B-2017-1189CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR.
PERMIT NO: B-2017-1189
20569 CEDARBROOK TER CUPERTINO, CA 95014-0457 (323 45 018)
USA BATH
CALIFORNIA
REMODELING INC
WEST SACRAMENTO,
CA 95691
OWNER'S NAME: GETSINGER DIANE AND FRED C
DATE ISSUED: 07/21/2017
OWNER'S PHONE: 408-806-7378
PHONE NO: (916) 740-6150
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO-
License Class B:C=36 Lie. #984796
Contractor USA BATH CALIFORNIA REMODELING INC Date 06/30/2019
X BLDG _ELECT —PLUMB
MECH X RESIDENTIAL COMMERCIAL
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.
JOB DESCRIPTION-
MASTER BEDROOM BATHROOM REMODEL (35 SY )
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
ompensation, as provided for by Section 3700 of the Labor Code, for the
erformancc of the work for which this permit is issued.
WFfor by
2have and will maintain Worker's Compensation Insurance, as provided
Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $20395.00
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above
Number
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
323
323 45 018
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the ap icant understands and w91 Oomply with all non-point
ertino M icier ode, Section 9.18.
source regulati7VJ;ij
180 DAYS FROM LAST CALLED INSPECTION.
a Date 7/21/2017
Issued by Abby Avende
- Sigma
ure
0 U11 DER FLa N
Date: 07/21/2017
I hereby affirm that I am exempt from tContractor's License Law for one of the
RE ROOFS:
roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:All
1. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove allnew materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 7/21/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. 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.
z. I have and will maintain Worker's Compensation Insurance, as provided for by
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
s. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Code, Cha ter 9.12 and
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
the Health & Safety Cod , tions 25505, 25533, and 2 3 .
f
or
be deemed revoked.
G
Om en r authorized agent:
r
APPLICANT CERTIFICATION
Date: 7/21/2017
EXODIN,
GRN
I certify that I have read this application and state that the above information is
COT SIR XTION
I hereby affirm that there is a construction lendirig agenc)0o the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 7/21/2017
CUPERTINO
:PE o
GENERAL RMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildinq0—cupertino.org
MPT'UMBM'ri nMECHANICAL nELECTRICAL FlmscELLANEous
PRO'Ec"A"DRE's 20569 Cedarbrook Terrace
APN # -b'2,5 - 4S - D I
"NERNA" Getsinger, Fred and Diane
PHONE 408.806.7378
E-MAIL
STREET ADDRESS 20569 Cedar brook Terrace
CITY, STATE, ZIP Cupertino, CA 9501 +=FAX
CONTACT NAME Mary Louise Smith
PHONE 916.378.4040
EMAILmary.smith@usabath.com
STREET ADDRESS 2500 Del Monte Street
CITY, STATE, "West Sacramento, CA 95691
FAX
0 OWNER 0 OWNER 13URDER 0 OWNERAQENT 91 CONTRACTOR OCONTRACTORAGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
_NAmEUSA Bath California Remo
CONTRACTOR Remodeling
LICENSE NUMBER
984,
NSE TYPE
B, C36
BUSS. LIC #
COMPANY NAME USA Bath California Remodeling
E -MALL
mary.sma@usabath.com
FAX
sTREETADDREss 2500 Del Monte Street
CITY, STATE, ZIP West Sacramento CA 95691
PHONE 916.378.4040
ARCMTECT/ENGMERNAW
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF I@ SFD,. DUPLEX 0 MULTI -FAMILY
BUILDING: [3 COMMERCIAL
PROJECT IN WILDLAND ❑ YES
I URBANINIERFACE AREA NO
PROJECT IN 0 YES
FLOOD ZONE EI NO
IS THE BLDG AN 0 YES
EICMERHOME? EI NO
DESCRIPTION OF WORK Tub to, shower conversion, two bkthrooms, remove and replace shower valve. in-kind, non-structural
end -of -scope
TOTAL VALUATION. $20,395.00
By. RECEIVED .
By my signature below, I certify to each of the following: I am the pro rty owner or authorized agent to act on the property owlaer's behalf. I have read this
application and the information I hav rov d is porrect. I h e re c cription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating 0 I 0e resentatives of Cupertino to enter the above -identified property B *inspection purposes.
Signature of Applicant/Ac Date:- 7.1,24='.
�ffptr
/
ION REQUIRED
7
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OVER-TIIE-COUNTER
Cl STANDARD
Z
0 LARGE�
PK
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MEPM&Mpp__2011.doc revised 06121111
IF__y. ids
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408)«777-3228!• FAX (408) 777-3333 • buildina(c�cuoertino ora
PURPOSE 7no'
This affidavit is a self -certification for the installation of all required Smoke and CarbonAlarms
for compliance with 2016 CRC Section R314,2016 CBC Sections 420.6 and 907.2.11.2 whor access
for inspections are required.
