02060106 CITY OF CUPERTINOI"- ..
BUILDING DIVISION PE T 1C9NT ACTOR--INF� ,0 ITON:
BUILDING ADDRESS: WPERMIT NO.
10188 RIDGEWAY DR CALIFORNIA BATHROOM REMO ELERS 02060106
OWNER'S NAME: APPLICATION SUB DATE
GRASSE CHARLES L JR AND CHRIS 783 REGENT PARK DR 06/18/2002
PHONE: SANITARY NO. CONTROL NO.
i
ARCHOTC`r/ENGINEER: BUILDNO PERMITO
O4083609706 INF
m C BLDG ELECT PLUMB MECH
as
LICENSED COMAACI'OR'S DECLARATION
y 1 hareb .truth that l an licensed ander : f Cha ter 9(commenen Job Description
Oz—o Y previsions f..i P 8 ������®
F_":c cormSeeeion]000)ofDivisinlormaBaainessagQ ressinnscode.andmyran,e BATHROOM REMODELING
is in full fo d cRcct. s/
aLicense Lk. U
3 D x+
t w. g ` f undcrstaM mY plans shall I be used as puECL
i<rec°Ns TION """ JUL 2 2 2002
`al>•I It-Pme di J
i
es,
n o Licensed Professional
e� OWNER-BUILDER DECLARATIONor BUILDING
hereby aRm r s rthat 1 am exempt from the ConmemLicense Law for the
F i¢ following reason.(Section 7071.5,Business and Professions Code:Any city or county $11000
Y"O which requires a permit to construct,alter.improve,demolish,or repair any s r tum
altkcc -prior m its issua ,a
ncelas¢quims,lic.,licansu
rforchpc.ittzsi
o flagnal staen
mmt
a. read h'l it licensed pubminupp the previsions of me Ommacmek Lice.Law(Chapter 9 pt� 1A Or,,��,,��s�. Valuation
m.onmenting with Section 7000)of Division l of the Business and Professions Cod<I �'r'ti � ',4'ZSC 7,V�YS-. ui �f�1'.! ',�� �� I''a•
or that he is a c qpt thelefram and ma basis for the alleggl ek<mptlon.Any vialmion
of Section 7011.5 by any applicant for a Permit subjects the applicant to a civil penalty
or not mom than five hundred dollars PS500). 101Ai'NI�bMtMATION Occupancy Type
°1,as owner of the property,or my employees with wages as their sole compensation.
will do the work and the structure is not Intended or offered far sale(Sec.]044{ -' --- - - -
,Businass and Professions Code:The Contractor's License Law does not apply to an 103 - UFER Required Inspections
'owner of property Who builds or improves thereon,and who does such work himself _ 10 4 - REBAR _
or thoughe
ohis own employe .provided mut such improvements era not intended or
'clicked far W..Jr.however,the Wilding or improvement is sold within one year of 105 — ANCHOR BOLTS
completion.me owner-baild<r will have the Write.of proving that he did not build or
improve Tor proteose ofsdc.). 106 - SEWER & WATER
O1,as owner of the property.an escwswely contracting with licensed contractors m - 202 — UNDERFLOOR PLUMBING
construct the project(sec.7044,Business and Professions Code:)The Contractor's 2 03 - UNDERFLOOR MECHANICAL'
License Law does not apply to an owner of property who Wilds or improves mcreon,
and who contracts for such projects with a contramor(s)licensed punu r,m the 204 - "UNDERFLOOR FRAME-- - - -
Contractors License Law. ,
°I am aaampaunder Sce. ,B&P C for this reason 205 - UNDERFLOOR INSULATION
Owner 301 - ROUGH PLUMBING
WO KE.PENSATIONDECLARATION 302 - TUB & OR SHOWER
I thereby amm,under penalty of penjany We of following declarations: 303 - ROUGH MECHANICAL
° 1 have and will maintain a Certificate of consent on sett-insure far Warkcrs 304 - ROUGH ELECTRICAL
Compensation, as Provided for by Section 37W of the Labor Cade. for rhe
pndmirmance of me wars,far whim anis pamrit is issued. 305 - FRAME
°I have and will maintain Worker's Compensation Insurance,as required by Section 306 - HOLDOWNS
3700 of the labor code,for the performance of me work far which thio permit is 307 — INSULATION
'.s d.My Wor lis Co pensai a Insurance canter and Policy number arc:
308 SHEE. 1 .. . .' "' """'
t LIO l 'Policy No. �ZI�I UiAr"I U {,�,•, ;. 4-,
e�, t CERTIFICATIONOFEXEMPTION FROM WOR KERS'0 31O'B t— uCaXTERIOR' 'LATH'(
COMPENSATION INSURANCE I'
.310' -.."INTERIOR LATH-
(T7nis section need not Iia<nmvmmd arae permit is for one hundred donate 311 - SCRATCH COAT
(E 100)or lex.)
