT Rc tl, Switch & Outlets ELECTRICAL
BRE2 RELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heati-ng MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
2 of 3
CITY OF CUPERTINO
crYo PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmd1 Sigas Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BRE111YENFAN Vent Fan Single Duct MECHANICAL
BREAWENSYS Ventilation Systems ]VMCHANICAL
'BSCBLVD Scb Specific Plan BUILDING
BSEISAIICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECL4L Special Lispection BUILDING
BSWDA Swimming Pool BUILDING
BTENIT Temporary Power ELECTRICAL
BTEnZPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Tcmp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERISHTFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERNIITFEE Mech Permit Issuance MECHANICAL
PPERMIT'FEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fcc sq foot PLUMBING
PLLONGRNGC Planning LR Comme/Multi-Faro PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Chane BUILDING
3of3
THROOMS
by Remodeling Specialists
1422 SARATOGA AVE. - SAN JOSE, CA 95129
EPHONE (408) 378-6700 CONTRACTORS LIC. #674083 1 r Date
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by Remodeling Specialists
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, CA 95129
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CITY OF.CUPERTINO
BUILDING DIVISION PERMIT t=CONTRA,CTT ,NFORMA110.,1I�l
BUILDING ADDRESS: BATHROOMS BY REMODELING ""Mr"'o-05110152
11331 BUBB RD
O1"VERS NAME: PE]i SUE DAM
• RICHARD & BARBARA SCHUMACH R1422 SARATQQA AVE 11 /29/2005
P NE:
SANITARY NO. CON-IROL NO.
(408) 378-6700
ARCHIECrIFNGINEER: BUILDING PERMfr INFO
'BLDG ELECT` PLUMB MECH
i00LIMNSED C&CRACTORT I)DECLARATION lob Descr1 tion
���+ rlt Scuba]UIBIaf Diviaon]af��rtm uOM16C SOS C�ode.,edmomrseing
+�a brunet=am p- REPLACE BATHROOMS FIXTURES (2 1/2) ,
?p o C'M'Or NON—STRUCTURAL
ARCH rECrs o
f s I uMuaartd my plana ah.B be 0001 n Ptblk rsordr
)y
e0C Lkumd Pmfc,aoal
` 3 OW NEA-BURDERDECLARATION
• I hucby ( to 1 am m0+npt from do Conuactofa l:My dry
O for the
O btrxh rtg runt Ornri, ]0115, adw.s,m Pm(arian Code:Any .m wwuy
3 9 hich tat ii to.permit m eaanay,ate.impm.e b e it, .zt any wtrnure
_2r p5ormas inwnce.awrcquaar We applkstfa tach Pumian rik,ugsd a,retawt
Flo (rnnr ,Mitt Sr fiotmWcpmvivW.n3onCoancm/+Llurs¢ �vlCaam9 Sq.F[. Floor Area Valu da 131
(c a it,U ttg wit Smim]D)a)N bazi,n 3 Nte ilattara P MPryAny
Codo)a
dw ti<a eaemvt Iltncfmm am dr batif ra t,akgm aemptbn Aar tioaden or
S=tion misbyany,ppllt:aW for.pnrnRwbj=4dbeantlkwm,wnpOnallyOf APN Number I
VupancyType
nm mart tba 11.bwdmd dollars(x503). 35623045 . 00
❑I.a oust of lit,Property,a my=Pwyma rhh W ipa a theae wm
axlpenadw �
will do do rark.,rtd to awwae is not Intended..Berm fm a.le(S..RW.Burin "��
wtd Plofemae.Cad Tho CoammaYa Liana I"clan not apply n an owe n Required InspEctions Y
property rho wlwr n impro.e.dtumrt,aad.hp ds,ach r«t hintreff a Moaµba
mmm�pk "w1edt,r�eimPa�mwn,Rnatt�ddoaR�feaa�IL. /3
hnrner.the auldag m hnpo.vouu a.mw wither aro yev of wmpkuoa to owrcr-
ealwer rIB boon to hvden a<anHng tha he dw�bbw a knpmve rar P,apoe� 10
ak). 06
❑1.n artna Or Ina'.Puv.w adaawy wna,aing wit Iimnred wnnranm m
wnatvt to prokn
mwahore cat�ravans ra,13.-. m.m Pmfain nn Cam ,
� a.p*m an wopaW 'ha buld,o,irnmeNertw,annd.
