10040022 CITY OF CUPERTINO BUILDING CONTRACTOR:KAYPERMIT KEITH LA PLAIN PERMIT NO: 10040022
BUILDING ADDRESS: 21904 CORTE MADERA LNLN
OWNER'S NAME: KAY&KEITH LA PLAINDATE ISSUED:04/05/2010
21904 CORTE MADERA PHONE NO:
;BR'S PHONE: 4087779462 CUPERTINO CA,CA 95014-1129
BUILDING PERMIT INFO: BLDG
ELECT PLUMB
�J' LICENSED CONTRACTOR'S DECLARATION r r
rr
License Class Lic.# rCOMMERCIAL
MECH RESIDENTIAL
Date__________-_ JOB DESCRIPTION:BATHROOM REMODEL(82.5SQ);NO RE-ROOF&NO
Contractor
I hereby affirm that I am licensed under the provisions of Chapter
STRUCTURAL
(Ccommencing withode and that my ticensens 7othe Business&Professions
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 Valuation:$15000
performance of the work for which this permit is issued. rovided for by Sq.Ft Floor Area:
I have and will maintain Worker's Compensation Insurance,as p
Section 3700 of the Labor Code,for the performance of the work for which this Occupancy Type:
permit is issued. APN Number:32645037.00
APPLICANT CERTIFICATION
I ertify that I toe comply
ty with all city and pplication county ordinancestate that the s and stave te laws relating PERMIT EXPIRES IF WORK IS NOT STARTED
correct. ation is
I agreeccomply of this city to
to building construction,and hereby faouthp authorize
purposes. (We)agree to save
upon the above mentioned property Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PEAR.ED INSPECTION.
P
SSUANCE OR
indemnify andp keep which may the City against
g aid City in consequence of the 180 DAYS FROM LAST
costs,and expenses which accrue agains l cant understands and will comply
granting of this permit. Additionally,the app
with all non point source regulations per the Cupertino Municipal Code,Section
Date:
Issued by:
9.18.
Date�—
Signature
k-r- OWNER-BUIRERE-ROOFS.
LDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
I hereby affirm that I inspection.
the following two reasons: Date:
I,as owner of the property,or my employees with wages as their sole compensation, licant:
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of App
Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE
I hereby affirm under penalty of perjury one of the following three 6.95 the
Ihave declarations:nCode,Sectionseqiement5505, under and 25534.ter I oflt maintain
d the hazardous
I omp and willn aspro
maintain a Certificate of Consent to self insure for Worker's California Health&Safety materials requirements er 9 12 and the Health&
compliance with the Cupertino Municipal Code, P
Copem
pensation,acoo, the provided for which Section permit of the Labor Code,for the
I ve and cell workin Worker's
le 'sthis is iprovided for by Safety Code,Section 25532(a)should I sdevices tore or handle hazardous material.
Additionally,should I use equipmentArea Air Quality Management District I will
I haveo and willmaintain
the a b r Code,
for Compensation Insurance,ceoftheascontaminants as defined by the Bay
Section 3700 of the Labor Code, the performance of the work for which this
permit is issued.
Healthn compliance with the Cupertino Muicil Safety Code,Sections 25505,25533nand 25534e� Chapter 9.12 and the
1 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
ner or a ori agent; Date:-�S'0
Compensation laws of California. If,after making this certificate of exemption,
become subject to the Worker's Compensation provisions of the Labor Code,I must CONSTRUCTION LENDING AGENCY
forthwith comply with such provisions or this permit shall be deemed revoked.
ERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT Cations for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state ordinancehat the s and state ve laws relating Lender's Name
correct.I agree to comply with all city and county
to building construction,and hereby authorize representativess. We)agree to saver Lender's Address
upon the above mentioned property for inspection pure
unify and keep harmless the City of Cupertino against
ty in conse1 liabilities,
judgments,the ARCHITECT'S DECLARATION
and expenses which may accrue against cantd uCnderstands and will comply shall be used as public records.
withti all o thiso permit• e reAddgulations
s the app
with non-point source regulations per the Cupertino Municipal Code,Section I understand my plans
9.18. Licensed Professional
l• -, Date 0 •
Signature , . i cc...