1 certify that in me Performance of the work for which this permit is issued.1 313 - ROOF NAIL
,shall not employ any p,rso in ymannera I tgb : lip ej<a to me Workers' 501 - FINAL ELECTRICAL' ENERGY
Compensation coy fCaN Dare 9 U L .502 - FINAL PLUMBING ENERGY
CcmrpkAppixant -.
NOTICETO [CANYnit,after making ns Cambium ofE.mmptio .you should 503 - FINAL MECHANICAL 'ENERGY
O Qbccom,subj<n the Workers ComPensation provisions of the Labor Cude,you must
forthwith coin ly with such provisions or this permit shall be deem504 ed revoked. _ FINAL BUILDING ENERGY
CONST RUCTION LENDING AGENCY 505 - FINAL ELECTRICAL .
1 hereby affmn that mem is a c.mmuctiun lending agency for the peanrmaoce
of the work for which mi: mit peris issued(See 3097.Civ.C.) 506 - GAS TEST
y p Lenders Name 507 - FINAL PLUMBING
Z Lender's Address
U Icenifymatlhaveraadthis applica0ionand sumthat the abuvemformmionis 508 - FINAL MECHANICAL
w t correct.I agree to comply with all city and county mu anew and one,law.reaiag 509 - FINAL GRADE
V
to Wilding construction.and hereby amhorick representatives ofthis city to enmrupon
>, w the above-mentioned pmpertyfor inspcciionpurposcs 510 - FINAL PLANNING
E.0 0. ("Ic,graetoxeve.indemnify and kmpharmlce;the City ofCapetian against 514 - FINAL UB C WORKS
V3' liabilities,judgments.cos¢and expenses which may in any way swerve again said
V Z City in consequence.1'he granting or this permit.
^ APPLICAN'TL'NDERSTA. SANDNILL COMPLY WrmALLNON-POINT Issued by: r Date tT�
SOURCE RLi'�YI..YIION \�/� r`. y'
gnmurc of Apppp//licaaarr/Comvctor Beim� Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will me applicam or future Wading«cuvani stare or handle W,mdaas material Type.of Roof .. ..
as defined by me Cuperoom Munich I Code,Chapter 9.12.and the Health and Safety
Code.Simian 255A(a)^
°Yr "° All roofs shall be inspected prior to any roofing_material being installed.
Will me applicant orf or Wading occupant use equipment or device which If a roof is installed without first obtaining an inspection, I agree to remove
ethic hazardous alt conmmiwnr,a Defined by the Bay Arca Air Quality Management
District all new materials for inspection. Applicant understands and will comply with
°Ye o all non-point source regulations.
1 have read the baaardoos materials requirements under Chapter fi 95 of the
California Health&Safety Code.Sections 25505.25513 and 23534,I understand thin
if me building due,not currently have a meant,that it is my responsibility to notify the
occupant of the requirements which must be mes on,to issuance of a Cerifieme of
Occupancy
A signature of Applicant Date
weer or authorized agent All roof coverings to be Class"B" or better'
OFFICE
(Cv= •ITY OF CUPERTINO oZ
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
�67APN# -3412 // OO ;? �j Date: / / o L
Building Address:• Zj
0 i g 8 a-1 9G
O(wner's Name: Phone#: L S6 7 C
00 (3 g� ,✓ -7,y
Contractor: License#:
C.I1 01!L /t//A- 6/aT lan.w n Y� qg
Contact: Phone#:
A-L,L y /LJ -36 a - 7 a
Applicant/Contractor: Fax #:
SA A 3 6 a 97
Buil Permit Info• ��,
13ld 1 Plumb Mech
J scription:
sidential: w-r^ To I U"Tr• Commercial:
Sq.Ft. Floor Area: Z $/Sq.Ft.:
Architect/Engineer: Valuation:
Type of Construction: Occupancy G ioup
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 <= 1O00A 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 v
I of3 �2,0 �v
�c� � C+ 6lTL/LCL �L�ZS /� /� ✓C %�
ok
j3AL
�,it f�- L//.YL
' �
APPROVED /7
IN p RDANCE WITH THE CITY 09 Q 91k
Cpm DES AND ORDINANCES
�De�
SA"I 3 "
fm
itris set of pla ' and specifications MUST, E
� Dept on thr iob at all times and it is utt, Z
pf to mak any changes or. alterations
Amo wdhuut written permission froOn m
tbro building Dept., City of Cupertino,
sfampSag of this plan and specification
-NALf NDi be held to permit or to be an
r 7 nj the violation of any pravisione
,a.
