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04080160 CITY OF CUPERTINO ° pk* BUILDING DIVISION PERMIT �CONTR°ACT®RANFORMA,!ft �Y�kd.'^` + BUILDING ADDRESS: AMERICAN BATH IND, INC rERMlr no.O4O8O16O OWNER'S NAME: PERMIT ISSUE DATE 12 IE, SANITARY gs O OL NO. ARCHITECUENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH trop LICENSED CONTRACTOR'S DECLARATION <. Iion7 whom Oat Iam0 On Bu underprovisionsofs Coca.and mmmensi is JOU DBSCrip[IOD Q� )I p i wish Section liam9(KI07of Division OatI ma lithe Business and ViSiOasionshapter ndmyli C=iftg GGgpQVsk�I{(il tlWl�j in tort nae am eR"'' CHANGE TUB TO SHOWERBOW o g= License Class L'Ie.g Z;:a Dale Contractor qq As shall ARCHITECTS DECLARATION SEP a� ��p4 2 1 Understand my plans shall W used u public records v `r( JyU ;w,,i Licensed Professional Q� S OWNER BUILDER DECLARATION Cury ON �I�I�® .�0 Y JNG 1 h. .('onto Nat 11. exempt from IW Cssions Code: :Any c Law for IW Ko O which mi otic... emit t RDLS.Business mpr Pre demob COTe:Any city or manly $ which requites a permit m mnmrrut,alter.improve,Jcmnlish,of repair any saaure poor In its issuance.also rcionet the applicant forsuch permit to rile asigned statement !'is that he ii limited pursuant to theproymmisOffContractor's Limme aw(Chaoca9 Sq.Ft. Floor Area Valuation neeH$ (commencing with kation 9D30)of Division 3 of the Business and Profession Code)or — Nat M is exempt therefrom and the basis for Use alleged exemption.Any violation of dnc�y11pp,,,, Section 9031.5 by any applicant for a permit subjects Oc applicant to a civil penalty of 3 A(?N Ml]i WJ 0 0 Occupancy Type not moa tun low hundred dollars(5500). I,as owner of the property,or my employees with wages as their sole campenxton, will do the work and On machine is not intended or offered for sale(Sec.7Da4,Business and Profession Code:The Contractor's Liana Lew dna not apply to an owner of Required Inspections property who builds rr improves thermn,and who does such work himself or through his Own employees,provided dimsuch improvements art not intended oroRered forsake.If. however.the building or improvement is sold within one year of completion,the owner- builder will haw da Wrden of proving Nal W did not Wild or improv for purpose of ,salt.). 1as owner of the proptny,am exclusively contracting with licensed contractors to mosinlct IW project(Sec.7W,Business and Profession Code:)The Contractors Li _ tank law don n0t apply b an OWnU of progeny who Wilds or ImproKm ulcRnn.and, who contracts for such projects with a communist licensed pursuant no the Contractor's License law. ❑lamem pe rSe .B&P C for this reason il Dau �s 4WORKm OMPENSATION Aate1 hereby aRrunder penalty of perjury arc of ftfollowing daclantion, ve and will maintain a CertRcalc of Consent to tilf-insum for Worker'sCompen- Ls provided for by Seem 3700 of the labor Code,for tW performm ee of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,as required by Section 37M of the LabOr Code,for die peof rmance alone work for which this Parent is issueJ. My Worker's Crmpertsauon 0uuanm canner and Policy number me Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Oris section need not he completed iftlr permit is for one hundred dollars(51(10) or Icss.) I terrify Our in tla perfarmame of the work for which this permit is issued,10.11 not employ any person in any manner an as to become subject m the Workeri Compenaton Laws of California Date Applicant NOTICE TO APPLICANT:If.after making this Cerrificate of Exemption,you should become subject to the Worker's Compensation provisions of the labor Code,you must .J Z, forthwith comply with such provision or this permit shall betleemed revoked. ? O CONSTRUCTION LENDING AGENCY [-r Iherehy affirm Nat time is a comtmetion lending agency for the performance of tY Ifo work for which this permit u issued(Sec.3M,Civ,C.) (s7 Lender's Name Z)Z Lenders Add. U C) I minify that I have read this appilemirn and some that Nc shove informatun is I, P coned I agree to comply with all city and county ordinances and moa laws misting to 0 U building construction.and hereby andiron,representatives of this city to enter upon the W ahoM-mentioned property for impecrion purposes. (, CL (We)agree to save,indemnify and keep hormions the City of Cupertino against rq liabilities.judgments.costs and expenses which may in any way amnc against mid City U z in consequence rfhe granting of This permit. APPLICANT NDERFA_NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOL CERE ULAT I (4 O�{ Re-roofs S nature of App c' VContnct Date HAZARD S MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding omupam store or handle ha allon material as de0rmd by Ne Cupertino Municipal Cod,Chapter 9.12,and the Health and Safely