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14100197W CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 512F CONTRACTOR: CLINE CONSTRUCTION PERMIT NO: 14100197 OWNER'S NAME: SAN JOSE, CA 95123 PHONE NO: (408) 924-0204 118— LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ INSTALL (13) CANNED LED LIGHTS THROUGH OUT UNIT Q' /4 77 License Class_Lic//. # D +o G.� � � t Contractor C((glf CZJA$ i- Date 0 :30-1 t— I hereby affirm that 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: $2000 performance of the work for which this permit is issued. 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: 34253211 00 Occupancy Type: -permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMI XPIRES IF W RK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 1 AYS OF ERMIT 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 DA LA CALLED INSPEC ION, indemnify and keep harmless the City of Cupertino against liabilities, judgments, / costs, and expenses which may accrue against said City in consequence of the (, 9 / Issued by: Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9 18. �_ 10 —30— / L� 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: 1 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. 1 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 Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this 3-30- (3-30-14 Owner or authorized agent: Date: permit 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 CONSTRUCTION LENDING AGENCY 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 j GENERAL P'MRMi i APPLICATION rA�ME P rig COMMUN1i `(DEV=LOPhli�ENi DEPAP,1 MENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3258(\lJ' mlamhl (408) 777-3228 • rAX (40B) 777-3333 • buildinoCg.cuos fino.ora \\ _ nua. - ❑ivrCF.Ax1c.4L i�CTRiCA _T ❑I'm CEL"A.r-pOUS P? Gid ADDRESS 2 <oo a ?BIT :r cDrzI 3y2 3 2l OS ?� 1 ldFis '✓iii SZr.E 7 A_*M' . ESS ' Saw�•e ary, STAin' Z--, . CON ACt' iSOKE I _B_31/_/ _TT STIP-_1 FDD?.=SS I CI'rf, STA = F?X I OV -,Ml '❑ GWh��'.L.•3LYT_DM� OY.� AM'7❑ L�;�� iCi G1Z ❑ CGx-,p_"cr k7.=_—cT ❑ aNax-a-i. ❑ D-Ev_' Gpza J 1L.'w'T CGhTr4C GRI�A2 1050" I LC'��sNub�! 2 514 I i.IC'>:sE7' 1 I Bu_.LICr . Ct Inc Cows+- I .1450✓► �t►KeGoe� �r ���"o n .LBS SiR oF7 ADDRESS r L Id. -13(w V. CITY, STAT':, ZIP K Ca q vs MOhi ARC:11=_ 1ENG1'IiBPI IQA1J.E I L1CLI\SE�\TGT «'Z. I BUS.1..ICr COh-?.A,Y WkIIISI E N�� II rA STRn—f 'ADDRESS CITY. STAia Z: I ?'HONB 'USE D_ ❑ s -m of DI PTS ❑ I an-FAI✓,l1.Y I SLP�TTMG ❑--�/�� MOMCT W 1' ZD7 A -'NM ❑ yn Lt?itAGAE4 I 1111.07eCT R" ❑ eBs OCOOmCI _ I IS = BLDG F>\T ❑ 1:5 ❑ NO % DEscPrP7rex or 1 oRx r�-•� Til e 14 /45 707V j p T IJA11ON": 2 O O d'` �n� By %N si larore below, I cel j to each. of Lh'v following: I am he propc.•� Ljy o;;mer or authorized agent to zct on �: groper y oy„1er's be a ` I z read u,is i I ,_.- _-ad thie ;. ,'On r--, d --•-_. ' __ �- t 1'r-ble local CUL�.)CGtlOrl and she irfo;Z;atoa I have ah. •dvd :S e�:2 rvt. 13�V- -� L.1� �e5�l .�L_�:. of (���,• orA Grl� `,ell: �L �S a'vyr.,.... Ct.. ._.V � N L a.l G17� 1..G or Q1L•�iGl]-ts and s�Le laws rel-<tli'z t0 ,11 1 . const .1C _l. I a:t_ho i pr sent OL l.Lp'.>:iiSO io .erlttr &,5 ?bov-_-identi ed ,pmpea y L �' e. for =.'ion Du -'poses. Si_^ar+re ofA_p hcaJt:-._e^tt Dote: NTr",..L D� OTRILkI IN_ R.QU' rT, J SIrDIxZ� Via. `} ��__�. m tp d ' _�. 01ME —� -_. � _ qM ME —Mll Cdr,a1-"��.M_. hl'lI1,SG`!7�_20I1.�OC 1'8V2SB.�i 06/=1/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ia,ADDRESS: 23500 cristo rey dr unit 512f DATE: 10/30/2014 REVIEWED BY: Mendez UNITS APN: BP#: VALUATION: 1$2,000 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # PENTAMATION 1 REAP1 PERMIT TYPE: WORK install 13 canned led lights through out unit SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Fixtures, Lighting 1BREMFIXT 13 # $72 1'ern�il f''crC'. PME Unit Fee: $72.00 PME Permit Fee: $48.00 t ox Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 TOTALS: A Travel Documentation Fee: 1TRAVDOC $72.00 Strong Motion Fee: IBSEISMICR 9�c7a. Miran C k i. .r.1'111ri;r Frye- Ikch. tn.v, r 11hiaTh. Nan Chc.ck Numb. Permit Fee, Other Plumb Insp flhanb. Insp. Fee: Elec. Plan Check 10.0 hrs $0.00 Elec. Permit Fee: IEPERMIT Other Elec. Insp. 1 0.0 1 hrs 1 $48.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Hire, Sanitary Sewer District, School or.. 1 Th— foot oro hnaod nn tho nroliminany isfarmatinn availahlo and are nnly an estimate_ Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Elf. 7/1/13) FEE QTY/FEE MISC ITEMS Phin Chtz c1 I `zee: Slvppl. 1't:' Fce= PME Plan Check: $0.00 1'ern�il f''crC'. PME Unit Fee: $72.00 PME Permit Fee: $48.00 t ox Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 Fees: A Travel Documentation Fee: 1TRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg* Stds Commission Fee: IBCBSC $1.00 $214.50 $0.00 TOTAL FEE: $214.50 Revised: 08/20/2014 Z35©a Diz. uW(T 51-L F Barrier Fireplace on Top Floor CUPERTINO q, lildino nprirtmer, REVIEWED FOR UODE COMPL.IANCF Reviewed By: 4/-,; Balcony 15'10'x 7V Living. Room--- LA !3!0* x 11'6' Den J5;70 110'6• x 1019, 15 S -P Dining 0 Closet ITT x 8'3' Closet Closet Fi!2*0' x 9 C �44 N - W,L - 09 o L 7 1 E 4' 60 Ut-1 LI— 2 00IG 00 hen KtG 2'0*) ST x UN" IER ��ELOpf,AE�� DEPAFIT"'�-N-T CONA,J,j BUILDiNG cUPTINO APPROVED kept at the A (catlrwu��, to make any T�.is So o" plans 354 It "JCtion. flun, d -vi„ job sit:2 dur'"19 cor"all .. , S lei, i S a 'ut a 01 ,Jd c� 35 a to e a ni a. D p ctrl i t -, T ;� tyn^ of all P . . . . . . . . . . Bath 54 4'6' 7W/D Ut-1 LI— 2 ADD 3 Bedroom !0'!0'x 14'0' Closet 11"x4' �q V, 64A 1h L CD