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04080162 CITY OF CUPERTINO y Ttf BUILDING DIVISION pERl� C®NTRA.CT.QRINFORM ON '.",R ..4i`d CS. .'tt , Ae^ .g BUILDING ADDRESS: wAMERICAN BATH IND, INC PERMIT NO,04080162 OWNER'S NAME: PERMIT ISSUE DATE E. SANITARY N . 1 IV I OL NO. ARCHOECnENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH 0 0 0 0 coo LICENSED CONTRACTOR'S DECLARATION w 1 hereby efrom that 1 a.licensed under provisions of Chapter 9(commencing lob Description iR with Section 7")of Division 3ofthe Businessand Professions Code,antlmylicensc is in full One and effect. �2 Lianae Class Lic.Is CHANGE TUB TO SHOWER k n Date Ccmmcmr L ARCHITECTS DECLARATION YI understand my plans shall he uacd a public records 81eaU ;off Licensed Professional ` g OWNER BUILDER DECLARATION <$ 1 hereby affirm Lou 1 am exempt fru.the Commomrs License Low for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county '' txi which requires a permit to annswn,alter.improve,dcmoltim,or repair any structure iy prior.its issuance.also requires the applicant forsuch morchm rile asignedsutemcnt —_< that he isliecreedpursuanttotMprevisionsofNcCortracmr'sLiccnseLaw(Chapter9 Sq.Ft. Floor Area Valuate n pro (commencing with Section 7")olDivision 3 of the B usinem and Professions Code)or y,F§ that be is exempt therefrom and one basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a Permit subjects thc applicant to a civil penalty of not more than fi3A6j1. pf9l>-r00 Occupancy Type Rise hundred dollars(5500). ❑1,as owner of the property,or my cmployca with wages as their sole compensation, will do the work and theswctum is not intended or offered for sale(Sec.70,1,4,Business and Professions Code:The Contractor's Uccom Law does not apply to an owner of Required Inspections pmpeny who builds orimprova thereon,and who divisions work himself or through his MALE own employ Wildinorithrtmment isosold mm withimne ear of Completion, ferrule.ownaL ��tl �� haweven Ones.Wilding Chats ch im rinemwithin oneyearofmmoffere,Ne owner Itdfr•—, NNNN builder will have the burden of proving that he did not build or improve for purpose of site 'd 1,as Owner of the property,am exclusively concocting with licensed contractors to constma the project See.70 .Business and Pmfeviom Code:)The Contractors Li QCD `u ryn Qt, mese Law does not apply to an owner of property who Wilds of improves themon,and V LI who Craft 5tgfor sucM1 pmjecu with a cont.nor(s)licensed pursuant m Ne Convectors Licen Layc\ I ea pude ee. B&P C far this rcuon 1I{Il' 11tq®,�q��NIpI' 1r W f/ER S COMPENSATION DE TION ��8 �®�p �J 1 hereby rffnd under penalty of perjury one of the following declarations: I have and will maintain a Certificate mearecnuo self-insure for Workers Compcn- tion,as provided for by Stttion 3900 Of the labor Code,for the perfurrom.of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 37W of the Labor Code.for the performance of the work for which this permit is issued. My Workers Compensation Immonce Cartier and Policy number an: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE This action need not Ix completed if the Permit is force hundred dollars(1100) or las.) 1 ecnify That in the perfnrmanco of the work for which this permit is issued.1 shall not employ any person in any manner so as to become subject m the Workeri Compensation Laws of Califamia.Dam Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,JO forthwith comply with such provisions or this permit shall be deemed newood. Z M CONSTRUCTION LENDING AGENCY I herebyRum that there is a construction lending gagcnry for the performance of C4 C.fir the work for which this permit is issued(Sec.3097,Civ.C) W Q lsndr's Name 7 Lendeers Address V Q 1 ttmfy that 1 have mail this appliestwo and state that the ahem infmmadmi is IS.