14070033CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 418F
CONTRACTOR:—TBP-49-BE
PERMIT NO: 14070033
D�FRMi D
OWNER'S NAME: NAJOUR DONALD G TRUSTEEw�
114C
DATE ISSUED: 07/10/2014
OWNER'S PHONE: 6509440190
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
418F- INSTALL (10) RECESSED LED LIGHTS AND (2)
License Class Lip. #
SWITCHES
Date l /
Contractor
I hereby, affirm t am licensed under the provisions of 4apter 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: $2190
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 34253182.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
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 AYS RMIT 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
NALLED
180 DAYS FRO LA 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
Issued by: Date:
granting of this per it. Additionally, the applicant understands and will comply
with a on- int s r regu ti n er the Cupertino Municipal Code, Section
9 18.
RE-ROOFS:
If is
Signat to
All roofs shall be inspected prior to any roofing material being installed. a roof
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 NrQuality Management District I
performance of the work for which this permit is issued.
will maintain compliarthe uniiplCode, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety C3, and 25534.Section
3700 of the Labor Code, for the performance of the work for which this
Owner or authorized 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'sCompensation
CDING AGENCY
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.
w'ork'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
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a.cupertino.org
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME i ' a Lft LICENSE NUMBED 5 .5 ;
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ARCHITECTIENGINEER NAME
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BUS. LIC #
COMPANY NAME
E-MAIL
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CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT M WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
11� 60 cess e& L " \% Lt Ruo& P_ K r 0 V�
2l- 2.v
TOTAL VALUATIO .�_ vl0 QO
RECEIVED BY:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatino, g construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION>KMIlRED
OFFICE USE ONLY
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MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
WE FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 23500 cristo rey dr 418f
im,
DATE: 07/10/2014
REVIEWED BY: MENDEZ
APN:
BP#:
EVALUATION: 1$2,190
xPERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Electrical
1B CEP] Recep/Switch/Outlets
PENTAMATION 1 REAP1
PERMIT TYPE: 19
WORK
418f INSTALL 10 RECESSED LED LIGHTS AND 2 SWITCHES
SCOPE
$0.00
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District_ etc )_ These fees are horsed on the nreliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711/13)
EN
MEL A
QTY/FEE
MISC ITEMS
/'llw1h. r" lata Ch(,cG
Elec. Plan Check 0.0 hrs $0.00
LI<>ct,_ I'�>rntit Fer:
Phitnh. N,,rmir T'ee%
Elec. Permit Fee: IEPERMIT
Electrical
1B CEP] Recep/Switch/Outlets
Other Plumb Imp.Ll I
Other Elec. Insp. 0.0 hrs $48.00
F-0-.0-1
hrs
$0.00
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District_ etc )_ These fees are horsed on the nreliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.002=
#
$48.00
Electrical
1B CEP] Recep/Switch/Outlets
Suppl. PC Fee: (2) Reg. ® OT
F-0-.0-1
hrs
$0.00
PME Plan Check:
$0.00
10 1
$72.00
Electrical
1BREMFIXT Fixtures, Lighting
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0 OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
Administrative Fee: 1ADMIN
$45.00
C)
E)
Work Without Permit? ® Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
0
i
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission .Fee: 1BCBSC
$1.00
�4ift a
$142.50
$120.00.
TOTAL FEE:
$262.50
Revised: 07/08/2014
Storage......... j--��
3'0° x 5'3"
Not Available Balcony
on Corner Units 7'5" x 7'2"
Bedroom
1,0'11'x 13'7°
,4
Closet 2�
6'$" x 4'2"
COMMUN'T Y DEVELOPMENT DEPARTMENT
BUILDING DIVISION - CUPIERTINO
APPROVED
This W of plans and specifications MUST be kept at the
job site during construction. It is unlawful to
chap make any
le
, or to deviate
uWare rom, without approval froBuilding Official.
The Stamping of th' an and spekation. SH
co hefd._to permi an aper Val of the violation
cf aFj prcvisia nY City Ordi nce or State Law.
sjTNo.
.
Living Room
15'0".xx 160,
Dining
12'6'x.8'9'
lip
ling at roP Floor..
i
MAMM90=10-
1z P2-
. ®,
Bath
J.i 5'�117•!x8'11" Entry
UPERTINO
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1fx�E?. r Iw C E COMPLIANCE
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