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13030157CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19358 SAKURA WAY CONTRACTOR: GREEN WORKS US PERMIT NO: 13030157 I OWNER'S NAME: MIYAKO HENRY 1 2500 OLD CROW CANYON RD I DATE ISSUED: 03/28/2013 I OWNER'S PHONE: 4089967643 SAN RAMON, CA 94583 PHONE NO: (925) 272 -4590 LICENSED CONTRACTOR'S DECLARATION License Class G 3 3 Lic. X G6 4 Z ? Contractor G fLC n1 W �)=5 �l Date 3 2—� / �l I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two 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 and will maintain Worker's Compensationdnsurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands an ill comply with all non -point source regulations per the Cupertino M ode, Section 9.18. 1 Signature 19 0 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 and will maintain 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. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city aud county ' ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. ,(We) agree to save indemnify and keep harmless the City of Cupertino, against liabilities, judgments, costs, and expenses which may accrue against said City in of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date JOB DESCRIPTION: RESIDENTIAL REPLACE (E) TUB WITH (N) WALK -IN TUB, SAME LOCATION. ADD (N) DEDICATED CIRCUIT (GFCI) Sq. Ft Floor Area: Valuation: $5000 APN Number: 37503019.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FR QWrAST CALLED INSPECTION. Is V. Date: RE- ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapsii 9.12 and the Health & Safety Code, Sections 25505, 25533, and 2 Owner or authorized agent: Date: 3 f3 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255 �O (408) 777 -3228 • FAX (408) 777 -3333 • buildinaCa.cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS ^2 54? • I APN # O 2 019 1zA (� wS OWNER NAME - / I' PHOtNFb 1,47? ^2 E -MAIL 1 J O i STREET ADD U 12 � CITY, STATE, ZIP C -�i�r� 7r�J0 e-1 %s©/ FAX CONTACT NAME PHONE E -MAIL STREET ADDRESS CITY, STATE, ZIP FAX 13 OWNER OWNER OWNER - BUILDER OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT �h+ CONTRACTOR. NAME GREENWORKS US LICENSE NUMBER 668492 LICENSE TYPE B C33 BUS. LIC# COMPANY NAME GREENWORKS US E-MAIL FAX 925- 265 -4590 STREET ADDRESS CITY, STATE, ZIP PHONE 4301 LAKESIDE DR. RICHMOND CA 94806 925 - 272 -4590 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK REPLACE EXISTING TUB WITH NEW WALK -IN TUB - SAME LOCATION. ADD DEDICATED GFCI CIRCUIT. EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA �% L REMODEL AREA 1 REMODEL AREA PORCH AREA DECK AREA TOTAL DEC"ORCH AREA GARAGE AREA: DETACH ❑ ATTACH I # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEINGADDED? []NO ADDITION? ❑NO PRE - APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES „ PAM., - " L VALUATION: = TOTAL VALUATION: PLANNING APPL # []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO , ,. Q5 By my signature below, I certify to each of the following: I am the property owner or authorized agent to a property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply withal] applicable local ordinances and state laws relating to building cons authorize representat' ertmo to enter the above - identified property for inspection purposes. Z Signature of Applicant/Agent: Date: SUPPLEMENTAL INFO REQUIRED TLA CK,TYPE ROUTING SLIP p 1HE- ❑ BUM DING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building OAR= couNZER permit for new building. EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El sTANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. 0-LARGE p FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to } 0 Ma rOa ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ..