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040600884 CITY OF CUPERTINO'"` a �- BUILDING DIVISION PERMIT �CONTRACTOR�NFORMAT,ION; BUILDING ADDRESS; WATTS CONSTRUCTION PERMIT N004060088 19865 BAYWOOD DR OWNER'S NAME: PERMrf ISSUE DATE JOE MARDESICH 3941 RINCON AVE oisho/2on4 _ SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSEDCONTRACTOR'Sa DECLARATION 1 Mrtby affirm Thal I am licensed un r provisions of Chapter 9 (commencing Job Descri lion j� \� A�•5 n p 1�10(XB.f Divismr3of the Basi d P.fessions Code. and my Lim. is in full and G �7 h - �,' or - BATRHROOM REMODEL ' Lice Class Lin. as t..\N Gonna SEP 23 2004 ARCHITECT'S DE��CLAR}} ION nJ my a shell be toed uTuWtfrtcnrds IW YL®YeIS/�Qtl �' Lia (cellon OW NEen'mrsDER DECLARATION I hereby a181m Nat 1 exmpn from me Conlns License Law for the Co I. Code: Any city or county followwhich sonsu Business and Proimprove. stroma demolish, which requires a Permit err cams domini requires poll any sltned alma nt plant Nits mitte Cp,also me for each fie ernma thu nt to a meapion of far Conrector'mfIese Law(Chapt enl Sq. FL Floor Area Valuation Business and Plofes vi Cmk)or mend gwitPuwantrodeofDiviomofofsConuacmr'aUcenxlaw(Cho Code) or wins Section 7000) of Division J that he s cog li and aper fm de alleged Any violation of Nal he 7 exempt the s any or ppiiCUon. Seton 70715 any cep fon permit subjects Ne applicant m a dein penalty of 6 � Occupancy Type p red doll not more Nan Rw hundred dollen (55007. five y yp ❑ 1, as owner of the property, in my employees with wages as deirsole compensation, ' will do the work and the awmure is not intended ornRertd forsale (Sec. 7014. Business and Professions Code: The Courteous Lianle Law does MI apply to an owner of Required Inspections Property who builds Or improves t erson, and who damsuch work himselfor through his own employers, provided that such improvements are, no'inteaded moRued for We. If, however. me building or improvement is mid within one year of completion. the owner - builder will have ths burden of proving that he did not Wild or improve for purpose of sola.). 1, as owner of me propeny, am exclusively contracting with licensed contractors to construct me pmjcd (See. 7014. Business and Professions Code) The Com musirs Li. cense law dors not pply to an owner of property who buflds or improves Neeson, and who contracts for such projects with a co rnactor(s) licensed pursue. to the Contimmes License Law. ❑ I am esempt under See. ,B@PC An this reason Ow r Data • WORKER'S COMPENSATIONDECLARATION I hereby affirm under penalty of perjury one of the following dttlantiom: have and will maintain aCerdlmm of Co.emmxlf-insure forworketsCompen- -.an. az provided far by Section 3700 of me Labor Cade, for the pertormanec of the work (m which Nis permit is issued. ❑ 1 have and will maintain Wmnsatio keYs Computation. Insuraaa, st required by Section 7700 of me Labor Code, far Ne perforreantt of me work for which min permit is issued., My rkces Comeat gesion Insunom carrier and Policy `K C RTIFI OF INSFROM WORKERS' CO COMPENSATION COMPENSATION INSURANCE (Thr section need WE becompleed if Ik Permit isloranc hundred dollies(g10) or REM) I mmfy don in me performance of the work for which this Permit is issued. 1 shall not employ any person in any manner in as to become subject o the Workers Compensation " Laws ofceifornia. Data Applicant NOTICE TO APPLICANT: If. after making this Car iOcae of Escmption, you mould become subject in me Workers Compensation provisions of the lahn CMe, you most forthwith comply with such provisions or this Permit shall be deemed mvoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm mat there is a consuuninn lending agency for the rinformance of me work fur which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address I avffy Nu 1 have read this application and sine ton the above information is Correct 1 agree to comply with all city and county oNivnas and some laws rolaling to building construction, and hereby aumodx mprexntatlws of this city to enter upon me •havices.judgm nmrest for impaction rty (We) agme to save, indemnify and keep ham lex the City of Cupertino against which may expenses which they in any way ett.e against Mid City Iiabilitimicence Of the Asequence of Ne granting of this vermis A PRCANT U ERST NDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date S RC R�L TION ��_ \ate l Re -roofs s .tanto g pp tc Dae HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardo is.aerial as 111ncd ay me Cupertino Municipal Code. Chapter 9. 