14070032CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 303E
CONTRACTOR TTS- T- ^�
PERMIT NO: 14070032
OWNER'S NAME: MAGGENTI LOIS M TRUSTEE
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DATE ISSUED: 07/10/2014
OWNER'S PHONE: 6509440190
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E]
303E- INSTALL (15) RECESSED LED LIGHTS AND 4
License Class`— Lie. # S
SWITCHES
Contractor Date
I hereby affirm that 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: $3500
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 34253110 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 CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
City in the
7AST
%
costs, and expenses ich may accrue against said consequence of
Issued by: Date:
granting oft h' ermi . on lly the applicant understands and will comply
With all n-poin ou regu ti er the Cupertino Municipal Code, Section
9 18.
4illRE-ROOFS:
Signatur to
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 ea Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance erti o i ipal Code, C apter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Co , Sectio 505,2 3 a d 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: ate: a
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
CON RUCTION 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.ora
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USE OF ❑ SFD .,DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN
FLOOD ZONE
❑ YES
❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
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TOTAL VALUATION: `� �JIN W
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 escri tion of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to "ding constructio an o ' e n tives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATI N QUIRED
OFFICE USE ONLY
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MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FM_7 FEE ESTIMATOR — BUILDING DIVISION
ialADDRESS:
23500 Cristo rey dr 303e
DATE: 07/10/2014
REVIEWED BY: MENDEZ
Pet`%tt;I Fee:
APN:
BP#:
*VALUATION: 1$3,500
'PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
USE: SFD or Duplex
Pi'raTr b, Fee:
PENTAMATION
PERMIT TYPE: 1 REAP1
WORK
303e- install 15 led lights and 4 swithces
SCOPE
NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the vreliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E f.' 7/1113)
PIU! (YwcR
Phunrh_ Pfcrrt Chccfi
Elec. Plan Check 0.0 hrs $0.00
Pet`%tt;I Fee:
Fumh. P<nnir (''err:
Elec. Permit Fee: IEPERMIT
$0.00
Other P,umb 1rrsT=.LJ
Other Elea Insp. 0.0 hrs $48.00
Pi'raTr b, Fee:
0.0
NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the vreliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E f.' 7/1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
® #
$48.00
Electrical
1BREMRECE7P Recep/Switch/Outlets
Suppl. PC Fee: (D Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
=1
$72.00
Electrical
1BREMFIXT Fixtures, Lighting
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0 0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
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Administrative Fee:
IADMIN
$45.00
0
G
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
0
i
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee:
IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission .Fee: 1BCBSC
$1.00
° dYa
Q ASL
n
$142.50
$120.00
TONAL FEE•
$262.50
Revised: 07/08/2014
CUPERTINO
building Department
Mode
,nKAPI IA.NrE
REVIEWEL) FUK
Reviewed BY 'f
One Bedroom One Bath 1 720 Sq. Ft.
15
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