14040125CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 403G
CONTRACTOR: BAY AREA ENTERPRISE
PERMIT NO: 14040125
OWNER'S NAME: CARL LARSON TRUSTEE
2110 MANGIN WAY
DATE ISSUED: 04/21/2014
OWNER'S PHONE: 6505371523
SAN JOSE, CA 95148
PHONE NO: (408)238-5043
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL EJ COMMERCIAL
UNIT 403G - REPLACE KITCHEN, BEDROOM & HALL
�y
License Class f2> Lic. # /
LIGHT
Contractor ./¢el—� (' 6- Date t—�
FIXTURES (11 TOTAL) & 1 BATHROOM FAN
I hereby affirm th. t 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
Sq. Ft Floor Area:
Valuation: $2000
performance of the work for which this permit is issued.
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: 34253188 00
Occupancy Type:
permit is issued.
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 PE IT ISSUANCE OR
to building construction, and hereby thorize representatives of this city to enter
upon the above mentioned property inspection purposes. (We) agree to save
180 DAYS F LED INSPECTION.
indemnify and keep harmless the C' f Cupertino against liabilities, judgments,
costs, and expenses which may ac a against said City in consequence of the
G
granting of this permit. Addition ly, the applicant understands and will compl
Z `
ued b
with all non -point sourcgfegulalns per the Cupertino Municipal Code, Section
9 18.
RE -ROOFS:
Signature Date II v/ //
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.
❑ WNER-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)
1, 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 de, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I s r or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment o vices 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 uality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cup rtmo nicipal Code, Chapter 9.12 and
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
the Health & Safety Code, Section 5, 255 3, and 25534.
'2
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
Compensation laws of California. If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
'IL(
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255. `
(408) 777-3228 - FAX ('408) 777-3333 - building(ftuaerlino.ora
PROJECr ADDRESS
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owNERNAN>E Cts L t�ir� art/
STREETADDRESS
CONTACT NAME %� I
STREET ADDRES S I(T
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13OwNFR ❑ owNER.BUJLDER ❑ OWNFRAGEHT! 7 CONTRACTOR
CONTRACTOR NAME G re q fe (° LICwl
COMPANYNAME E-A
STREET ADDRESS W u
/10 1�/lQvt r`l
4 / TI LXI REVISION / DEFERRED ORIGINAL PERMIT #
APN# 403 CL. 3 Y Z- S-3
l ��
ioNE �50-3"3 "lSZ3 EMAB Fr,.dferlrandP
STATE, ZIP FAX
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FATIi ZIP FAX
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❑ CONTRACTORAGENT . ❑ ARCHnwr ❑ ENGINEER ❑ DEVEIAPER ❑ TENANT
LICENSE T BUS. LIC #
re 5 T2 is -t-; c D t,,f FAX
,$TATE, ZIP PHOATE
----u.", %JuxnnmLICENSENUMBER
COMPANY NAME
STREET ADDRESS CITY. STATE, ZIP
DESCRIPTION OF wORK
lice- - WVCIatn It (l ucres
EXISTING USE PROPOM USE CONSTIL TYPE # STORIES
EXLSTG NEW FLOOR DEMO TOTAL
AREA AREA AREA N6fAREA
BATHROOM MTCH N orn=
REMODELAREA mmoo AREA REMODELAREA
PORCH AREA DECK AREA TOTALD=MORCHAREA GARAGHAREA: DETACH
ATTACH
# DVARI G UNITS: IS A ND UNrI ❑ YES SECOND STORY OYES
BEINQADDED7 ❑NO ADDITION? ❑NO
USE
FAX
PHONE
L v
TYPE I OCC. I SQ -FT- I VALUATION (S)
PRE -APPLICATION OYES IF1'ES PR ZCOPYOF ISTHEBLDGANT TAL VALUATION:
PLANNMAPPL# []NO PLANNINGAPPROVALLEITE2 EICHLERHOME3 13YES
0010
BY mY signature below, I certify to each of the following: I am the property owner or authorized act on th perty owner's behalf. I have read this
application and the information I have provi ed is correct. I have the Description of Work an verify it is rate. I agree to comply with all applicable local
ordinances and state laws relating to buil ' conshtletion I tatives of Cupertino to enter the above -identified for ' tion
Signature of Applicant/Agent: AR 2 Purposes.