Code,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes RINu Will the applicant or mtorc W9dingmcupantUse equipment Orduvimm which If a roof is installed without firs[obtaining an inspection,I agree to remove hxaardoua air contaminants as unlined by the Bay Area Air Quality Management all new materials for inspection. rte ❑Y *ks I have real Oeloxambiss materials requirements under Chapter 6.95ofdue Califnr- niaHealth&Sart C ,Satin 25505.W33 and 25534.I understand Nu if the Wilding donnotemocoll haw tenantth 1 my=MMbility Iremufy Neacapantrrthe mquim7Lswh him m ortoismarea'draeemEcaatorOccupancy. Signature of Applicant Date V l &( 1916`-1 All roof coverings to be Class "B"or better Owner or mohorimd agent Dme CITY of CUPEWrINO BUILDING DIVISION PERAD CONTRACTOR INF©RMA:� NN S BUILDING ADDRESS: AMERICAN BATH IND, INC PERMIT NO.04080160 OWNER'S NAME: PERMIT ISSUE DATE 40 (rio) 47r)-s2on VONE: SANITARY N . ONTROL NO. ARCHM-CrIENGiNEER; BUILDING PERMIT INFO BLDG ELECT PLUMB MECH O O uZee, M LICENSED CONTRACTOR'S DECLARATION >; C 1 hereby affirm that I am licensed under provisions nr Chapter 9(commeneing lob Descripftion p ��Aa eiUw With Section7") the Businessand Pmfusium Code.and my license is `I aryl ml tare arta errmr. CHANGE TUB TO SHOWER uHa A/�\a License Class Lic.M F Dale Contractor .4 ARCHITECTS DECLARATION ?�U l understand my plans shall he used ss public records SEP �- 2GG4 ''w Licensed Professional •reg OWNER-BUILDER DECLARATION p Y91111 e E 1 ame .(firm thin 1 L exempt from the Crsions ut et:Any Lew for the p o followinguires a porm(Smit t construct. Business and improve. de io li h.Cutlet:Any cilyan Or roomy K m�.which inquires a permit to rnnnnmt alter,improve,demolish,or repair any uncture w—" 2�a hprior to its issuance,also thea (cant for such iso file a signedarmament at he i4RmmedpursuaoimtheproviisionsOftheC(m�rorsucros, a (Chapter 9 Sq.Ft. Floor Area Valuation `e�p (commencing with Section 7")of Division 3 of the Busirms; ad Professions Cad.)or i that he is exempt thcn,from and the basks for the alleged exemption.Any violation of inmnn,� pp,�. Section 7031.5 by any applicant for a permit writhes the applicanuo a civil penalty of 3�1�IIi DSut];I WT(]0 Occupancy Type not more than Eve hundred dollars($50D). P Y YP El 1,as Owner of the property,or my employees with wages as their sole compendou an, will do the work and the structure is not intended or offered for sale(Sec.7044,Business and Profession Code:The Contractor's License Law dins not apply to an Owner of Required Inspections property who builds or improves thereon,and who door such work himself ar drought his own employee,Provided Nat such improvements are not intended oroRered forsale If, however,the building or improvement is sold within one year of completion,the owner, milder will have the burden of proving that he did not build ar improve for pan.of JK5 -1.as owner of the property,am collusively contracting with licensed contractors to consumer the project(Sec.7044.Business and Professions Code)The Contractor's Lt- manse Lew does nor apply u,an..or of property who builds or improves themon,and who commas for such projects with a eammactor(s)licensed pursuanuo the Courtrai License Law. ❑I.ear pr Leer Se B&P C`for this reason Date <,/ I rot 0 ' WORK 'S COMPENSATION DEP hairRATION I hereby afro under penalty of perjury am of the following declarations: I have and will maintain aCrriOeatr of Consent o self-inion,for Worker's Compen- sation,as provided for by Section 3700 of the labor Cade,for the performance of dm weak for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued My Workers Compensatian Insunme carrier and Policy number am: Cartier: Policy No.: _ CERTIFICATE OF EXEM"ION FROM WORKERS' COMPENSATION INSURANCE (This section need not hceompic¢d Etter Permit is Intone hundred dollars(6100) or less.) 1 eerlfy that in the performance of the work for which this permit 6 issued,1 shall not employ any person in any manner so 0 t become subject to the Worlahs Compcnsalion Laws of California.Drew Applicant NOTICE TO APPLICANT:IL after making the Certificate of Exemption,you should become subject to the Worker's Compensation provisims of the labor Code,you must ,J O forthwith comply with such provisions or this perm it shall be deemed revoked. z CONSTRUCTION LENDING AGENCY I hereby affirm that Nets is a construction lending agency ler rhe performance of the work for which this permit is issued(Sec.3097,Civ.C.) Lenders Name Lender's Address az V Q 1 certify that 1 have read this application and sate that the above information is , D, E torten 1 agree to comply with all city and county ordinances and state laws miming to QU building construction.and hereby authorive represcnalivcs or this city to corer Upon the shave-mcounned property for ina,mucar purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino againsl to liabllitior,judgmans,coss and expenses which may in anyway sector agarntsaid Ciy // C.) z in consequence of the granting of this permit. / ` '\ S APPLICANT . UNDERSTAN S AND WILL COMPLY WITH ALL NON-POINT Issued by: Date t SOURCE RE ULATI h I (4 Co { Re-roofs S' nature of AppEmmVComm� Dale HAZARD USMATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hilarious marctial as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Calc.OYoonn 25532(.)