12. and the Health and Safety Cade, 0cnnzss3zVm(.)7 An All roofs shall be inspected prior to any roofing material being installed. Will Ne applicant or future building acupam use equipment or devices which If a roof is installed without first obtaining an inspection, I g agree to remove p I hazardous air contaminants az Ucfned by the Bay Area Air Quality Management all new materials for inspection. tierces [3Ycs Z<No 1 road me haramms materials requirements under Chapter 695 of the Cslif.. nip is tyCode,Sati=ns M5.35533md2533a.lundcrawdth.ifde building dor n current haw a moans m. it is my rmponsiNlity m notify me mmupant of Ne nya Whswbfv'uRac elpt;ormimuamm.f]CSniRCa cupamy. Signature of Applicant Dale All roof coverings to be Class "B" or better O tnraumetmedagent Dae CITY OI' CUPERTINO .... �avR "R BUILDING DIVISION PER ... �T IN'FQ _>•s�.r�.., _ . e�'�a�.f�--v `tae BUILDING ADDRESS: WATTS CONSTRUCTION PERMIT N004060088 19865 BAYWOOD DR OWNER'S NAME: PERMIT ISSUE DATE JOE MARDESICH 3941 RINCON LYE 06/10/2004 E: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job 1 hereby affirm Nei I am licensed un Cr provisions of Chapter 9lcommcncing �'a �I rt— wi mi n]0(10)o(DivisionJof NC Bmi and Prafeviuns Cp4a-Mmylicmeis �smmntl[tn nn anderra� �/,�>,�g4t111'll�tfk/yr`+_x' BATRHROOM REMODEL Lice Clazs \ Lic. g i rti rt%_ (t `\n ki •. Cammw�.� . A �.y 1r6 s�7 200x1 ARCHITECTS DECLARATION I fu tad my paBr shallMuuJ es�uhlifrtcnrds • fJ Lis nK OWNER -BUILDER DECLARATION Ifi I M1crthy mTrm Not 1 em exempt from Nc Contractor's License law for tM heremfiesby > to mason. (Section ]031.5, Business and Professions Code: Any airy or county L) WJ2000 -q which "toms a permit In construct. alter, improve, demolish, or repair any structure It prior mics issuance. also requires lM applicant for ouch KMiuo file a signed statement Commcmr's License Law (Chapter 9 Sq. Ft. Floor Area Valuation i that M is licensed puruanuo Nc provisions of the, 3 (commencing with of Division 3 of she Business and Professions Coca)or that M is exempt shcrfrom and the b tie far the alleged exemption. Any violation of CIO 0 Occupancy Type Section ]031.5 by any appinam for a permit subjects the applicant a civil penalty of nos mom Nan five hundred dollars (SSW). I, azowner of he propcny, or my employees with wage, as Nei, ulc compervsun, Required Inspections will do the work, and the aboard. is not intended or oriented for sale (Sec. ]044, Business Said Professions Code: The Contractor' License law docs not apply m an owner of prbpeny who builds m improves Shaman. and who docs such work himself or through his own employes, provided that such improvements, art not intended or offered foraak. IL however, Ne building or imprevement is old within one year of completion, Ne owner builder will have She Imrden of proving Nat M did not build or improve for purpose of sale.). rJ 1, as owner of the property, am exclosivCly converting with ImcnKd contractors to constant the project (Sec. 7144. Business and Profusions Code:) The Conlaao,'s Li. came law dors not apply to an owner of property who Wilds or improves Neman. and who conmcta for such projects with a eonsacmr(s) located pursuant in the Contractor' License law. 0 1 am exempt under Sec. , B & P C for Nis season Owner Date *WORKER S COMPENSTFON DECLARATION I hereby affirm under penalty of perjury one of dre following decimations: - 1 have and will maintain a CCnificam of Consent to self-imum for Workers Compen- sation, az provided for by Section 3700 of the labor Code, far dee performance of tM work for which this pavan is issued. ❑ 1 have and will maintain Worker's Compensation Insurance , as required by Section 3700 of the Labor Code. for She performance of She work for which this Permit issued. nis -j My keit Comnlnsunna earticr and Policy �rybb\����{{�Z� IrJ ON FROM WORKERS' 7 CE �D� fpli9 OM O f/ CERTIFIC � OMPE SATION COMPENSATION INSURANCE ("nosseclion need not M completed tittle Permit