GENERAL INFORMATION
Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms d/or Carbon
Monoxide Alarms be installed in the following locations:
AREA SMOKE ALARM -CU-ALARM
Outside of each separate sleeping area in the immediate vicinity of X X
the bedroom(s)
On every level of a dwelling unit including basements X X
Within each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning applianc es and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall c mply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battE
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or al -
not result in the removal of wall and ceiling finishes or there is no access by means of attic, baser.
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is
alarms which must be connected to the building wiring.
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above
installed in accordance with the manufacturer's instructions and in compliance with the Califo.
and California Residential Codes. The alarms specified below have been tested and are operati
date signed below.
Address: 0561 CeJd 7 — Cugar „nd ,,C4 Permit No.)
Specify Number of Alarms: # Smoke Alarms # Carbon
^ _ 1 have read and agree to comply with the terms and conditions of thi
operated.
tions do
.t or crawl
mired for
have been
Building i
as of the
417--[l
ntractorName � �............. ..Y_14.
..`. Q.....,..J.................. nu lli2 Signatue....... k►........................ Llc.# .......!.�.Y 796....... Date: 7
Smoke and COfonn.do� revised 12/15/16
CUPERTINO
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 7-3228 "FLAX (408) 777-3333 • building(a7cupertino.org
Owner Name s + Vi ane. Q firs l llY Permit No. l
Address lbs -(A C bi-DUr_ -
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of fonn.
E4<o Go to Question 2.
Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its
plumbing, installation of water -conserving plumbing fixtures is not technically feasible?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
RrNO Go to Question 3.
'3 Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 110 1. 1 through 110 1.8do not apply. Skip the rest of the form and sign bottom of form.
C'No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
❑ No My real property is built and available for use. or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through 1101.8, do not apply. Skip the rest of the form and sign bottom of form.
IJ" Yes My real property is built and available for use or occupancy on or before January 1, 1994.,
Civil Code Sections 1101.1 through 1101.8,4pply. Check one of the three following statements and sign
bottom of form..
Please check ONE of the following:
❑ My property is a single-family residential real property. See Civil Code Section 1101.4.
On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures
to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017' all non-
compliant plumbing fixtures shall be replaced wiih water -conserving plumbing fixtures (regardless of whether
Xoperty undergoes alterations or improvements).
V My property is a multifamily residential real property.; See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water -
conserving plumbing fixtures throughout the buildings(regardless of whether property undergoes alterations or
improvements).
❑ My property is a commercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliantplumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements).
I, as the owner or owner's agent of this properly, certify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's
installation requirements, and that the water-conserving,plurnbing fixtures comply with the requirements as indicated in the
table on the following page. ,f\ ; � , _ / ,
Owner or Owner AgentsSignature: ARM, WE Date ;��
Upon completing and signing this Certificate; please return it to the Building Division in order to final your building permit.
SB407 2015.doc revised 01105/17
1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB407 2015.doc revised 08/26/15
Non -Compliant
Water -Conserving Plumbing Fixture
Plumbing Fixture
(Fixture Complying with Current Code Applicable to New Construction)
Maximum Water Usage/Flow Rate
Fixture Type
Water Usage
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
(Flow Rate
2013 CALGreen Div. 4.3
2013 CALGreen Div. 4.3
2013 CALGreen Div. 5.3
- Single -Family
Multi -Family
Commercial
Residential
Residential
Water Closets
Exceed 1.6
Single flush toilets: 1.28 gallons/flush
(Toilets)
Gallons/flush
Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite,
average flush volume of two reduced flushes and one full flush
Urinals
Exceed 1.0
0.5 gallons/flush
Gallons/flush
Showerheads
Exceed 2.5
2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of
gallons per minute
U.S. EPA WaterSense Specification for Showerheads
(A hand-held shower is considered a showerhead.)
For multiple showerheads serving one shower, the combined flow rate of all
showerheads and/or other shower outlets controlled by a single valve shall not
exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to
allow only one shower outlet to be in operation at a time.
Faucets —
Exceed 2.2 gallons
Maximum 1.5 gallons per
Within units:
0.5 gallons per minute @ 60
Lavatory
per minute
minute g60 psi; minimum
Maximum 1.5 gallons
psi
Faucets
0.8 gallons per minute @
per minute @ 60 psi;
20 psi
minimum G.8 gallons
per minute @ 20 psi
In common and public
use areas: 0.5 gallons
per minute'.@ 60 psi
1.8 gallons per minute
60 psi
'Faucets;
Exceed 2.2 gallons
1.8 gallons per minute @
1.8 gallons per minute
1.8 .gallons per minute @ 60
Kitchen
per minute
60 psi
@ 60 psi
psi
Faucets'
May temporarily increase
May temporarily
up to 2.2 gallons per
increase up to 2.2
minute @ 60 psi, and must
gallons per minute @
default to maximum
60 psi, and must
1.8 gallons per minute @
default to maximum
60 psi .
1.8 gallons per minute
Where faucets meeting
@ 60 psi
the above are unavailable,
Where faucets meeting
aerators or other means
the above are
may be used to achieve
unavailable, aerators or
reduction.
other means maybe
used to achieve
reduction.
1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB407 2015.doc revised 08/26/15