12080218CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT I IOD
CONTRACTOR: BAY AREA ENTERPRISE
PER51 IT NO: 12080218
OWNER'S NAME: EISENBERG EDIT11 TRUS'T'EE•
21 101NIANGIN WAY
DATE ISSUED: 08212012
O\VNEMS PHONE; 6509440118
SAN,IOSE, CA 95148
PHONE NO: (408)238-5043
❑ LICENSED CONfRAcfOR'S DECLARATION
r ELECT r PLUMB r1
u Q 1/7 8/ 7
BUILDING PERMIT INFO: BLDG
License Class - U Lie: d_
(- RESIDENTIAL (- COMMERCIAL r
Contractor 3at ^r A CAEir-S,e)atc rl-21 ZO11--
AI F.CH
JOB DESCRIPTION: REPLACE SHOWER PAN AND WALLS—LA- IIoD
hereby affirm that turn licensed under the prvlyisions nfChapter ')'
(commencing,, iih Section 7000) of Di%kiun 3 of the Business S Professions
Code and that me license is in fall force and effect.
I hereh'v afhrlll Il older penalty ar perjury one of the follo"ing tier 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: 54500
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of die work for which this
permit is issued
APNNumber: 34253031.00
Occupancy Type:
APPLICANTCERTIFICALION
I certify that I have read this application and slate that the above nlforinatio n is
correct. I agree to comply with all city and county ordinances and state laws relating
PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property fin- inspection purposes. (,Are) agree to save
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless tl City ofCupenino against liabilities,judgments,
180 DAYS FROM ST CALLED INSPECTION.
costs, and expenses which ma , cmc rainsf said City in consequence of the
granting of this pemlf. Addi orally, the applicant understands and will comply
with all non -point source re r the Cupertino Municipal Code, Section
Issued by: (� ��/ Date:
9.18.
Zo/2
- G
�/I,
Signal re Date
RE -ROOFS:
❑ OWNER -BUILDER DI'CLARATION
All roofs shall be inspected prior to any roofing material tieing installed If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
I hereby affimn that 1 am exempt from the Contractor's License Law for one of
inspection.
the hl111111'lllg two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
Signature of Applicant: Date:
will do the work, and the structure is not intended orof7ered for sale (Sec.7044,
Business R Professions Code)
Las owner of the property, am exclusivelycontracting with licensed contractors to
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
construct the project (Sec.7044, Business R Professions Code).
r
1 hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE
declarations:
1 have read (lie hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self -insure for Worker's
California Health S Safety Code. Sections 25505, 25533, and 25534. 1 will maintain
Compensation, as provided for by Section 3700 of the Labor Code, for the
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ilealth S
performance of the work for which this permit is issued
Safety Code. Section 25532(x) should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance, as provided for by
Additionally, should 1 use equipment or devices which emit hazardous air
Section 3700 ofthe Labor Code, for the performance of the work for which this
contaminants as defined by fire BaY Area Air Quality Management District I N'ill
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued
I Iealth S Safety Codi. Se 1 .15505. 25533, and 25534.
I ceniry That in the performance of die work for which this permit is issued, 1 shall
not employ any persoo in manner so as to become subject to the Worker's
Caer or, ant a • t: f(/ 2/ / �Q� 2,
Compensation laws of California. If. after making this certificate 0fCxenlpti0n,I
Date: U 11
become subject to the Worker's Compensation provisions of the Labor Code, 1 must
forthwith comply with such provisions or this pemlit shall be deemed revoked.
CONST'RUCT'ION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of Nork's
APPLICANT CERTIFICATION
for which this permit is issued (Sec. 3097, Civ C.)
I certify that I have read (his application and stale that the above information Is
Lender's Name
correct. I agree to comply with all city aal county ordinances .and state laws relating
to building construction, and hereby authorize representatives of this city to enter
Lender's Address
upon the above mentioned property for inspection purposes. (We)agree to save
indennnilj• and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may, accrue against said City in consequence of the
ARCT I1TECI"S DECLARATION
grantingoflhis permit. Additionally ,.the applicant understands and Will comply
I understand my plans shall be used as public records.
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
I"I FEE ESTIMATOR -BUILDING DIVISION
WFADDRESS:
23500 Cristo rey dr #110D
DATE: 0 8121 /2 01 2
REVIEWED BY: larrys
Alech. Permit Fee:
AI'N:
BP#:
`VALUATION:
$4,500 n
*PERMIT Tl'1'E: Building Permit
PLAN C 11ECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex
Elec. Imp. Fee:
PENTAMATION
PERMIT TYPE: 1R3 RE IN I
YORK
bathroom remodel
SCOPE
$0.00
NOTE: This eminate doer not include jeer due to other Departments (i.e. Planning, Public II'orks, Fire, Sunilary Sewer District, School
District, etc.). These feer are baser/ on the prelintinarr information available and are only an estinatte. Carnet the Dept for cuhin'I info.
