12110159CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 207DI CONTRACTOR: MISSION VALLEY I PERMIT NO: 12110159
ELECTRIC INC
OWNER'S NAME: GASPAR CASTELL
PO BOX 3332 1 DATE ISSUED: 11/302012
OWNER'S PHONE: 6509440100 1 FREMONT, CA 94539 I PHONE NO: (510) 74541347
❑ LICENSED CONTRACTOR'S DECLARATION
License Class / D Lie. # 1-17"..t,
Contractor ate
I hereby trm that I amlicensed un er 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.
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.
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
permit is issued.
APPLICANT CERTIFICATION
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
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-pointsegulatiorfs per the Cupertino Municipal Code, Section
9.18. / 1
-.30'/Z
❑ OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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
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
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
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.
Date
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH r RESIDENTIAL r COMMERCIAL I—
JOB DESCRIPTION: 207D - 5 LED LIGHTS, 12 SWITCHES, 20 RECEPTICLES
Sq. Ft Floor Area: I Valuation: $2500
APN Number: 34253058.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DA S FROM L CALLED INSPECTION.
Issued by: O Date
RE -ROOFS
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining inspection, I agree to remove all new materials for
inspection.
S' nature ofApplirant Dale:
o -r
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent:
Date:
I 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 Address
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building(&cuoertino.or0
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PRDIECf PI WB-DL1ND ❑YES
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DESCRIPTION OF WORK
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TOTAL VALUATION: 7_£� �-.,
RECEIVED BY:
By my signatme below, I certify to each of the following: I= the property owner Orauthorized agent to act on the property owner's behalf.I have read this
application and the inforrna .on I bane is co¢ect I have read the Description of Work and verify it is accurate. I agree to comply, with a0 applicable local
ordinances and state laws tela' to corrstmcd I anthodzerepresentatives of Cuperticc _ eater the above-idmdfiedprope,- for inspection pu Poses.
Signature of Appficaut/Agent Dare:
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RMATIO QUIRED
OFFICE USE ONLY
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❑ OVER-THE-COUNTER
❑ EXPRESS
❑ STANDARD
❑ LARGE
❑ MAJOR
A% M5—PMucApp-3011.doc revised 06/31/11
Z07 b CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
m
0
ADDR! Z-�) 5 00 CPSroX DATE: 11/30/2012
REVIEWED BY: larrys
QTY
APN: BP#: I
'VALUATION: &aZir
'PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition /
PRIMARY SFD or Duplex
Other Elea Insp.0.0 hrs$45.00
PENTAMATION 1REAP10
USE:
$113
PERMIT TYPE:
WORK
5 led lights, 12 switches 20 rete titles
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
Plum t, W.m C,,,;
QTY
UNITS
BP FEES
Elec. Permit Fee: IEPERMIT
Recep/Switch/Outlets
1BREMRECEP
Other Elea Insp.0.0 hrs$45.00
37
#
$113
,°,•; ;rx 7 rr:
PME Unit Fee:
$113.00
PME Permit Fee:
$45.00
Administrative Fee: 1ADMIN
$42.00
Work Without Permit? O Yes 0 No
$0.00
TOTALS:
f A
Travel Documentation Fee: ITRAVDOC
1 $113.00
Strone Motion Fee:
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District etc.). These fees are based on the prefinddua Information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E•fl 7/1/12)
FEE
Plum t, W.m C,,,;
Elec. Plan Check 0.0 1 hs $0.00
sl: <i:. �'�-.,,;q h1,-:
Pluu,h. A,,,,n, f'r.:
Elec. Permit Fee: IEPERMIT
(elm r 'l &ch le,y,
Ihlm, Ph„nb ins1,.
Other Elea Insp.0.0 hrs$45.00
.. h;.
NUMA /,;V;, 12,
, ,,.
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District etc.). These fees are based on the prefinddua Information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E•fl 7/1/12)
FEE
QTY/FEE
MISC ITEMS
PME Plan Check:
$0.00
,°,•; ;rx 7 rr:
PME Unit Fee:
$113.00
PME Permit Fee:
$45.00
Administrative Fee: 1ADMIN
$42.00
Work Without Permit? O Yes 0 No
$0.00
,�<Il',UtrPil lIGID UiI,j P'('c'S:
f A
Travel Documentation Fee: ITRAVDOC
$45.00
Strone Motion Fee:
$0.00
Select an AdministrativeV
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$245.00
$0.001
TOTAL FEE:
245.00
Revised: 10/01/2012