�» . .. . ...:........... ._,,. ..... ,,. ,. . ENyTRQNWNTAL HEALTH.. BldgApp_2011.doc revised 06121111 FM_7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION lialADDRESS: 19358 SAKURA WAY DATE: 03/28/2013 APN: 375 03 019 BP #: REVIEWED BY: MELISSA *VALUATION: 1$5,000 %PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair • PRIMARY USE: SFD or Duplex PENTAMATION PERMIT TYPE: 1 RPFI WORK REPLACE E TUB WITH N WALK -IN TUB SAME LOCATION SCOPE 0.0 ,41ech. Ilan Check I I . Plumb. Plan Check 10.0 1 hrs $0.00 Elec. Plan Check 10.0 1 hrs $0.00 iL1ec•h. l'evnnit Fee: Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: IEPERMIT OrheF ;Llech. Insp. Other Plumb Insp. 0.0 hrs $45.00 Other Elea Insp. EE hrs $45.00 A ech. Insp. Fee: Pluvnh. hasp. Fee: Elec. Insp. Fee: NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These ees are based on the relimina information available and are only an estimate. Contact the De t or addn'l in o. FEE ITEMS (Fee Resolution 11 -053 Ef. 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Plumbing $10.00 IBPFIXTURE Fixture set on One Trap Suppl. PC Fee: Q Reg. ® OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 F-T-1 Electrical $133.00 IBREMMISC Special Circuits Permit Fee: $0.00 . Suppl. Insp. Fee:( Reg. ® OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $90.00 Consir action Tax: Administrative Fee: IADMIN $42.00 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure A Travel Documentation Fee: 1TRAVDOC $45.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 �y $178.50 $143.00 Revised: 01101/2013 C. s end specifications MUST be k t Onstruction. It is unlawful to make any alterations on same, or to deviate vAthout approval from the Building Officia of this plan and specifications SHALL N I b" `' : `' to p >.rrni a an approval of the violation of � 1g` sio any City Ordinance or State Law. PERMIT N0. � f 013 d- C � a z v n o0 c� a s a c� rn cvp .. z� suilq;n9 D Aa'�� a MAR 2 3 2013ent gEU'VED Review d'd CdDE COMP��AN � Y C a 2 CD a r z m � � w z = x M CD z 0 0 / m 0 w s 0 o T� CD cvp .. z� suilq;n9 D Aa'�� a MAR 2 3 2013ent gEU'VED Review d'd CdDE COMP��AN � Y C a 2 CD a r z m � � w z = x M CD z 0 0 / m 0 w s 0 o T� ZZ h .:fit UU �z �a z xM �.. o 2 O s N .., m - x o NT Z ~ O 9 Z Onp�m T� On��Z m ;o O 1Ty y D Z n n C O p G G G DO 2 � x0 o z i i �z z° z a ~ o m m a m HENRY MIKAYO SAFEGUARD TUBS D V z N 19358 SAKURA WAY A DIVISION OF GREENWORKSUS MAR 2 1 w N CSLB #668492 W CUPERTINO, CA. 95014 4301 Lakeside Drive, Richmond, CA 94806 a �i� �s Designed for your Independent Ufestyie WALK -IN TUB INSTALLATION INSTRUCTIONS AND OWNER'S MANUAL C .5 "x26.5 "x40" L/R (w /o wall extension kit) L/R (with wall extension kit) e'o. "77 ��wFO FcR � zQ13 co© ew�d By COMpt / F UNPACKING THE UNIT 1. Inspect the carton for any damage: Take a picture if possible. CAREFULLY RECORD ALL PERCEIVED DAMAGE and contact us as soon as pos 'sible . 2. DO NOT LIFT THE TUB BY THE PLUMBING PARTS. Doing so can result in leaks, forwhich the installer is responsible. All Walk -in Tubs are water tested before they leave our factory and the bathtub you have purchased has passed inspection. 3. inspect the unit for damage even if there is no carton damage. All product damage must be reported within 72hrs . Once the unit is installed, suirface damages will be assumed to be installation- related if not reported priorto installation. Installers are responsible for damage that occurs once the unit is put in place. NOTE. - Remove all packaging material except for the protective plastic. This has been placed on the tub at the factory to eliminate abrasions from handling. This should only be removed at final cleanup. 4. Inspect the plumbing for any fittings that may have loosened in transit. 