12060033 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22803 LONGDOWN RD CONTRACTOR:AMERICAN KITCHEN& PERMIT NO: 12060033
BATT I
OWNER'S NAME: MASEGIAN JOHN D AND KELLY A 1758 JUNCTION AVE UNIT D DATE ISSUED:06/06/2012
OWNER'S PHONE: 4088737712 SANJOSE,CA 95112 PHONE NO:(408)436-8151
A LICENSED CONT'RACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT r PLUMB r
License Class D Lie.B Sia S 3 e
MECH (— RESIDENTIAL r COMMERCIAL r
Contractor llrev44-0-' K`T-VA+1 a: f7gte4 Date (P—L^/Z.
1 hereby affirm that I not licensed under the provisions of Chapter 9 JOB DESCRIPTION:SINGLE FAMILY BATI IROOM REMODEL 485QI-I'
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
_ 1 hereby affirm under penally of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,;a provided for by Section 3700 of the Labor Code,for the
performance of the work fix which this permit is issued. Sq.Ft Floor Area: Valuation:$1129.,
I have and will maintain Workcr'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 APN Number:34233048.00 Occupancy Type.
APPLICANT CERTIFICATION
I emit) that I leve read this a pplication and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities.judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of This permil. Addilinnally,the applicant understands and will comply —/7 _/ l L
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: , _ sur //9/l/� Date:
9.18.
Signam ^'%:` Dale
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If roof is
installed without first obtaining an inspection.I agree to remove all new materials for
I hereby affirm that I am exempt from the Contractor's License 1-aw for one of inspection.
the following two reasons:
.._ h as owner of the property,or m}employees with wages as their sole compensation, Signature of Applimnt Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the propeny.am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(See 7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the fallowing three IIA%ARDOUS MATERIALS DISCLOSURE
dcclarntions: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a C'ertilicatc of Consent to self-insure for Worker's California Ilealth&Safely Code,Sections 25505.25533,and 25534, 1%ill maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Cade,Chapter 9.12 and the Ilealth&
performance of(he work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
- I have and will maintain Worker's Compensation Insurance,as provided for by Additionally.should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Ray Area Air Quality Management District 1 will
Permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safcty Code,Sections 25505,25533,and 25534.
1 eerily that in the performance of de work for which this permit is issued,I shall
not enmploy any person in any manner so as to become subject to the Worker's woe r h
Compensation laws of California IC after making this certificate of exemption,) Dale:
become subject to the Worker's Compensation provisions of the Labor Code,I must
Rxthwvith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
I hereby affmm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec-3097.Civ C.)
I certif}'that I have read this application and state that the above information is Lender's Name
correct.I agree to comply with all city and county ordinances and stale laws relating
to building construction,and hereby authorize representatives of this city to enter Lender's Address
upon the above mentioned Property I'or inspection purposes.(We)agree to save
indemnity and kap harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the
granting of this permit Additionally,the applicant understands and will comply I understand my plans shal I be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34233048 .00
DATE ISSUED. . . . . . . : 06/06/2012
RECEIPT #.,. . . . . . . . : BS000017009
REFERENCE ID # . . . : 12060033
SITE ADDRESS . . . . . : 22803 LONGDOWN RD
SUBDIVISION . . . . . . ,
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MASEGIAN JOHN D AND KELLY A
ADDRESS . . . . . . . . . . : 22803 LONGDOWN RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : AMERICAN KITCHEN&BA
CONTRACTOR . . . . . . . : WARTENBERGH, JOE LIC # 21316
COMPANY . . . . . . . . . . : AMERICAN KITCHEN & BATH
ADDRESS . . . . . . . . . . : 1758 JUNCTION AVE UNIT D
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408)436-8151 -
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 11, 295 .00 1. 00 0. 00 1 .00 0. 00
1BSEISMICR VALUATION 11, 295.00 1.13 0. 00 1 .13 0. 00
1REMRESBAT SQ FEET 1 .00 588. 00 0. 00 588.00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 590. 13 0. 00 590 .13 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 590.13 #21955
---------------
TOTAL RECEIPT 590 .13
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 22803 Longdown Rd DATE: 06/06/2012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: $11,295
`PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION
USE: pPERMIT TYPE: 1R3SFDRE
WORK Bathroom remodel 48 sq ft).
