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03120126
CITY OF CUPER'I'INO a ' +'¢ a'v= "� .v-�e BUILDING DIVISION PERMIT JON"," BUILDING ADDRESS: BATHROOMS BY HANS PERMIT N0.3120126 nWNER'S NAME: PERMIT ISSUE DATE I E: - SANITARY NO, CONTROL NO. (408) 978-3053 7AIC'�'IlITEC IENCINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am Booed under provisions of Chapter 9 commerving Job Descrip ❑ection 7003)ofDivision3 ofthe Business and Promaxiuns Code,and my license is in full fno:e m feet. LI F3 License Class Lie.a /� REMODEL 2 BATHROOMS FEB 16 2004 Dam Cumra`eLor,�_ `, ARCHITECTS DE ATION �W U I umetsW my plan:shag W used u public rttords yqy tLLF LiccnscdPmfcssinnel - BUILDING `Og OWNER-BUILDER DECLARATION <P I Wrehy aif,.that 1 am c..nmo from the Comrii License Law for the 00 following mason.(Sectiun 703[.5 Business and Pmfcsslnns Code:Any cllyor county 'm which requires a permit to construct,ACT,improve,demolish,or repair any atrucme to prior to its issuance.also nupM=the applicant for such permit to file a signed statement ESC that he islicenuJPursuaouothepr�visi�nsoftheCommcwr'sLicensoLaw(ChapmrY Sq. Ft. Floor Area Valuation Y~� (commencing with Section 7000)of Division 3 of lM Business and Professions Code)or `< Nat he is exempt Remfrom and the baso for the alleged exemption.Any violation of ,wwhwi�s,A, Section 7031.5 by any applicam for a permit subjects the applicant to a civil penalty of 3.1lmsJl41sa1sWel00 Occupancy Type not more than five hundred dollars(S5W). p Y yP ❑1,u owner of the property,or my employees with wages as their sole compensation, will do Ne work,and ate suuewm is not intended or offered for sale(Sce.7044,Business and Pmfessimu Cade:The Comuacmh License Law does not appy m an owner of Required Inspections property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements arc not intended orpRered foraale.If, howewf.Ne building or improvement is sold within me year of c.rndod.n.the Owner- Wilder will have Ne burden of praying that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am uclusively contracting with licensed contractors to construct the pmject(Sec.704,,Business and Professions CodcJ The Convictor's Li- cense law does not apply to an owner of pmpeny who Wilds or improve Memon,and who contracts for such projects with a conmacmr(s)licensed pursuant to the Convacmrs License L. Cl I am exempt under Sec. B k P C for this reason Owmer Dam WORKER'S COMPENSATION DECLARATION 1 hereby alBnn under penalty of perjury one of the following doelarations: ❑1 haw and will mainuln a Certificate of Consent to self-insum for Worker'sCompcn- station,as Provided for by Section 37W of the IaWr Code.for the performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,u ecuired by Section 37W or the labor Code.for Ne performance oldie work for which this permit is issued. My Worker's pematioo lnmo aicr and PoIIicy OFnor rep" 20 o, CERTIFICATE OF E%EM OM WORKERS' COMPENSATION INSURANCE Qhisseetim need not W completed if the permit is intent,hundred dollars(SI(X)) or mu.) 1 certify that in the performance of Ne work for which this permit is issucd,l shall not ' employ any person in any manner an as Io Wcomc subject p the Workers Compcumion taws of California.Date Applicant NOTICE TO APPLICANT:IL after making this Cerificam of Exemption,you should become subject to the Worker a Compensation provisions of the labor Code.you most .,z forthwith comply with such prnvisiou or this permit shall he deemed invoked. z O CONSTRUCTION LENDING AGENCY [— Ibepahy affirm Nat them its coutmct(on lending agency lir the perfurnanec of Ri the work for which this permit is issued(See 3097,Civ.C.) (y `� Lender's Name .D7 z Lenders Address U O 1 certify that 1 have read this application and sum that the above infmmadun is D, F coven.1 agree to co with all city and county ordinances and sum laws palating to pU building conswcti hereby authonx repmscmatives of this city to enter upon the ahovo-omaniunrA pc ty or its Cion rposes H pW, ( ogre m w, ndc i p less the City of Cup mm.against h Nabi 'c udgm not. Cut nd pc 'ch a in anyway accmc agaimslmid City U