5. Read the following instructions completely before installing this product. If the' home-owner or installer has any questions, please contact us . 6. You must follow all instructions in this manual. FAILURE TO READAND COMPLY WITHALL INSTRUCTIONS CAN RESULT IN PRODUCT DAMAGE OR INJURY TO BOTH INSTALLER AND HOMEOWNER. IT WILL ALSO RESULT IN ASSUMPTION OFALL LIABILITY BY SAID INSTALLER. RESPONSIBILITIES OF THE INSTALLER Installer must inspect and water test the product prior to installation to ensure the unit is free of defect and /or damage. In the event of a problem, the unit must not be installed. If the packaging or product has been U please contact us immediately is product is designed to be installed by a licensed tradesperson; used plumbers and electricians should be employed to insure proper tallation. Installer assumes all liabilities for installation procedures. e cVp RFC, Re`7e OF0 ,4C 84917 �ae� O egey OFCpMp two-2 � /q�CF INSTALLATION PREPARATION 1. Check the floor area where the tub is to be installed. a. Clean area of any debris or trash. b. Use a 5 or 6 -foot level and determine if the floor is level. If the floor is not level, adjust all leveling feet to perfectly level the tub. Note: it is important that all leveling feet are completely touching the floor and level for the door system to work properly. i i I I ! 2. Check to ensure that fhe drain piping has been "roughed -in" at thie proper location. 3. Ensure that the proper electrical service has been installed at the pump location. 11VO REVI�4R 2 d ZO 'ant F�r'C FC,R Cp 0-4 Re�1ewed By D� CC�P!.JAIV A Unit:inch D a� 1.0 /F -As the external thread connector of the hot and cold water P i' a the P user interface is reserved '/z ".Protruding 1.2" from gtound. Recommended to install a pipeline valve for easy maintenance. 2.0 -To ensure smooth drainage , the bathroom should have drainage holes? 03.1 ". THE INSTALLATION FOR WALL EXTENSION KIT 60 "x32 "x40" L/R (with wall extension kit) i i tub B 6, Ozone Water purification will start automatically. 7. Auto lock key function (computer control panel) The system will automatic lock if computer control panel isn't opeirated within one minute of powerin on , all the function keys will lock. PiressEg key again for 2 seconds to re ease the locked keys . Notice: In order to prolong the lifetime of this product, please don't press on /off key frequently, the time interval should be over 30 seconds. MAIN CONTROL BOX Connection Of Bathtub controller POWER SUPPLY: )IOV /80Rz RATED POWER: 28208 e o WATERPROOF: )Px< � 9 MODEL: T05A CA3I 0 MAIN CONTROL BOX Wn.er pump Wirld pump (out'L /U.9KW) IouL3 /0.4KW) POWER) IK 0 (AC'2v1 Ozone a, "QY9� a s POWUR2 TK ® Hcate_ L (Cp L) /1. SKW) W1L el' leve) swi LCR Temp de,,ector Techn qg. rameters are anise without notice MAR 20 i,,q men# REV /EKED Fo � Reviewed By CODE cO1WPC 1,g1VCE Working condition and features Rated voltage 110V linsulated resistance >50M n Rated power 2820W Pressure resistance 1250V /0.5mA�1min Rated frequency 6OHz Waterproof grade 1PX4 Loading parameter Loading item Rated loading voltage Rated loadingfrequency Rated loading power Other Heater 110V 60Hz 150OW Water pump 110V 6OHz 900W Wind pump 110V 6OHz 40OW Light AC12V 10W i Ozone AC12V 10W Connection Of Bathtub controller POWER SUPPLY: )IOV /80Rz RATED POWER: 28208 e o WATERPROOF: )Px< � 9 MODEL: T05A CA3I 0 MAIN CONTROL BOX Wn.er pump Wirld pump (out'L /U.9KW) IouL3 /0.4KW) POWER) IK 0 (AC'2v1 Ozone a, "QY9� a s POWUR2 TK ® Hcate_ L (Cp L) /1. SKW) W1L el' leve) swi LCR Temp de,,ector Techn qg. rameters are anise without notice MAR 20 i,,q men# REV /EKED Fo � Reviewed By CODE cO1WPC 1,g1VCE MUTT- FUNCTION HANDHELD SHOWER WITH BACK FLOW PROTECTOR HYDRO MASSAGE FLOW RATE CONTROL Hydro massage is