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13080166CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 41117 CONTRACTOR: BETACONSTRUCTION PERMIT NO: 13080166 OWNER'S NAME: BENJAMIN FRANA 3498 CHERRY AVE DATE ISSUED: 08/22/2013 OWNER'S PHONE: 4086230280 SAN JOSE, CA 95118 PHONE NO: (408) 623-0280 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ ❑ LICENSED CONTRACTOR'S DECLARATION License Class_ Lic. # �����/� UNIT 411F- INSTALL 10 SWITCHES AND 20 OUTLETS, 7 Contractor 1 �, ��,.�P Date �/a / 3 RECESSED LIGHTS, REMOVE AND REPLACE FANS, HEAT (� P ,,1 gh LAMP IN (2) BATHROOMS, 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 Sq. Ft Floor Area: Valuation: $1800 performance of the work for which this permit is issued. 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: 34253175.00 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 WITHIN 180 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 DAY M LAST CALLED INSP CTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Issued by: C Date: 4,��-- granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18. / cy Signature s Date i �13 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) I, 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. I 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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: Pja/l 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 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 CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION Y 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �u► (408) 777-3228 • FAX (408) 777-3333 • buildinwftupertino.ora I—I PLUMBING n MECHANICAL I✓I ELECTRICAL M MISCELLANEOUS MEP MISC PROJECT ADDRESS Sb � ` ^ APN # 2� 53 III -7 OWNER NAME .AVcI)_�A.. •r �1. PH I� G.��%�O 0 �TG4ri 1!`1c4-� G/ICk�� STREET ADDRESS ^ CITY, STATE, ZIP O LFt iY�/r 'o A FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONT R NAME r ��- LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL, FAX STREET ADDRESS C CITY, STA;E� I J49YL tn n � PHONE ARCHITECT/ENGINEER NAME LICENSE NUMB# 2 Z n� 7 BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SID or DUPLEX ❑ MULTI -FAMILY BUILDING: ❑ COMMERCIAL PROJECT IN WI DLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK c-, TOTAL VALUATION: 17 RECEIVED By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on th property owner's behalf. I have read this application and the information I have provided is correct. 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 building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date:- ate:-SUPPLEMENTAL SUPPLEMENTALINFORMATION REQUIRED OFFICE USE ONLY W ❑ OVER-THE-COUNTER ❑ EXPRESS U zU a ❑ STANDARD ❑ LARGE a ❑ MAJOR MEPMiscApp_201 Ldoc revised 06/21/11 ,/_ CITY OF CUPERTINO No FEE ESTIMATOR — BUILDING DIVISION Lfech. Plan Check Plumb, Plan Check Elec. Plan Check 0.0 1 hrs $0.00 F17k, r. Permii Fee: Plumb. Permit Fee: Elec. Permit Fee: IEPERMIT Other ,llech. Insh. Other Plumb Imp. Other Elea Insp. 0.0 hrs $47.00 rilech. Insp. Fee: Plumb. lrrsp. Fee: Glee. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (La Planning►, Public Works, Fire, Sanitarp Sewer District, School utstrtct, etc . 1 Hese ees are oasea on the preumma ADDRESS: 23500 Cristo rey dr DATE: 08/22/2013 REVIEWED BY: Mendez FEE APN: BP#: "'VALUATION: 1$1,800 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex 30 # Electrical $97.00 IBREMRECEP Recep/Switch/Outlets PENTAMATION PERMIT TYPE: 1 REAP1 i WORK I unit 411f- install 10 switches and 20 outlets 7 recessed lights, remove and replace fans heat lamp in SCOPE (2) bathrooms, Lfech. Plan Check Plumb, Plan Check Elec. Plan Check 0.0 1 hrs $0.00 F17k, r. Permii Fee: Plumb. Permit Fee: Elec. Permit Fee: IEPERMIT Other ,llech. Insh. Other Plumb Imp. Other Elea Insp. 0.0 hrs $47.00 rilech. Insp. Fee: Plumb. lrrsp. Fee: Glee. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (La Planning►, Public Works, Fire, Sanitarp Sewer District, School utstrtct, etc . 1 Hese ees are oasea on the preumma information avanaote ana are onty an esumate. contact the ue t or aaan z info, FEE ITEMS (Fee Resolution 11-053 E . 7111121 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 30 # Electrical $97.00 IBREMRECEP Recep/Switch/Outlets Suppl. PC Fee: (E) Reg. 0 OT 0.0hrs $0.00 PME Plan Check: $0.00 1 71 Electrical $70.00 IBREAfl;= Fixtures, Lighting. . Permit Fee: $0.00 Suppl. Insp. Feer Reg. ® OT 0 0 hrs $0.00 PME Unit Fee: $0.00. PME Permit Fee: $47.00 ym Construction Tax: Lfech. Plan Check Plumb, Plan Check Elec. Plan Check 0.0 1 hrs $0.00 F17k, r. Permii Fee: Plumb. Permit Fee: Elec. Permit Fee: IEPERMIT Other ,llech. Insh. Other Plumb Imp. Other Elea Insp. 0.0 hrs $47.00 rilech. Insp. Fee: Plumb. lrrsp. Fee: Glee. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (La Planning►, Public Works, Fire, Sanitarp Sewer District, School utstrtct, etc . 1 Hese ees are oasea on the preumma information avanaote ana are onty an esumate. contact the ue t or aaan z info, FEE ITEMS (Fee Resolution 11-053 E . 7111121 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 30 # Electrical $97.00 IBREMRECEP Recep/Switch/Outlets Suppl. PC Fee: (E) Reg. 0 OT 0.0hrs $0.00 PME Plan Check: $0.00 1 71 Electrical $70.00 IBREAfl;= Fixtures, Lighting. . Permit Fee: $0.00 Suppl. Insp. Feer Reg. ® OT 0 0 hrs $0.00 PME Unit Fee: $0.00. PME Permit Fee: $47.00 Construction Tax: Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 i Travel Documentation Fee: ITPA VDOC $47.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 . _ . L � . $13950 . $16700 '� � � �w� a ° � ` .,' � " $306.50 Revised: 07/01/2013 Stora r vL-,, ro 'D 0' F 11— jfZ 4' A*4n8T be kept at the It is unlawful to make any n same, or to deviate "n t z p, oval from the Building Official. r",'hjs plan and specifications SHALL NOT pt,'r,rt or to be an approval of the violation !"Jo.ns of any City Ordinance or State Law. CUPERTINO Ruilding Department AUG 2 2 2013 Dt',T7 -:Jj� '4 REVIEWED FOR CODE COMPLIANCE P E RNA i TF IVO. M &ZC Ole Reviewed By: P�� yr�-