12120091CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 207D
CONTRACTOR: BAY AREA ENTERPRISE
PERMIT NO: 12120091
OWNER'S NAME: GASPAR CASTELL
2110 MANGIN WAY
DATE ISSUED: 12/18/2012
OWNER'S PHONE: 6505371523
SAN JOSE, CA 95148
PHONE NO: (408)238-5043
❑ CONTRACTOR'S DyE-�CLARATTION
F
tLICENSED
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class ` Lic. #i
Contractor 1 � l� � Date 1'1.� � � �'d�
MECH RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: UNIT 207D - REMOVE AND REPLACE SHOWER VALVE
(commencing with Section 7000) of Division 3 of the Business & Professions
AND
CLEAN UP SURROUND
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.
I have and will maintain Worker's Compensation Insurance, as provided for by
Sq. Ft Floor Area:
Valuation: $3000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 34253058.00
Occupancy Type:
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 hereky authorize representatives of this city to enter
upon the above mentioned prop for inspection purposes. (We) agree to save
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless t ity of Cupertino against liabilities, judgments,
costs, and expenses which may crne against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. A diti Wally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point sour a gu tions per the Cupertino Municipal Code, Section
9.18.
Signature Date l �i 1
L�
Issued by: A/✓ j C�%�l Date:
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
1, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous ma r' Is requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health & Safety C de Sections 25505, 25533, and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cuperti o unicipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532( s uld I store or handle hazardous material.
Additionally, shouldI use a ui ment or devices which emit hazardous air
I
permit is issued.
contaminants as de e b e Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
maintain compli wit a Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Health & San ode, ons 25505, 25533, and 25534.
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
Owner or a horized agent: L
forthwith comply with such provisions or this permit shall be deemed revoked.
Dater
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
I hereb affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating
for wh' h tpis permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender s Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CLIPERTINb
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildincl(ftupertino.org
-2
❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS +^ �' 7
1
APN # '
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STREET ADDRESS
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME 4 L C_i
LICENSE NUMBER' 7l 7
LICENSE TYPE
BUS. LIC #
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COMPANY NAME f
E-MAIL
FAX
STREET ADDRESS L�
-CITY, STATE, IP fes"
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PHONE
JCP
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK -
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO TOTAL
AREA
AREA
AREA
BATHROOM
KrrCHEN
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
T DECK/PORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
I
# DWELLING UNITS:
IS A SECOND UNIT []YES
SECOND STORY ❑ YES
BEING ADDED? []NO
ADDITION? ❑NO
PRE-APPe6ATION ❑YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑YES
ZI IVSD B'
2
TOTAL VALUATION:
PLANNING APPL # []NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO3"
C}GC
J
By my signature below, I certify to each of the following: I am the grope owner or ized a en .to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have r escription of d verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I aut fie rep en of upertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent:Date:
SUPPLEMENTAL INFORMATJFN REQUIRED
s '
PIS CaECK TYP1d ;
w ROITII�G $IJP ,
_ New SFD or Multifamily dwellings: Apply for demolition permit for
OVER THE -COUNTER € �
e,"x
BIiILDING PLAN REVIEW � g
existing building(s). Demolition permit is required prior to issuance of building
k
permit for new building.D
p
EJ►PiEss' h spPLANNING
PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials DisclosureQ
sTAiyDAiiD
fl uBiiGwoilxs 0 X
form if any Hazardous Materials are being used as part of this project.
_` z
� �
❑ � LARGE �
D � FIRE DEP1� � . � �,�
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑
3� '
❑ SANITARY SEWER
submittal of Building Permit application.
MAJOR
DISTRICT. �
❑ ENVIRONMENTAL HEALT$ <'...
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FM -7 FEE ESTIMATOR—BUILDING DIVISION
im,ADDRESS:
23500 Crito Rey Dr --7DATE:
12/18/2012
REVIEWED BY: Sean
UNITS
APN:
BP #:
"VALUATION: 1$3,000
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
#
PENTAMATION 1 RPFIX
I PERMIT TYPE:
WORK
Unit 207D: Remove and replace shower valve and clean up surround.
SCOPE
Su/)/al. I isp Fee
APPLIANCE / EQUIP TYPE
FEE ID
Plumb. Plan Check 0-01 hrs $0.00
QTY
UNITS
BP FEES
I:,c(, Vec:
Fixture or Trap
1BPFIXTURE
CJtIr lsl<.�c _ Inv,.
1
#
$10
Perinif
I
Su/)/al. I isp Fee
PME Unit Fee:
$10.00
PME Permit Fee:
$45.00
(,'onsli-Itction Tax.,
Administrative Fee: ]ADMIN
$42.00
Work Without Permit? 0 Yes (F) No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VD0C
$10.00
Strong Motion Fee: 1BSEISMICR
-T
'.'.:Jr. fiat, t ,'.f (t,
Plumb. Plan Check 0-01 hrs $0.00
i"I"CC
I !',> li� I"c"
Plumb. Permit Fee: IPPERMIT
I:,c(, Vec:
()rlu,)' Ah;c 1. 1„'P
Other Plumb Insp. 0.0 hrs $45.00
CJtIr lsl<.�c _ Inv,.
11� cIz. IRJp I „r:
l'iz nba In"p. F.Ic:
Iacr _ Imp. Fco:
NOTE: This estimate does not include fees due to other Departments ('tie. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7.11112)
FEE
QTY/FEE
MISC ITEMS
Plan Chock Fee:
:Suppl. PC' fee
PME Plan Check:
$0.00
Perinif
I
Su/)/al. I isp Fee
PME Unit Fee:
$10.00
PME Permit Fee:
$45.00
(,'onsli-Itction Tax.,
Administrative Fee: ]ADMIN
$42.00
Work Without Permit? 0 Yes (F) No
$0.00
'Llvurtec(I Plannin teas:
Travel Documentation Fee: ITRA VD0C
$45.00
Strong Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$143.501
$0.00 TOTALFEE:
1 $143.50
Revised: 10/01/2012