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14010110CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 318F CONTRACTOR: BAY AREA ENTERPRISE PERMIT NO: 14010110 OWNER'S NA SAN JOSE, CA 95148 PHONE NO: (408)238-5043 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ UNIT 318F - REPLACE 18 (E) OUTLETS & SWITCHES, License Class Lic. # REPLACE (E) KITCHEN & HALL LIGHTS & REPLACE (E) / �i — �l y BATHROOM EXHAUST FAN Contractor Date I — I hereby affir that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code d that my license is in full force and effect. I hereb irm under penalty of perjury one of the following two declarations: I have d ill maintain a certificate of consent to self -insure for Worker's pe provided for by Section 3700 of iheiabor Code, for the pe o ce of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $3100 ha d will maintain Worker's Compensation Insurance, as provided for by APN Number: 34253141.00 Occupancy Type: Sec n 7 0 of the Labor Code, for the performance of the work for which this ermit ' ' sued. 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 WITI] IN 180 DAY SUANCE 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 DAYS ED INSPECTION. 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 by: granting of this permit. Additionally, the applicant understands and will comply with all non -point source regul tions per the Cupertino Municipal Code, Section 9.18. Signature Date 17" (� 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. ❑ 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 S construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirementC ter 6.95 of the California Health & Safety Code, Sections 25505an 2 534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municie, hapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I ndle hazardous IDate: I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment os hich emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Are it anagement District I performance of the work for which this permitis issued. will maintain compliance with the Cupe no Muode, Chapter 9.1 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25 , 2 34. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: 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 CONSTRU TION LENDINAGENCY 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 _I hereby affirm that there is a cons ction 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 repiesentatives 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 918. Signature Date CONSTRUCTION PERMIT -APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPER'i-1NO (408) 777-3228 • FAX ?408) 777-3333 • _building0cuoefto.orcl ❑ NEW CONSTRUCTION F-1 AflTImnw n At TAR.-MnV /Tr rwua�nernrr ir.t rcnnr.. %J PROTECT ADDRESS erg / 04 OwxER1 FAX 4KO CONTACT NAME PHONE 23 8 - 57b 3 EMAIL f'e 2 r'� • Cd 01 STREET ADDRESS _Ian / CITY, ST ZIP $ 7ARcm FAX ❑ OWNER ❑ OWNER -BUILDER ❑ owmmAGENT CONTRACTOR ❑ CONTRACTORAGENT ❑ ECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE!M LiCENS� E BUS. LIC # .;,re COMPANYNAME Q 0. EMAIIS��- C O FAQ{ STREET ADDRESS 2 ,l M� r$1 C. STATE, 21P San mese c01fill{ 00 PHONE ARCHITECTIENGINEER NAME LICENSENUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CTTY, STATE, ZIP PHONE DESCRIPTION OF WORK /► I 1 � •E G. replace h&1A 04AP0 Abh 40 OtW4 Y A.