12030037 CITY OF CUPERTINO BUILDING PERMIT
RUILDING ADDRESS: 869 BETTE AVE CONTRACTOR: H5U- I U Ut UtILKNIINFlu I PERh11INV: 12030037
OWNER'SNAME: VENNINGIULIALTRUSTEE DATE ISSUED:03/082012
OWNER'S PHONE: 4082528929 PHONE NO:
LICENSED CONTRACI'OR'S DECLARATION r_ r r
c/�� Q C� BUILDING PERMIT INFO: BLDG ELECT PLUMB
license Class // Lie.0 O
D1ECH r RESIDENTIAL r COMMERCIAL r
Contractor
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE EXISTING TUB,INSTALL DEDICATED ISAmP
(commencing with Section 71W0)of Division 3 of the Business&Professions GFCI
Code and chattily license is in full force and effect. OUTLET,INSTALL NEW WALK-IN BATH TUB
hereby affirm under penalty of perjury one of the following hyo declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation.as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
I have mid will nmimain Worker's Compensation insurance-as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$11500
APPLICANT CERTIFICATION
1 certifv that 1 have read this application:ted site dint the above information is APN Number:36927047.00 Occupancy Type:
correct.I agree to comply with all city and county ordinances and state laws relmin_g
to building construction,and hereby amborize representatives of this city to enter
upon die above mentioned property for inspection purpose. (We)agree to save
indemmnify and keep harmless the City of Cupertinoagainst liabibitie.judgments. PERMIT EXPIRES IF WORK IS NOT STARTED
costs,mid expenses which may accrue against said City fn consequence of rhe
grinning of this permit. Additionally,the applicant underslamds:md will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
wrtli all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM L 'T CALLED INSPECTION.
9.18. J!(
Signature f. Datc�J y Issued by: •V Date:
❑ OWNER-BUILDER DECLARATION
hereby affirm that 1 am e<anpt from the Contractor's License Law forone of RE-ROOFS:
the following two reasons: All roods slmall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed svithoU first obtaining all inspection,1 agree to remove all new materials for
will do the work.and the structure is not intended or offered for sale(Sce.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting wink licensed contractors to Signature of Applin-tot: Date:
construct the project(Sec.7044,Business&Professions Code).
hereby affirm under penalty of perjury one of rhe following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent no self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation.as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code.Sections 25505,25533,and 25534. 1 will maintain
Section 3700 of the labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter9.12 and the Health&
Safety Code,Section 25532(x)should 1 store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify thin in the performance of the workfor which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so is no become subject to the Workers maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of Cnlifumia. If.after making this certificate of exemption,I Heal(h&Safety Code Sections 25505,25533,and 25534.
become subject to Elie Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. Own ter s ri agent: Z
Uatr.3�T
APPLICANT CERTIFICATION CONSTRICTION LENDING AGENCY
I certifv that I have read this application and state that the above information is
correct.I agree to comply with all city and count•ordinances mid stale laws relating I hereby affirm that there is a construction lending agahcy for the pertomhance of work's
m building constmcliom,ad hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Cie C.)
upon the above mentioned properly for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence orlhe Lender's Address
granting of this pemhil.Additionally,the applicant undersnannds and will comply
with all non-porn[source regulmioms per the Cupertino Municipal Code,Section ARCHITECI"S DECLARATION
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
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COMMUNITY DEVELOPMEN1 DI PA RnVEIIT
BUILDING DIVISION-Cl PI RT NOM
APPROVED
This set of plans and specification! N J,T to 6pt at the
Job site during construction. It is inI tw I o;hake any
0' 5" changes or alterations on same x to'deviate
therefrom,without approval from tt Building Official.
The stamoina of this plan nrid QnaHfl itions SHALL NOT
be held tooer it or to be an appro d of the violation
of any provis nes ofanyCity int ce or State Law.
o
DATEee//)�_D �' _
tV (V ��.-"."� l��. -iS
PERMIT `C�Y
4,. 6..E S ACEI\/E'f�
COMMUNITY DEVELOPMENT DEPARTMENT MAR 08 2012.
