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15040054CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 853 COTTONWOOD DR PERMIT NO: 15040054 T)FTP -77 OWNER'S NAME: HATCHER JOHN C AND JO ANN M DATE ISSUED: 04/08/2015 OWNER'S PHONE: PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E] REPLACE (E) TUB W/ WALK IN TUB IN GUEST BATH W/ License Class y Li1 c.. #-85 DEDICATED BREAKER Contractor;Z4--- � e— jel—nDate 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. Sq. Ft Floor Area: Valuation: $14900 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 APN Number: 36917035.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITIIIN 180 D OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS F AST CALLED INSPE ION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Issued by: Date: 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. --�7D/ RE -ROOFS: Signature/ r''> ��?�t lt1V ate y �Y5� 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. ❑ OWNER -BUILDER DECLARATION Date: Signature of Applicant: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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) HAZARDOUS MATERIALS DISCLOSURE 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, an:7Date: 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 Owner or authorized agent. /� 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 CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) p y p p Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 918. Signature Date CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION V 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 O (408) 777-3228 • FAX (408) 777-3333 • building ftupertino.orq n iii—PPA rI111F1Q(-VTr ANIP01 tc MEP misc IJrvrr.�,rrru�n ' ---- rPLUMBINU PROJECT ADDRESS 053 / � _ von w o _ ` �� (� „ APN 11 G ' ^s. OWNER NAME ��L L✓� I �\ �V ii'_ PHONE�o 255y� t E-MAIL STREET ADDRES _ jj CITY, STATE, ZIP e�j ` qj i FAX CONTACT NAME ---{f (f `, V E-MAIL kDS 'V STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OwNER-BUB.DER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NA E � sr� u� IVB LICENSE NUMBER 3fa03 LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRES k�v� CITY, STATE, P Z1. PHONE 1 { I �1L,Y, ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME _ E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES ❑ IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO BUILDING: COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE NO DESCRIPTION OF WORK , �I LkI \fi TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the 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 with all applicable local ordinances and state laws relating to building construction. I authorize representat' f Cupertino to enter the above--id/entified p/roperty for inspection purposes. Signature of Applicant/Agent: _�_s Date: Y SUPPLEMENTAL INFORMATION REQUIRED IJSF_ONL. j u r �,°e, "w OVER TH><COUNTER � � a a I- MEPMiscApp_2011.doc revised 06/21/11 WA ,�,�� CITY OF CUPERTINO -Mi FFX,, F.QTIMATnR — RITIT.DING DIVISION 61' ADDRESS: 853 cottonwood dr DATE: 04/08/2015 REVIEWED BY: Mendez APN: BP#: "VALUATION: 1$14,900 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: I PENTAMATION 1 RPFIX I PERMIT TYPE: 19 WORK re lace a tub w/ walk in tub in quest bath w/ dedicated breaker SCOPE ,ilech. Plan Check Mech. Permit Fee: Ocher Uech. Insp, Wech. Irish Fee: Plumb. Plan Check 10.0 1 hrs $0.00 Elec. Plan Check 10.0 1 hrs $0.00 Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: IEPERMIT Other Plumb Insp. 0.0 hrs $48.00 Other Elec. Insp. 1 0.0 hrs $48.00 111urnb. huh. Fee: Elec, Insp. Epee: NOTE: This estimate does not mcluae fees aue to otner vepartmenrs y.e rianning, ruouc rr urns, Mire, ouiuru.y "CWC, "tat, & a, 11— Cnntart tho Dont far addn'l info. LiuL/•a.o, cit.. • i•cuc •.•.0 w•v vwv».... ..... �.......�. FEE ITEMS (Fee Resolution 11-053 E . 7/U132 ___ �____�_____ __. _________ FEE _____ QTY/FEE MISC ITEMS Plan Check Fee: $0.00 11 # $10.00 Plumbing 1BPFIXTURE Fixture or Trap Suppl. PC Fee: (F) Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 F 3 $48.00 Electrical IBREMRECEP Recep/Switch/Outlets Permit Fee: $0.00 Supp/. Insp. Fee Reg. ®OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $96.00 L Consirtictaon 1'tr_e: _ Administrative Fee: ]ADMIN $45.00 O E) Work Without Permit? ® Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $1.94 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 M, $191.94 $58.00 F,E:,E$' $249.94 Revised: 04/01/2015 v,\ ` ruk7s I -GFT- 11E IF �a C C- G10"' Installation Layout Customer: 053 COAOMW©OA 'P12 Existing Door WH Elec Extras C a 3 yNotes� Length: h: inches ` ub or show Fiberglass ast Iron�7�' Existing Surround: Til ' iberglass-/ Culf. Marble Window Over Tub: 'es�No Distance between tub and vanity/toilet: �inches� Vanity decrease door: Yes�� Width: "—Cinches Tub Fill Time: � mins Tub Drain Time: t mins Distance between floor and window: inches Front/Back:�2 Hall: Interior: -'— inches Bathroom: inches Size: �rigallons Age: _(_year — Brand: 6(0"KU Type: Das/Elec ank/Tankless - Crawl Space: Yes Allo Attic: es No J Breaker Brand: C --:kA Space Avail: es> No Reverse Plumbing: Yes No Safety Bar(s): # Back_W.All� helf•.�� ( �,S, 9� � ��f/ Surround: Yes No ate-- Bone Tile Faux Pony WaIM ��'�s iE DPane1: Yes �Vo Shower Bracke Slide Ba� Curved/Straight Rod RR 1%2ni'tY� Head Rest /Seat Cushion OTHER: •'.vn }wST be l�Ppt at the ft&R DgortSs} is Ig ttt Yes Tub Typ RH LH hite Bone � yE urge: c 31x53 8x5 28x48 MEDT TUB Soaker RIS RT�iiet;� t� OTHER: Existing Plumbing: R C JUL Which Bathroomi:l Master Guest -:: (a 1) First Floor Second Floor Cr jk 'i ., P ' rnag�, s c4a.ir,eqw sts, extra work, etc t lir Gig i nature• .i �'� - :iA 1 NO. !0101/ Date: