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14070034CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 418G CONTRACTOR � PERMIT NO: 14070034 DBIERM iED OWNER'S NAME: MAXHIMER ELIZABETH TRUSTEE W1A CG C DATE ISSUED: 07/10/2014 OWNER'S PHONE: 6509440190 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL 418G INSTALL (10) RECESSED LED LIGHTS AND 2 rr License Class Lie. # SWITCHES C �! Contractorf I hereby affirm that I am rsed 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: $2190 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 34253200 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 DAYS OF 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 180 DAYS FRO ALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, City in consequence of the costs, and expenses which may accrue against said Issued b Date: y' granting of this permit. Additionally, the applicant understands and will comply with all non- o ce r ulati ns per the Cupertino Municipal Code, Section RE -ROOFS: 918.. Signature D7ate-) 8 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 th Bay a Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with th u rti M icipal Code, Chapter 9.12 an I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety do 2 505, nd 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized age . ate: [ 6 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 CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingna.cupertino.oro M PLUMBING n MECHANICAL ZELECTRICAI `3 nV �O 1 F—MISCELLANEOUS MEP MISC PR�ECT ADDRESS C,'StokoU , �- 315(o2Z'C APPN # 3�f22 53 I p PW ti1 _lq'�'�`� 7-MA�aoOWN STREET ADDRESS CI ST TE, ZI i � 2v� ► 0 C' . of FAX CONTACT NAME` ` PHONE� _ - ` c.•`.., MAIL STRE T ADDRESS ,,bG�V1 r. 5`T2 CITY, S ` Ql__.C.L V �1 �. 9� FAX l - ` 'lLt'1- Q 2't• C ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT (-CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME� OR I LICENSE NUMBED SC> S 5 LICENSE TYPEC', � BUS. LIICC WC # 3 e * Cn COMPANY NAME ` C� y� t" `- ` E-MAIL \YC.�, `i7IM FL/ L _ 1, 1. ` ` JJe LZ STREET D,DRESS_ r ,+ ` 4 1 \J CITY, SOT I�� Q � L PHONE E- q _ ARCHITECT/ENGINEER NAME LICENSE NUMBER BUYS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI-FAMn.Y BUILDING: ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK I V" C 1 �/ �� •� Q Q 5 5 '� C l) U ► ` t,'� ,re"**"— 7-0 A 2Co �'`� 5 w � ��.-� TOTAL VALUATION Z I lip , UO 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 o er's behal . 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 agre to comply wi all applicable local ordinances and state laws relating t nstrgp ion. I authorize represent4tives of Cupertino to er the above -identified property for inspection purposes. Signature of Applicant/Agent: A ate:. SUPPLEMENTAL INFORMATION REQUIRE OFFICE USE ONLY W ya, w' x ❑ OVER-THE•COUNTER ❑ EXPRESS ❑ STANDARD U<. ❑ LARGE a ❑ MAJOR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FFF FSTIMATOR - BUILDING DIVISION ka,ADDRESS: 23500 Cristo rey dr 4188 DATE: 07/10/2014 REVIEWED BY: MENDEZ APN: BP#: "VALUATION: 1$2,190 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex Electrical IBREMRECEP Recep/Switch/Outlets PENTAMATION PERMIT TYPE: 1 REAP1 WORK 418q INSTALL 10 RECESSED LED LIGHTS AND 2 SWITCHES SCOPE Other Elea Insp. 0.0 hrs $48.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Pire, sanitary sewer Distract, scnoot n:cw:ns otn 1 Tbncn Ione nro Aa vd nn tho nroliminam infnrmatian availahle and are anly an estimate. Contact the DeDt for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Phrr h. PL�w Chcc,; Elec. Plan Check 0.0 hrs $0.00 Electrical IBREMRECEP Recep/Switch/Outlets Fee: t'iumh. Permit fec. Elec. Permit Fee: 1EPERMIT (?rt�t,s 1t Inc Vit. ir, � Other Plumb 7rup. Other Elea Insp. 0.0 hrs $48.00 PME Plan Check: $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Pire, sanitary sewer Distract, scnoot n:cw:ns otn 1 Tbncn Ione nro Aa vd nn tho nroliminam infnrmatian availahle and are anly an estimate. Contact the DeDt for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.002= # $48.00 Electrical IBREMRECEP Recep/Switch/Outlets Suppl. PC Fee: Reg. ®OT 0.0 hr's $0.00 PME Plan Check: $0.00 10 $72.00 Electrical IBREMFIXT Fixtures, Lighting Permit Fee: $0.00 Suppl. Insp. Feer Reg. Q OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 Administrative Fee: IADMIN $45.00 C) E) Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning_Fee: $0.00 Select a Non -Residential Building or Structure E) i Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee_ IBCBSC $1.00 SS,B ®�LS A �tim_ $142.50 $120.00 TOTAL FEE: $262.50 Revised: 07/08/2014 IC_IFCUPERTINO iilil�inr7 Department I IuFFE COPY L o 0 2014 F"EVIEWDU F- . ij'; z' U Cam LIANCE Reviev'Veci E. Storage COMML)NrfY DE b ELOPNI A D'EPARTi ENT 3'0" x 5'3" BUILDING AASION PERTINO --Not-Available on Corner Units Balcony IBRO D -- 7.5 x.7!2.-..... _ — ..: This set of -pla __.ns an specifications UST be kept at the coerctionis nlawful to make any 15. or altIto ations on sa e, or to deviate 'th ithoutpproval from a Building Official. -:_ The --Stamping of ttziplan and spec ications SHPIL'' OT be -tFeld to -permit be an app Val of t. :- =n -- of 2,;-�:,.,��„ns, ny`C'ity Ord ancn c ...,.. �.�. Ey --Bedroom. _ - - 10'1V x 137”. D.ATE 1.10• ( - -1 PEiLUT N-0. 1-127 _ -Dining _ 12'6" x 99' -- -- Closet- ✓ • High Ceiling at Top Eloor___c7 6'8 x 47 t Bath' 5'0" 915 Kitchen_ _ _. 0 O To" X 11'0" O O 2 2,7110 .e . 0 hos i Celt. AD 4