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN • 32645037. 00
DATE ISSUED • 04/05/2010
RECEIPT # • BS000010098
REFERENCE ID # . . • : 10040022
SITE ADDRESS • 21904 CORTE MADERA LN
SUBDIVISION
CITY • CUPERTINO
IMPACT AREA
OWNER • KAY & KEITH LA PLAIN
ADDRESS • 21904 CORTE MADERA LN
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1129
RECEIVED FROM • KAY LA PLAIN
CONTRACTOR LIC # *OWNER*
COMPANY • KAY & KEITH LA PLAIN
ADDRESS • 21904 CORTE MADERA LN
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1129
TELEPHONE
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
1BCBSC VALUATION 15, 000 .00 1. 00 0 . 00 1. 00 0 . 00
1BSEISMICR VALUATION 15, 000 . 00 1. 50 0 . 00 1 . 50 0 . 00
1REMRESBAT SQ FEET 1.00 570. 00 0 . 00 570 . 00 0 . 00
TOTAL PERMIT : 572 . 50 0 .00 572 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
CREDIT CARD 572 .50 MC
TOTAL RECEIPT : 572 .50
CITY OF CUPERTINO
-ett ADDITION/REMODEL
CUPEK�TINO PERMIT APPLICATION FORM
APN # 2 Li, - �j 3_7 , d Date:
Is a 2"d unit being added? Yes ❑ No,2" If yes, please fill out the permit application for 2"d unit.
Building Address:
2i�ioCo,rtNLa .-ck_ G u vfiv�o
Mailing Address (if different from building address):
Owner's Name: Phone# :
a r \ Lc. (-t-Cc 77? q qF G 2-
Contractor: Phone#:
0 Wt,. Q.✓ bti i (01(54.-V Fax #:
Contractor License#:
Cupertino Business License#:
Contact: I Phone#:
Fax#:
Building Permit Info:
Bldg. ❑ Elect. ❑ Plumb. ' Mech. ❑ Hillside ❑
Job Description:
Addition-What is being added?(Be Specific):
What is being remodeled (not including addition)?
ck vctiv\.
Remodel Includes Re-Roof: Yes ❑ No a If yes list number of squares
Remodel Includes Structural: Yes ❑ No
Do you have the pre-application planning approval? Yes ❑ No Er
If yes, please provide a copy of your planning approval letter. Planners name:
Square Footage: 't-kvL/L
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen Bath g2 SJ Other
Type of Construction (Usage Class): Occupancy Type:
SKACJ -rte.l iy
1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT,V-B
Valuation: Please check this box if the project is a
dt- j 000 second-story addition ❑
Project Size: ExpressO Standard ❑ Large ❑ Major❑
Please complete relevant portion of the Green Building
Checklist & attach it to the application or if applicable, Green Building Points Achieved:
include in plan set & the sheet index.
***For Office Use Only*** Revised 07/06/09
Over-the-Counter 0
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
1MECPLNCK Stand Alone Mechanical M
Pln Ck (hourly
1PLMPLNCK Stand Alone Plumbing P
Pln Ck (hourly)
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1TRAVDOC Travel &Documentation B
1BUSLIC Business License B
1,-0"" 2'-11"
Existing Area
7'6"x 11'0"
=82.5 sq feet
Tub
Final Area
7'6"x 11'0"
=82.5 sq feet
IN ACCORDANCEHWITHDTH
CUPERTINO CODES AND OF DINANCFS
DATE tJ irO
SIGNED r
This set of plans and specii
be kept on the lob at all tones andlit sST
unlawful to make any changes or Alterations
on same without written
the Bu' Pe1'mis..wn from
The stampingg Department, Ci of�rupertino.Cupboard
The
ALL this plan and sperifications
held to permit mit()be an
approval of the violation of 4)y p/Avisions
of any City Ordinance or gtate?aw.
•
Cupboard
�1 1
Job: Scale:3/4„=1.0.