is for one hundred dollars (ELM) rr mss.) 1 certify than in She perfermencc of NC .,it for which this Pc.I, It issued. I shall nos employ any persun in any manner o as to become subject in She Workcs Compensation Laws of California. Dasa Applicant NOTICE TO APPLICANT: IL after making this Ccnificate of Exemption, you should become subject to Ne Worker' Compensation provisions of She, Labor Code, you must forthwith comply with such provisions at this Permit shall te deemed mvnkcd. s CONSTRUCTION LEN0ING AGENCY I Manby affirm Nat Vertm is is s a c construction lending agency for See Performance of the work for which this permit is issued (Sec. 3M7, Civ. C.) Lender's Name lender's Address 1 tvdfy that I have ,cad this and se, Nat She SWw iws mining is City and county correct 1 agree m comply with all city and county ordinance and sum laws a building construction. and r upon t e euthon purpoesematives of this city m enter upon the for U ahovc-mentioned Propene for inspection purposes (We) agme to outs indemnify and kith harmless the, City of Cupenst S against judgmacam. cawing expenses which may in anyway accrue against said City / > in onsequencc of the gaming of this permit. A PLICANT,U DERSTgqNDS AND WILL COMPLY WITH ALL NON -POINT Issued by:94Q� Date 5 RCEREGUL TIONS, ��nZs rt \ Re -roofs Type of Roof Signitum of ApplicmUComractor HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future Wilding Occupant store or handle haordous material az defined by She Cupertino Municipal Code. Chapter 9. 12. and the Health and Safety Code, Section 25532(.)7 to All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove loYes Will the applicant or future building oceupant use equipment or dcvicu which mit havrdnus air contaminamu as darned by the Bay Arca Air Quality Management all new materials for inspection. District] / 0YC3 ZY's[Nu , 1 vem.d Nehamrdousm=rialsmquimmenuundcr Chapwr6.95of Ne Califon ria He & yCOdc.Seedans255(15,25533and2534.lun&mwdtheifthc building Zf des Ot curcntiy have a mare that is is my mspomihiliry m nodl'y the wcupam Of dm mqu menu whim use W I'ft poor w issuance of a Cenific!IXcupanry. Signature of Applicant Dale All roof coverings to be Class "B" or better O r.,au@otixcdagent Data Z(4? CITY OF CUPERTINO OCITY OF CUPERTINCO PERMIT APPLICATION FORM d(Lu 6o od-s— N # 31 / ' (/ (� � � J Fee Description Fee Group Date: i9 - \ 6 • C) � Building Address -\n ( Mailing Address (if different from building address): BBOILERI Boiler <= 100,000 Btu MECHANICAL Owner' Name, Boiler> I OOK to 500K Btu MECHANICAL Phone #: Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu Contracto : tn BBOILER5 License #: Contact: �( Phone:z3.1622 Construction Tax Cupertino Business License#: BCONSTAX Fax: BUILDING BCONSTAXBQ Building Permit Info: BUILDING BCONSTAXH Bldg 2' Elect L9' Plumb Ell' Mech ❑ Job Description: Residential ❑ �, `Q�+y� Commercial ❑ Sq.Ft. Floor Area: / t d ELECTRICAL BELEC1001 S/Sq.Ft.: Cost of Project: \V), BELEC200 Elec Svcs 600V <= 200A Occupancy Gro Type of Co struction: Energy BUILDING Please check t 'is box if the project is a Energy Add Multi BUILDING BINVESTIGA second -story addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK 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 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 <= IOOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING CJ 1 of 3 * -2's-t 21 CITY Of CUPERTINO r L CITY OF CUPERTIN(o PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING J BPCESSPOOL Cesspool PLUMBING \ BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING J BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ection',Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT _ Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Fumace > 1 OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL C 2 of 3 CITY OF CUPEkTINO $CITY OF CUPERTINO* PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmd] Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL _ BREMVENFAN Vent Fan Single Duct MECHANICAL \ BREMVENSYS Ventilation Systems MECHANICAL _ BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE - Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BS WIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING • 3of3