0-
fa wpoeta wit•canmmor(a)ti
Panum On to Cdoarnh
Limns tar.
❑Iva avnp vihr See .Bd PCfa tha ream
Due
WORKERS COMPEILSAIION DECLARAT
I hveby.11.ower penalty of perymy,One Or the ralbrag �
❑Mute pr WII for by
.Cara 37 D)of Conant,Codmf. far VJateh Canpea
tuna,r povi this
for by Seetwn d. a(to L Wer Code,fa the pufvmaw of Ne
wart far rhlcb thio pmmit a irnN.
❑I baro and rill maintain W ,Campemuioa Inau,rta,n trywred by Sccaioa
71(10nftbc ltaba Code,far tc pafamvtw Of do rat far rhkh nit Pemua IS luted. -
My Wor s Canpenvtioo Bawrma r.niv and Polky nun,=art:
Gaaa .5a *V5 6o - PakyNO.: eySW 1aet 7,2/0/
CEKr FICATE OF EXEMPnON FROM WORKERS
COMPENSATION INSURANCE
rnns awa.rob eat be wmy, .d to permn a forme huMCO dnfraOt($100)
a leu)
1¢ fy WL i0 the perfamaace Of to work fa which to Pvml+lr 1a I"I tut
employ any penen i0 any aanomran n to bcvrmc mbjm m de Wants'Compmmuon
la.r,or California Duc
NOTICE
Ncorne bj APPLICANT:B,afkr maung to CcNn^"th E+abor imi.,"aaW
bnome whim m to Wont).,Can Or th n pwrluaru of Nc IAba Cock,you moY
O ZO ratrith wmgy r W ouch prv.iumf a w.Permit rw1 ee aw,ttea rt.otra.
Z
14 CONSIRUCnON LENDING AGENCY
[� .. I hertby afnrm tha tert a,®mrvcdw kntng agtary ra to param.aw a
C:> tc work ra which tai,pmoia a Imnd l5ec]IRI.CI,.C)
W�Q Lance,Nann
o z Lcodch Mdren
U0 1 w,dfy that 1 laan too dda appllaloo ant Wt dm tx.bo.c wonn.tbn a
cotta.I.gra a comply rvh all dry arw warty Wantur ca tad rtak an rcaual m
I] buikini wn tOn.and lamby authorize mpmsotau.aoftha my n c: rc .pnn the .
a .ro.e-maaiama P.Pmr I.In,p .papas,
(We),grte
On a.S indcmafy aad keep humlea de City of Cuptr im apMLL
E"ti U,bilitijWgmeaa.amtaandnpcn0a rhlch may w any way wane.tawt raw coy
U Z in aan¢gsoa or to g ng Of to P=iL Z da l
^ APPLICANT UNE) NOS AND WILL COMPLY WITH ALL NO POINT Issued by: Date //� K
SOURCE REGU
///-q
�/- Re-roofs
sigtwaanarAppl
HAZARDOUS
AZARDaUSMATEIUALSDISCLOSURE Dab, Type of Roof
Will to,ppl'daa Or fuart bOdlding o xuPant ate Or\.MI^brurdun may nl
a defad by do Cupenbo Moa W Cade.Chat.,9.12.W th Halt and Way
.Scaian 155314)] All roofs shall be inspected prior to any roofing material being installed.
❑* ❑Nn
Rgll te,ppliaR Or fatae baiwinr awapuu=egulpm:nL Or de,5m which If a roof is installed without first obtaining an inspection,I agree to remove
wait haawta a,contamirt,m.a&orae by to B,Y Aru Air Otalay M,a,pmrat all new materials for inspection.
Dia;,]
❑Yn 0 N
Ihaat red 010�nrxaa mqulretn:n0 a rCbap 6.95Of tc Calif.
naFta"SL( Savw0 MSM.15573 am 25534.1 urtdctvm that if do building
doe,tea a,n,.. thw it a my myanability,m army to Occupaa a dte
mart naa, b mpdam vuacor,CaO"""O'Oq Signature of Applicant Date
Owner a wtlmNacd agent D„e All roof coverings to be Class"B”or better