Keith&Kay La Plain Date:3/30/2010
21904 Corte Madera Lane
Existing Cupertino
Job:La Plain Bathroom
CA 95014
Sheet: I
408-777-9462 I o
BOO
00
C
t0
tio
Om
0,00 RD: `
13Y-
Tub
'/,"Hot Feed Cold Feed
Job: Scale:'/."=1'0"
Keith&Kay La Plain Date 3/30/2010
21904 Corte Madera Lane
Bath/Shower Wall Cupertino
Job:La Plain Bathroom
CA 95014
408-777-9462 Sheet:3 0F i
O Toto
Flush ToiletAquia DIIual
O Kohler Mariposa
O 1 Bath 5'6"x 36"
OProfile neo
Oshower recep
Kohler Rough
Valve
5 O Thermo Trim+
vol ctl&diverter
OTub Spout
77 Handshower
OO Holder
O Hose
10 Thermo Trim+
Vol ctl
11 Showerarm
15
O 12 Showerhead
GOO 13 Faucet
Millm000
O
O OO O 15 Drain
O
13
0
sy
0
0
0
13
Job: Scale:'/+"=1'0"
Plumbing Keith&Kay La Plain
21904 Corte Madera Lane Date:3/30/2010
Cupertino Job:La Plain Bathroom
CA 95014
408-777-9462 Sheet: G- i;;
m0
00
00�
0
0000
Tub
Shower Receptor
0
RE: INT )
Job: Scale:'/"=1'0"
Keith&Kay La Plain p :3/30/2010
21904 Corte Madera Lane
Bath/Shower Wall Cupertino Job:La Plain Bathroom
CA 95014
408-777-9462 Sheet: cL Ire
•
• Vent
Tub
EII::
15 ® Shower Receptor
tri
P Trap
P Trap
To main
2"Waste
REC.-2 Fin7 ETD
Bv;_
Job: Scale:4"=1'0"
Keith&Kay La Plain Date:3/30/2010
21904 Corte Madera Lane
Bath/Shower Wall Cupertino Job:La Plain Bathroom
CA 95014
408-777-9462 Sheet: .5 cc
A
14
•
GFI 14 Surface Light
eExtract Fan
16
0
•
Bv
GFI
� 14
I -1
Job: Scale:%"=1'0"
Keith&Kay La Plain Date:3/30/2010
Electrical 21904 Corte Madera Lane
Cupertino Job:La Plain Bathroom
CA 95014
408-777-9462 Sheet: 6 �,c ,c
•
1. Aquia II Dual Flush Toilet
Category Model Number Style
Toilets CST416M Transitional
• Elongated skirted design, two piece toilet.
• Dual-Max® Flushing System.
• Push button style flush option.
• Upgrade with an Oval SoftClose®seat.
• Large, 2-1/8"fully glazed trapway.
Decorative, high profile two piece toilet. Dual flush (1.6 GPF / 0.9 GPF) performance
option to allow apporiate water usage.
Tank cover, fittings, chrome plated push button, less seat.
TOTO's Dual-Max®flushing system, found on several of our most popular High
Efficiency Toilets, offers the option of a 1.6 gallon flush or 0.9 gallon flush based upon
need. Exceptional water savings paired with outstanding performance -- that's Dual-Max.
2. Mariposa®5.5' bath -K-1229-RA
Mariposa®5.5' bath with integral apron and right-hand drain
With multiple installation options for drop-in models and an integral tile flange on alcove
and apron models, KOHLER ProFlex baths offer flexible solutions without additional
expenses or lengthy modifications.
• 66"L x 36'W x 20"H _ C%
• Three-wall alcove installation
• Constructed of acrylic
• Includes integral apron and tile flange to simplify installation
Designed for one-person bathing BY
• Textured bottom surface
3. Profile®neo-angle shower receptor-K-9866
Profile® neo-angle shower receptor, 38"x 38"
Create an open look with the frameless design and minimal hardware of a Profile
shower. With its innovative shape, this Profile 38" neo-angle shower receptor makes the
most of a compact space and offers versatile door placement options.
• Single threshold
•
7orfe
• Constructed of acrylic
4. Rough, iBox Universal Plus 3/4"w/Service Stops 01850181
• Required Rough for installation of Raindance Rainfall Showerhead part
#28411001
• 4 port universal rough w/service stops for concealed installation
• Includes 3 x 1/2" reductions and 1 x 3/4" plug and seal
• Easy installation, noise reduction, water tight
• 1" extension kit part#13595000 not included
5. S Thermostatic Trim wNolume Control and Diverter
• Thermostatic temperature control Jig
• Volume control and diverter for 2 outlets
• Anti-scald 100-degree safety stop .
• Flow 8 GPM @ 44 PSI
• Set your preferred water temperature
• 7/8" shallow extension set#13596xx0 (sold separately)
• Requires iBoxTM Universal Plus rough#01850181
Part#04231000
6. Metris S S Tub Spout
• Solid bras-+; ..
• 1/2"female NPT inlet or 3/4" male
Part# 14413001 By �_
Part# 14413821 ----- ---
Part# 14413831
7. Raindance S 120 AIR 3-Jet Handshower
• Oversized 5" spray face
• AIR-injection technology
• Features Quiclean cleaning system
• AIR, Whirl AIR, and Balance AIR spray modes
8. Porter'E Holder with Outlet
• Integrated hose connection
• 1/2" NPT female inlet F_`
• Handshower holder adjustable to 6 positions
• Wall mounted
• Fits all hoses with a conical nut
9. Techniflex 63" Hose
• With brass swivel connector to prevent hose twisting /r j
• Revolutionary solid color finish
10. S Thermostatic Trim wNolume Control
• Thermostatic temperature control
• Volume control for 1 outlet
• Anti-scald 100-degree safety stop
• Flow rate 8 GPM @ 44 PSI
• Set your preferred water temperature
• 7/8" shallow extension set#13596xx0 (sold separately) \
• Requires iBoxTM Universal Plus rough#01850181
Part#04230830
Part#04230820
Part#04230000
11. Standard Showerarm, 6"
• 1/2" male supply
• Includes escutcheon plate
• Not to be used for oversized and square showerheads
12. Raindance S 120 AIR 3-Jet Showerhead
• Oversized 5" spray face r}' ' t ''s.J
• AIR-injection technology
• Features Quiclean cleaning system
• AIR, Whirl AIR, Balance AIR spray modes
• 95 no-clog spray channels
c! �`.
+:HANSI'
TAO
13. HANSAFORM Widespread Lay with Pop-up i
two handle, wide spread lavatory faucet �°" 4111
HANSAFORM fes'. kisJ .
with swivel laminar flow and pop-up waste
Flow rate: 1.5 gpm @ 60 psi
14. SURFACE SINGLE LIGHT
Item No. 2881
• Glass Shade: Mouthblown, Satin Etched Cased Opal 1"1*
• Note that backplate is not of standard size.
• Single light designed to be mounted onto a standard vertically installed switch
box. Max. width of wall opening should be less than 2 1/2".
• Bulb: Al 9 incandescent, 100 watt max.
• UL listed for damp locations.
• ADA compliant.
15. Shower drain, for use with plastic pipe, gasket included
This KOHLER shower drain features solid brass construction for durability and reliability.
Resistant to clogs and buildups, it includes a connection gasket and is intended for
installations with 2" outlets.
• Perforated strainer shower drain
16. Extract Fan : NuTone Ventilation Heater/Fan/Light Com i ? 'FICA- -
Model#665RP
BY:
The fast-warming 1250W fan-forced heating element provides optimum pe
smaller space, efficient fan evely distributes warm air through room. Designed for easy
installation, four-way adjustable hangar bars and mounting clips help speed installation
in compact 2" x 6" construction. Engineered to cut installation time and expense,
improved hangar bar locks position after securing unit to rafters.
70 CFM, 4.0 sones, UL Listed, HVI-2100 Certified
Uses one 100W bulb (sold separately),light lens easily snaps on and off
Built-in junction box accepts plug-in fan motor and light receptacle
Do not install unit over bath tub or in shower stall
MFG Brand Name : NuTone
MFG Model # : 665RP
MFG Part# : 665RP
►, Community Development
• 10300 Torre Avenue
Cupertino CA 95014
{ .
-` Telephone(408)777-3228
CITY 0F Fax(408) 777-3333
PEKTINO
Building Department
All Cupertino building permits must meet certain conde s related o most commont�mg
environmental quality and public peace and safety.
conditions are described below.
STORMWATER POLLUTION CONTROL
State law requires that Cupertino, 12 other Silicon Valley cities, Santa Clara County and
the Santa Clara Valley Water Dcontrol stormwaterstormvpolluater tolnucontroE awstion. ting local
are key parts
residents and businesses and enforcing
of the City's compliance efforts.
Stormwater pollution prevention: It's up to us
In northern Santa Clara Valley, storm drains flow directly to local creeks and San
Francisco Bay, with no treatment. Stormwater pollution is a serious problem for wildlife
dependent on our waterways, for people
le living
mw ter pollution d baylands, and for the -
local water supply. Common sources o
ude:
• Dripped oil, fuel, and antifreeze from vehicles and heavy equipment;
• Construction debris, including dirt, concrete and paint;
•
• Landscaping runoff containing pesticides or weed killers; and
• Any material dumped or spilled into streets or storm drains
The property owner and the contractor share ultimate responsibility for activities
occurring at a construction site and
nowemployees.ldresponsible for any environmental
damage caused by subcontractors
For more information on construction-related stormwater requirements, see the
Stormwater Quality Regulations section of the City of Cupertino web site at:
http://www.cuoertino.org/city government/departments and offices/
environmental services
COMMUNITY NOISE CONTROL
The basic noise control requirements for construction sites are as follows: ,
• Typical construction work hours are:
- Weekdays - 7 a.m. to 8 p.m.
- Weekends - 9 a.m. to 6 p.m.
• 'Construction other than street construction is prohibited on holidays.
• Residential daytime noise levels from complaint site - 60 dBA
• Nonresidential daytime noise levels from complaint site - 65 dBA
For more information on noise control, please see Chapter 10.48 of the Cupertino
Municipal Code, which can be accessed at http://www.amlegal.com/cupertino ca/
Greg Casteel
Building Official