13070105 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23100 VIA ESPLENDOR UNIT V42 CONTRACTOR:BETACONSTRUCTION PERMIT NO:13070105
OWNER'S NAME: ROBERT FORSTER 3498 CHERRY AVE DATE ISSUED:07/16/2013
OWNER'S PHONE: SAN JOSE,CA 95118 PHONE NO:(408)623-0280
❑ LICENSED CONTRACTOR'S DECLARATIION JOB DESCRIPTION: RESIDENTIAL COMMERCIALE]
License Class_ Lic.# 9 Z 7—yl x VILLA 42-INSTALL 10 RECESSED LIGHTS,14 SWITCHES
AND 42 OUTLETS THROUGH OUT
Contractor !04(�(1 Arm Date
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:$2400
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:34255027.00 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 80 DAYS 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 DA F M LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, �y
costs,and expenses which may accrue against said City in consequence of the Issued b
granting of this permit. Additionally,the applicant understands and will comply Y Date:
71
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 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
Signature of Applicant: Date:
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)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
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
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: DaT `G
permit is issued.
1 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 CONSTRUCTION LENDING AGENCY
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.)
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
9.18.
Signature Date
I
GENERAL PERMIT APPLICATION
I
:-1 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O�
•CUPERTINO,CA 95014-3255
10300 TORRE AVENUE (1
(408)777-3228•FAX(408)777-3333•building0D-cugertino.ong
misc
Ct1PIE: &,54O
❑PLUMBING ' . ❑MECHANICAL ELECTRICAL ❑MISCELLANEOUS
PROJECT ADD
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06; I I��GI C�I�t YL42 APN# 3 12. 55 2—7
OWNERIto/S - - l/D: E-MAII
STREET ADDRES§ - C TATE,ZIP 1`e�C7 tJ�L -FAX
CONTACT NAME PHO O Z TE-MAII_j��40,lti-m,�,,:n yhod�) - r
STREET ADDRESS CITY,STATE,ZIP f 7 FAX
❑ OWNER ❑ QWNER-BUII.DER. ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT 11ENGINEER 11DEVELOPER ❑TENANT ..
CONTRACTORNAME i � OL�v�1 r IVil, LICENSE NUMBERg/L��� � LICENSE TYPE 43BUS.LIC#
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ARC!Hn. T/ENGINEERNAME LICENSENUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS j CITY,STATE,ZIP PHONE
USE91`!: EP SFD of DUPLEX ❑'MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN []YESBUII.DING•: -. ❑COMMERCIAL URBAN INTERFACE AREA E] NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTIOI T OF wORIC 1:
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By;my slgnatue Ibelo 'I certify:to each of the following: I am the property owner or authorized agent to act on e p rty owner's behalf. I have read this
application and the Information b have provided is correct. I have read the Description of Work and verify it is accur I agree to comply:with all applicable locale.
ordinances•and:state Paws retatmglto building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.:
Sig ature of Apphcant/Agentl. Date: //A/3
SUPPLEMENTAL INFORMATION REQUIRED
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MEPMiscApp_2011.doc revised 06/21/11
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CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 23100 via esplendor villa 42 DATE: 07/16/2013 REVIEWED BY: mendez
APN: I BP#: *VALUATION: 1$2,400
*PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION 1 REAP11
USE: SFD or Duplex PERMIT TYPE: i
WORKvilla 42- install 10 recessed lights, 14 switches and 42 outlets through out
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Fixtures, Lighting 1BREMF►xT 10 # $70
Recep/Switch/Outlets 1BREMRECEP 56 # $227
TOTALS: a $297.00 41 _
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Mech. Plan Check Plumb. Pion Check Elec.Plan Check 0.0 hrs $0.00
FW:ifech.Perrnit Fee.: Plumb.Permit Fee: Elec.Permit Fee: 1EPERMIT
1,11 P,
OtIno-;tlech.Insp. Other Plumb Insp. Other Elea Insp. 0.0 hrs $47.00
Allech.Insp.Fee: Plumb. Insp.Fee: Elec.Insp.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 prelimina information available and are onl an estimate. Contact the Dept for addn'l info,
FEE ITEMS(Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC 1 ee
PME Plan Check: $0.00
Perrnit Fee:
Suppl. .Insp Fee
PME Unit Fee: $297.00
PME Permit Fee: $47.00
Construction Tax: -F-T
Administrative Fee: /ADMIN $44.00
Work Without Permit? O Yes 0 No $0.00
Advanced Planning Fees:
Travel Documentation Fee: 1TRAMOC $47.00 i
Strong Motion:Feet IBSEISMICR $0.50 Select an Administrative Item.
Bldg,Stds Commission Fee: 1BCBSC $1.00
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$436.50 $0.00 ... n $436.50
Revised: 07/01/2013
OUPERTINO
uil ing Department
F it
JUL 16 2013
EVIEWED FOR CODE COMPLIANCE
® Reviewed BY: Min
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APPROVED
This set of plans and specifications MUST be kept at the
job site during construction. It is unlawful to make any
changes or alterations on same, or to deviate
therefrom, without approval from the Building Official.
The Stamping of this plan and specifications SHALL NOT
be held to permit or to be an approval of the violation
of any provisions of any City Ordinance or State Law.
S )Y4.
DATE _ -7./r .I 3
PEPWIT NO._1 -3V70/05—