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04080161 CITY OF CUPERTINO BUILDING DIVISION PERMIT C®NTRAGTORANFORMATION BUILDING ADDRESS: PERMIT N0, AMERICAN BATH IND INC 04080161 E. 2 6 PERMIT ISSUE DATE NE: IFTEW—MANORTO ST. SANITARY f(s➢8 19 2 004ROL NO. ARCHITECT/ENGINEER: —8 2 U 0 BUILDING PERMIT INFO BLDG ELECT PLUMB MECH no0 LICENSED CONnseddo ,p DECLARATION I� �® 1 Mrtby afrm Net 1 am ORA under Provisions of ION Y(commencing Job Descripti Ikplt� wish Section 7")r'of Division Sof tie Business and Profession Code.and my lim.is n�n in full forte and effect. qLicense Class Lic.g CHANGE TUB TO SHOWER Dow TSEP ? 1004 ARCHITECTS DECLARATION ECL Yly�� I understand my plan shall be used as public mcmW 3gG ucen dPmhbs and 5 OWNER-BUILDER DECLARATION 1 herchy,(Sere on I em exempt from the Contractors License Lew for We O following mann.(Section IIomm Business and tee.do inns Cade:Any city m county m which required•permit re mnurud pMe improve,deermit t file maim any svucuw t?< prior,its issuance.also requires the applicant for such permiuofelea Laalmhapterd (that comma c¢nmdpursuant to We provision of of Contractor's Linc Law(ChapwrY Sq.F[. Floor Area VdIOd[ Q s WH$ (commencing with Sccuon 7000)of Division lnftM Business and Professions Ca M)or Wt M is exempt therefrom and the basis for We alleged exemption.Any violation of Section 7031.5 by any.pplium far a permit mbjew the applicant o a civil penalty ofApl.I Nu�IJler00 Occupancy Type re N not moan five hundred dollars(5500). 3ZZ 661151 u 1,as owner of the pm,,my,or my employees with wages as Weir sole campensallan, will do We work.and truawcwre is not intended moffertA far sale(See.70,14,Burn•... and Profession Code:The ContraelaYa Limme Law does not apply to an Owner of Required Inspections prepury who Wilda oringtomms dumon,andwho doessuch work himselfor through his own employees,provided Nat such improvements are not invaded orolrertd for sale It. however,the W ildiag or improvement is sold within one y=ar of oampleuon.We owner- builder will have We Womm of proving Oat he did not Wild or improve for purpose of gale,). 0 1,as owner Of We propeny,am exclusively contracting with licensed contractors to consumer she project(Sec.7004,BuinW and Pmmusion Cade:)The Contractor's Li. came Law dos not apply w an owner of property who Wilds or improves Onecon,and. who contracts for au rojttu wish co a nuacwr(s)licensed pursuamw Oe Camractor's License lawram. [ I ram u der .B&P C for this reason Owner/ Daw l7 L1 ER's ENS ON DECLAaION 1 hereby affirm under Penalty of perjury one of We following declaration: aConsand will maintain a Cenilu eof Consent w mif-insure for WorkefsCamped- ent p c wvd for by section 3700 of We Labor code,for We performance of the wink for which this permit is issued. ❑1 have and will maintain Wmker's Compensation Immorm.as required by Section 3700 of the labor Cole,for We performance of We work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy,number am: Cartier. Policy No, CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thixsecdon need not be completed tithe Permit is for one hundred dollars(SIM) or Its..) 1 minify Nal in We Performance of We work for which this Permit is issued,I shall not employ any person in any manocran as to became subject to the Workers Compensation Laws of Califamitt.D. Applicant NOTICE TO APPLICANT:if,after making this Cer ifcau of Exemption,you should become subject to We Worker's Compensation previsions of We Labor Code,you mut wJ Z forthwith comply with such provisions or this permit shall W deemed revoked. z4 CONSTRUCTION LENDING AGENCY [+ IWmbyaffrm Nat Nese iso construction lending agency to,We pafarman¢of a 7 We work for which this permit is issued(Sec.3091,Civ.C.) W QLender's Name 6. Lender's Address U Q 1 certify Nat I ham read this application and rude that the above information is fy P correct I agree to comply with all city and county ordinances and sure laws totaling lO �U building construction.and hereby munrim representatives of this city to emmr upon the above memioncd proParty for inspection purposes. (We)agrtt on save.Indemnify and keep harmless the City of Cupenino against f y liabilities,' cnu,cosu end expcnau which may in any way aecnc againduid City / U z m co roc of Ne bnaating of Nis permit APPLI NT DER NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURIC RE UL TI 1116U Re-roofs ignawrc of Applic HAZARDOUS MATERIALS DISCLOSURE Daw Type of Roof Will We applicant or future Wilding oecupant store or handle ha axi us material as defined by We Cupertino Municipl Cade,Chapter 9.12.and Or Health and Safety Cmlc.Section 25532(x)? ❑YarNa All roofs shall be inspected prior to any roofing material being installed. 