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14100052CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 327D CONTRACTOR: HANKINS PERMIT NO: 14100052 CONSTRUCTION INC OWNER'S NAME: FREMONT, CA 94536 PHONE NO: (510)795-9654 JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL ❑ LICENSED CONTRACTOR'S DECLARATION UNIT 327D - REMOVE (E) TUB & REPLACE WITH (N) � 'c�pp /-�7 4) Lic. # SHOWER x License Cl``as``ses� Contractor�� 3l�n�� Date j I hereby affirm that I am licensed under the provisions of ha ter 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 Valuation: $6400 performance of the work for which this permit is issued. Sq. Ft Floor Area: 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: 34253104 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 IT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 DAYS �-e LLED INSPECTION. upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of theDate: is granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations PIZ, I Ithe Cupertino Municipal Code, Section 9 18. RE -ROOFS: Date—� All roofs shall be inspected prior to any roofing material being installed. If a roof is Signature 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, do the work, and the structure is not intended or offered for sale (Sec.7044, will 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. 1 will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Code, Section 25532(a) should I store or handle hazardous declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Health & Safety material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the issued. air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municip, 1 Code, Chapter 9.12 and performance of the work for which this permit is the Health & Safety Code, Sections 2550 25533 an / 5 4. 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 Owner or authorized agent: 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 I I hereby affirm that there is a construction lending agency for the performance of become subject to the Worker's Compensation provisions of the Labor Code, must work's for which this permit is issued (Sec. 3097, Civ C ) forthwith comply with such provisions or this permit shall be deemed revoked. 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 CITY OF CUPERTINO TTT r, crr7Aii A ml1D DUTY "YT%Td ' "lVTCT(-)N 1'1J1J 11 ADDRESS: 23500 CRISTO REY DR 327D DATE: 10/09/2014 REVIEWED BY: MELISSA APN: 342 53 104 BP#: *VALUATION: $6,400 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1 RPFIX PERMIT TYPE: i USE: $10 WORK UNIT 327D - REMOVE E TUB & REPLACE WITH N SHOWER Suppl SCOPE APPLIANCE / EQUIP TYPE FEE ID - -- --- - QTY/FEE QTY UNITS BP FEES Fixture set on One Trap IBPFIXTURE 1 # $10 Suppl PME Unit Fee: $10.00 PME Permit Fee: $48.00 l,. o Zsirl"" '/ion Tax: Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes No $0.00 TOTALS: i Travel Documentation Fee: ITRA VDOC $10.00 Strong Motion Fee: IBSEISMICR ik'J Plan Plumb. Plan Check 10.0 1 hrs $0.00 1<zyz Plumb. Permit Fee: IPPERMIT l�h�cr'L>ra,ar c',h. 7rr:>i_, Other Plumb Insp. 0.0 hrs $48.00 fnsp. Plumb. 111',q). FCC: lhof—f Qnhnnt NOTE: This estimate does not inctuae fees aue to omer vepartmerao (t e. r su.t.«ws, 1-1 - �• �� - - _.. _. _ __ __ _ _ _, —_ _ . ., .• _ ___ �__�______ _.__._ ._....a,.Al,. —i ...., —i. , not oehavinta Cn"mrt /he Dent for addn l info. Ulstrict, etc.). [nese Lees ure uu�eu ur, n .uo..w..+. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) FEE - -- --- - QTY/FEE ---- MISC ITEMS Sj,lf)j)/, 1)(' , PME Plan Check: $0.00 Suppl PME Unit Fee: $10.00 PME Permit Fee: $48.00 l,. o Zsirl"" '/ion Tax: Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes No $0.00 11 C.f ti'L�i�L'C%id ixf C iil{�T{f�; 'LE:�. i Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.83 Select an Administrative Item Bldg Stds Commission .Fee:. 1BCBSC $1.00 $152.83 $0.00 TOTAL FEE: $152.83 Revised: 08/20/2014