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13120012CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 312F CONTRACTOR: BAY AREA ENTERPRISE PERMIT NO: 13120012 OWNER'S NAME: HAROLD TAYLOR TRUSTEE. 2110 MANGIN WAY DATE ISSUED: 12/03/2013 OWNER' PHONE: 6505341523 SAN JOSE, CA 95148 PHONE NO: (408)238-5043 ❑ LICENSED CONTRACTOR'S DECLARATIONF F BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class G Lic. # q L l 01 ' I r r MECH RESIDENTIAL COMMERCIAL Contractor 864, AW,,M Date 114 3( w13 ir I hereby affirm that/ I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions JOB DESCRIPTION: Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: t. 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 ;ranting of this permit. Additionally, e applicant understands and will comply with all non -point source regul i rs per a Cupertino Municipal Code, Section 9.18.;{ Signature Date. ❑ OWNER -BUILDER DECLARATION I hereby affirm that I aro exempt from the Contractor's License Law for one a the following two reasons: t. 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) 2. I, 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: 1. 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. 2. 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. 3. 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 [ 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. Signature Date REMOVE (E) SHOWER PAN, TILE WALLS & VALVE & REPLACE WITH (N) PLASTIC PAN, WALLS & VALVE Sq. Ft Floor Area: APN Number: 34253137.00 Valuation: $3500 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS ISSUANCE OR 180 DAYS LLED INSPECTION. Date: All roofs shall be inspected pyo any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I have read the hazardous materials requirements under C Health & Safety Code, Sections 25505, 25533, and 25534. I the Cupertino Municipal Code, Chapter 9.12 and the Healt 25532(a) should I store or handle hazardous material. Adid equipment or devices which emit hazardous air con am* aJJ Air Quality Management District I will maintain corn i I Municipal Code, Chapter 9.12 and the alt Sa ty of 25534. Owner or authorized agent: pt 95 of the California aintain ncompliance with i/gafety Code, Section Wally, should I use as defined by the Bay Area with the Cupertino , Sections 25505, 25533, and Date: f _q7 A19Y 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 I understand my plans shall be used as public records. Licensed Professional CCUPERTINO I I I wRw rnNCTRTTr` 1nV V O` CONSTRUCTION PERMIT:APPLICATION /� O COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION � V 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255. (408)777-3228 - FAX x408) 777-3333 • buildinaCu yger ino.ora M AT1T%rITn1.T (-1 I Ut —-------- - +-+.�s�+� vauvuvru,rrAtAUI IF PROJECT ADDRESS Z3 rmIon z r"I uhell2F3O T. !in W iW- 7ILS T- PHONEC ro . 5 3 j -1 r23 E MAn �-- STREErADDRESS 2 7 Sv CWe.4;b C. ` , STATE, ZIP FAX Tv Ko CONTACT NAME PHON SZ — 2.3 8 - S'a 3 E 1.4AHre c7 T . Cd tf-ti STREET ADDRESS /! (, r/ CITY. sT3 ZIP 7ARCHITECT FAX ❑ OWNER ❑ OWNER H=ER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTORAGENr ❑ ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME GI"e Fe LICENSE ER LICENSa E BUS. LIC # S COMPANY NAME r _ - g FAX STREEFADDRESS 2I/ IYu o �t CITY %J S a rX �►'sc C- j%,- q s (q! 00 PHONE ARCH[TECUENGINEER NAME LICENSENUMBER BUS. LIC # COMPANY NAME E-MAIL. FAX STREETADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK (v �• In Rcowc — FLe w• a ; S t� n o 5hou"tr 4O% e a ,� l (t S V'AP uJ a.� 14i S f r G (.� �GS R `%C S EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC SQ.FI: VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NErAREA BATHROOM Kn'CBENOTHERREMODEL AREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAIDIORCHAREA GARAGEAREA: DETACH ATTACH I # DWELIJNG UNITS: ISA SECOND UNrr OYES SECOND STORY OYES BEWGADDED? 13 NO ADDITION? ONO PRE -APPLICATION O YES IF YF -%PROVIDE COPY OF PLANNINGAPPL# ONO PLANNINGAPPROVALLErM ; ISTHE BLDG AN O YES EICBLERBOAf0 ONO 4 r ` `� x 4 *`: TOT jU�A� N; By my signature below, I certify to each of the- wing: I owner or auth on the . I have read this y FMthe application and the information I have prOVI is coraecG I e tion of oak v ordinances and state laws relating to buil nsttuction T fives of Cupertino to en ove-idea' ed property for inspection purposes. Signature ofApplicandAgent; Date: I Z / 3 SUPPLEMENTAL INFO ION` QU 1' 1 T PB S ..:. ROUPING S! IP s _ New SFD or Multifamilydwellin gs: ply for demob on permit for ?~ ' ❑ ovERTHE c910- Ett D suu DING PLAN xEt'IE\v existing building(s). Demolition permit is required prior to issuance of building permit for new building. g' � EAPRESS _ _ ❑ .;PLAnA:HNGPLAN RE�7E\Y _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure D STANDARD s ❑ pUBLJC �� ORKS Form if any Hazardous Materials are being used as part of this project O ❑FIRE Copy of Planning Approval Letter or Meeting with Planning prior to LARGE. x y DEPT` _ Submittal Of Building Permit application 0 MAJOR. ti ❑ SAnrrARY SEIVER bISTRICT • ❑ •' RN\'IROND9EN-IAL HEALTH BldgApp 2011.doc revised 06/21/11 �� CITY OF CUPERTINO I'AY. �.�I FF.F, ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 23500 CRISTO REY DR UNIT 312 DATE: 12/03/2013 REVIEWED BY: MELISSA UNITS APN: 342 53 137 BP#: *VALUATION: 1$3,500 *PERMIT TYPE: Plumbing Permit 1 PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Multi-FamilyBuildina USE: Dwelling is >3 Stories 0 Yes Q No PENTAMATION 1 RPFI PERMIT TYPE: WORK REMOVE E SHOWER PAN TILE WALLS & VALVE & REPLACE WITH N PLASTIC PAN WALLS SCOPE I& VALVE PME Unit Fee: APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Fixture set on One Trap 113PFIXTURE 1 # $10 Permit .Fee: .Suppl. Insp Fee PME Unit Fee: $10.00 PME Permit Fee: $47.00 Construction .Tax: Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes 0 No $0.00 TOTALS: h�� $ 1000 Strong Motion Fee: 1BSEISMICR I :Wech. Plan Cheek kch. Permit Fee: Other ,tech. Insp. heck Insp. Fire: Plumb. Plan Check 10.0 1 hrs $0.00 Elec. Plan t:heck Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: Other Plumb Insp. r 0.0 hrs $47.00 Other Elec. Insp. Plumb. hrsp. Pee: Elec, Insp. Fee: NOTE: This estimate does not include.jees due to other Departments (ie. rlanning, rubric worlrs, Tire, aanuary newer vislrict, acnooi atn 1 Th.— foo. —a hn.od nn tho nralymmamt i"fnrmadnn availahlo and are nnly on ectlmate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7� FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee PME Plan Check: $0.00 Permit .Fee: .Suppl. Insp Fee PME Unit Fee: $10.00 PME Permit Fee: $47.00 Construction .Tax: Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes 0 No $0.00 �1 dvanced Planning Fees: Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 * r-- W-r50 $149. $T`U7L FEE 0.004 $149.50 Revised: 10/01/2013