14020136CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 219C
CONTRACTOR: BAY AREA ENTERPRISE
PERMIT NO: 14020136
OWNER'S NAME: ADA HOLLOWAY
2110 MANGIN WAY
DATE ISSUED: 02/24/2014
OWNER'S PHONE: 6505371523
SAN JOSE, CA 95148
PHONE NO: (408)238-5043
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
REPLACE (E) SHOWER PAN & RESIN WALLS & VALVE
License Class $ Lic. # 01Big n
A
Contractor 14 ta. f Date Z 3
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 heAeby affirm under penalty of perjury one of the following two declarations:
I h and will maintain a certificate of consent to self -insure for Worker's
Co pensation, a provided for by Section 3700 of the Labor Code, for the
per rma e of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $3500
will maintain Worker's Compensation Insurance, as provided for by
�hrarid
700 of the Labor Code, for the performance of the work for which this
APN Number: 34253049 00
Occupancy Type•
peissued.
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 IT ISSUANCE OR
to building construction, and hereby an ze representatives of this city to enter
'
1 D INSPECTION.
upon the above mentioned property for s ction purposes. (We) agree to save
indemnify and keep harmless the City o C ertino against liabilities, judgments,
costs, and expenses which may accrue ain t said City in consequence of the
- Z Z
Date:
granting of this permit. Additionally, t applicant understands and will comply
Y
with all non -point source regulations pe the Cupertino Municipal Code, Secti
9 18.�
70
RE -ROOFS:
Signature Date
A 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.
ElNER-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) sho Id 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 equipm t or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by theB y Area it Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the C pertino Mu ' ' Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Section , 2 , and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: 2
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
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
CONSTRUCTION PERMIT -APPLICATION p`
COMMUN1 Y DEVELOPMENT DEPARTMENT • BUILDING DIVISION O�
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 \�
CUPERTlNO (408) 777-3228 • FAX W8) 777-3333 • building0cuDettino.om
❑ NEW CONSTRUCTION ❑- ADDMON ❑ ALTERATION / n REVISION / DEFERRED ORIGINAL PERMIT #
PROIECr ADDRESS
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existing building(s). Demolition permit is required prior to issuance of building
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WaSTtNG USE
PROPOSED USE
CONSTR. TYPE
#STORIES
SUPkLEMENTAL WORION REQUA
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n
ROUTING SLIP
_ New SFD or Multifamily dwellings: ply for demolion permit fora
.
❑BUII
existing building(s). Demolition permit is required prior to issuance of building
I
USE TYPE
OCG
SQ.Fr.
VALUATION (S�
EXLSTG
NEW FLOOR
DEMO
TOTAL
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_ Copy of Planning Approval Letter or Meeting with Planning prior to
_
I ARGE
AREA
AREA
AREA
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❑ ENVIRONAMMAL HEALTIi '.
BATHROOM
XUCBEN QrAHR
BldgApp 201I.doc revised 06121/11
RFMODELAREA
REMODELAREA AREMODELAREA
PORGIAREA DECKAREA
TOTALDEC&?OWXMEA GARAGEAREA DETACH
❑ATTACH
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# DWELLING UNITS:
ISA SECOND MW U YES
SECOND STORY ❑YES
BEINGADDEDY ONO
ADDITION? ONO
PRE -APPLICATION ❑ YES Y YES, PROVIDE COPY
PLANNMAPPL# ONO PLANtaNGAPPROVALLErIER
IS THE BLDG AN (] YES
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-----a• - �- rw r. �• auW�, ��„� w acL u�cpmpeny owner's Denatt. 1 have read this
application and the information I have provi is coaeck I have th tion of Work and verify it rs accurate. I agree to comply with all applicable local
ordinances and state laws relating to btu? onstr»ction I a fives of Cupertino to enter the above -identified property for inspection purposes.
Signature of pp
Date:
SUPkLEMENTAL WORION REQUA
<
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ROUTING SLIP
_ New SFD or Multifamily dwellings: ply for demolion permit fora
❑BUII
existing building(s). Demolition permit is required prior to issuance of building
OVER T$E COUNTER
a
DING PLAN RE�7EtV =
permit for new building
O E7�PRESS
❑ ;PLAA�IIdGPLAN REVI W
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
D, STANDArtD , 5
❑PUBLIC tit OR
Form if any Hazardous Materials are being used as part of this projeck
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_ Copy of Planning Approval Letter or Meeting with Planning prior to
_
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❑FIRE DEPT
submittal of Building Permit application
�' DSAJOR
❑ SAnTTARYY SE1iBR DISTRICT
-
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❑ ENVIRONAMMAL HEALTIi '.
BldgApp 201I.doc revised 06121/11
CITY OF CUPERTINO
IRIPF. FQTIMATOR — RITII,DING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 23500 CRISTO REY DR #219C
DATE: 02/24/2014
REVIEWED BY: MELISSA
UNITS
APN: 342 53 049
BP#:
*VALUATION: 1$3,500
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Du lex
USE: p
#
PENTAMATION
PERMIT TYPE: 1 *PFI
WORK
SHOWER PAN & RESIN WALLS & VALVE
SCOPE
,'sup/ol. I77:y Fee:
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Fixture set on One Trap
113PFIxTURE
1
#
$10
,'sup/ol. I77:y Fee:
PME Unit Fee:
$10.00
PME Permit Fee:
$47.00
("oll";/Fli".71 07 Tt?.i:
Administrative Fee: IADMIN
$44.00
Work Without Permit? ® Yes 0 No
$0.00
TOTALS:
Travel Documentation Fee: 1TRAVDOC
$10.00
Strong Motion Fee: IBSEISMICR
�h,dr fe:,aY C?rLr_It Plumb. Plan Check 10.0 1 hrs $0.00 I uc. Pi,'?Cis>ct�
L1e1.1.1. 1'errrn'i 1'ee..' Plumb. Permit Fee: 1PPERMIT
0f/1t,7. ;L1c;?-, A. 1,u'r" Other Plumb Insp.0.0 hrs 1 $47.00 (,}thea d ie{ . Imp,
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer utstrtct, Scnooi
n: gra.. .. s;. - L-4 -- rL- .,Il... ... fn ...Orin., n..n:lnhlo nail Oro Only Ori ectirr�nte_ rnntart the Dent far addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7/11131
FEE
QTY/FEE
MISC ITEMS
Plan Fce:
ur'l.iL, PL.'Z.`i: v'
PME Plan Check:
$0.00
,'sup/ol. I77:y Fee:
PME Unit Fee:
$10.00
PME Permit Fee:
$47.00
("oll";/Fli".71 07 Tt?.i:
Administrative Fee: IADMIN
$44.00
Work Without Permit? ® Yes 0 No
$0.00
Fees:
Travel Documentation Fee: 1TRAVDOC
$47.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
TATS
$149.50
$0.00 : TOTAL FEE:
$149.50
Revised: 01/15/2014