14040012CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 512H
CONTRACTOR: BAY AREA ENTERPRISE
PERMIT NO: 14040012
OWNER'S AME: NORMAN BALDWIN
2110 MANGIN WAY
DATE ISSUED: 04/02/2014
OW S PHONE: 6505371523
SAN JOSE, CA 95148
PHONE NO: (408)238-5043
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
LICENSED CONTRACTOR'S DECLARATION
51211- REMOVE AND REPLACE 10 SWITCHES, 22
I _
License Class � Lic. #
OUTLETS,
REMOVE SHOWER TILE WALL AND INSTALL NEW
Contractor Date
SHOWER
I hereby affirm kat I am licensed under the provisions of Chapter 9
VALVE, REPLACE HEAT PUMP AND DUCTING -
(commencing with Section 7000) of Division 3 of the Business & Professions
MAINTENANCE
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: $45000
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
APN Number: 34253251 00 Occupancy Type:
permit is issued.
APPLICAWr CERTIFICATION
I certify that I have read this appli on and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with a c , and county ordinances and state laws relating
WITBIN 18 AYS OF PERMIT ISSUANCE OR
to building construction, and h e authorize representatives of this city to enter
upon the above mentioned pr a for inspection purposes. (We) agree to save
180 DAYS LAST CALLED INSP CTION.
indemnify and keep harmles th City of Cupertino against liabilities, judgments,
said City in consequence of the
14 L -1 -
costs, and expenses which ay ccrue against
Issued by: Date:
granting of this pe i . A itionally, the applicant understands and will comply
with all non -point o rce gulations per the Cupertino Municipal Code, Section
918.
RE -ROOFS:
Signatu Date_!f[!9:/
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.
❑ OWN R -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I a 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 DISCLO E
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements on r rapter 6.95 of the
California Health & Safety Code, Sections 5505, 25 3, nd 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino nicipa Co , Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) uld I s ore r handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use q ip ent o d ices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the ea Ai Q ality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the rti cipal Code, Chapter 9.12 and
the Health & Safety Code, Sectio 2 50 , 2553 , and 25534.
I have and will maintain Worker's Compensation Insurance, as provided for by
(/ 70/
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: I Z
i
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
918.
Signature Date
CUPERTINO I
F— NEW coNSTaucTrow
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408)777-3228• FAX ('408) 777-3333 • buI1di�n_g0_cuDertino.org
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTORAGENT . ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER ,
LICENSE TYPE
BUS. LIC #
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DESCRIPTION OF WORK
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EXISTING USE
POOPOSED, USE COMM
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# STORIES
USE TYPE OCC.
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VALUATION (S)
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NEW FLOOR
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TOTAL
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NET AREA AJ
BATHROOM KITCHEN
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REMODELAREA REMODELAREA
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TOTAL DECK/PORCH AREA
GARAGE AREA: DfrACH -
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# DWELLING UNITS:
ISA SECOND UNrr [-]YES
SECOND STORY
BEINGADDED? ONO
AD 1TION? NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS E BLDG AN YESEC� g£y .k s , s
`, TOTAL VALUATION:
PLANNING APPL # E] NO PLANNING APPROVAL LEITER
EI ER HOME? ❑ NO <
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By my Signature below, I certify to each of the following: I aqttte p wner or authorized agent to act on the property o 's behalf. I have read this
application and the information I have provided is correct I h d the De cription of Work and verify it is accurate. I agree o omply with all applicable local
ordinances and state laws relating to building construction uthorize repres ntatives of Cupertino to enter the above-iden ' p perty o %� urposes.
Signature of Applicant/Agent: Date: I _
SUPPLEMENTAL INFORMATI REQUIRED
,
h�PCKT:,YPFsa ,< _
ROUTING SLIP .•;:_ .
_ New SFD or Multifamily dwellings: Apply r demolition perms for
❑
existing building(s). Demolition permit is requir prior to issuance buildingeovElzrxE
CoutSrER V�
auu.DING rLAN REQ
permit for new building.
❑EXPRESS y
❑ PLA11\INGPLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
srArDaRD >
❑ rusL.IC'Ny Pts
Form if any Hazardous Materials are being used as part of this project
F.
LARGF gaa a
❑FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
❑ SAAITAR
submittal of Building Permit application.oRk
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sERT:R n sTRlcT
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❑ `ENVIRONMENTAL HEALTH';"
BTdgApp_2011.doc revised 06/21111
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471.4
CITY OF CUPERTINO
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FEE
»•-- »•
QTY/FEE
ADDRESS: 23500 Cristo Rey Dr. # 512h
DATE: 04/02/2014
REVIEWED BY: Mendez
liaX,JU
APN:
BP#:
VALUATION: $45,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
SFD or Duplex
hrs
PENTAMATION 1REAP10
PERMIT TYPE: i
USE:
$0.00
1 #
$70.00
WORK
1512 h -REMOVE AND REPLACE 10 SWITCHES 22 OUTLETS REMOVE SHOWER TILE WALL AND
SCOPE
I INSTALL NEW SHOWER VALVE, REPLACE HEAT PUMP AND DUCTING- MAINTENANCE and p
it
Mech. Plan Check 0.0� hrs $0.00 .1'lhwl%. Plan C'hec3, Elec. Plan Check 0.0 hrs $0.00
Mech. Permit Fee: 1MPERMIT F'iffrrib. 1'trrrxtr j'=e. Elec. Permit Fee: 1EPERMIT
Other Mech. Insp. 0.0 �rs$47.00 0thc r Pitrmb Iri>pE1_L__ Other Elec. Insp. 0.0 hrs $47.00
7117411) In p. Fee -
NOTE: This estimate does not includejees aue to otner tueparamenas (i.e. r[ur[r[w[g, a •,..., - .• _., __.. _. _ ____
fho T)onf far nddn'1 info_
District, etc). mese fees are vasea un ane reurrunu[
FEE ITEMS (Fee Resolution 11-053 Ef . 7/f 1113)
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FEE
»•-- »•
QTY/FEE
_-__ _._
MISC ITEMS
Plan Check Fee:
$0.00
L 32 11 #
$107.00
Electrical
IBREMRECEP Recep/Switch/Outlets
Suppl. PC Fee: Q Reg. O OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
1 #
$70.00
Mechanical
IBREMAIR A/C Units (<=10K cfin)
Permit Fee: Hourly Only? O Yes (E) No
$0.00
Suppl. Insp. Fee: Reg. OOT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$94.00
C'onsfiwcrion Tax:
Administrative Fee: IADMIN
$44.00
O
E)
Work Without Permit? O Yes No
$0.00
Advanced Planning Fee.
$0.00
Select a Non -Residential
Building or Structure
0
O
Travel Documentation Fee: 1TR4VDOC
$47.00
Strong Motion Fee: 1BSEISMICR
$4.50
1.0 hrs
$139.00
Inspections
IsTINSP Inspection, Hourly
Bldg Stds Commission Fee: IBCBSC
$2.001
A-
$191.50
$316.00 TOTAL FEE:
$507.50
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