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04080044 CITY OF CUP ERTINO BUILDING DIVISION PERMIT y d6�n.CONTRACTOIR!INFORMATION `�,4,: BUILDING ADDRESS: AMERICAN BATH IND, INC PERMIT NO. 4080044 OWNER'S NAME: PERMITESUEDATE 12 E: SANITARYO. ROLNO. ARC HITLCTIENGINCER; BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 noes LICENSED CONTRACTOR'S DECLARATION ;-r 1 hereby affirm that I am licensed under provisions of Chapter Y(commencing Job Description �� szw yith Section hereby affirm vetIa olithesed nder pr visions of hapten mel my 9(com(commencing is <n in full fame and effect. ;�� u«era tic.. REMOVE TUB, INSTALL SHOWER STA L Z'p DaLL' Contractor —�`y ARCHITECTS DECWI��,TION ./ 1. vl undersand my playa shall be usedulNhlil;eWms CEP �/ 2U04 3iau v 3 n� Licensed Professional fail pj OWNER-BUILDER DECLARATION p ///� i0 1 hereby maso affirm thin 1 am exempt from the CnalrnCmf6 eLicense Ac Law for Inc I p O following moon. hermit t ]construct, Business,amr, and Pmfdconol Codc:Any city m county Km which myusesapermit toreenres thepplicimprove,h permits or repair anytatement priorhesScensed puralso nt10 tet proisioisoftant hesachatortinicensle ae Law lCha111Cn1 FFthat(commescingwiit pursuant10 theof Divines of theeBusinss; nd Prof LawsCrudecfY Sq.Ft.Floor Area Valuation G Me, (commencing Section and basison]nf theeged ssnplmn.An vi Cada or i thin he u exempt thc¢from and Ne ands for the alleged exemption.Any violation of Section703 s MLSby any reddapplicant for s(S500Permit subjects the applicant acivil penalty of 3A"jlAttg�er00 Occupancy Type not mom Nan Rve hundred dollars(5500). r ' ❑ 1,us owner of the propmy,or my employees with wages u their sole compensation, will do the work and the swctus is not intended or offered for sale(Sec.7061,Botiniss and Profcasions Care:The Conmdmrs Liana Law dors not apply to an Owner of Required Inspections property who buildsor impeow_t thereon,and who doessuch work himself oribrough his own employcet,provided Ihal such imp avemena arc not intended or offered for sale.If. however.the building of improvement is sold within one year of completion.Ne Owner- builder will have the bumen of proving Nat he did not build or improve for paryax of ssi ll. y-'.as owner of the pmpeny,am exclusively contracting with licensed contractors to construct to project(Sec.7W ,Business and ProfessionsCode:)TheContractor'sLi- ecou Law docs not apply to an owner of property who builds or improver themon,and who contracts for such projects with a conoacmr(s)licensed pursuant the Contractors Bice se Law. ❑I sum exempt under Sec. .B&P C for this reason Own 1 1 Doli IFZ 6 Ir C4 WORKER'S COMPENSATION DECL ApA 1 hereby aRrm under penalty of perjury arc of the following dalantiona: ave and will maintain a CerdGate of Consent self-insure for Worker's Compeeon, r- on Provided for by Section 37M of Ne Labor Cade,fm Ne performance of Nc work If which this permit is issued. ❑I ave and will maintain Worker's Compensation Insurance,as"tared by Section 3700 of the Labor Code,for the performance of Ne work for which this permit is issued. My We Compensation Insurance carrier and Policy number am: Carrier: Policy No.: . CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thisscainn need not W COMPlmed ink permit is far one hundred dollars(51(1(1) or Inv) 1 Certify Nat in the performance of Ne work for which this permit is issued,1 shall not employ any pCRon In any mannerso as to become Subject to the Wooten'ComfleM1tadon Laws or California.Dara Applicant NOTICE TO APPLICANT:If,after making Nu Certificate of Exemption,you should become subject to the Workers Compensation provisions of Ne Labor Cole,you most .J z forthwith comply with such Prnvisimcs or Nis permit call he drained revoked. ZOCONSTRUCTION LENDING AGENCY