`4 ordinance or State Law.
• b
II
h,
3y
SUBMITTAL
#1
0
CITY OF
BUILDING DIIVIISONNOPERMIT CONTRACTOR INFO TINT
BUILDING ADDRESS: PERMIT NO.
10188 RIDGEWAY DR CALIFORNIA BATHROOM REMO ELERS 02060106
OWNER'S NAME: APPLICATION SUB DATE
•GRASSE CHARLES L JR AND CHRIS 783 REGENT PARK DR 06/18/2002
PHONE: 4083609706 SANITARY NO. CONTROL NO.
Z ARCHITEC(ENGINEER: BUILDING PERMIT INFO
00
BLDG ELECT PLUMB MECN
m
�yy
Z z a LICENSED CONTRACTOR'S DECLARATION Job Description
OZ-m� Ihen:7000)om ivisihat 3.fthudundcrprovisiunzofnbCWm,.d.ylcncnw BATHROOM REMODELING
F m with section]000)of Drvisi nJof the Business agl(Pr feesions Codc,and my license
a is in ruse ro d e(rea. e//� w� d
s 6 LicI Lic. ■ �m.®
u�3r Dm7�4 Comra< �.� ie
I unders:ark mY PIanR sha 1 be uused as pu is reccards
arh� 2002
w E o a Licensed Pmfcssionel JUL 22.
OWNER-BUILDER DECLARATION
1 hereby affirm:hal 1exempt from the Contractor's License Law for the
F Z a following man.(Section]031.1.5,Business and vePoemoli h,or Any city structure. Al
E F o which requires a permit to conswcr,ol¢r.improve,demolish,or repair any swcmre. bite
3 .prior to its issuance,also requires the applicant for such permit to file a signed au«mem.
that h4 it licert4,ed pibuannq the provisions of the Commerce.,Lt..Law(Chaptm9 r, _ Q4 F[s IFsOr,d,re� s., r N Valuation
Iranian ruling with Sreiion,7760d)of Division J of the Business and Prolysion.s Code) .Q.} I`Y ' 1"li:%�.YJr:'19/'UC
nr that he i7 exempt any
applicant
p li and the huffs for the cts the
pplicanoo Any violation
of Seaton,lh m v any dreg dollar,
for a permit'ubja¢the cpplkanno o civil penulty-
ormm�mremanr.enunareaamlara(Ss(n)' 101APNPb(9SMATION `^���- 'tt Occupancy Type
❑I,uowncr of me progeny.ser my employees with wages az Neir sole mmpensaion. 102 PIERS
-
-will do the work.and the insurance is'nm itneaded or offered for sale 7Dt4;'
'Business aoil Profession,Code:The Contractor's License Law docs nor apply to an 103 - UFER Required Inspections'
owner of property Who build,or improves thereon,and who does such work himself 104 - REBAR
or through Ms own employees.pmvided that such improvements are am intended or
'"-offered to?sale.If,however,the building- improvement is sold withinn-one - of - .._.. .__.—,. ..._.__. . .
ot itnpra.en tomo ._..--105.. --...ANCHOR BOLTS ',.,•.,'�.. ..
completion,the owner-builder will have the burden of proving that he did not build or
improve(c"tin,seofmled. 106 - SEWER & WATER
Le --.. __ __- d 202 - 'UNDERFLOOR PLUMBING .- --1 7
..C I,ee gwher or tec mopeny.am Burin i ss a contracting with mused eamruamts to ...... ... ..
ctheonstruct does rsppl]oil,Owner(if andertywhion.,cwe:7Thevestmcmrs 203 - UNDERFLOOR MECHANICAL mid, 1 '
,- License Law doer'not apply to an owner th progeny who builds oeimproves thereon,
. Con raco commas for such Projct'm.with.a commctor(s)licensed pursuvnt to me.. . ..-._. . - -204-- - -UNDERFLOOR' FRAME— '---'- ------ ---- --- -- --
01 amines pt ad,Law.