BUILDING DIVISION-CUPERTINO 5' 3"
APPROVED BY:
This set of plans and specifications MUST be kept at the
iamb shn durinq construction. It Is unlawful to make any Scale 1"=1.5'
iiProject:��WaIkeIm,Tutin�all
` from ngoftioiai.
ExistingmFloorPlan
The stamping of this plan and specifications SHALL NOT r- {
be held to permit or to be an approval of the violation
of anyprov,--ns of any Cit Ordinance or State Law. typ!
OwnerU�/n�n
0
BY
DATE
PERMIT N0.
_ C�G�rrina�
Contractor: Lawrence Prell
Home Safety Baths, Inc.
448 Dubois Street
San Rafael, CA 94901
CA LIC# 940190
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BUILDING DIVISION-CUPERTIM' . ::I GFCI.' MAR 0 8 202
APPROVED
This set of plans and specifications MUST be kept at the BY:- !
job site during construction. It is unlawful to make any
changes or alterations on same,or to deviate
therefrom,without approval from the Building Official. Scale 1 rr=1.5 r
ThQ strmoirel of this plan and specifications SHALL NOT
Project:,EWalk3Int TubAnstal loyal of the violation �,I
Proposed FloorsPlan City Ordinance of State Law.
Ownerc•_ WFFICL OF i
vni
PERMIT NO.
Contractor: ' Lawrence Prell
Home Safety Baths, Inc.
448 Dubois Street
San Rafael, CA 94901
CA LIC# 940190
415 456-0233
I"K EXTENSION PANEL
Home Living Solutions.. /� ao � INSTALLATION
Step 1. Slide front
IMPORTANT:
g �. ril end screw --- __`` _ `` of nel tub. onto Iron)
of tub.
1 P�Ige to studs.
ray UtF4_ot f rce tub flange Step 2. Slide top
f� to studBtfils will cause panel 0 over the Pangs
I ul5rdoor to leak.
1� Step 3.Refer to Detail
fa
A on fastening flange
' Was stun to studs and sealing.
Ory bo
INSTALLATION DETAILS "'°' Top Panel"B'
mewall
sed
DETAIL B
MODEL 3052
eexl%- . _ r _ smme
75 gal. Operating Capacity Drywall Screw I Tub
Tub The Flange \
Removable access Electrical supply
panels m F location Front Panel
.. M m Z 54 rz
3 I I I
a s O J J
V V
w m E» _ >
E p .2,03 c mar m
a Z y `�- B o m
Water line I w m ° $ o W
�...y _....._....._..._._ I L..B_J �Z c W c w E soiE l
QC %a' oc 52' .__I.. _._..L_.........I
+C ........ ...
1 I 10 1 0 IQ ` . — 1 • t rye
I � �
'I 1 tD iC C. C I
C C._0.. O
' . 1 1 %'dour drain u:,upling m � m o' := r
t a I
I L... ...____.. 'i 75
I `* I 12'h" m of c m r m
n o. t I v
To dcw drain' ,I 15°.. i f` U a
N
Confcdnntial,Copyright 9 2009 Home Living Solutions.All riuhls reserve
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 869 Bette Ave DATE: 03/08/2012 REVIEWED BY:
APN: BP#: °VALUATION: $11,500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair
PRIMARY SFD or Duplex PENTANIATION
USE: pPERMIT TYPE: 1 REAP10
WORK Remove existing tub. install dedicated 15 amp GFCI outlet install new walk-in bath tub.
SCOPE
.ltevh. PAva Ch<.k Plumb.Plat Check 0.0' hrs $0.00 Elea Plan Check 1 0.0 1 hs $0.00
Mrmh. Fannia Fee. Plumb. Permit Fee: IPPERAIIT Elec. Permit Fee: /EPERAIIT
il;hrr dL.h lrnp. Other Plumb Insp. 0.0 hrs $44.00 Other Elec. Insp. 0.0 hrs $44.00
bf»h. lnyt Per, Plumb.In."P.Fee: Fier,Insp. Fee:
NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Works. Fire,Sonat•Sarver District,School
District,etc.). Thesefees are based on the Prefinifnan in ornmtion available and are only nn estinmre. Contact the Dept for addtt'1 info.
