B-2017-1187CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1187
22812 LONGDOWN RD CUPERTINO, CA 95014-2650 (342 33 009)
USA BATH
CALIFORNIA
REMODELING INC
WEST SACRAMENTO,
CA 95691
OWNER'S NAME: VISHWARUPE SUSHII.AND ASHWINI TRUSTEE
DATE ISSUED: 07/21/2017
OWNER'S PHONE: 408-390-7430
PHONE NO: (916) 740-6150
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO-
License Class B: C-36 Lic. #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 AND GUEST BATHROOM REMODEL (80 ST)
I hereby affirm under penalty of perjury one of the following two declarations:
I'I have and will maintain a certificate of consent to self-insure for Worker's
pensation, as provided for by Section 3700 of the Labor Code, for the
CbF
prmance of the work for which this permit is issued.
' < I e and will maintain Worker's Compensation Insurance, as provided for by
v
Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $20000.00
permit is issued.
APPLICANT CERTIFICATION
I 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
and state laws relating to building construction, and hereby authorize
3 42
342 33 009
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 applicant understands and will comply with all non-point
source regulatis er tMuni ' I Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
xllt)��I:,U;�
;•SignatureDate 7/21/2017
Issued by AbbyAvende
Date: 07/21/2017
I hereby affirm that I am exempt f Contractor's License Law for one of the
o the
RF ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
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 all new 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, aux 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.
i. I have and will maintain Worker's Compensation Insurance, as provided for by
H�ARDOUS 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, C apter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code,Vs505, 25533, an 55 4.
Labor Code, I must forthwith comply with such provisions or this permit shall
i
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 7/21/2017
I certify that I have read this application and state that the above information is
CONS ICTION
I hereby affirm that there is a construction lendAMgenKy/,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
ARC'HITECT'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
NEW coNmucnoN
"ARCIN 1 R"I , --0
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
i
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 • buildingftugerflno.o[g
F-1
ADDITION El ALTERATION TI [I REVISION/ DEFER -RED
ORIGINAL PERMIT #
PROJECT ADDRESS
APN # �)42,— -6'5-
22812 Lon down Road
OWNER NAME
Vi sharupe, Sushit & Ashwini
PHONE
1 408.390.7430
E-MAIL
I
STREET ADDRESS
22812 Lon down Road
_
CITY, STATE, ZIP
Cupertino, CA 95014
FAX
CONTACT NAW MLouise Smith
ary
PHONE 91 .378.4040
E-MAIL
sTnith@usabath.com
STREET ADDRESS
2500 Del Monte,�Street
CITY, STATE, ZIP
West Sacramento, CA 95 691
FAX
13 OWNER 13 OWNER BUILDER 0 OWNERAGENT 19 CONTRACTOR 13CONTRACTORAGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER C3 TENANT
CONTRACTOR NAME
USA Bath California Remoqe!n
LICENSE NUMBER 984796
LICENSE
"h, C36
COMPANY NAME
USA Bath California Remodeling
E-MAIL
FAX
FAX
STREET ADDRESS 2500 Del Monte Street
CITY, STATE, ZIP West Sacramento, CA 95691
PHONE 916.378.4040
ARCMTECT/ENGMERN"E
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK Tub to Tub and Shower to Shower replacements in the master and gest baths. Please see plans for
1
i -
detailed scope
EXISTING USE
1
PROPOSED USE
CONSTR�TYPE
# STORIES
1
USE
TYPE
OCC.
SQXT.
VALUATION ($)
2
&VSTG
NEWMOOR
DEMO
TOTAL
AREA
AREA
AREA
NETAREA
BATHROOM 4-xlO &
KITCHEN OTHER
REMODELAREA
REMODELAREA REMODEL AREA
I
Sx8
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA
GARAGE AREA:
HDETACH
ATTACH
I
4 DWELLING UNITS:
LS A SECOND UNIT [3YES
SECOND STORY []YES
I BEINGADDED? ®NO
ADIDMON? ®NO
PRE -APPLICATION [:IYES IF YES, PROVIDE COPY OF
IS THE BLDG AN YES
, BY -r,
TSAL VALUATION:
-7-0-
PLANNGAPPL# []NO PLANNING APPROVAL LETTER
IN
FICHLERIFtOME? EO NO I
U"D
, I �Av
01 M -
By my signature below, I certify to each of the following: I am C property owner or authorized agent A act on the property owner's behalf. I have read this
application and the information I have providedI is correct. h read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating t co tio thorize representatives of Cupertino to enter the above-identifiedproM for inspection purposes.
Signature of Applicant/Agent; Date:
Z
6
SUPPLEMENTAL
=ition Dpermit
PLANCMCKTYPK
ROUTING SLIP.
OVER -nu -COUNTER
BMMMGPLAN WVWW
New SFD or Multifamily dwellings:7:p =fdem for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. i
0 EXPRESS
-PLANNfNG-PLANAEVWW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
D STANDARD- A
]PUBLIC WoRics,
form if any Hazardous Materials are being used as part of this project.
LARGE
b FIRE DEPT
Copy of Planning Approval Letter or Meeting with'Planning prior to
nMAJOR
❑ S-ANffARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVMOD"ENTAL M"Mlm
BldgApp__201 1. doe revised 06121111
•
SMOKE / CARBON MONOXIDE ALARMS
(161'
OWNER CERTIFICATE OF COMPLIANCE
A � COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
U T NO 10300 T9RRE AVENUE• CUPERTINO,CA 95014-3255
(408)77 -3228•FAX(408)777-3333• buildincq(a�cupertino.orq
PERMIT CANNOT BE FINALE#UNTIL 1'HIS CERTIFICATE HAS BEEN
COMPLETED,SIGNED AND
RETURNED TO THE BUILDING DIVISION
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms
for compliance with 2016 CRC Section R314,2016 CBC Sections 420 6 and 907.2.11.2 where no interior 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 and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA SMOKE ALARM CO 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 appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply 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 battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl
space.Refer to CRC Section R314 and CBC Sections 907.2.114 and 420 6.2.An electrical permit is required for
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 has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes.The alarms specified below have been tested and are operational, as of the
date signed beloweln
Address. �(� \ Ltsr\i hA dOdi CLT 1 ar10 r Permit No. B20 17- 1127
otsoi
Specify Number of Alarms: #Smoke Alarms. 4, I #Carbon Monoxide Detectors I L- I
I have read and agree to comply w'th t ,- terms and conditions of this statement
Owner(or Owner Agent's)Name: tcii,� ; '
Sf � ��1�' Signature • ;•r�•. Date:q 1
Contractor Name:
Signature Lic.# Date:
Smoke and CO forin.doc revised 12/15/16
Abby Ayende
07/24/17
07/24/17
B-2017-1187
Abby Ayende
Abby Ayende
07/24/17