14100195E
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 111C
CONTRACTOR: CLINE CONSTRUCTION
PERMIT NO: 14100195
OWNER'S NAME:
SAN JOSE, CA 95123
PHONE NO: (408) 924-0204
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
INSTALL (6) CANNED LED LIGHTS THROUGH OUT UNIT
License Class_ Lic. # I? % 1:713J c C �
r
-C CO 5 �_ l0 — 3 y
ContractorCh'y K Date
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: 34253020 00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT XPIRES IF WO IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 0 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 OM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Date:
granting of this permit. Additionally, the applicant understands and will comply
Issued by:
with all non -point source regulations per the Cupertino Municipal Code, Section
RE -ROOFS:
9 18.
/ O .3 Q„ �–`
,_
Signature Date l J
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 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(Q
30
Owner or authorized agent: Date:/0-30-/L
permit is issued.
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
GENERAL PERMIT APPLICATION
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COMMUNITY DEVELOPhAENT DEPART MEN T • BUILDING DIVISIOl'. `"�
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iFPh/iscE?p_2D1 _1.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Fixtures, Lighting 1BREMFIXT 6 # $72
TOTALS: $72.00
ADDRESS: 23500 Cristo rey dr unit 111c
DATE: 10/30/2014
REVIEWED BY: Mendez
L,,, ch, /'erin,"t Fee:
APN:
BP#:
*VALUATION: 1$2,000
*PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: SFD or DuplexF
phind'), hisp. Pee:
PENTAMATION
PERMIT TYPE: 1 REAP1
WORK
install 6 canned led lights through out unit
SCOPE
tlPijll. IYi.s/.> �'e'E'
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Fixtures, Lighting 1BREMFIXT 6 # $72
TOTALS: $72.00
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
MoricL etc )_ These fees are haced on the nreliminarv, information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13)
ir�c?,. NIaYr C"/:E<ck
t'hin7b. Ilan Ch �cl,�
Elec. Plan Check 0.0 hrs $0.00
L,,, ch, /'erin,"t Fee:
pirlmb. Permu /'Ce'
Elec. Permit Fee: IEPERMIT
SuPPI, N, Fee
0111eF I'ium1 I11s7a.ELI
Other Elec. Insp. 0.0 1 hrs $48.00
it"" ' h2cr,_ t , e.:
phind'), hisp. Pee:
$0.00
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
MoricL etc )_ These fees are haced on the nreliminarv, information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan �.YL£<ck Fee:
SuPPI, N, Fee
PME Plan Check:
$0.00
tlPijll. IYi.s/.> �'e'E'
PME Unit Fee:
$72.00
PME Permit Fee:
$48.00
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? ® Yes 0 No
$0.00
1`1']Vollret ! I'It'r �xtirt 1�tt�s:
Travel Documentation Fee: ITRAVDOC
$48.00
Strom Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
L s
'
$214.50
$0.00 TOTAL FEE: °
.,. i
$214.50
Revised: 08/20/2014
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COMMUNITYDE!/EI.OPM1=N I DEPARTML- soi,,faWtDue%RoH-1n;Sho-r
BUILDING DMSION - CUPERTINO
APPROVE®
This set of plans and specifications MUST be kept at the
job site during construction. It is unlawful to make any
changes or r Bio s on same, or to deviate
therefrom, with o al f"�(same,
Official.
.n o{ n d s ifIcatiors S; -I?. L NOT
Th Starnp� g
be held to porrni. r an
3 ViG!%tival
0 a:: O" k) c;."s City Ordinat,ce or Maio Law.
;',--,7 iT NO.
?z s F
40P q 145 4.
A 1) P -z- C��4� - '
LivOOitl..
...... _ ..._.
I4Fr x 1r7":
_
_
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__ Bedroom
11,6, x. i"
Bedroom
1 2'Q` x.15 4` ...
j%�Rl3ig
at Topes.
.
u
V x2'0`
r
16'8'
x 5`6
i
o
NO
iCltcli
s
_ .,_
.�
Closet Bath
x 50 5'4- X,6°
i117
Bath
7
It• ---t=
"
`,-r .... - ..
,g�i(aiYXl OE B2U7[00(II on First RMT
COMMUNITYDE!/EI.OPM1=N I DEPARTML- soi,,faWtDue%RoH-1n;Sho-r
BUILDING DMSION - CUPERTINO
APPROVE®
This set of plans and specifications MUST be kept at the
job site during construction. It is unlawful to make any
changes or r Bio s on same, or to deviate
therefrom, with o al f"�(same,
Official.
.n o{ n d s ifIcatiors S; -I?. L NOT
Th Starnp� g
be held to porrni. r an
3 ViG!%tival
0 a:: O" k) c;."s City Ordinat,ce or Maio Law.
;',--,7 iT NO.
?z s F
40P q 145 4.
A 1) P -z- C��4� - '