SCOPE
11rJr. N... 'i). !'G un 1, /'lue Chcr6 l7rr. !'li,n('ircrA
I1.•rh !'.•%"it Fr.•: l'GunG, Pe, ni;F.r: F:hs' l'rrnvrl h:•;.
Jr/rrr 11rch. /ny Olhrr Ph... Lavp. Oihur/i/rr. hnl�.
hi'l, P:'," PhnnG. hop, Fer: Oc, pap, F.r.
NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelimina information available and are on1 p an estimate Contact the Dept for addn'I info.
FEE ITEMS (Fee Resohnian 11-053 E11. 7///l 11 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 48 s.f. Remodel, Bath (<=300 so
Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $588.00 /RE,%lRESBAT
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-.0 Reg. 0 OT FO.OThrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
C'rac O 11(11(M -IM.
d M0ir.rlr„liW 0
Work Without Permit? 0 Yes 0 No $0.00 E)
Advanced I'lannina Pee: $0.00 Select a Non-Residential G
'l'rrml lJr�cniurrruirlinl (i:a'.+': Building or Structure 0
I
SUOTU Motion Fee: /BSEISMICR $1.13 Select an Administrative Item
Bldg, Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $2.13 $588.00 TOTAL FEE, $590.13
Revised: 05/01/2012
Community Development
' 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CffY OF Fax(408) 777-3333
CUPEkTINO
Building Ike artment
JOB ADDRESS: PERMIT#
2-7,003 L0,06blw-)
OWNER'SNAME: . 'cLy PHONE # z/oS VA-ffi �l
GENERAL CONTRACTOR. A�Lciir ,j GC,-rC:41,N.e>,47,, FAX # `/off-r1n,-a, �V3
I am not using any subcontractor �o-oo-/z
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
cope r .cam
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•buildingWcuoertino.orO
❑ NEW CONSTRUCTION El ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT rI
PROJECT dDDRE55APN% -� ^
03 Latta W,l I?A•
OWNERNAMEki PII NE t E-MAIL
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STREET ADDRESS CITY.STATE,ZIP FAX
2803 Lo,,C,�o..AJ IZ4• vaka..Aro
CON-FA 1AAIE Po - E-MAIL
{..J �7f/.C•2 T(/.J �'dy36 - gl h )oM"IA-A+••�$rl.laAN KITW:..0 AwA,364/. CT-
STREIr AUURI! 5 CITV,STATE ZIP AX
Ni A+ loss (A SS�/z JP Yf6 -A/�3
❑OWNER ❑ OWNER-GUILDER ❑ OWNER AGENT yl•CONTRACTOR ❑CO.NTRACEDR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONT.R rIno� LICENSENJ1. @R LICENtrPE DUS LIC%
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COpIPANY NAME E-MAIL FAX
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SETRSs AC A E
SL :5 IS5POOy
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ARCI IITECr/ENGINEER NAME LICENSE NUMBER BUS.LIC%
COQ%II'ANY NAME E-MAIL FAX
STREET ADDRESS CITY.STATE.ZIP PI IONS
DE IIT N OF WORK
vkai_ f Krt
Abk> C-11Ok o L6 Iri-r.
LXISTINGUSE PROPOSE SL CONSTR.TYPE 'STORIES
f� USE TYPE OCC. SO FT. VALUATION(S)
I(XIS'1'G MEW FLOOK DCVO TOTAL
AREA AREA AREA NET AREA _ 5272-1 2 ✓/� �3 Y
BAIIIROO%1 MTCIIEN DTIIE0. !
REMODEL AREA 99sl- RENODELAREA REMODEL AREA
POROIARLA I DECK AREA TOTAL DECK ORCH AREA GARAGE AREA' DETACII
ATTACH
w
DWELLING UNITS'. IS A SECOND UNIT ❑YES SECONDSTORY []YES
BEING ADDED! IFINO ADDITION! !NO
PRE-APPLICATION [:1 YES IF YES,PROVIDE COPY OF IS TICE BLDG AN ❑YES RECEIVEqBY: 1;: TOTAL VALUATION:
PLANNINGAPPL% ;KNO PLANNING APPROVAL LETTER EICHLERHOME} 'ONO /1 - I •t ' ?_95
By my signature below,1 cenify to each of the following: I am the property owner or authorized agent to act/onthe property owner's behalf. 1 have read this
application and the information I e provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and slate Imus rel g to it cc t Ion. I autho ze representatives of Cupertino to enter the abov/y-id/eftifed propeny for inspection purposes.
