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04030256 CITY OF CUPERTINO a:qa��+ "1'k�ry.'a�♦/"`s.a�7, BUILDING DIVISION PERMI! W�1-'r'1..k1l1^4n5��5�'6LLll' RYYAT � BUILDING ADDRESS: BATHROOMS BY HANS PERMIT NO.04030256 PERMIT ISSUE DATE ER'S NAME: SHEL SCH SANITARY NO. CONTROL NO. PHONE: (40.6- — BUILDING PERMIT INFO ARCHITECIENGINEER: BLDG ELECT PLUMB MECH p 0 0 0 0 yOF,F LICENSED CONTRACTOR'S DECLARATION Job Description vY m 1 hereby affirm that 1 am licensed under provisions of Chapter 9(cammeneing �'��■ �® <i� with Sectio ] �3��he Buflinc�indP fcssioaa Code,,and myliccna is `g ooRmme 0J0 BATHROOM REMODEL ;�� L7.ena a TSO 8 2004 —o Dam Cantmctar JUN 2 ARCHITECTS DEC ft n� 1 undersoo y plana¢hall be used u pts t ecnrds ;a Licensed profession.] BUILDING OWNER-BUILDER DECLARATION gf I hereby affirm that 1 am exempt from Ne Contractor's License Law for the i M C following reason.(Section 703 L5,Business and Professions Cadc:Any city or county which requires a permit to construct,alar,improve,demolish,or repair any structure y prior to its issuance,also requires the applicant for such Permit o file a signedsuamenl Valuation m the that he is licensed pursuant rt provision¢of the Conuutur's License Law(Chapter 9 Sq.F[.Floor Area y $ (commencing with So,don700o)of Division 3 nftho Businessond Profmsiane Cnde)ur y thm be is exempt themfrom and the buffs for da alleged exemption.Any violation of Section 7031.5 by any applicant for a permit ubjects the applicant to a civil penalty of 3 i92N20 IBB O O Occupancy Type nor mom that I,.hundred dollars(S500). ❑1,u owner of the property,or my employers;with wages as astir sole,compenution, wilt do the work.and the structure is Outiomaded or offered hostile(Sec.7044,Business Required Inspections and Professions Cade:The Conmetor's Liana Law does not apply u ow an ner of q p property who builds or improve thereon,and who does such work h(mself er through his own employees.provided that such improvements am not intended oroRered for seta.If. however,the building or Improvement is sold within one year of completion,the owxr- builder will have IN burden of proving that he did oat build or improve for purpose of atim.). ❑1,as owner of the property.am exclusively convecting with licensed contractors in construct the project(Sec.7044,Basin=and Profession;Code:)The Contracter's Lb came Law dors not apply to an owner of property who builds or improves thereon,and who convects for such projects with aconamis or(a)licensed pursuant In the Contractors License I. I am exempt under Seo. ,B&P C for this moon ser Data WORKER'S COMPENSATION DECLARATION I items, M.under penalty of perjury one of the following declarations: ❑I have and will maintain aCenificam of Consent to self-insum for Workeri Compere H.O.as provided for by Section 3700 of the labor Code,for We performance of the ark for which this permit is issued. � i -n I have end wi 1 cin in Cr.Cd- a/((HLLbfifi I n ru rtgmr y Section 3 W Lab ode a ......r the work for which this permit is issued. My Warkc a se o n u nee camicnn. Polity --�ZOZG Q/— &0Y Ce er. 'y Na.. C RTIFICATEO E NFROM WOR ERS' COMP ATION INSURANCE section need not becompoled Bthe permit is foronehundred dollars($100) or loss.) 1 certify that in the performance of the work for which this Permit is issued,I shall not employ any person in any mannerao as to become subject to the WorkersCompensatian Laws of California.Date Applicant NOTICE TO APPLICANT:If,afar making this CcniReau,of Exemption.you should become subject to the Worker's Compensation provisions of the Lehr Code,you must O forthwith comply with such Provisions m this Permit shall be decreed revoked. ti CONSTRUCTION LENDING AGENCY [-r.