- ❑IamnemptunderSec. B&P C for thisrtason 205 - UNDERFLOOR' INSULAT•ION
owner` Dte' 301 - ROUGH PLUMBING
_ • ' WORKER'S COMPENSATIONDECLARATION 302 - TUB & OR SHOWER
-I thereby aM.snder,"d!yofNij�ry6.Ofthe folIrwinguse lmanoas. 303 - ROUGH MECHANICAL
❑ I have and will maintain a'Cfnmcme of Codsa d to uB-inaurc for Wmleca 304 - ROUGH ELECTRICAL
4 Compemmi...-as provided for by Section 3700 or the Labor Code, for the
performance of the work far pmrn this 0ermn_is issued. 305 - FRAME
C 1 have and will miiamm Worker's Compensation Insurance,as required by Section 306 - HOLDOWNS
37M of the hbor Cade,for the rforrnance of be,work for which his permit is _
a
i�sr�d.My Wo ea C pcis n Insurance carrier and Policy number arc: - 3 7
:..- INSULATION
J(, o4ZlQ o!Un r�o 1 ` -----30 0 8 -= S K--._-__.-._. ..._,... - ----._ --- -
.. : �ahiic 1 HEETROC . .. . ,
ERTIFICATIONOFEXEM"IONFROMWORKERS'' ' - .� �3��0�9' - ''EXTERIOR` LATH'+:
` ' RA
COMPENSATION IN
SUNCE I''•.'•is __.._............. _:.......,.,--....
_..,... .. .,, _ . _. .: ...... .. .:... .. _ .... . 3'10-•`;-;-INTERIOR-'liATH-:._ ..;.... . _
'a I.. Mia iochminem nor 6c i amPleted if the pc.air is far one hundred dollarst�
311 - SCRATCH COAT I' -
(sloo3 I 1
1 n fY�h t th pert ce f the ork rot son h iht permit 3 13' - .-ROOF-NAIL
rs ed l 501 - FINAL ELECTRICAL
t
sM1`II t pl Y.toy p:. Y n tq,h Ftyrpynj t t th W lee s
Co Pe t m w IC Die 9 /V O 502._-. FINAL PLUMBING ENERGY.
.APP( ttr must .._ ----------
NOTICETO ICA`T If f mak g Cerffcme fEs<mptbn you:no Id 503 - FINAL MECHANICAL"ENERGY '
buca s Meer thn Wo k e C pens t pm s o(th I W Cale yn
O form mo mplywith .bp nso i P t.nauxa«mm«vokea. 504_ FINAL BUILDING ENERGY
..
Eliz) - . �' CONSTRUCTION[.ENDING AGENCY 505 - FINAL ELECTRICAL r
� ' ,, (hereby aRrm chat the uconswnion lent ng agency for the pertntmance 506 GAS TEST 1
s
Of
the work for which this permit is i...W(Sec.3091,Civ.C.1
lenders Name'- ---' �
°•'z Lenders Address 507 - FINAL; PLUMBING.... .. ..
: v;0 508 - FINAL MECHANICAL
I cenily than I have read this applicn tan and acme that the above infarmwion is
ta+.[.. uorreci.I agree to comply with all eay:nd county ordinances and ante rams claim, 509 - FINAL GRADE
'. O U to Wilding conorwaien.nvdherebyauthorice«presenmavr,.rthis city merrier upon 510 - FINAL PLANNING
th W e tneJ m
ppeny f 'nepern ppo
rse
(We)agcr to sae.indemnify and kiciop WlsitneCityOfCupcninoagmaat 514 - FINAL UB C WORKS
Vi
liabilities.judgments costs nd pens' which may to any way accme age n•r said
U Z Cty' . q cc fth g i ng of th emat..
"-'
AT LICANTUNDERSTAN SANDWILL COMPLY WRH ALLNON.POINT/ Issued by: Dale �`-
SOURCERIii'.YIX/IUN� - Me a'`. y
�igwtu fAppbcunVCcmmnor lsdic, Re-roofs v/
HAZARDOUS MATERIALS DISCLOSURE
..
Will the applicant rt t wildinga pa tstorec handle haemdousmaterial` .Type.of_Roof_ .._ ... _ _ _� ........ .. .._ _.__.. ... _ .._..-
t' 'aa Jct ad by th C p n Man . I Cod Chapter)11 d the Health and Safety s„] y
code.,gCeY n355321) r I'D t. - (vf r i ilv l s y), ., t( Id, f':1UL 'Fx in is a;
_ All roofs shall be inspected prior to any rooting,ma[erial being installed
Willits ppl i for Wilding Occp nt use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
soft h...than a r co mmmanss a defined by the Bay Area Air Quality Management
[District? all new materials for inspection. Applicantunderstands and will comply withoY` - ' allnon-point source 'regulations. l ,have tend themhardous materials requirements under Chip¢r ti.95 of the
allfemiaHmlth&SafetyCode.Sinons25505.25333and25534.IundcmandtharNa Wilding does not currently have a tenant;that it is my responsibility to notify themi'mo ofrhe requirements which must W met priorm is.,mnoe.ofo Ccnifica«of
wner or amM1arizcda cn
pa"`y /Signature of Applicant Date
�y All roof coverings to be Class"B"or better
„-.. .
OFFICE .. . .. . - _