Signature of Applicam/A m: Date b/ 6//Z-•
SUPPLEM 50AL INFORMATION REQUIRED -PLAN CH.ECK rPE - I- ROU rnNG sl.ir .
New SFD or Multifamily dwellings: Apply for demolition permit forOVER-T116COUNTER. l BUILDIN,G PLAN REVIEW y
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. El' EXPRESS PLANNING PLAN REVIEW
-
_Commercial Bldgs: Provide a completed HaTdrdous Materials Disclosure ❑'•STANDARD,-- O;,PUBLIC WORKS
form if any hazardous Materials are being used as part of this project. '.p LARGE. D Plage DEPT' `
Copy of Planning Approval Letter Or Meeting with Planning prior to ,;O ,MAJOR, , - 'O'.SANITARY SEWER DISTRICT
submittal ol-Building Permit application. - ..
i ❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06121111
r` Wen
bt9-w�A:sY V d%YJ'
JUN 0 6 2012
rowr& o"% ^ ed
. U Z5 By
COMMUNITY DEVELOPN DEVELOPENT DEPDEN
'
BUILDING DIVISION CUPERTINO CVP TINqn
APP 0 ED Building a rtme
his set of plans and speci ica ions MUST.be kept at the -
ob site during construct) nr tis unlawful to make any ,I JUN 0 6 2012
changes or alteration 'o same,or:to.devlate
therefrom,without appro al, m.the BuIlding,Offlclal. = REVIEWED FORO MLI NCE
e stamping of this plan d peclfldetions SHALL NOT'
Reviewed By:
e held to permit or to b an approval of,fhe,violation
o City Ordinance or.State Law.
UAIE
PERMIT NO. 1aa k 23 -
17 1 E COP
Bathroomr.-re,mo'del' Kiln same layout
New bathAub ,-and--:plumbing
fixtures
Install GF-l',,- -. ou,tlet.
Bath room-rfan ' wi;th fluorescant light
GL ,//�I��GLr+'i'a�`Uf/ �(li✓ /�Oi✓O�'/�E % ter%GGTG�J
L . .
� �iating
9`' 7
CUPERTINO
Building Department
JUN 0 6 2012
REVIEWEp FpR C
Reviewetl 6y: MPLIANCE
American Kitchen & Bath
Bathrooms By Han,
AKIB
Design and Build
1758 Junction Ave# D
San Jose, CA 95112
Phone: (408)436-8151 .
Fax: (408)436-8153
CA Lic # 513838
05/15/2012
Ms. Kelly Masegian
22803 Longdown Road
Cupertino, CA
Phone: 408-873-7712,.•cell: 649-9937
Upstairs Bathroom
Site work and demolition
EPA required lead testing
Contractor to supply building permit, cost of permit not included
Supply dust and floor protection
Remove vanity, tub,toilet, flooring;medicine cabinet and mirror
Dispose of debris at-an approved facility
Framing
Frame for recessed medicine cabinet'on•sink wall and shower door blocking
Electrical/Mechanical
Supply and install Panasonic Whisper VF,08VF2-in same location as existing on same switch
Supply and install GFIC outlet's and'dedicate if needed
Plumbing
Supply and install customer;provided shower valve,with shower/tub trim, raise head if needed
Supply and install Arnerican'standard:P�inceton.tub with pop up drain and overflow
Install customer provided faucet
Supply and install drain, stop and,supply line
Supply and install Toto Drake.elohgated-toilet With soft close seat, seal, stop and supply lines
Wall repairs
Close off side medicine cabinet
Supply and install water resistant sheetrock
Sheet rock repair and texture affected walls and ceilings to match existing
Prime then paint walls and ceiling ;1 color 2 coats Kelly Moore paint including trim
Cultured Stone
Supply and install Cultured Stone Almond.Brown onyx to approx 86",
Includes corner caddy and'Jarge recessed soap/shampoo
Cabinetry/Countertops .
Supply & install MerillaCMaple Toffee vanity,-triview mirror,j-cab & li
Supply & install Corian Witch Hazel vanity top with Cameo White 81 ink and coved sOMERTINlO
Finishes Building Department
Supply and install tile flooring;on a mortar'floatwith tile.base,
Upstairs Bathroom RemodehEstimate$11,295 �d JUN 0 6 2012
1 REVIEWED FOR O MPLIANCE
By:
Owner Initial Cont.Initial Reviewed
, r �