I hereby aMrm that thea is a construction lending agency l'm the Pcrfunomm of C thework for which this permit is issued(Sec.]09],Civ.C.) La am V D]Z lender's Nc .7 z Lender' Address U O I Certify that 1 ban read this application and sate that me above information is ";: correct I agree to comply with all city and county ordinances and state laws slating to QU building conswnian.and hereby autnoriae mprexmatives of this city to enter upon Inc >" above mentioned property for inspection punwses (~CL (We).,me to save,indemnify and keep named.the City of Cupertino agaimt N liabilities,judgments.costa and eape.which may in any way.cane against said City iss U z APPLICANrnsequenccUNDER SfANC(S Ah WI L MPLY WITH ALL NF,N-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Si tura of ApplicanUCanvanor Dam HAZARDOUS MATERI [&DISCLOSURE Type of Roof Will the applicant or future building Occupant tore or handle hazardous material as defined by Ne Cupertino Municipal Code,Chapter 9.11,and Ne Health and Safety Cade.Section 25532(a)7 All roofs shall be inspected prior to an roofing material being ❑Yea Na P P Y g g installed. W the applicant or res building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove hazardous air conaminana az defined by the Bay Arca Air Quality Management all new materials for inspection. ct7 JJ C]YcsNa I have maJ Ne Wood!ous materials mquiremants under Chapter 6.95ofOn,Califor- nuHcsleA,Safety 0(Mc. dans 255(15,2557 and 255]6.1 undersand let if Nc building . d^ca not eusendy tut a ant t it u m pansinility m Testily the asaPam of Ne sgnire.aawnicnmav at ormissa aanccNifica¢aracana^dr' Signature of Applicant Date i Owner ar. ' iacdagent an, All roof coverings to be Class"B" or better CFPY OF CUPEWFINO ' BUILDING DrvI51oN PERM aCONTRACT(1R5INFQRMA�N f; BUILDING ADDRESS: PERMIT NO. AMERICAN BATH IND, INC 04080044 OWNER'S NAME: PERMIT[.SUE DATE ONE: SANITARY 20. 1 OL NO. ARCHITECT/ENGINEER: 1 BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 ."Q z LICENSED CONT'RACTOR'S DECLARATION y-F. 1 hereby affirm that i am licensed under provisions of Chapter 9(commencing Job Description <zw with Section l(XkB of Divixion3u(NC Buxinca ane Pru(csxinns coat.and myliccnecis in full wcr,m foes Rct. �'' REMOVE TUB, INSTALL 'SHOWI TI�L�9 p j ? Li i Class Ccru u A t8 Damt,� ComucWr vl ARCHITECTS DECU64 ATION Yya 71 underoand my plans shall he used as pahlicmcords JdU S�- Z�Ui 3 o h Licensed Pmfcaunnal r {� i g OWNER-BUILDER DECLARATION VLI I hereby affirm Nat I am exempt from the Contractors License law for the f ip O following reason.(Section 1113[.5,Business and Professions Code:Any city m county tnt /nt fn1 K m which requires a permit to enrestmct,alter.improve,dcmnlixh,m repair any msuctam u 11 11 k u_h.prior it)Its issuance.also requires the applicant for such permit m file a signed summ in y �5ia that he B licensed pursuant the provisions of the Contractor's Lions Law(Chapter 9 Sq.Ft.Floor Area u� �IVaaIu t.0 xFo (commencing with Section 70t of Division 3 of the Business and Profeasinm Cede)of u 5d,' .5§ that he is exempt therefrom and Be,basis for the alleged exemption.Any violation of Section 7031.5 by any applicantfor A permit subjects the applicant to a civil penalty of 3AU_V*gr00 - Occupancy Type Dat ma¢than five hundred dollars(21500). e ❑I,as owner of the property.or my employ on with wages of their sale compensation, will do the work and the ewcure is not intended or offered for sale(See.1044,Business and Professions Code:The Connotes's License Law does not appy to an owner of Required Inspections property who builds or improves thereon,and who does such work himself or through his awn employees,provided Nal such improvements are not intended oraRered for sale.If. however,the building or improvement is Sold within one year of completion.the owner builder will have the burden or proving that he did not build or improve for purpose of sale.). 