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 7harardoux air contaminants as defined by We Bay Arca Air Quality Management all new materials for inspection. ❑Yns CD A l have mrdous materials toquitomcnu under Chapter 695 of We Califr. ,.N.a1`.1=yd—=ccdon25M5,25533and25534.1undcnundNuifshcWilding not cmrtm hos a vnan nenuw ch t 'enoI norwiasuanec0 aCertificawafOccupancy. Signature of Applicant Date crorauNaOOdagcm ,m fl All roof coverings to be Class"B"or better CITY OF CUPEWYINO %'+' 't,;777777-7777 ", BUILDING DIVISION PER ,,RACA,,0R` ,,N ON k, BUILDING ADDRESS: PERMIT NO. AMERICAN BATH IND INC 04080161 e. 2 6 PERMIT ISSUE DATE ONE: O ST . SANITARY t08 19 2 @(*r30L NO. ARCHITECT/ENGINEER: — BUILDING PERMRINFO BLDG ELECT PLUMB MECH' 0 0 0 0 boa LICENSED CONTRACTOR'S DECLARATION lob Description y C. Sc'hereby affirm that 1 am tumbled under provisions of Chapter 9(commencing Z.U with nion]IXMgof Division 3 ofthe Business and Pm(essinn,Code.and my license is in full force and effecc. �=RLicense Class 1.'¢.p CHANGE TUB TO SHOWER .Fn Data Contncur J ARCHITECTS DECLARATION yy a I understand my plans shall he used as public records JyU u H Licensed Pmfcminnal -ioa OWNER-BUILDER DECLARATION a2 I affirm that 1 am cxcmpt from the Contractor's License Law for the naso _o o following rims..(Semon 1071.;Business and Improve. demolish. Code:Any city of county y$ which requires issuance.gismo ser mires t e pplicmm,improve.h permits nr repair any svucmu priorse)sl esedpursuant requires thevision of for suchpermitat Olessigned statement that he is licensed gurauanus the previsions of @e Contractor's Liccnsc Law(Chapter Sq.Ft. Floor Area Valuat 0 0Q ylz-m (commencing with Section]IXl)of Division 3 of the Business and Professions Code)or i 5� Nat he is exempt thctefrom and the basis far the urcled caemption.Any vialmion of (j1I3 Section 7031.5 by any applicant far a permit subjects the applicant m a civil penalty of 3 /{}�Ntls]DT8eroo Occupancy Type not come than five hundred dollars MOB. z 61 rj 1.$o ❑1,at;owner of the property,or my employees with wages as their sole compensation, will do file work,and the suucmm is not muctood or offered for sale(Sec.]Ba4,Business Required Inspections and Professions Code:The Conuadors License Law docs not apply to an owner of q P property who builds or improves thereon,and who does such work himself or through his awn employees,provided that such improvements are r m intended ora@red for sale.If. builder ill haveding or den oaemem lssol he did of year of improedf r the ownore of ®� n ba as �� builder will have Ne burden of improvement i Net he did not build m improve for propose o! P Ill'\5�\I'j1I //-.a sale.). ❑I.as Owner of the progeny.am eaelusively contracting with licensed contraction to construct the pmjcn(Sec.]Dad.Business and Pomsta ons Codc:)The Comment U. D �oo cense Law dors not apply to an owner of property who builds or improves daemon,and who costal for such projects with acontruroHa)licensed pursuant a the ContractorvCp s Cr 4 [ empcu der B&PC for s Date KERS MPENSATION DECLAB�'TIONtrllU L� B U N� 1 hereby affirm under p sat,of perjury ane of the following declanfions: 1 have and will maintain a Cenirate intermittent to self-insure for Worker's Compen- , Bads.,is provided for by Section 37W of the Labor Codc,for the peas mmanec of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,az requited by Section 37W of the hbor Cade,for Ne pmfmmance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number art: Cartier. Policy Net CERTIFICATE OF EKEMPrION FROM WORKERS' COMPENSATION INSURANCE (This seefim mod not k embineted irtM permit is for one hundred dollars(SIM) or less.) 1 certify Bar in the performance of the work for which this permit is issued.I shall not employ any prison in any manner so as to become subject o the WorkersCompensation Laws mCalifornia.Dau Applicant NOTICE TO APPLICANT:If,after making this Cenilicale of Exemgtinn,you should become subject to the Worker's Compcmatinn provisions of the Isbnr Code,you must .J Z forthwith comply with such provisions or this Permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY I hereby aRmm Nat them is a eomhvftinn lending agency for the Performance