z in co ounce Ne ran ng in no. APP SOU A LD OST MPLY WITH ALL NOWPOINT Issued by: Date Zf O Q� S' t rt of Ap Re-roofs Dem HAZARDOUSMATERIA DISCLOSURE Type of Roof Will the applicant or future building men t stem or handle hazardous material Is d ned by the Cupenino Mu mipal Codc.Chap Code,Section 25532(a)7 .12,and the Health and Safety ❑yes No All roofs shall be inspected prior to any roofing material being installed. t' g an If a roof is installed without first obtaining inspection,I agree to remove Will Me applicant me'futme building occupant use cquipmcal or devices which p $ dt hazardous air conum''anu defined by the Bay Area Air Quality Management all new materials for inspection. Ducrm,? ®A'N ❑Yes ✓ N I hav dumb aide sera rialsr uundcrChaper6.95ofthcCsllrof- niaHcalth S rye ISO c sins ) 5 534.1 un rsmnd the if de Wilding dors not c Iy h to nls dully m till'be ocaupam or the rtquimmcn m I orc aCcruuficate cupancy. Signature of Applicant Date ow rut.ut d e - Doe All roof coverings to be Class "B"or better BUILDING DIVISION PER 'CO NTaAACTOR INFORM , N BUILDINGADDRESS: BATHROOMS BY HANS PERMITN(b3120126 199c;:7 PEWKKAN OWNER'S NAME: PERMIT ISSUE DATE NE: .492r TIFTON WAY SANITARY NO. 2 CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH .Oo LICENSED CONTRACTOR'S DECLARATION Job Description C I hereby affirm uta,I am licensed under provisions of ChOOSCFIp Chapter 9(commencing u, with Section 70M.f Division" J fOc Businesand Prufessiuns C.de,and my license is n in full force an fes i ? Licence Class Lie.a` 14 REMODEL 2 BATHROOMS �Fp Date CuntARCHFTTCI S DE or MATION I undc�my plans shall W used as public records � U a G Licensed Pmfessirnal S OWNER-BUILDER DECLARATION +�<� 1 hereby affirm that I am exempt from the Commetors License Law for the 0C following msson.(Section 103 L5,Business and Prore.Num Codc:Any city Or county K m which requires a femur to construct,alter,improve,demolish,or repair any.mmetum 'j: prior m its issuance.also rrqwre the applicant for such Permit to file a signed statement < thathcislicensedpursuantWtheprovisionsofOcContractor'sLicenseLaw(Chapter9 Sq. Ft. Floor Area Valuation yHD (commencing with Section 7M)M Division 3 of the Business and Pmless;.m Codc)or s.`f Nn he It emmpt therefrom and Ne buu for Ne alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjseta the applicant o&civil penalty of 3]f1�3`bl3ulffbel0 0 Occupancy Type not more than five hundred dollars(5500). ❑I,uowner of the pmputy,or my employee with wages as their role compensation, will its the work and the svumurc is not intended or offered for sale(Sec.1014,Business and Pmrexsmru Code:The Contractor's Lice.law docs or apply to an twne,of Required Inspections propeny who builds or improves themon,and who docs such work himself ser through his own employees,provided Na such improvemenu are not intended or offered for sale.IL however,the building or improvement is sold within one year of completion,the owner- Wilder will have the burden r!pruvin,Nu he did not build or improve for purmsc of ole.). a��0 ❑I,b owner of the pmpeny.am exclusively contracting with licensed contractors i. J rouwm the es not (Sec.loan.Business and Professions Codei The Conheeton. nd /�y ccue law doe;not apply b ts owner of pmpeny who Wires or improves thereon,and V/ who contracts for such projects with a eantissmr(q licensed pursuant m IW trato Concrs �C Licensense Law. ❑lam exempt code see .B&PCfm Nis reason . Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby drum under penally of perjury one of the following declarations: 1 have and will maintain.Con ricate of Consent m self-insure for Worker.Compere sation,at provided for by Smdon 3100 of Or Labor Code,for the peRormance of the work for which Nis permit is issued. 