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13100040N CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 118D CONTRACTOR: BETACONSTRUCTION PERMIT NO: 13100040 OWNER'S NAME: EDWARD MORLEY 3498 CHERRY AVE DATE ISSUED: 10/03/2013 OWNER'S PHONE: 6505371523 SAN JOSE, CA 95118 PHONE NO: (408) 623-0280 JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL II [` LICENSED CONTRACTOR'S DECLARATION License Class_ Lic. #%Zi/_ ADD 5 (N) RECESSED LIGHTS IN KITCHEN, & REPLACE (E) HEAT LAMP & EXHAUST FAN IN BATHROOM �11As�`��n� Date 10/33 tJ Contractor 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: $1250 3 have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 34253036.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITIIIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 DAY L T CALLED INSPECTION. 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 Iss Date: 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. �D /e-3 RE-ROOFS: Signature Date 3 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. 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: I have and will maintain a Certificate of Consent to self-insure for Worker's Health & Safety Code, Section 25532(a) should I store or handle hazardous 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 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by for this the Health &Safety Code, Sections 25505yy, 25534, nd 25534. ,5/3 � Section 3700 of the Labor Code, for the performance of the work which Owner or authorized agent: C '�4�� Date 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I I I hereby affirm that there is a construction lending agency for the performance of become subject to the Worker's Compensation provisions of the Labor Code, must work's for which this permit is issued (Sec. 3097, Civ C.) forthwith comply with such provisions or this permit shall be deemed revoked. Lenders 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 CUPERtTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(Qcupertino.org oa`1vMEP ° misc F-1PLUMBING (—(MECHANICAL IOQELECTRICAL Fl MISCELLANEOUS PROJECT ADDRESS ,LZ � O 0 e f t `LQ. ,^ , h' j J JJ�1 jJ//�� ` APN # O 7 / Cj OWNER NAME F �./ V 1/1 I / I �) R PHONE NS 3 % /T 2, 3 7 / V Y�1 ���^,�/ &MAIL STREET ADDRESS 6 C STATE, ZIP 1r ' FAX CONTACT NAME 1 6.e ir} C a' rv\a n; PHONE J 7E -IL STREET ADDRESS CITY, STATE, ZIP FF ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME, A Lkiciaim LICENSE NUMBERIj ZZC ; (r/777E_g BUS. LIC # COMPANY NAME (1. E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEERNAM6E LICENSENUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY BUILDING. ❑ COMMERCIAL PROJECT IN WB,DLAND ❑YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK e V (f� Ct 54- 1 a L-, - TOTAL VALUATIO By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the 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 di Lenstruction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED' "µ `' ° TA7VDARD MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO SUV Ti c'f'7M A TnlD _ RTTrr .D_1Nf_.DIVICInN Mech. Plan Check 10.0 1 hrs $0.00 Phunb. Plan Check Mech. Permit Fee: 1MPERMIT Plumb. Permit Fee: Other Mech. Insp. rO.0 I hrs 1 $47.00 Other Plumb Insp. FT laech. Insp,Fee: Plumb. Insp. Fee: Elec. Plan Check 10.0 1 hrs $0.00 Elec. Permit Fee: IEPERMIT Other Elec. Insp. 1 0.0 Thrs $47.00 IElee. Insp, Fire: NOTE: This estimate does not include7ees aue to otner uepartments ts.e. reannLng, ruunL r.v.nJ, [ L, O, �LLLLLL.L•y -.... ��••��- __- rns,tnrt rho Dont for addn'1 info. "LJ LL LI: L, GL -z. i/L L;uc Q. u•.. .wras v.. ...r FEE ITEMS (Fee Resolution 11-053 ,E .'. 7111132 23500 CRISTO REY DR # 118D DATE: 10/03/2013 REVIEWED BY: MELISSA IWIADDRESS: APN: 342 53 036 BP#: *VALUATION: 1$1,250 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi-Famil Dwellin Y g Buildina is >3 Stories ® Yes ® No PENTAMATION 1 REAP11 PERMIT TYPE: USE: PME Plan Check: WORK ADD 5 N RECESSED LIGHTS IN KITCHEN & REPLACE E HEAT LAMP & EXHAUST FAN IN SCOPE I BATHROOM Mech. Plan Check 10.0 1 hrs $0.00 Phunb. Plan Check Mech. Permit Fee: 1MPERMIT Plumb. Permit Fee: Other Mech. Insp. rO.0 I hrs 1 $47.00 Other Plumb Insp. FT laech. Insp,Fee: Plumb. Insp. Fee: Elec. Plan Check 10.0 1 hrs $0.00 Elec. Permit Fee: IEPERMIT Other Elec. Insp. 1 0.0 Thrs $47.00 IElee. Insp, Fire: NOTE: This estimate does not include7ees aue to otner uepartments ts.e. reannLng, ruunL r.v.nJ, [ L, O, �LLLLLL.L•y -.... ��••��- __- rns,tnrt rho Dont for addn'1 info. "LJ LL LI: L, GL -z. i/L L;uc Q. u•.. .wras v.. ...r FEE ITEMS (Fee Resolution 11-053 ,E .'. 7111132 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F-6-1 # $70.00 Electrical IBREMFIXL Fixtures, Lighting Suppl. PC Fee: Q Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 F 1 # $24.00 Mechanical IBREMVENF Ventilation Fan Permit Fee: $0.00 Suppl. Insp. Fee -.00,0Q Reg. ® OT hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $94.00 Cnnsimction Tax: _7_1 Administrative Fee: IADMIN $44.00 E) Work Without Permit? ® Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure (E) ®, Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $9:4:.00 9 $280.50 Revised: 08/01/2013 JOBADDRESS: �'�•� Cri �, L� ,�� //�� PERMIT#IO� OWNER'S NAME: PHONE # GENERAL CONTRACTOR: °� BUSINESS LICENSE#P'l ," ADDRESS: ij C. CITY/ZIPCODPR CA *Our municipal code requirgs all businesses working in the city'.to have a City`of Cupertu `o business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A .CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information f,. V SUBCONTRACTOR BUSINESS NAME VS, INESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date (�vt/I�JCE(1- : fiDw� /K I'1Ll.,riy Storage 3'0'x 53" ,.No, Avai:2bi2 ` Or 7rnar:Jn:,s� T, fl I i i Bedroom 1011" x 137' i I I Closet 1 5'8"..x 47 i Bath 5'11"x8'11" N) ® Emergency Response System C Balcony 5'x: Q ( C COMMUNITY DEVELOPMENT DEPARTM NT BUILDING DIVISION - CUPERTINO � f•r P RO iD APPROVED This set of plans and specifications MUST be Job site during ept at the construction. It is unlawful to charges or alterations on same, ake any or to d therefrom, without approval from the Buildin iate I Official, The stampitWhLhftMn and specifications S Q be held to F1 tit 6132 be ^pproval ALL NOT i of the of any provisions y Ordinance or S' iolation I to Law. BY IN © Electrical Dutiet PERMIT NO. Dini 12 REVIEWED FOR C Reviewed By. High ::eii:ng a: lop 1-1,xv Entry^ ;0"x95'to I i PERTINO ' qui ina Reparkment 4 `._ ( C Kitchen I j x I © Cai„ to Taievisirn Ouliet i Model AD j One Bedroom One Bath Deluxe i.AT FA\CHO SAN AMTON10 _ Fir,,.; 74gi: d+r >t'ixaen;,mn•..-i:n�,: xntus,<:br,:•t:u m;J i::.ret na,��• �eP1G,�e cG) ,le on . vutiet COMPLIANCE I I I I I i 1' I- i -- -- 1 foot i