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15010013CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23400 VIA VENTURA UNIT VD17 CONTRACTOR: BAY AREA ENTERPRISE PERMIT NO: 15010013 OWNER'S NAME: SAN JOSE, CA 95148 PHONE NO: (408)238-5043 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E] UNIT 17 - REPLACE (E) 30 OUTLETS, 14 SWITCHES & 2 License Class Lic. BATHROOM FANS. ADD 7 (N) RECESSED LIGHTS (4 IN Botl Ain2` Date �S Z�S KITCHEN AND 3 IN HALL) Contractor I hereby affirm t at 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: $3200 erformance of the work for which this permit is issued. 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: 34255002.00 Occupancy Type: permit i 'ssed. APPLICANT CERTIFICATION I certi 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 inspectio urposes. (We) agree to save ALLED INSPECTION. indemnify and keep harmless the City of Cupe 'n against liabilities,)pd ents, costs, and expenses which may crue again sak City in consequen Date: / granting of this permit. Additi all the li t understands and will comply with all non-point source reg i s er t e upertino Municipal Code, Section 9 18. el i 1 RE-ROOFS: Signature Date `/ / 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. ❑ OWNE -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 DISCLO URE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements unde Chapter 6.95 of the California Health & Safety Code, Sections 25505, 2553 and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal C e, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store r handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use a ipment or de ces which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Ba Area it Qu ity Management District I performance of the work for which this permit is issued. will maintain compliance with the C o unit pal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sect' 255 , 533 d 25534. z Section 3700 of the Labor Code, for the performance of the work for which this �' 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 CONSTRU TION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a consttiction 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 )1� a C�C "7 R'Q TOTAL VALUATION: By my signature below, I certify to eaA of the following: 1411 the p rty owner or authorized agent to act on the property er's behal . s application and the information I have provided is correct ver a Description of Work and verify it is accurate gree to c with all applicable Iota ordinances and state laws relating to building constru 'on. I uthoriz representatives of Cupertino to enter the above- property with purposes. Signature of Applicant/Agent: Date: S P j MEPMiscApp_2011.doc revised 06/21/11 GENERAL PERMIT APPLICATION o EP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION O 1 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 _ CUPERTM!NO (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org MISC Vv T1/1 EIPLI9,MING .j. ❑ MECHANICAL OELECTRICAL ❑ MISCELLANEOUS PROJECT ADPRFcc Ve vilft I q APN # O OWNER NAME�./ ' TFAX CONTACT NAME `� PHONEED ` 5�a E-MAILr STREET ADDRESS I 0-A rtn iJa CITY, STATE, ZIP C�1' �S�IIf FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENTCONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NULICENSE TYP BUS. LIC # COMPANY NAME p n P� �� E-MAIL i�Q ® 4 ' S' (C. d m ' FAX Y F� r- f-1 STREET ADDRESSr CITY, STATE, ZIP C PHONE 38 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDING: ❑ COMMERCIAL INTERFACE'AREA NO URBAN INTERFACE FLOOD ZONE NO EICHLER HOME? NO -30 14 t DESCRIPTION OF WORK �`40iACe ®a4ja > yro W4 Gv b r, `I- h r oow. �� n s': a C�C "7 R'Q TOTAL VALUATION: By my signature below, I certify to eaA of the following: 1411 the p rty owner or authorized agent to act on the property er's behal . s application and the information I have provided is correct ver a Description of Work and verify it is accurate gree to c with all applicable Iota ordinances and state laws relating to building constru 'on. I uthoriz representatives of Cupertino to enter the above- property with purposes. Signature of Applicant/Agent: Date: S P j MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO WN FEE ESTIMATOR — BUILDING DIVISION im,ADDRESS: 23400 VIA VENTURA VD 17 DATE: 01/05/2015 REVIEWED BY: MELISSA Mech. Permit Fee: IMPERMIT APN: 342 55 002 BP#: *VALUATION: 1$3,200 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Suppl. PC Fee: (j) Reg. 0 OT PENTAMATION 1 REAP1 PERMIT TYPE: WORK UNIT 17 - REPLACE E 30 OUTLETS 14 SWITCHES & 2 BATHROOM FANS. ADD 7 N SCOPE RECESSED LIGHTS (4 IN KITCHEN AND 3 IN HALL) $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, tire, sanitarysewer utstrtct, scnoot t)ictr;rt etc ) Those fees are haced nn the nrelimina" information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Elf. 7/1/13) llhwib. Pkoi Check Elec. Plan Check 0.0 hrs $0.00 Mech. Plan Check 0.0 hrs $0.00 Mech. Permit Fee: IMPERMIT I'luimh. f'€:r-mit 1z« _ Elec. Permit Fee: 1EPERMIT Other Mech. Insp. 0.0 hrs $48.00 C)tlze 1'Iun2iz Inv).Other Elea Insp. 0.0 hrs $48.00 14ech, Inq'), Fee: 111wiib. hisp..Fee. t.reC'. LP br. Fc'c;': NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, tire, sanitarysewer utstrtct, scnoot t)ictr;rt etc ) Those fees are haced nn the nrelimina" information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Elf. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 44 # $168.00 Electrical 1BREMRECEP Recep/Switch/Outlets Suppl. PC Fee: (j) Reg. 0 OT Q.0 hrs $0.00 PME Plan Check: $0.00 1 7 $72.00 Electrical 1 IBREMFIXT Fixtures, Lighting Permit Fee: $0.00 Suppl. Insp. Feer Reg. OT 1 0.0 1 hrs $0.00 = # Mechanical $50.00 IBREMVENF Ventilation Fan PME Unit Fee: $0.00 PME Permit Fee: $96.00 ,'oustruction Tax: F7 Administrative Fee: ]ADMIN $45.00 0 E) Work Without Permit? Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 1 0 i Travel Documentation Fee: ITRAVDOC $48.00 Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 � 36 w . ��r $190.50 $290.00 < < TOTAL o... $480.50 Revised: 10/01/2014