of IZ > the work for which this permit is issued(See.3(19].Civ.C.) W Q Lrmbm's Name lender's Addlms U 01 cenify that 1 have read this application and sus that Ne above information is W F commit l agree to comply with all city and county ordinances and spite laws miming to OV building construction.and hereby authorilL repreuntafives of this City to enuf upon the r u7 slave-mcntiuned pmpemy for imiteedon lomases 4. (We).,me m save,indemnily and trip harmless the City of Cupertino agarrm liabilities,uAgmcnu.cosu and capcmes which may in anyway acme agebmtsaid Cicy UZ income ncciof the Smming of Nis gamic. ^ APPLI NT IN.DER NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale SOURC RE ULATIo .� �(. l Re-roofs ignaurc of AppliCaHAZARDOUS MATERIALS DISCLOSURE Dau Type of Roof Will Ne applicant or future building Occupant store of handle hanrduus material az defined by the Cupenins Municipal Code.Chapter 9.13,and the Health and Safety Code,Section 25532(0)? All roofs shall be inspected prior to an roofing material bei. installed. ❑res r�,Na P P Y g g Will the applicant or(mus building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove • limit harardons air conumimmis an defined by one Bay Arca Air Quality Management all new materials for inspection. Dlsuriet? Q Yea I have rcaQQ the havafdnue materials requirements under Chapter 6.95 of the Califor- niuHeahhhl:adYcu >Sttdons25505,25533and25534,1 undersundthathric,building does not cumem havfl a'Ienanl,thm it is my responsihil ity m m nily the occupam of Ne requircmenu wh chat ttic mct�norm lssuvtce nfa Cerdpcam Of Ocapancy Signature Of Applicant Date o efaranmori,edagmnl 'DaY D All roof coverings to be Class "B"or better CITY OF CUPERTINO om 2 of 4 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp: Rng : Sub: Blk: Lot : APN . . . . . . . . . 32615130 . 00 DATE ISSUED. . . . . . . : 08/19/2004 RECEIPT # . . . . . . . . . : 26753 REFERENCE ID # . . . : 04080161 SITE ADDRESS . . . . . : 22445 CUPERTINO RD # 26 SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SUNNY VIEW MANOR ADDRESS . . . . . . . . . . : 22445 CUPERTINO RD CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : SUNNY VIEW HOME 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 OFEE 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 . 79 0 . 00 39 . 79 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 BSEISMICOM VALUATION 2 , 000 . 00 0 . 63 0 . 00 0 . 63 0 . 00 ---------- ---- ------ ------ ---- ---------- TOTAL PERMIT 314 . 30 0 . 00 314 . 30 0 . 00 - OCITY OF CUPERTINO* *2C CUPEI�TFINO PERMIT APPLICATION FORM g Ah APN# 32- 6 [5 /Oo Date: k/('1/04 Building Address: Mailing Address (if different from building address): Owner's Name: S�nnY �, Phone#: tl C)8 -2_5-3 4300 Contractor: License#: Contact: GLLu� /,s �puN�n Phone: 2>3 1-3ao Cupertino Business License#: Fax: - Building Permit Info: �/ Bldg ❑ Elect ❑ Plumb L!1 Mech ❑ Job Description: e / Residential Commercial (P Sq.Ft. Floor Are : $/Sq.Ft.: S —fl Cost of Project: Occupancy Group: r- 1 Type of Construction: Please check this box if the project is a 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> 100K 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 hid/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 W2, 6 7s-3 1of3 L—� � ' / � 0 amweWITY OF CUPERTINCP CITY OF PERMIT APPLICATION FORM CUPEkTINO 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 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 BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM .S'tonn/Raln 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 BREMFD{T Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace> 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 DI WITY OF CUPERTINO* CITY OF 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 BSPECUL 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 Change BUILDING I • 3 of 3 CS3 F:(��R Cf WITH T�INA�"DES `= .�at III SPCI—, a 1 timss and is is un '� oa k6F1 ;� r annes or alterations nv,n9" nn said wi Foit v'' 'v �f Cupe'rtinun fro mei ilding f� its pla snd specification3s The stamPiT.o - ;HALL NOT be held to F= �� anpf()V 11 ui uro rwiauti " , g� Ordinance u �mte � , o 1 anY CdY v e � G s a 99-„ — 240 10 `N� P NT O [ � NFfU J q 9 � C � . G co "'EC - O : . AU • 19 1C CITY OF CUP ± INO O BUILDING DF PA MEW r c. xU io a ' m J K d • Existing tub O 12 1N30 39 fliine ®NIA 3 AO 30 • .D t 6 i env 3 1333d 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