controlled alternatively by water force . You can adjust it manually or automatically. Rotate the knob or press the nozzle to control water column strength. DRAINAGE Rotate the cover clockwise to close the drain. Rotate the cover anticlockwise to open the drain. When the water is over the maximum level the excess water will be drained by overflow. wp gUilajng p �T/ /V® 82013 Reviewed Or? Coos CC�p� !A/VCR 'V 10 SAFETY INSTRUCTIONS IMPORTANT SAFETY INSTRUCTIONS INSTRUCTIONS PERTAINING TO RISK OF FIRE, ELECTRICAL SHOCK OR INJURY TO PERSONS WHEN USING THIS UNIT, BASIC PRECAUTIONS SHOULD ALWAYS BE FOLLOWED. WARNING: Risk ofpersonal injury. Use this unit for its intended use as described in this manual. DO NOT use attachments not recommended by the manufacturer. _ WARNING: Risk of personal injury. To avoid injury, exercise caution when entering or exiting your walk -in tub. WARNING: Risk of personal.. injury. To reduce the risk of injury, do not permit children or persons with disabilities to use this product unless they are closely supervised at all times. _ WARNING: Risk ofhyperthermia and possible drowning. People using medications, herbal remedies, sleep aids,and for having adverse medical istory should consult a physician before using this product. WARNING:' Risk of personal injury. Water temperatures over a 100 ° F (38° C) may be hazardous to your health. Check and adjust water temperature for your personal comfort. _ WARNING: No food orAlcoholic Beverages. Use of your bathtub immediately after meals is not recommended. Avoid alcohol consumption before or during the bathing. Alcoholic beverages can cause drowsiness or hyperthermia resulting in loss of consciousness or even drowning. WARNING: Pregnancy. If you are or think you may be pregnant, consult, your doctor before using the bathtub. WARNING: Risk ofpersonal injury. Risk of electric shock; do not perrnk electric appliances (such as a hair dryer, lamp, telephone, radio or television) within four feet of this bathtub. _ WARNING:'Risk ofpersonal injury. Never drop or insert any objects info any openings. _ WARNING: Risk ofpersonal injury. Do not operate this unit without the guard over the suctionfittings.The unit must be connected only to a supply circuit that is protected by a ground -fault circuit- interrupter (GFCI). Such a GFCI should! be provided by the installer and should be tested on a routine basis. To test the GFCI, push the test button. The GFCI should interrupt power. Push the reset button. Power should be restored. If the GFCI fails to operate in this manner, there] may be a ground current flowing, indicating the possibility of an electric shock. Dojnot use this massage bathtub. Disconnect thejet massage bathtub and have the problem corrected by a qualified service representative before using.To reduce thelrisk of electrical shock, dedicated electrical supply circuit(s) must be grounded. To do this,connect the f the 3- conductor wiring cable to the grounding terminal of the electrical v nelandry continuously to the green grounding!screw on the GFCI or receptau) f compartment. . ui/din9 SAVE THESE I ' 1C'l # T aP'c_"f Rejq 8 2013 WFp F Reviewed gR. CODE CO /12. fO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408 - 777 -3333 JOB ADDRESS: 1 9 3 � Q r%A Ij &4 PERMIT # OWNER'S NAME: Z-,J Q M f A- O PHONE # `f , V q 3 GENERAL CONTRACTOR: G f-t- ,Juj I-5 Us BUSINESS LICENSE '# ADDRESS: 430 ( Jk- D CITY /ZIPCODE: )?' C-Pfwl oA) % Y<204 "Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR. AND ALL SUBCONTRACTORS HAVE AINED A CITY OF CUPERTINO BUSINESS LICENSE. 3 z� // 3 I am not using any subcontractor — S 2nature Date Please check applicable subcontrors ands a the following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date