(•-' cormeL 1 agree to comply with all city and county continues and slate laws palating to CU building concoction,and hereby authorrm represCumtiwcs of this City to enter upon the above memioncd d Cost for inspection purposes. F 6W. (We)agree to save,indemnify and keep haamless the City of Cupertino against fn liabilities it cnu.cosu and cxpcna which may in any way accuc against said City V z in eo sane of the gra ming of this Permit. (� '—' APPL A UNDEERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ` SOU E EGULA7IONS. 14 k-1 Re-roofs Si u poli n "rodeo Date ' AZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or fuwre building acupanr store or M1anJlc M1eaarduus material as derided by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety CWC,Section 25532(x)? All roofs shall be inspected prior to an roofing material being❑rs No P P Y g g installed. If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which g mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. lrie't? ❑Yes GQIzs 1 h ve mad the hazardous materials rtquirements under Chapter 6.95 of the Cali for, nisHealth Safe yCCppdc,Sccdon255f15.25533.dJ 534.1und..dMthlifthc building does not Once y hSJ,atenant,that it is my selfe sibilu,be nmily the occupant or Lifercyuim now ichlmLot be met rico m issuance of i Cemfiesteof OccucY .3 O Signature of Applicant Date wncr err 'roti agcn 'Dam All roof coverings to be Class "B" or better aYO *CITY OF CUPERTINO* 47�1 PERMIT APPLICATION FORMo 2 CUPERTINO N # 326 Is— / ? 0 Date: Building Address: Mailing Address (if different from building address): ;?;z445- Gl• ei1,no iZ/) is Owner's Name: sc'l,n / U e-�J Phone#: z 5 J -4300 Contractor: License#: p-�eriG'<� Qg7,/7 Contact: Phone: 25-3 430(1 Cupertino Business License#: Fax: Building Permit Info: Bldg ❑ Elect ❑ Plumb Mech ❑ Job Descripti fwh Shou/e– �yf ' Residential Commercial Sq.Ft. Floor ea: $/Sq.Ft.: / S' Cost of Project: Occupancy Group: Type of Construction: Please check this box if the t is a second-story addition: ❑ ro'ect 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 IM 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 BELE 200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1of3 WITY OF CUPERTIN(* 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 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 BREMFD{T 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 WITY OF CUPERTINO* CITY OF PERMIT APPLICATION FORM CUPEkTINO 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 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 • 3 of 3 ,r dam 4Z UPERTINO BU BSG - T g¢ rnon �phi U QUA c � SAL n,< s d � o ua b +L • Ps"� � a Qa O iry Hw 0 .' No Oe GUP_" .. :AD__ 1 .l OC Ni 1 L z �N §IGI` E — This so_c : ns : I -ecif•- an it MU T pr wept ct ••3 Ic:•. t tire�� an is 7.YJtlh t4 L ',' ai vcVto .!;P; " i Z(ati� °i ��'Q Uid"I" permis in ftM. c3 r „( • �-c,� r 1 �i KOEIVEIN n5ri�liH uG fir r�ii . F CUPERTI 10 - - - - r MARM mooA QniviJ En 'AS x'i f 93nson3 Jezol� �c mood»8 mooibsS 'or xr O19201 :J9201� _ 19169H Existing tub RECEIV a AUG i � 2N4 CITY OF CUPERTINO � D 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 CITY OF CUPERTINO .,.agwst " '' BUILDING DIVISION PERMIT = CONTRAC '0W, 1V ORMA'TI�N . BUILDING ADDRESS: PERMIT N0. AMERICAN BATH IND, INC 04080162 OWNER'S NAME: PERMIT ISSUE DATE RUNNY ITTRW MANOT? -309Q7 E: SANITARY N OL N0. ARCHITECr/ENGINBER: BURRING PERMIT INFO BLDG ELECT 0 PLUMB MECN t� 0 �0, LICENSED CONTRACTOR'S DECLARATION lob Description y6 I hereby mnot that I we Ikemed under provisions of Chapter 9(commencing r with Section 7000)of Division 3 of the Business and ProfeWom Code,and my liceme is inmumaeanderrect. C GE TII� TO SHOWER z Limmo Chu Lk.« Dam DEC ARCHITECrS PS DECLARATION ( / I understand my phm small Nosed as public records 7 G Licemd Pm(ewianal /- 3 OWN E a exempt from DECLARATION a� I Msehy,(Sect that 11. exempt from d r Cssions o License law for the S p o following mown,(Section IIDLS Business and improve. Professions Come:Any city at county $ which requires a e,also re cine the eller,improv.demolish.m rtpsig any wtrmurt Fzy Met he prior so is Wusedpurom to restom theapplicof foomeCote Permit miae Law(ed suloment C (commecingwdpursuanu00MofDidommltheConutimuma3cemelaw(Chaplor9 Sq.F[.Floor Brea `+� Valuate n $ (commencing pth Swoon]000)of Diasiion sfrnflMBue exemption. vi Codm)of that Ise b tempt therefrom and the bub for the alleged es.ption.My violation of Section 7031.5 by any applicant for a permh subjects the applkant In.civil penalty of 3 AM 011MIXT 0 0 j' Occupancy Type not Timm than five hundred doll.