Date:
SUPPLEMENTAL INFO Z)N REQUIRED
PLANCHECKTyP$ = ROUTInGSLIP
_ New SFD or Multifamily dwellings: Apply for demolition permit for y
❑ OVER THE COUI3TER�a ❑ .BUII DLNG PI AIV REVIEIV
existing building(s). Demolition permit is required prior to issuance of building ,hf
permit for new building. ❑ ExPxEss ❑ PLAA11NGpI pN RE\7EA'
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ Sr ARD ❑ plrBLrc �i oizxs
form if any Hazardous Materials are being used as part of this project
L4RGE ❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application MA►ox ❑ SFil\ITARY SEIVER DISTRICT =
z ❑: HNV[RONMENTALHEAL7H
BldgApp 2011.doc revised 06/21/11
AW5
(61t,
CITY OF CUPERTINO
FiPF. 1 .CTTMAT0R — RITILDING DIVISION
23500 CRISTO REY DR UNIT 403
1 DATE: 04/21/2014
REVIEWED BY: MELISSA
IQADDRESS:
APN: 342 53 188
BP#:
*VALUATION: $2,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
SFD or Duplex
$0.00
PENTAMATION 1 REAP 11
PERMIT TYPE: i
USE:
Mech. Permit Fee: 1MPER1vffT
F'larrnb. F'Er a3t l`ec-:
WORK
REPLACE KITCHEN BEDROOM & HALL LIGHT FIXTURES 11 TOTAL & 1 BATHROOM FAN
$47.00
C)r/ er 1111,1M)7rf.>,=>.
SCOPE
1<:<bhlP,vJ. 1`dB:
NOTE: This estimate does not include fees due to other Departments (t.e. rtanntng, ruouc rrorn�, �'tre, �uiauuiy UG.vG
h 1' anon available and are onl an estimate. Contact the Dent or addn'l info.
District, etG . These Lees are based on t e pre tmtna
FEE ITEMS (Eee Resolution 11-053 Ef 7/f 1113)
to orm
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
,.
11 #
$70.00
Mech. Plan Check 0.0 hrs
$0.00
1'Iniub. Purr Check
Elec. Plan Check 0.0hrs $0.00
Mech. Permit Fee: 1MPER1vffT
F'larrnb. F'Er a3t l`ec-:
Elec. Permit Fee: IEPERMIT
Other Mech. Insp. 0.0 hrs
$47.00
C)r/ er 1111,1M)7rf.>,=>.
Other Elea Insp. 0.0 hrs $47.00
1<:<bhlP,vJ. 1`dB:
$0.00
flha L hip, Fc'c?:
0,0
hrs
$0.00
NOTE: This estimate does not include fees due to other Departments (t.e. rtanntng, ruouc rrorn�, �'tre, �uiauuiy UG.vG
h 1' anon available and are onl an estimate. Contact the Dent or addn'l info.
District, etG . These Lees are based on t e pre tmtna
FEE ITEMS (Eee Resolution 11-053 Ef 7/f 1113)
to orm
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
11 #
$70.00
Electrical
IBREMFIXT I Fixtures, Lighting
Suppl. PC Fee: Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
L_1_J #
$24.00
Mechanical
1BREMVENF Ventilation Fan
Permit Fee:
$0.00
Suppl. Insp. Fee: Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$94.00
C;,;rr;ir tt{'fio 7 71U.
Administrative Fee: 1ADMIN
$44.00
Work Without Permit? ® Yes (E) No
$0.00
Advanced Planning Fee.
$0.00
Select a Non -Residential
Building or Structure
E)
Travel Documentation Fee: ITRA VDOC
$47.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
BldP_ Stds Commission Fee: IBCBSC
$1.00
$186.50
$94.00
TOTAL FEE:
$280.50
Revised: 04/01/2014