1508021311
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 325E
CONTRACTOR: BAY AREA ENTERPRISE
PERMIT NO: 15080213
OWNER'S NAME: WORCESTER ETHEL R TRUSTEE
2110 MANGINWAY
DATE ISSUED: 08/31/2015
O ER'S PHONE: 6509440118
SAN JOSE, CA 95148
PHONE NO: (408)238-5043
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
License Class Lic. # / �l
REPLACE 18 (E) OUTLET/RECEPTACLES, INSTALL 5 (N)
RECESSED LIGHTS & UPGRADE SHOWER (NEW PAN,
Contractor &+y f� t/�aq FK Date
fi T 3 --)-a,1 �
VALVE)
STALL
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
ompensation, as provided for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $4500
performance of the work for which this permit is issued.
Iave 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: 34253124.00
Occupancy Type.
ermit 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 ' spection purposes. (We) agree to save
180 DAYS PECTION.
indemnify and keep harmlessa Ci Cupertino against liabilities, judgments,
costs, and expenses which acc a gainst said City in consequence of the
1-3
3 i
granting of this permit. Ad it the applicant understands and will comply
Issued by: Date:
with all non -point source r g at s per the Cupertino Municipal Code, Section
9.18.
Zp
ROOFS:
Signature Date 3'
All roofs shall any r be inspected prior to y 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)
1, 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(0) should tore or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipme o 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 AiVQuality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cup tin unicipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25 5, 2 33, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized agent: Date:
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(cD.cupertino.org /-s-0
[_1 NEW CONSTRUCTION El ADDITION b6 ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
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❑ OWNER ❑ OWNER-BUILDF,R ❑ OWNER AGENT 10 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGMEER ❑ DEVELOPER ❑ TENANT
CON CTOR NAME
LICENSE NUMBER
F7NjW;E
BUS. LIC #
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COMPANY IdME
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STREET ADDRESS
CITY, STATE,
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ARCHITECT/ENGINEER NAKE
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK Jj,.C.,r f ,q N u /•e .)60 JU 51 ?T/_yh C ,�
A d 4 R-� r I` �'S .kibqN ra— too ui a y- e W o ,. 'c
S
XISTING 11SF1 PROPOSED USE CONSTR_TYPE
#STORIES
USE TYPE OCC.
SQ.FT.
VALUATION ($)
F.XISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODELAREA
REMODELAREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: LJDETACH
❑ ATTACH
I
# DWELLING UNITS:
IS A SECOND UNIT DYES
SECOND STORV DYES
BEING ADDED? ONO
ADDITION? ONO
PRE-APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ LUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ N
By my signature below, I certify to each of the following: I am the pr perry wrier or authorized agent on the property owner's behalf. I ve read this
application and the information I have provided correct. I haver the scription of Work and it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building struction. I a ehtatives of Cup to enter the above i ntifed r e or inspection purposes.
Signature of Applicant/Agent: Date: 3
SUPPLEMENTALORMA N REQUI ED
PLAN CHECK E
ROUTING SLIP
OVER-THE-COUNTER
❑
_ New SFD or Multifamily dwellings: A for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
BUILDING PLAN REVIEW
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL. HEALTH
B1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
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 preliminary information available and are only an estimate. Contact the Dept for addh 7 info.
FEE ITEMS (Fee Resolution I1-053 E(L 7/1/13,)
ADDRESS: 23500 CRISTO REY DR #325E
DATE: 08/31/2015
REVIEWED BY: MELISSA
"< ..
APN: 342 53 124
BP#:
*VALUATION:
$4,500
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi -Family Dwelling
USE:
Buildina is
3 Stories 0 Yes E) No
PENTAMATION 1 RPFIX
PERMIT TYPE:
WORK
REPLACE 18 E OUTLET/RECEPTACLES INSTALL 5 N RECESSED LIGHTS & UPGRADE
SCOPE
SHOWER (NEW PAN, VALVE) STALL
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 preliminary information available and are only an estimate. Contact the Dept for addh 7 info.
FEE ITEMS (Fee Resolution I1-053 E(L 7/1/13,)
FEE
Plumb. Plan Check 0.0 1 hrs $0.00
Elec. Plan Check 1 0.0 hrs $0.00
"< ..
Plumb. Permit Fee: IPPERMIT
Elec. Permit Fee: IEPERMIT
$0.00
Other Plumb Insp.0.0 hrs $48.00
Other Elec. Insp. 0.0 hrs $48.00
Suppl. PC Fee: C) Reg. 0 OT
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 preliminary information available and are only an estimate. Contact the Dept for addh 7 info.
FEE ITEMS (Fee Resolution I1-053 E(L 7/1/13,)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
#
$10.00
Plumbing
IBPFIXTURE Fixture set on One Trap
Suppl. PC Fee: C) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
=
$48.00
Electrical
IBREMRECEP I Recep/Switch/Outlets
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. () OT
0.0
hrs
$0.00
= Electrical
$72.00 1BREMFIXT Fixtures, Lighting
PME Unit Fee:
$0.00
PME Permit Fee:
$96.00
Administrative Fee: IADMIN
$45.00
Q
E)
Work Without Permit? Yes E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
i
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.59
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$190.59
$130.00
TOTAL FEE:
$320.59
Revised: 07/02/2015