($500). ❑1,u owner of the PmPcrtYm my employee with wages u the'v wk compemrlon, will do the work.who the elmeum b not nmMedoraffertd farsam(Sec.7014,Budmsa Re uire S eC -ons tad Profmiom Code:The Commumor's License law does ant apply he an owner of q property who bulldse impmvs thereon.and whodms sOchwork himselfor mough his / own.ployem.provided that such Improvements.notimnded mattered forum.If. J however,the building or Improvement is wld within one year of completion,Ne owner. builder will have the burden of proving the he did Tat hold or Improv for purpose of ate.). 41,as Owner of the property.am exclusively contracting with licensed comocmrs to mm en the project(Sec.7044,Business sed Proftodom Cade:)The Contrw7e's Li- case law does not apply w an ownor of property who builds or improve dmmon.and whom foravch mjecuwithaconv tor(n7liamedpumanlwft Cmt oes Lke ❑1 ca pude w. ,BkPCfor Nis recon O r Dste (� W ERS COMPENSATION DF TION c 1 hereby anion under penally of perjury arc of the following declaration: ave and will maintain a Cardinale of Co.,m self-imam fm Worke/sC.per- sw on,u provided for by Section 3700 of the labor Code,for Ne performance of the work for which this permit is Issued. ❑1 haw and will maintain Wormer Compemtum Iwrantt.as required by Swoon 3700 of the labor Code,for the performance of the work forwhich this permit is Wand. My Wnrkse.Comp oundon Imuena eerie and Policy number.: Center.. Policy No.: CERTIFICATE OF EKEMPTON FROM WORKERS' COMPENSATION INSURANCE ('fhb modest recd not M completul if the permit isforom hundred doll.($100) or less.) 1 cu ffy Net in Ne performance of the work for which this permit it issued.I shall am employ any person In any mannose as w became subject o the Workcn Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you Amid become subject to tae Workefs Compensation provlsimu of the labor Code.yen muss 0z forthwith comply with wen provisions or this permit shall be deemed mvaked. z Toth.. CONSTRUCTION LENDING AGENCY f•" Ihereby M.that Nem los construction lending geny far the perfmmance of Ci 7 tho ,it for which this Forms,b Wood(Sen.3077.Civ.C.) Qlarder's N.c =,z Larders Add. U U0 m I certify that 1 haw red this appllesen tion and saw dthe show Information b D. W.I.I at— comply with all city and county ordinances and sum laws Miami ro O building construction,and hereby amhadm sepmsenutives of this city to color upnn the til aha.-mentiomd property for inspection purposes. fY (We7 epee Io uv,indemnify and kap barml<u the City of Cupertino agdmt roti Iiabilide menu costs and expenses which may In any way awn.sgdmt said City U z In con taws the granting of Nin Pound ... APPL A D RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU B EG ONS. Re-roofs Si at p h or Dente AZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or futm building=upset Row or handle husdous matedai u de0md by the Cupertino Municipal Code,Chapter 9.17,and tk Health and Safety Code.Section 25532a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes 0�No Will the applicant or future building occupant on equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove hansdaus air conumimnu as defined by the Bay Arse Air Quaiity Management all new materials for inspection. Wlet? ,.tN'' ❑ 4 Yea o I blKGlibehuadous materials requirements under Chapter 6.95o(the Critter- nieHasW Safe y`de.S.-d.25S05.25533and2553/.lundermM thuifde Wilding docs rot erten y h a tenant.the It b my remo amiHly to notify den Occupant of the require now icn abc dor to iwuww ofa Cemfmam of Ocw eY Signature of Applicant Date senor car soda enD All roof coverings to be Class"B"or better