611�asr of the property,am exclusively contracting with licensed contractors to Construct the project(Sec.7044,Business and Professions Code:)The Contractors Li. rase law does not apply to an owner of progeny who builds or improves Rieman,and who contracts far such projects with a eontrzetor(s)licensed pursuant to the Contractors likens Law. ❑1 am exempt under Sec. .B&P C for this reason Own G/lu it $ .t-1 WORKER'S COMPENSATION DECLA I hereby ORE..under penally of perjury moo of Ne fallowing declarations: I have and will maintain a CeniBcmeof Cmuent to sesu lf-inm for Workei s Compen- sation,u provided for by Section 3700 of the Mbar Cock,for me performance of dw work for which this permit is issued. 1 have and will maintain Worker's Compensation insurance,ax required by Scotian 37W of the labor Cone,far the performance,of the work for which this permit is issued. My Worker's Can pensauon Insurance Cartier and Policy number am: Canien policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be camplcted if the permit is faronc hundred dollars($19)) mss.) 1 certify but in be iffmmane.of the work for which this permit is issued,1 shall nut employ any person in any mannose u W become subject o the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,aper making this Ccnificme of Exemption,you should _ become subject to the Worker s Comprosiumn provisions of the Labor Code,you must .�Z forthwith comply with such provisions or this permit shall M deemed revoked. 'Z O CONSTRUCTION LENDING AGENCY (. I hemhy affirm that Caere is a construction]ending agcnry,lot the performance of [� the work for which this permit is issued(Sec.30W,Civ.C.) W� Lender's Name Under's Address C.)Q 1 certify that I ham read this application and sum that the above information is correct.l agree to comply with all city and county ordinances and Slide laws deleting to probuilding conswctinn,and hereby authorim represcnutivea of this city W enter upon IM atwve-mentioned property for inspccuon purposes P. (We)agree to save,indicmmfy and lump harmless the City or Cupertino against Fr rA liabilitiesjudgments,costs and expenses which may in any way accrue against said City / V z in consequence of the granting of this permit. '—' APPLICANT UNDERSTANDS A DIWILL CZ7LY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. I / (��// Re-roofs Sii§n tore or ApplicanUCommnnr / Date HAZARDOUS MATERI ISS DISCLOSURE Type of Roof Will Ne applicant m future building occupant store or handle hvarJous material as defined by the Cupeninn Municipal Code.Chapter 9.11,and the Health and Safety Code.Section 25532(x)? - All roofs shall be inspected prior to any roofing material being installed. Q Yes No Will thea applicant or fur re buildin t use equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove pp g by Ric B a Air Quality emit harardnm air contaminants u dcGncd by the Bay Arca Air Quality Managcmcm all new materials for inspection. . Disuin? 0 Yes \3g Nu 1 have mad the harandous materials dequfmmcnu under Chapter 695 of the Califor- nia Health&Safety Code,Sections n505,25533 and 15534.1 understand thm if the Wilding Jaz notcuaemly have a l dl it is m�rupomihility m nodly d¢mcupant of the requirerucnuwhic"roust ctyAare,isanan«ora cerdfiaaW of aeapanry. Signature of Applicant Date j \ Iwo c, All roof coverings to be Class"B"or better Owner or ati rived agent t Dam CITY OF CUPERTINO I� 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp : Rng: Sub: Blk: Lot : APN . . . . . . . . : 32615130 . 