13120013CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 119C
CONTRACTOR: BAY AREA ENTERPRISE
PERMIT NO: 13120013
OWNER'S NAME: JOHN HOPPRICH TRUST ET AL
2110 MANGIN WAY
DATE ISSUED: 12/03/2013
OWNER'S PHONE: 6505371523
SAN JOSE, CA 95148
PHONE NO: (408)238-5043
LICENSED CONTRACTOR'SDECLARATION
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BUILDING PERMIT INFO: BLDG ELECT PLUMB
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License Class Lic. # U�'Z' V(�
MECH RESIDENTIAL COMMERCIAL
Contractor Qt. t.� ,�'�G` ��" Date
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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:
REPLACE 18 (E) OUTLETS & SWITCHES, REPLACE (E)
i. 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
KITCHEN & HALL LIGHTS & REPLACE (E) BATHROOM
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
ectton 3700 of the Labor Code, for the performance of the work for which this
EXHAUST FAN
rmit is issued.
APPLICANT CERTIFICATION
1 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
Sq. Ft Floor Area:
Valuation: $3100
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
APN Number: 34253026.00
Occupancy Type:
all non -point source regulations per the Cu ino Municipal Code, Section 9.18.
Signature
Date
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's: License Law for one of
the following two reasons:'
1. 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 foyi
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:
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.
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
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
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.
.PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Date:_4�Z/Z J1 3
RE -ROOFS:
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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I have read the hazardous materials requirements under Cha a 6.95 of the California
Health & Safety Code, Sections 25505, 25533, and 25534. I dl aintain compliance with
the Cupertino Municipal Code, Chapter 9.12 and the Heal Safety Code, Section
25532(a) should I store or handle hazardous mater' 1. A di 'onally, should I use
equipment or devices which emit hazardous air c m' ants as defined by the Bay Area
Air Quality Management District I will maintai mp ance with the Cupertino
Municipal Code, Chapter 9.12 and the Hea th afe Code, Sections 25505, 25533, and
25534.
Owner or authorized agent:
Date: ahZf
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
CONSTRUCTION PERMIT -APPLICATION O\
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 /I
CUPERTINO I (408) 777-3228 FAX ?408) 777-3333 • buiidinof ypertino oro
❑ NEV CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION / DEFERRED \ORIGINAL, PERMIT #
PRO)ECr ADDRESS
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EXISTING USE PROPOSED USE
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EXISTING USE PROPOSED USE
CONSTR TYPE
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USE
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VALUATION (3�
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NETAREA��
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REMODELAREA REMODELAREA RBMODELAREA
DEWGADDEW ONOADI)MON? []NO
PRE APPLICATION []YES IF YES, PROVIDECOPYOFIS THB BLDG AN ❑YES TOTAL OVAL1Jgnd
PLANNINGAPPL# NO PLANNINGAPPROVALLEITEt EICHLERHOME? ONO : ? £ 8 D•� � -z., `7,�/iON-
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By my signature below, I certify to each ofthe slowing: I am the awner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have pmvi is correct I have on of Work and vea* it is
ordinances and state laws relating to on I a fives of Cupertino ter the abo� v�identifi . I agree to imp ly with all applicable local
Signature ofApplicant/Ageot Date:
are l ��o fZ0 on purposes.
_ New SFD or Multifamily dwellings: Jkfply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
_ Commercial Bldgs: Provide a completed -Hazardous Materials Disclosure
Form if any Hazardous Materials are being used as part of this project
_ Copy of Planning Approval Letter Or Meeting with Planning prior to
submittal of Building Permit application.
❑ `Mgidl D41 'iAL HEALTH
BJdgApp 2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ka,ADDRESS:
23500 CRISTO REY DR UNIT 119
DATE: 12/03/2013
REVIEWED BY: MELISSA
Plumh. Permit l-ee: Elec. Permit Fee: IEPERMIT
APN: 342 53 026
BP#:
"VALUATION: 1$3,100
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
USE: SFD or Duplex
Suppl. PC Fee: E) Reg. ® OT
PENTAMATION
PERMIT TYPE: 1 REAP1
WORK
REPLACE 18 E OUTLETS & SWITCHES REPLACE E KITCHEN & HALL LIGHTS & REPLACE E
SCOPE
BATHROOM EXHAUST FAN
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Phanb. Plan Check Elec. Plan Check 0.0 hrs $0.00
Mech. Plan Check 0.0 hrs $0.00
Mech. Permit Fee: 1MPERMIT
Plumh. Permit l-ee: Elec. Permit Fee: IEPERMIT
Other Mech. Insp.0.0 hrs 1 $47.00
Oilier Plumb Insp. Other Elec. Insp.0.0 hrs $47.00
1llech. Insp. Fee:
Plumb. Insp. Fee: Dec. Insp. Fee:
Electrical
IBREMRECEP Recep/Switch/Outlets
Suppl. PC Fee: E) Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
2
$70.00
Electrical
1 IBREMFIXT Fixtures, Lighting
Permit Fee:
$0.00
Supp/. Insp. Fee Q Reg. ®OT
0.0
hrs
$0.00
0 # Mechanical
$24.00 IBREMVENF Ventilation Fan
PME Unit Fee:
$0.00
PME Permit Fee:
$94.00
Construction Tax:
T�
�u
,fl
Phanb. Plan Check Elec. Plan Check 0.0 hrs $0.00
Mech. Plan Check 0.0 hrs $0.00
Mech. Permit Fee: 1MPERMIT
Plumh. Permit l-ee: Elec. Permit Fee: IEPERMIT
Other Mech. Insp.0.0 hrs 1 $47.00
Oilier Plumb Insp. Other Elec. Insp.0.0 hrs $47.00
1llech. Insp. Fee:
Plumb. Insp. Fee: Dec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (tie. Planning, Public works, tire, YantraryNewer uisiricr, ,enoot
niefrint atn 1 Thaeo foot aro haaod nn tho nroliminary infarmatian availahle and are only an estimate. Contact the DeDt for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7�
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
=#
$47.00
Electrical
IBREMRECEP Recep/Switch/Outlets
Suppl. PC Fee: E) Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
2
$70.00
Electrical
1 IBREMFIXT Fixtures, Lighting
Permit Fee:
$0.00
Supp/. Insp. Fee Q Reg. ®OT
0.0
hrs
$0.00
0 # Mechanical
$24.00 IBREMVENF Ventilation Fan
PME Unit Fee:
$0.00
PME Permit Fee:
$94.00
Construction Tax:
Administrative Fee: IADMIN
$44.00
1
E)
Work Without Permit? ® Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
A
Travel Documentation Fee: ITRAVDOC
$47.001
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
_
$141.00 , u
$327.50$186.50
Revised: 10/01/2013