• < OA 4.e 4 -h 'w ke et se • . V9 .250- -- EXISTING USE PROPOSED USE e Coyx TYPE # STORIES . I USE TYPE OCC ALUAMON (3) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODELAREA REMODE.AREA REMODELAREA PORCH AREA DECK AREA TOTALDEMPORcH AREA GARAGE AREA DETACH J ❑ ATTACH I # DWELLING UNITS: IS A SECOND UNTr ❑ YES SECOND STORY ❑ YES BEINGADDED? ❑NO ADDITION? [:]NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APDL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑YES EIC HLER HOME? s t e TOTAL VALUATION: I O By my signature below, I certify to each ofthe flowing: I am the owner or authorized agent to the property owner's ave read this application and the information I have provi is correct I have th escription of Work and v erify it is accurate. I agree to comply with all a ble local ordinances and state laws relating to builnstruction. I a n fives of Cupertino to enter the above -identified property for inspection purposes. Signature ofApplicant/Agent Date: ir-- 2,0/� SUPPLEMENTAL INFO ON Q . s-f.,,�l'LAT`1=GHE�IC'r'PYP>��.w.� ROU77NGSLIP � _ _ New SFD or Multifamily dwellings: ply for demob on permit for OYER.IAE - existing building(s). Demolition permit is required prior to issuance of building. CODI5TER war BUII DING PLAN RE)7Ew _ permit for new building. Ni-EaPxEss ❑ .PLAAADVGPLANRE�Iv _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure g P D STAI�ARD z w i] PUBLIC *VORIG4 form if any Hazardous Materials are being used 8s part of this project I.ARe> > s ©'FIRE Copy of Planning Approval Letter or Meeting with Planning prior to DEP,7 _ submittal of Building Permit application �" A&i TOR , SANITARY SEIi�RDISTRICT ' . . � _ ~ r ❑ .:_eNVUiotYl�4En'TAI, HEALTx ;. . BldgApp 2011.doc revised 06121111 CITY OF CUPERTINO rr, r rcrrtikir A Tl1D — U11T77 11TN(`_ nl<VTI.Q Mech. Plan Check 0.0 1 hrs $0.00 .Plw ib. Pleat Check Elec. Plan Check 10.0 1 hrs $0.00 Mech. Permit Fee: 1MPERMITPlumb. Permit Fee: Elec. Permit Fee: IEPERMIT Other Mech. Insp. 0.0 hrs $47.00 Other Plumb Insp. Other Elea Insp. 0.0 hrs $47.00 lilech. Insp. Fe -e. Plumb. lnslt. Fee: Elee, Insp, Fee: ArnTFI. This ectimate does not include: fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School L ed the relimina information available and are on1v an estimate. contact the ue t or aaan i info. Distrtet, el"J. These ees are as on. FEE ITEMS (Fee Resalution 11-053 E . 7�f /IL13) FEE QTY/FEE MISC ITEMS ADDRESS: 23500 CRI$TO REY DR 318E DATE: 01/17/2014 REVIEWED BY: MELISSA F 18-1 # $47.00 APN: 342 53 141 BP#: "VALUATION: $3,100 xPERMIT TYPE: Building' Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Du lex p PME Plan Check: PENTAMATION 1REAP10 PERMIT TYPE: USE: 4 1 $70.00 Electrical IBREw= Fixtures, Lighting WORK REPLACE 18 E OUTLETS & SWITCHES REPLACE E KITCHEN & HALL LIGHTS & REPLACE E SCOPE BATHROOM EXHAUST FAN Mech. Plan Check 0.0 1 hrs $0.00 .Plw ib. Pleat Check Elec. Plan Check 10.0 1 hrs $0.00 Mech. Permit Fee: 1MPERMITPlumb. Permit Fee: Elec. Permit Fee: IEPERMIT Other Mech. Insp. 0.0 hrs $47.00 Other Plumb Insp. Other Elea Insp. 0.0 hrs $47.00 lilech. Insp. Fe -e. Plumb. lnslt. Fee: Elee, Insp, Fee: ArnTFI. This ectimate does not include: fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School L ed the relimina information available and are on1v an estimate. contact the ue t or aaan i info. Distrtet, el"J. These ees are as on. FEE ITEMS (Fee Resalution 11-053 E . 7�f /IL13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F 18-1 # $47.00 Electrical IBREMRECEP I Recep/Switch/Outlets Suppl. PC Fee: (j) Reg. ® OT: 0:0. hrs $0.00 PME Plan Check: $0.00 4 1 $70.00 Electrical IBREw= Fixtures, Lighting Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 'O.OT070 hrs $0.00 L J # Mechanical $24.00 1BREN1vENF Ventilation Fan PME Unit Fee: $0.00 PME Permit Fee: $94.00 Consiruclion Tax: Administrative Fee: IADMIN $44.00 G) Work Without Permit? ® Yes (j) No $0.00 Advanced Planning Fee: - $0.00 Select a Non -Residential Building or Structure E) 0 Travel Documentation Fee: 1TRAVDOC $47.00 Strong Motion Fee: IBSEISIGIICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $186.50 $141.00 s rya. .. o, _��,�„ $327.50 Revised: 01/15/2014