? o All roofs shall be inspected prior to any roofing material being installed. or 11-0 Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove -irmit heharardnus air mnaminans as defined by the Bay Area Air Quality Management all new materials for inspection. ? ❑Yes [}Iles i I havereaJ rM hmanducti ucrialsmmde quircenu unr Chapu:r6.95OrtheCalifw- maHealth&Safe Code.Schon 25505,25533ano25534.lundcrsand Natifthe buil) docs not cureml have atenan4 thpl'is my responsibilitym nndly tfte mmupml car the rrgaimmgos wh hma urn, pfiar res issaanmarll'eNBn¢Or Ocep ry. Signature of Applicant Date �1 Y/ " Via' I ef(b I All roof coverings to be Class "B"or better Owner or aummoacd agent bme CITY OF CUPERTINO •em 1 of 3 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp: Rng: Su APN . . . . . . . . 32615130 . 00 DATE ISSUED. . . . . . . : 08/19/2004 RECEIPT # • . . . . . . . . : 26753 REFERENCE ID # . . . : 04080160 SITE ADDRESS . . . . . : 22445 CUPERTINO RD # 29 SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SUNNY VIEW MANOR ADDRESS . . . . . . . . . . : 22445 CUPERTINO RD CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : SUNNY VIEW HOME CONTRACTOR . . . . . . . : WAYNE CARDELLINI JR. LIC # 24618 COMPANY . . . . . . . . . . : AMERICAN BATH IND, INC ADDRESS . . . . . . . . . . . 30987 SAN BENITO ST. CITY/STATE/ZIP . . . : HAYWARD, CA 94544 TELEPHONE . . . . . . . . : (510) 475-8200 •FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ----- - - --- ---- ------- --- BPERMFEE VALUATION 2 , 000 . 00 83 . 16 0 . 00 83 . 16 0 . 00 BPLANCHK PERMIT FEE 83 . 16 110 . 98 0 . 00 110 . 98 0 . 00 BENERGY PERMIT FEE 83 . 16 39 . 79 0 . 00 39 . 79 0 . 00 BPSEWER SEWER SYSTEM 1 . 00 21 . 58 0 . 00 21 . 58 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BPVENT UNITS 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00 BPWATER UNIT 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00 BSEISMICOM VALUATION 2 , 000 . 00 0 . 63 0 . 00 0 . 63 0 . 00 ---------- ---------- ---- ---------- TOTAL PERMIT 314 . 30 0 . 00 314 . 30 0 . 00 ( - 40ITY OF CUPERTINO% �f CUPE(� F PERMIT APPLICATION FORM v4PFv/ APN # Date: 8 v 32 6 (S- /3C, Building Address: Mailing Address (if different from building address): �we4, .o 2,7 Owner's Name: Phone#: 5uran)/ ule�J a5-3 4300 Contractor: Ak+cnCa o gafh License#: Contact: C�wi� J Phone: 4oV Cupertino Business License#: Fax: zss-cois- Building Permit Info: —/ Bldg ❑ . Elect El Plumb L7 Mech ❑ Job Description: Residential ❑ � !a Commercial L� Sq.Ft. Floor Area: $/Sq.Ft.: 1r 5F Cost of Project: L� OL ago Occupancy Group: � Type of Constructio —,- n Please check this box if th project is a second-story addition: ❑ Project Size: Standard CD/ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax-Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING v6 7S 3 1 of 3 31 . 30 d- WITY OF CUPERTINO% CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING ell BPREPIPE Re i eOfFixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 din MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT _ Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BRENC RAP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 W-ITY OF CUPERTIN40 CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection BUILDING BSWIM Swinuning Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee s foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 • ' �j nn I]11�1� 15 li"Iii uULL0 b(AIJ r r 1 to -01 20 � m 2 5 € oc5 go P r / a 3 d I ° oc � weu — � IN ACCURDA V E N]tilt E CM pfi o vI1Y10.18 � �D RDI/NANGES D / I _ l Zt SIGNED �7 This set of plans and specifications MUST be kept on the job at all times and it is un lawful to make any changes or altoration9 on same without written permission from the building Dept., City of Cupertino. The stamping of this plan and specification% SHALL NOT be held to permit or to bo do approval of the violation of any proviltlon9 ,f anv City Ordinance or )tate Law c [ID �O m Fmig u` F I r r 41 X v C N LU N Gl O V Q r � GJ i m . t Existing tub O r O � new shower stall Scope of work 1-remove existing tub 2-relocate drain 3-install new shower stall • 4-install new mixing valve 5-install new shower door