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03110126
CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRCIt)RINFORMATI©N Ra ' sYYfk�T:.� BUILDINGADDREsS. BOYER SHOWER CO INC PERMITN�311O126 21702 COLUMBUS AV PERMIT ISSUE DATE OWNER'S NAME: ROL MILLER 4847 BANNOCK CIR 11 21 2003 SANITARY NO. CONTROL NO. NE. (408) 379-8600 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH 0 0 0 0 IOmp LICENSED CONTRACTOR'S DECLARATIONJob Description I bemby affirm Nat l am licensed under pmvisiom of Chapter 9(eommcncing - m in withSuction7")ofDivision3ofthe BuincssendProressiuesCode And full force and effect. BATHROOM UPGRADE/GAS LINE +< LlccnuClua Lic.g-Contracts' TO DRYER /GAS TO FIREPLACE Date ARCHITECTS DECLARATION CONTRACTOR: ROBINSON' S PLUMBING E 1 unduutaml my plans shall he uud As public reenrds `yU Liccnud Pmfcssional y9�3 Oe,I am CUILOER DECLARATION 2 f I hereby seaso aRrm shat 1 1. nusin from the Contractor's C e:Any c Lew for the o o following season.(SucduI 711713,Business and ane dcaou Code:Any city or county 3$ which requires•permit m cnnamcL tlter.imProre,dcmalah,fir¢pair any nmcmm priormisissuantt.sts requires the applicant rorsuehpermit to(Lie asigned statement - S Ft.Floor Area Valuation 2ZxO that be is licensed pursuant totheprovisions or the Contractor'.LmenuLe.(Charter 9 q• . 2 $ (commencing with Section 7000)of Division 3ofthe Business and Professions Code)or $4000 Lt don he is esempt therefrom and me basis for the ailcgcd eaemptian.Any violation of Schon 7031.5 by any applicant for a permit subjects the applicant to A civil penalty Of APN Number .Occupancy Type .pt more Nan it.hundred dOlau(M). ❑I,ssowner of the prop6ty,mmy employee with wguu Heir tale mmpewdon. will do the work,and do.hin ore isnot intended oro@red instate(Sec.7(1 Business Re aired Inspections and Pmfeuions Cade:The Comrector'.Lt..Law does not Apply so An owner of 9 p property who builds or Im proves Nerwn,and who does"uch work himsel r or through his Own employers,provided Nu such impmvemenu tae not latendcd oralfered for sale.If, havoc.,our building or impm ounent is sold within arc year of completion.me owrcn Wilder will have du bureen of proving that he did not build or improve for purpose or - talc . 1,a Owner of the property,em exclusively convecting with licensed contractors m `e net the project(Sec.7014.Business and Pmfruions Code:)The Canm(toh U ccue law dos not apply As an owner Of property who builds or Improves liu m er.end. - whocontractsfmsuchprojectswithaeanvurear(s)licensed pursu nt m the COntri Lice.Law. ❑I Am exempt under Sec. n .B&PC for this reason '9.wner CA n.6Q� 1 j-�/ I m, Data 0-71208 W00.KER'S COMPENSATION U 1 hereby arum under penalty of perjury aro of the following decian d ou: �Ihaveandwillf.,b, aCertificate Of ft UboCl ,rumfar Workeh Compeno were,r provided for mi Ss issued.7700 of the Isbor Cade,for the pesfo.....f the were for which this permit le issuM. ❑1 have and will maintain Wmaces Compewdon Insurance.u requited by Section 3700 of the Labor Code,fm the performance of the Wart for which this Permit is issued. My Werkce,Compensation Insurance carrier and Policy number tae: Carrier. Policy NO.