�. I hereby M.the them is a Construction lending agency for Ne Performance of tx 7 the work fur which this permit is issued(Sec.3097.Civ.C.) W Q Lender's Name P z Lender's Address V Q I certify that 1 have read this application and soon thm the above Information is V. H C09CCL l agree to comply with all city and county ordinances and sum laws misting to P C V building constructio a ndhembyauNodumprcscmmivmof NiscirymcnaruPonthc above-mention p N ty(Orin [tion purposes F G W )as en a ,Ind. at and keep harmless the City of Cupertino against rq Bob ad, cn ,co tssaadecs Id It may in any way seem.agamatimid City U"/ in co an ft Sr 0 i o It Pc it. a A APP N R D ILL COMPLY WITH ALL NON-POINT Issued by: Date SOU C 3 _rn F/ Re-roofs is Anplicon UC nim e, Doc HAZARDOUS MATE IALS DISCLOSURE Type of Roof Wi thC applicant or future building accupantemm or handle harudous national defined y the Cuno Municipal Code,Chapter 9.11,and the Health and Safety c,Sccu.n 25532fpa)?ertiAll roofs shall be inspected prior to any roofing material being installed. ❑Yes ISN. 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 haaa dCaa air conmmimm s m defined by the Bay Arca Air Quality MIN,Cni cm all new materials for inspection. District? M ❑Yes L]Rv4- y I haver dIN haardoa amrials re, irctxnu underChafter 6.95 of the Califor. nice Heal yCc ed as 255 5.255 and 25534.1 undcrsundthetifthe building docs not Corm . a e 4 the i onr sponslbility an nod' tbe"stip t of the nequir.memaw h t su a.racen0.aa.f .aPaq�r. �ignatureofApplicant Date Go' 1Da All roof coverings to be Class"B"or better Owner or salon, agent CITY OF CUPER�S.CT©R� l7RlVIAT ( N BUILDING DIVISIONSION PERMIT „�UI, BUILDING ADDRESS: BATHROOMS BY HANS PERMITNO.0403OZS62282Q STONERRIDGE ST ' OWNER'S NAME: PERMIT ISSUE DATE WNSHEL SCH E: SANITARY N . CONTROLNO. 4 ARCHITECfIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LOO LICENSED CONTRACTOR'S DECLARATION - - - — --- - - --- — - Job D05Crlphpp p, II Giao 1 W.by affirm Nat 1 am limned un er mvisions of Chapmr 9(commencing i UL U with Sxu 7 Buun ndP (tumor Coic.1ni myliccn¢is r afar 5<� int°Dr°ma Fir BATHROOM REMODEL .Lp04 Z Lkenae Lic.X Dar Canfact SUN 2g Y4 ARCH ITELTS OEC R b YQ~a A O W 1 umicrau my plans shall M used u Pu c V.% iG Licensed Professional BtjILr®ING OWNER-BUILDER DECLARATION I hemhy affirm that I am exempt from the Commences License Law for[be i o 0 following mason.(Section 7031.5,Business and Profession,Code:Any city Or County v m which requires A permit o conumct,alcor,improve,demalim.m.,.it any strucon, Fzy ptonoits W.mce,elan acquires mc applicant for such permit to rile a signed slnement rho he is licensed pursuant o the provisions of the Contractor's License Law(Chapter 9 Sq.F[.Floor Area Valua[ron FC$ (commencing with Section 70100)of Division Sof the Business And Profusions Code)or 3.. Nat he is exempt Nemfrom and the basis for the alleged exempdon.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 312]IlBsftlt ISC17 O O Occupancy Type °tat mom than row hundred dollars(5500). ❑I,n,owner of the property.a,my employees with we Sea as their ole mmpensa0°^, will do the work and the snnure is not immortal or offered forsal.(Sec.7044,Business - Required Inspections and Professions Code:The Contractor's License Law docs not apply o e a^owner of q p progeny w ho builds or improves themon.and who does such work himself or through his own employees.provided that such impmwmenu art notinlended wafered for sale.If. however,the building or improvement is veld within one year Of completion,the owner- builder will haw the burden of proving that he did not build or improve for purpose of sal..). ❑1,As owner of the propeny.am excluMvely contracting with licensed contractor to construct the project(Sec.7044,Business and Professions Code:)The Comment's Li. Came Law dos not apply to in owner of property who Wilds or improv merson,and, who convects for such projects wit a contracor(s)liceread pursuant In the Contncors License Law. ❑Iamexemptunder Sac. ,B&PCformismason - Owner Dam -. WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I haw and will maintain a Cenifieam of Consent wolf-insum forWarkeb Compen- ution,es provided for by Section 3700 of the Labor Code,W 0u performance of me ark for which this permit is issued dmlaZa r - y I have end wi I ei in r'a C rX/g•0�6-I &lYesaimgaur✓ y Section 3 th Lab o n.mcco(theanakforiahich Wiapermirlaissumd. My Works n e o n Tree carrier end Poliry ��� O1^ &C Y Ca M-. Na.. C RTIFICATE O E N FROM WOR ERS' COMPS ATIONINSURANCE section need notbccompleted lithe per is