00 DATE ISSUED. . . . . . . : 08/06/2004 RECEIPT #• . . . . . . . . : 26573 REFERENCE ID # ' . . . : 04080044 SITE ADDRESS . . . . . : 22445 CUPERTINO RD # 34 SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SUNNY VIEW MANOR ADDRESS 22445 CUPERTINO RD CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : SUNNY VIEW LUTHERAN CONTRACTOR . . . . . . . : WAYNE CARDELLINI JR. LIC, # 24618 COMPANY AMERICAN BATH IND, INC ADDRESS . . . . . . . . . . : 30987 SAN BENITO ST. CITY/STATE/ZIP . . . : HAYWARD, CA 94544 TELEPHONE . . . . . . . . : (510) 475-8200 OEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - --------- ------------- ---------- ---------- ---------- ---------- --- - BPERMFEE VALUATION 2 , 000 . 00 83 . 16 0 . 00 83 . 16 0 . 00 BPLANCHK PERMIT FEE 83 . 16 110 . 98 0 . 00 110 . 98 0 . 00 BENERGY PERMIT FEE 83 . 16 39 . 92 0 . 00 39 . 92 0 . 00 BPSEWER SEWER SYSTEM 1 . 00 21 . 58 0 . 00 21 . 58 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BPVENT UNITS 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00 BPWATER UNIT 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00 BSEISMICRE VALUATION 2 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 --------- - ---------- - - -- ---------- TOTAL PERMIT 314 . 30 0 . 00 314 . 30 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ------------ ----- ------------ ------ - ----------- CHECK 314 . 30 00003610 TOTAL RECEIPT 314 . 30 s tl- CITY OF CUPERTINO• CUPEf�TINO PERMIT APPLICATION FORM APN# 32 / (�_ /3 o Date: Building Address: Mailing Address (i"JifferdDt fro building address): Owner's Nan Phone#: 2S3 4300 Contractor: Bn y� License #: Contact: Q�/, 1 0eu. a Phone: 35;3-f30,9 Cupertino Business License#: Fax: SS 6 of S Building Permit Info: Bldg ❑ Elect ❑ Plumb Mech ❑ Job Description;- ,Qcmode-7Gy yA Maali 5AAO„'u S Residential ® Commercial Ef Sq.Ft. Floor Area: �_� $/Sq.Ft.: Cost of Pro' ' $ �Oeo Occupancy Group ' Type of Con trPlease check this b proj uction: ect is a to Showe. Eyclw second-story addition: ❑ Project Size: Standard Ea`� Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> l OOK to 5OOK 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> IOOOA ELECTRICAL BELEC200 Flee Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 3D `( - CITY OF CUPERTINO� CITY OF PERMIT APPLICATION FORM CUPERTINO Quanti 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 BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP hid 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 rinkler/Backflo 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 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 BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 °(� �- CITY OF CUPERTIN! CITYOF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs 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 Ins 'ection 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 Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 � I J 1 } EIVED 4 W96VO oulyadnO 44096VOoulyadnO 4�OS6VOoulyadnO @1 ouguadn0 644ZZ @1 oulyadn0 944ZZ @J oulyadnO 6448 :Ss PPV sells :sswppV joueWmalAAuung :smPPV ISOM l ��. Im 1 4iy`� Q o � s v \ Wlpi^Btl ewan�e e c \ issx DwPore o W' t 41 KU - • v IN P,CCCPD, 4CE WITH THE CITY OF CJPErrq, "N'C r'JD-S AND ORDINANCES oATE_._. _�� SIGNED T .is set of plans and specifications MUST be kC31 on the job at all times and it is unlawful tc, make any changes or alterations on same written permission m the Building D—artment, City of Cupertino, i atamping of this plan and specifications L N07 be held to permit or to be an L.,aua! of the violation of any provisions of .. ,nr State Law. 00 a 0� 34 ~ O I _ S • r J � x to wCEIVE- D D J � rD M AUS - E 2504 rD CITY OF CUPERTINO mo niNn nFpAaTMENT Existing tub O Cir+ of (:;uFERTINO °. ., *"MAC ')r-PAQTMENT O new shower stall Scope of work 1-remove existing tub 2-relocate drain 3-install new shower stall ® 4-install new mixing valve 5-install new shower door