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE Crisis ucdm reed par beemnplemd tribe Permit 4 feronchunduddnllan(SIBo) M Iese.) I deify that in the performanec of the work for which this Permit is issued.I NAZI net employ any person in any manneran As be become subject to the Workers COMPematlon Laws of Califami&Data Applicant NOITCE T'0 APPLICANT:If,her meting this Certificate of Exemption,you should become subject to the Worke's Compcnsadon provisions W the Icahn Che,you must OZ forthwith comply with such provisions or this permit hall W dcemcd revoked. �C CONSTRUCTION LENDING AGENCY Ihemhy M.Net mere is•construction lending agency for Out lerform.of yv . the work to,which on.permit a stood(Sec.3097.Co.C.) W QLeackes Namm M. Lender'.Address U1 cenffy that I have read Nie appliculon and sus that the above information is IA mrr¢t.I agree on comply with all city and county ordinances and state laws mating to buildingeonswee construction,And Inde nifyAjudiudrteep hatnmiw•s of this city mencrupnn the W eWva•mcmimcd propedy for Inspection Purlmua CSjuegroes,cove,indemnifyandkith may Citycu Cupertino against ^A rA InconmqucngmenW ensuing expenses which may In my way eccroe against said City 4/// U 7 A APPLICANT of UNDERSTANDS Of this Permit Date/ G L7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGU T S A_�, Re-roofs Igmmreof ApplicantlConusemr Des �I of Roof HAZARDOUS MATERIALS DISCLOSURE •]pe Will the applicant or future building uccupanurou or handle havudous materiel As dented by dm Cupertino Municiptl Cods.Chapter 9.12,and the Health and Safety Code.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. C Yea 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 mit havardous nit contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ,��/ QYce To I have real the haurdrus macrols requirements under Chapter 6.93 ofthe Califor. M.Health&Safety Coda.Sccdons 735115,35537 and 2553!.1 understand thou ifthe Wilding dors not currently have a temnL thos is is my responsibility to rami l'y the occupant N the requirctrus which must met prior In iA nanee of a certificate or occupancy. Signature of Applicant Date " -2d y20e All roof coverings to be Class"B" or better neror a tho ned agc t Date CITY OF CUl"ERTINO BUILDING DIVISION PERMIT 1ACONTRACTOR INTO,ORMATION. BU I I.DING ADD RESS: BOYER SHOWER CO INC PERMITNL03110126 21702 COLUMBUS OWNER'S NAME: PERMITISSUEDATE ROL MILLER 4847 BANNOCK CIR 11/21/2003 WE: SANITARY NO. CONTROL N0. (408) 379-8600 ARCHITECT/BNGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH :oo LICENSED CONTRACTOR'S DECLARATION G7 O O O eE 1 hereby arfifm mal I am re<naed undo,provisions or Chapter 9(eommeaeag Job Description S Azw with ection 7")or Division 3 of he Business and Professions Code.and my license is in full mrecand effect, BATHROOM UPGRADE S ' INE i License Class Lic.N ;r`o Date Contractor TO DRYER /GAS O'°`F,+IREP ACE uJ RCHITEGTSDECLARATION CONTRACTOR: R�)�,INSON ' SrPLUMBING Ida 1 undersand my planshall E 7'S s DECLARATION Accords v` e A. Licensed Professional l C OWNER BUILDER DECLARATION L<g 1 hereby affirm that I am exempt from the Contractor's License Law for the r '0 following moron.(Section 7031.5.Business and Prolaxions Coal:Any lily or county ' <ea w which requires a permit to construct,alter,improve,demolish,or repair any structure prior o its issuance.also requires the applicant for such perm it to flc a signed statement V < that he is licensed pursuant tothe previsions ofthe Contactor'sLiccascLaw(Chapter 9 - Sq. Ft. Floor Area "jam Valuation �FG (commencing with Section Division 3 of the Business and Professions Cssac)ur // $4000 �� $ Nat he is exempt tnemrmm and the bazb for me alleged csemption.Any violation of Y 4 0 0 0 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number I )�J -Occupancy Type AOL more than five hundred dmlaa(s500). �%� \ Occas ane T e ❑ I.as,ownerof the propeuy,i,my employees with wages as until sole compensation, �•/ will do the work,and the stuchm is not intended or offered(or sale(Sec.7W,Business /✓. !a/ nes Professions cone:The conBaaora ndwtho Law sees or apply to an owner or Required Inspect Property who builds,proof improves thereon,and who a«a sten anile Mmselrershmugb his