0 1 Wve and will maintain Worker's Compensation Insurance,at required by Section 3100 of the tabor Code,for the performance of the work for which this Permit is issued. My Worker's Qn peruation tossers carim and Polley na/m r3rt' Carrier. Gyt/i1�o.: e ( v/ _ CERTIFICATE OF EKEMRnOP FROM WORKERS' COMPENSATION INSURANCE menaced.need Mt W completed If tW permit is for..hundrod dollars(SIM) or la,.) certify that in to performa ac of the work for which this permit Is issued,l shall our employ any perun in any manner an u m Weumc subject m the Wmkari Compceadon taws of California.Date Applicant NOTICE TO APPLICANT:If,after making thu Cenineme of Exemption,you should become subject to the Workeri Compensation provisions of the Labor Cock,you must .J O forthwith comply with such lowhinna Or Ni,permit shall W deemed rcrokoc. ti pjy CONSTRUCTION LENDING AGENCY f-n lWo,bysflirm Nat thcnesaconstmctimt lending agency for Ne perrmmanarr R'r Ne work for which but permit Is issued(Sec.3091,Civ,C.) V.)Q Lamler's Name = z Under's Address V Q 1 certify Nat 1 have read this application and state that the above information is IL F COmRt.1 agree to Co. with all city and county ordinances and suit laws¢lard.,to OU Wildingcmtstmcd hereby euthorve repmscmatives of this city to enter upon the shovel miuned rope Ly or ice coon rimes H y (W egrt to ve, cads nicp less Ne City of Cupertino III _ Uh RON udgm no. ser cad be "ch a manywayacc.c a,sinstlaid City Z me he. Ne ran ng In Issued by: Date ` ^ APP I ANT D RST 5 m1L MPLY WITH ALL NON-POINT SOU L 0 �a C Re-roofs s' t rcr(Ap Dam HAZARDOUS MATERIA DISCLOSURE Type of Roof Willy OcCi rdnofutorc Municipal uccu tcmm or hendichvarduus material C recd by be Cupertino Municipal Co,Ce.Chap 9.13,and Nc HcaIN and Safety Cale EI e035513(a)1 p p y g g installed. EI Yes, "Ne All roofs shall be inspected Tier to an roofing material bei. Will be appreantrr�.t.r�building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove Kit I,It ardour air conmm u defined by the Bay Area Air Quality Management all new materials for inspection. �/ ❑Yes IdN , 1W, dutch vrAsno rials uundcr Ch,W6.95rrIWCaiifm. nia Heelth S' IyC ISceoma 5 S. 553a.lunderstanddrafthcbtridin, docs note 1,h te m, s ,ihi)ity,. dlylheacupam.f Na myuircmco m t or c aCedr, cupancy. i Signature of Applicant Dale ow rmauth P d 6 Mu: All roof coverings to be Class "B" or better - OCITY OF CUPERTINA 3 �� r 2� CITYOF PERMIT APPLICATION FORM CUPERTINO MWAPN # 3 1 r o Date: Building Address: O Owner's ame: a 2 Phone#:1 _ S3 0 — ? ,37 - ,3 t 707 Contractor: License #: 1 Contact: Cupertino Business License#: BuilditiT ermit Info: 1 Eec / Plumbg Mech ❑ Jo escription: Residential Commercial ❑ Sq.Ft. Floor Area: O Q S� $/Sq.Ft.: Cost of project: \ n O©� Occupancy Group, Type o�Construct'on: ^ t I �, � �F'C S Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> l OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM 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> 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 1of3 '/ '/ / � / WITY OF CUPERTINOS CUP TYOF O PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING 1 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 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 Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cf n MECHANICAL BREMAFRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace> l 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 • 2of3 ,:C,01 *CITY OF CUPERTINCO CITY OF PERMIT APPLICATION FORM CUPE TINO uan i Fee ID Fee Description Fee Group BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Sips, 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 Insection BUILDING BSWIM 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 Issuance PLUMBING PPLBG I Plumbing Fee sq foot PLUMBING ZADDCHG Address Change BUILDING BMISCELL Building Misc Fees BUILDING • 3 of 3 't • RECENE � 5'1 � � cs a � I�— 11'1 APPROVED w VEcmol • tp p(xOROAN S A ORDIL�AND� COPEI pAiE�� ' st SIGNED specitications a Uft This set of p as and it i ua kept on the lab at al times r an, make any changes logo' or 0o same without written Permission troin the buiiding DePt•, city of CuPe�no. iOn' of this pier,and sPectficbe ar LIVING ARE"-,'aplL NOT be held to permanor P ar. rowsions )PProval of the violation of law. 79 sq ft r any City ordinance 01 State � 5, 1 � • � O N C 0 CE � E 3 0 200" o LIVING AREA 79 sq ft • 5'3 EI 7 1D 0 EEC 3 0 200" i pt N Co A COPY } • P o LO • RECEIVED DEC 3 0 2003 0 CON •