FEE ITEMS (Fee Resolution 11-053 EN 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Electrical
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $44.00 IBREAIRECEP Recep/Switch/Outlets
PN1E Plan Check: $0.00 F 71 # Plumbing
Permit Fee: $0.00 $9.00 /BPFIXTURE Fixture or Trap
Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $88.00
Cotcni Ron Tax.-
Administrative
ax.Administrative Fee: IADAIIN $41.00 Q
Work Without Pennit? O Yes G No $0.00
Advanced Plannine Fee: $0.00 Select a Non-Residential G
Travel Documentation Fee: ITRAbDOC $44.00 Building or Structure t�
Strong Motion Fee: IBSEISMICR $1.15 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $175.15 $53.00 TOTAL FEE: $22$.15
Revised: 1/19/2012
. e
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE t CUPERTINO, CA 95014-3255
CUPERTINO (408)7773228 • FAX(41008) 777-3333 • buildinG(cbcuoerdno ora
El NEW CONSTRUCTION El2 ADDMO0 4 ALTERATION/TI ❑ REVISION/DEFERRED O
RIGINAL PLE[RRN=#
PROIECTADDREss / Q L I 'max,
OWNERNANE < 2 �t-A E-MAIL
' v � �/,^ ./J PHONE�J(� 'IOW
STREET ADD RE !' CTTY, STATE ZIP FAX
6 Y/ T'L (/ri' d Ad • 4/
CONTACT NAME fG4 p N/E E-MAM
=ss
STATE IIP FAX
mmom�.. o/
El OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT wQ20NTRACrOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME L11 NUMBER � l O LICENSE TYPE Bus.LICN
COMPANY NA W �p E-MAIL
F
o E-MAIL�- [' sti SSI ys6-o/
STREET ADDRESS. 1/6d S 'J� CiTY,STATE IIP G` 0 M
ARCHR'ECT/ENGIN'EEt NAME
LtCENSE NUhIDER BUS.UC p
1
COMPANY NAME E-MAIL
FAX
Si1L=ET ADDRESS CRY,STATE ZIP PHONE
DESCRIPRONOFWORIC Ln0VZ: r
v41✓M' 'To — r41,7 (;e
.e -6A-el, d / v a✓n
EC)STING USE PROPOSEDUSE CONSTR.TYPE I ASTORtES
' rD�G
USE TYPE OCG sQFT. VALUATION(5)
FLOOR DEMOAREA NETAREA
KRCHgNAREA RFMODELAAEA REMODELAREA
A AREA TOTAL0 CK/PORC•H AREA GARAG<AREA: DETACH
UNITS: MAEECO"UNTT ❑YES SECONTI STORY ❑YES
B6=000D' ❑NO ADOTRON". ❑NO
PRE-APPLIGT[ON ❑YES IFYFS,PROVIDECOPYOF tSTHXBLDGAN ❑YES REC CB Y: TOTAL VALUATION:
PLANNING APPLN []NO PLANNING APPROVAL LEC I EIMER EOMEr 0N
By my signatrr2 below,I certify to each of the following: I am the property owner or authorized agent to act on the prpperty owner's behalf.•I have read this
application and the information I have provided is Cele CL I have read the Desciption of Work and verify it is actuate. I agree to comply with all applicable local
ordinances and state laws relating tpdin ,. c� I anthorim repmz,ntadves Of Cupertino to Iter the above
-ideati5ed property for inspection purposes.
Signaane of Applicant/Agenn Data: de /Z
SUPPLEMENTAL WrORIAA110N REQUIRED PLAN CHECIC RotrtvYG sLs
New SFD or Multifamily dwellings: Apply for demolition permit for �ovER-TH�covNTER 1-1 BtiRDiNc PLAN REVIEWexisting building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PLANMG PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLlcwoRICS
form if any Hazardous Materials ate being used as part of this project. ❑ LARGE ❑ FTEE bEPr
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. ❑ 'NLUOR ❑, SAMTARYSEWER Dmmcr
' ❑ E.Nvmo.:vmvraL BaALTO.
B1dgApp_20l l.doc revised 06/21/11