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12090217CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR 2191: CONI'RACI'OR: BAY AREA ENI'ERPRISE PERMTTNO: 12090217 O\VNER'S NAME: ANNASMITH 2110 MANGIN WAY DATE ISSUED: 09252012 OWNER'S PHONE: 6505371523 SAN_IOSI., CA 95148 PHONE NO: 1+081238-5043 ❑ LICENSED CONTRACTOR'S DECLARATION r IJ r. BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class_ Lia k gin girl ' r_ . rr, DI F,CII RESIDENTIAL COMMERCLV. Contractor 'aGl *re., [Mk Date 911_r/'201'F— I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: 219E - SHOWER REMODEL(FRESFIEN UP SHOWER WALLS (commencing with Section 7000) of Dix ision 3 of the Business & Professions & PAN R SHOWER VALVE) Code and that my license is in full force and effec(. 1 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. 1'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 Sq. FI Floor Area: Valuation: $2000 permit is issued' AI'I'I.IC\N'1' CF.R'TIFIC.\TION I cenifv that I have read this application and state that the above infommtion is correct. I agree to comply with all city and county ordinances and state Imes 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 may accrue against said City in consequence of the granting of this permit' Addifi nally, the applicant understands and will comply with all non -point source ,re 7ations per the Cupertino Municipal Code, Section 9.18. Signature Dae ❑ O\VNF-R-BUILDER DEICLARATION hereby affirm that 1 am exempt from the Contractor's License Law' for one of the following two reasons: 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 sole (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). hereby affirm under penally of perjury one of the following three declarations: 1 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 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the perfortnanee of the work for which this 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 my manner so as to become subject to the Worker's 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 forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is cored. I agree to comply with all city and county ordinances and state laws relating to building construction, mrd 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 may accrue against said City in consequence of the 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. APN Number: 34253083.00 1 OccupancyType: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: //25-1- RF. -ROOFS: All roofs shall be inspected prior to my roofing material being installed. If a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. Signature of ApplimnC Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code. Sections 25505, 25533, and 25534. I will moinuhin compliance with the Cup• ino" unicipal Code, Chapter9.12 and the Health & Safety' Code. Seclinn 255 'I.) should I store or handle haze rdous ma leria1. AJJitionally, should I e quipment or derives which emit hazardous air contaminants as deftn )the RayArca Air Quality' Management District I will maintain cum plia nee Ih the Cu pertian Municipal Code, Cha pier 9.12 and the Ilealth & Sgfe i Sections 25505, 25533, and 25534. agent: y 2 z Dale: \ CONSTRITCHON LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097. Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Date I Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION 1w S: 23500 Cristo Rey Dr. 7APN: DATE: 09/25/2012 REVIEWED BY: Sean UNITS BP FEES BP#: 'VALUATION: 1$2,000 *PERMIT TYPE: Plumbing Permit PLAN CIIECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # PENTAMATION PERMIT TYPE: 1 RPFIX WORK 'Shower remodel. SCOPE SuppL Insp Fee APPLIANCE /EQUIP TYPE FEE ID Plumb. Plan Check 0.0 hrs $0.00 QTY UNITS BP FEES F:/u'. Par+nir Fee: Fixture or Trap 1BPFIXTURE Order F.lce. Imp. L1 I 1 # $10 Perinit Fee: SuppL Insp Fee PME Unit Fee: $10.00 PME Permit Fee: $45.00• Construction Tax: Administrative Fee: IADM/N $42.00- 42.00Work WorkWithout Permit? O Yes (j) No $0.00 TOTALS: i Travel Documentation Fee: ITPU vDOC $10.00 Strong Motion Fee: /BSEISMICR i n+s esnrnare noes tar ureivaefees aue to atter Deparinrenty (i.e. Planning, Public 11'orks'• Fire, Sanitary Sewer Dicrricl, Schaal District.inlnnrrnrim. elel. These %Pet are bated ntt I/re nra/i..rinnrn ...... ;/nA/a ..n.t ..,,, .,..1„ ,.., .:....... �,......,...r... n.._. r__ ........ .. :.. c. FEE ITEMS (Fee Resolulion 11-053 CIX 7/I/11l Afech. Plan Check Plumb. Plan Check 0.0 hrs $0.00 Flee. Plan Check ,b/ech. PermA Fee: Plumb. Permit Fee: /PPERMIT F:/u'. Par+nir Fee: Other,tfech. Insp, Other Plumb Insp. 0.0 hrs $45.00 Order F.lce. Imp. L1 I ,19ech. In.,p. Fee: Phonh. hisp. Fee: F.ice. Imp. Fee: i n+s esnrnare noes tar ureivaefees aue to atter Deparinrenty (i.e. Planning, Public 11'orks'• Fire, Sanitary Sewer Dicrricl, Schaal District.inlnnrrnrim. elel. These %Pet are bated ntt I/re nra/i..rinnrn ...... ;/nA/a ..n.t ..,,, .,..1„ ,.., .:....... �,......,...r... n.._. r__ ........ .. :.. c. FEE ITEMS (Fee Resolulion 11-053 CIX 7/I/11l __.____.__. FEE _. ._._...... QTY/FEE .... _............ _....... 1 ........... ...--- ....". MISC ITEMS Plan Check Fee: SupPL PC Fee PME Plan Check: $0.00 Perinit Fee: SuppL Insp Fee PME Unit Fee: $10.00 PME Permit Fee: $45.00• Construction Tax: Administrative Fee: IADM/N $42.00- 42.00Work WorkWithout Permit? O Yes (j) No $0.00 Advanced Planning Fees: i Travel Documentation Fee: ITPU vDOC $45.00 Strong Motion Fee: /BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee 18CBSC $1.00 SUBTOTALS: $143.50 $0.00 TOTAL FEE: $143.50 Revised: 07/01/2012