VV own employm,provided or i Inas such improvement arc not can of mtirercd for owner, however.the building or improvement is sold within one year or completion.Ne owner, builder will have dm burden of proving for he did not Wild or improve for purpose Of Z1,m owner of the property,am exclusively contracting with licensed convectors to c tum the pmject(Sec.7D44.Business and Professions Code:)The Contractor's Li ccmc law docs not apply to an owner of properly who builds or improves treason,and who commcu for such prujeca will a conaamor(s)licensed pursuant m the Cmnractur's Licems law. ❑ 1 am exempt under Sec. .B h P C ror this reason 9wncr COAAQ 0.�74 A b0 Qi& Dam ll-2F'1V`9 WORKER'S COMPENSATION DE(2. TION 1 hereby affirm under Penalty of perjury one of the following declarations: 1 have and will maintain a Certificate of Conscnl to self-insure for Worker's Compere cation,as provided for by Section 3700 of the Inhor Code,for Ne performance of the work for which Nis permit is issued. 1 have and will maintain Workers Compensation Insurance,as required by Section 3700 of Ne Taber Code,for the peRmmavice of he work for which his permit is issued. My Worker's Co.fensmion lnsame.carie,and Policy number aa: Conner: Policy No.: CERTIFICATE OF EX EM MON FROM WOR K ERS' COMPENSATION INSURANCE (This section need not M completed if the permit is fm one hund¢a dollars(Sip)) fir h..) 1 eerily Nm in the pe rfumanee of Ne work for which oris permit is issued,I shall not employ any Penson in any manner so as to become subject to the WorkersCompensation Laws of California,Date Apprcam NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should Let$Object to the Workers Compensation provisions of the Labor Code,you must �O foMwilh comply`"'ir such provisions or this perm i t shall be,deemed mvokcd. Z CONSTRUCTION LENDING AGENCY I hereby aM'rm Nal here is a construction lending agency lot the performance of 5 the work for which his permit is issued(Sec.3(87,Civ.C.) w 0Lender's Name 0. Lender's Address � z U O 1 emir,the,1 have read this appncatmn and sure that the above inrmmmitn is 'J. P cornet.1 agree to comply with all city and county ordinances and sutc lads misting to OU Wilding construction.and hereby autbarine representatives of his city to cover upon the C How mentioned PmPcry for inspection puspous. (We)agree to Lave,indemnify and keep harmless the City or Cupertino against F' N liabilities,judgments.costs and expenses which may in any way see=against said City �}�/ U in consequcncc of the gaming of this permit. / '—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dat eeG� SOURCE REGU AT S o Re-roofs is ofApplieaH Contractor HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof Will the applicant or future building Occupant store m handle hararaous material As defined by the Cupeninn Municipal Code.Chapter 9.12,and the Ileahh and Safety code.semina zss3z(a)7 All roofs shall be inspected prior to an roofing material beim ❑Yes 5x(m P P Y g g installed. Will the applicant of future building Occupant use equipment or aevieca which If a roof is installed without first obtaining an inspection, I agree to remove hvardous air contaminants az Jcrinca by the Bay Area Air coal fly Management all new materials for inspection. Distrin7 ❑Yes I have mad he ha uhmsmaterials requirements under Chapter 695 of the Califon ria Hallo K Safety Coale,Sections 25505.25533 and 25534.1 undersand ALL if Al Wilding does not curently have a tenant Nat it is my neslamsibilay to norly the Occupant of me requircruna which most mel prim"to is umce fir a cerireate or OccuPpncyy. S ignature of Applicant Date All roof coverings to be Class"B" or better ncr or aAtu ri.d spent Das