14020137CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 324E
CONTRACTOR: BAY AREA ENTERPRISE
PERMIT NO: 14020137
OWNER'S NAME: DONALD BERGLUND
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 ❑ COMMERCIAL E]
REPLACE (E) TUB/SHOWER & RESIN WALLS & VALVE
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PJ (' n
License Class Lic. # a 1 •'
Contractor gay( ttf Date
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: $2500
I have and will maintain Worker's Compensation Insurance, as provided for by
ection 3700 of the Labor Code, for the performance of the work for which this
APN Number: 34253123 00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXP ORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WIT 0 DA F PERMIT ISSUANCE 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
0 DAY CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgment
costs, and expenses which may accrue against said City in consequent e
granting of this permit. Additionally, the applicant understands and will comply
Date:
with all non -point sourcegulations per the Cupertino Municipal Code, Section
9
918. •r
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Vt
RE -ROOFS:
SignatureJDate T "/
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. 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) should 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 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
performance of the work for which this permit is issued.
will maintain compliance with the Cu ertino nicipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 5 , 2 33, and 2 34.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: Z
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
�O
COMMUNIi'Y DEVELOPMENT DEPARTMENT.• BUILDING DIVISION13
10300 TORRE AVENUE • CUPERTINO, CA 950143255 . v`
CUPERTTNO (408) 777-3228 - FAX ?408) 777-3333 • buliding0cupertino orn
[:]NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / Ti , REVISION / DEFERRED ORIGINAL PERMIT #
.OJECr ADDRESS
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PHONE E-MAIL' — -
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CONTACT NAME
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❑ OwNER ❑ OwNat Bun DFR ❑ OWmmAGENT CONTRACTOR ❑ CONTRACTORAGENT' ❑ ARCMMCrr ❑ ENGBMM ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME
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PHONE
ARCHITEMENGINEER NAME
LICENSEINUMBER
BUS. LIC #
COMPANY NAME
EMAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK Q a . T� a fee -{ ^eop v c h
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MaSTING USE
PROPOSED USE
CONSIR. TYPE
SSTORIES_
.
USE TYPE OCC
SQyr- VALUATION (S)
r =rl
NEW OMR
DEMO -
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
ICFrCIIEN
OMIER
REMODELAREA
REMODELAREA
REMODEL AREA
PORCRAREA DECKAREA TOTALD=)POI=AREA GARAGEAREA DETACH
❑ ATTACH
# DWELIMG UNITS:
ISA SECOND UNrr ❑ YES
SECOND STORY ❑YFS
BEINGADDED? ONO
ADDITION? ONO
PRE -APPLICATION ❑ YES IF YTS, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
TAI,yA //TJON:
G -
PLANNINGAPPL# NO PLANNINGAPPROVALLErrER
❑
SICMERROME? ❑NO
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Ss
By my signature below, I certify to each oftlle flowing I Fmnthe owner or audio agena pnaperty owner's behalf 1 have read this
application and the information I bavepro ' is correcL I e th Work
onof and v itis accuate I agree o comply with all applicable local
ordinances and state laws relating to b nsttuction. I rives Of Cupertino to enterthe above -identified property for inspection
purposes.
Signature ofApplicant/Agent ]Date:
SUPPLEMENTAL INFO ION Q ��3 BE.
New SFD or Mulfifamily dwellings ly for demoli on permit forff
ROtf�
;:RUUL INGexisting building(s). Demolition permit is sequiredprior io issuance of buildingpermit
for new building.pLgNADVG�7Ew
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STAI�`DARD ❑ ^PUBLIC l� ORKS
form if any Hazardous Materials are being used as part of this project s
LARGE ❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with PIanning prior to
submittal of Building Permit application. ❑ nsA rok sAnrrnxx
• EAVHtONA3El,TAL HEALTH :. .
BldgApp 2011.doc revised 0621/11
CITY OF CUPERTINO
1 FFF. 1PQT1MATnR — RITH.nING DIVISION
ADDRESS: 23500 CRISTO REY DR #324E
DATE: 02/24/2014
REVIEWED BY: MELISSA
-
MISC ITEMS
APN: 342 53 049
BP#:
"VALUATION:
1$2,500
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE:
-----[
Alteration / Addition / Repair
PRIMARY
SF D or Du lex
USE: p
PERMIT TYPE: 1 RPFIX
PERMIT TYPE: �
WORK
REPLACE E TUB/SHOWER & RESIN WALLS & VALVE
SCOPE
PME Unit Fee:
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Fixture set on One Trap 1BPFIXTURE 1 # $10
TOTALS: $10.00
Plumb. Plan Check 10.0 1 hrs $0.00
�rir Fee: Plumb. Permit Fee: IPPERMIT
C t1ar °et. h,�-p, Other Plumb Insp. 0.0 hrs $47.00 ofhg=f
ED
f'Tun?b. T / , Fee: lrimc. tot . P, r
NOTE: This estimate does not includefees due to other Vepartmenrs i.e. rtanntng, ruottc rrorA3, rare, ouauauay—w— {I &-ty uLLLvvL
�..s:rw..t., t^n.,tL.�t tho Dont fnr nLliln'1 infn-
IILJIL LI.L, GLI.. 1LLcuc Gcu wLc �wuL.w yr r•r.. •..............
FEE ITEMS (Fee Resolution 11-053 E . 7f� /1/13)
...._..-�.-..-- —.---------
FEE
------ --- -
QTY/FEE
-
MISC ITEMS
Plan CCbec k FCC:
PME Plan Check:
$0.00
,'?uppl, 111,51) 1`ee,
PME Unit Fee:
$10.00
PME Permit Fee:
$47.00
Administrative Fee: IADMIN
$44.00
Work Without Permit? ® Yes 0 No
$0.00
GftCdilL'<'L¢t`rclt'ittZ?r£, I'£'L'S':
Travel Documentation Fee: ITRA TVDOC
$47.00
Strong; Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldy, Stds Commission. Fee: IBCBSC
$1.00
Of � �5
$149.50
$0.00 TOTAL FEE:
$149.50
Revised: 01/15/2014