foram hundn:ddollars(SIM) sr,k,.I I certify that in the performance of Ne work for which this penal,is laswE,1 shall not employ any person in any mannerso As to femme subject to the Workars'Comp.nsatlon Laws of Califomia.Dam Applicant NOTICE TO APPLICANT:it.armr making this Certificate of Exemption,you should become subject to me Worker's Compensation provisions of me labor Code,you must ,J O foMwim Comply with such provisions or this permit shat]be deemed n caked.. z ti CONSTRUCTION LENDING AGENCY [r I hereby alarm that them is a comnction lending agency for the performance or a> the work for which this permit is issued(Sec.3097.Civ.C.) Q Lendoea Nam. Z Landers Address U V 0 1 certify mat 1 hew reel this city and Application and sum con tiro above Information ie IT.F bunco.I agree ct comply with all city and county eminences of antl cute hws .oma t e CW ahow-raconatructio yrorI aCfOtm,epmsentativ of this city oanmr upon tiro W shove-mention pc ty(ori Minn PUfPDWL LL W)ag t C e,ode m and keep hay in an me City of Cupertino admirer n„fp liabili a,udg on .c uand e s ich may in any way a<cmc against aid City U 4 in co n f gr 'n a th Pe it. APP I 'R !1. D ILL COMPLY ITH L NON-POINT Issued by: Date SOU C .sI J , 1 —fn IIJJ �I// Re-roofs sig Ap icaHA R ar Dem Of Roof HAZARDOUS MATE Occupant upa DISCLOSURE Type WIal y t e Cupent or future ipi lCo ,Chpeorc oradthandle Health andaesodous Safety u darned y the Cupertino Municipal Cade.Chapter 9.11,and t¢Health roti Safety Code.Sector,155320)7 All roofs shall be inspected prior to any roofing material being installed. 40 El Y. N° Will the applicant or future building Occupant u¢equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit h....dnus air contaminants ss defined by the Bay Area Air Quality Management all new materials for inspection. Disuics7 ❑Yes shave%h. ; ami smaarl.l.. i.menuundcrChapmr6.95ofmcCalifor- niaHm1th&Sitns255 .155 an,1255J4.lunderslandmatifmc building Jos not torte t.ma i m spon,ihility o not IW°coup of the mqimmcnud a cof.Carbine amar mpagFy. ignatureofApplicant Date mer°,oat o,ir aScar Da All roof coverings to be Class"B"or better G � *ITY OF CUPERTINO* / CITY OF PERMIT APPLICATION FORM a� ' 2-J'6 • CUPEkTINO Date: Building Address: Mailing Address (if different from building address): 2282D �D C9C > OwnerS4Name:�Phone #: z1D� ' I J 4? 7<� Con actor: , S License#:EDAFc�kgLcg -5 Contact: �(�-3 3_��7 Cupertino Business License#: S Fax: Building Permit Info: Bldg Elect'❑ ` Plumb K Mech Job Descripti n: Residential Commercial ❑ Sq.Ft. Floor Area: ,30 $/Sq.Ft.: Cost of Project: 15Oco Occupancy Gro : Type of C struct n: Please check this box if the project is a second-sto addition: ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 —Boiler> IM 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 <= 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 BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of ���' 2-7 JOITY OF CUPERTINO CITY PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb 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 BPINTERCEP Ind Waste Interce for 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 rinkler/Backflo PLUMBING BPSTORM Stonn/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 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 Furnace MECHANICAL BREMFURNOV Relo Furnace> I 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 BRENMSAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL 2of3 + p CITY OF CUPERTIN* CUPE(�TINO PERMIT APPLICATION FORM Vanti Fee ID Fee Description Fee Group REMTHEATR 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 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 Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING • s 3 of 3 • Ora1� Arfxllopy RL T ^ MAR 312004 M PERT 0 'APPROVED 08 pAn�Wli©i0RINAKES G ' PAT. S114411" la yea rc P is ® It, li P n job at all times and it al un 1swt,d to n ak any Changes or altcratfon° ermn frau o o t lame ith tut written Pissio erfmo. t is auildi g elilt his City of Cup ecificatiorfs he Stem 'Ktplan and sp ho �_ H,111 N violation p 'inance or e: w 13'8 • } L, 6e O � - O G - � 3 Lo 1 l 10'2