3
FEE ITEMS (Fee Resolution ll -053 Eff' 7/1/11)
Alech. Plan Check
Phonb. Plan Check
El,,. Plan Check
Alech. Permit Fee:
Plumh. Permit Fac:
Elec. Penni? Fee:
Orhm A1ech. /nap.
Other Plumb Insp.
Other Elce. hup.Ll
Alech. hrap. Frye:
P/urrtb. Lisp. Fee:
Elec. Imp. Fee:
NOTE: This eminate doer not include jeer due to other Departments (i.e. Planning, Public II'orks, Fire, Sunilary Sewer District, School
District, etc.). These feer are baser/ on the prelintinarr information available and are only an estinatte. Carnet the Dept for cuhin'I info.
3
FEE ITEMS (Fee Resolution ll -053 Eff' 7/1/11)
FEE
QTY/FFF
MISC ITEMS
Plan Check Fee:
$0.00
120 s. f.
$600.00
Remodel, Bath (<=300 sO
/REAIRESBAT
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Stipp]. Insp. Fee:(D Reg. Q OT
F0,0hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
rldininimratice Fee:
Work Without Permit? O Yes (j) No
$0.00
Advanced Plannine Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
A
Travel Doctuneniadon Fees:
Strong Motion Fee: IBSEISABCR
$0.50
Select an Administrative Item
BI(Ig Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$1.50
$600.00
TOTAL FEE:
I W11.50
Revised: 07/01/2012
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ff l
(408) 777-3228 • FAX (408) 777-3333 • bui1cing(d.)cupertinO.0rg %
❑ NEW CONSTRUCTION ❑ ADDITION
/a vg' -0.2/F
^/ &l
10ALTERATION/TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS zs��
3cvl'sf� a
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APNtl ;� -53-03/
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OWN �R� AM �vnc �v
PHONE•
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E-MAIL. r-
�QeY•
STREETADDRESSCITY, STATE, ZIP FAX
2j5n1 (7V, 12e !le(� JrL 9�0/�/ -O-
�v 10 &!S fp 3 -S—V0
CONTACT NAME,,, c Fc,.Jh
PHONE
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E-MAIL !�
ve cte, c'olr�
STREETADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT
IbJ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMES`
LICENSE 14UNIBER n/7
LICENSETYPE
BUS. LICM q
d
p( /
COMPANY NAME rJ0 A-'`� E%17
rJ
E-MAIL /r 1 �.1 COQ
d
FAX
STREETADDRESS
CITY, TATECSZIP�
c !s iy3
PHONE
k -23g /3
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC d
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK 2 U
� % („^. A Q / `
� V -e
C
�
EXISTING USE
PROPOSED USE
CONSTR. TYPE
4STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (5)
EXIAG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NETAREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODELAREA REMODEL AREA
PORCH AREA DECK AREA
TOTAL DECK/PORCH AREA
GARAGEAREA: DETACH
❑ ATTACH
N DWELLNG UNITS:
IS A SECOND UNIF ❑Y'Fs
SECONn STORY OYES
BEING ADDED' ONO
ADDITON" ONO
PRE -APPLICATION OYES IF YES, PROVIDE COPY OF
IS TIIE BLDG AN ❑YES
RECEIVED BW
TOTAL VALUATION:
PLANNINGAPPLO ONO PLANNING APPROVAL LETTER
I:ICHLF.R I TOME' ONO
^
- - -
By my signature below, I certify to each of foil Ging:
the property owner or authorized agent to act on the property owner's behalf. 1 have read this
application and the information I have provide i orrect
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 in o tructi
thorize representatives of Cupertino io enter the above -identified property for inspection purposes.
Signature ofApplicant/Agem:
Date:
SUPPLEMEN'IINFORrMATONREQUIRED
--
_--
rl.\NCHrCK,J'rYPE
Rrnn'INgM.q• _
❑ ovPSlnTli[;Iioun l'eR❑'i;w
LufnG i•I.\N'.ut:YlT:w
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new, building.
❑rzi•RFss-
❑ r1ANNrNc rt.,aNREv1EW"
_ Commercial Bldgs Provide a completed I lazardous
Materials Disclosure
ElSTASDARD
❑''rUBLICNVORKS
form if any I lazardous Materials are being used as part
of this project.
-
❑ LARCF,-
❑ .FIRE. DEP`F
Copy of Planning Approval Letter or Meeting with
Planning prior to❑
-
_
submittal of Building Permit application.
MAJOR
❑ SANITARY SE\PFR nISTRiCI'
I ❑ GN\'IRON.�It:NL\i, 16L\Ll'IP:._ _
BldgApp_201 1. doc revised 06/2//11