15120008CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 210D
CONTRACTOR: BAY AREA ENTERPRISE PERMIT NO: 15120008
OWNER'S NAME: DURHAM DAVID L TRUSTEE
2110 MANGIN WAY DATE ISSUED: 12/03/2015
OWN 'S PHONE: 6505371523
SAN JOSE, CA 95148 PHONE NO: (408)238-5043
-� LICENSED CONTRACTOR'S DECLARATION
-UNIT
JOB DESCRIPTION: RESIDENTIAL Ej COMMERCIAL ❑
210D - ADD 7 (N) RECESSED LIGHTS, REPLACE 2
License Class Lic. # 9(17 a)
BATHROOM FANS & 23 OUTLETS/12 SWITCHES
..4r
-g A-iP Date �`L 3 Z0
Contractor .� _._
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
C pensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $3000
have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 34253 06 1.00
Occupancy Type:
ection 3700 of the Labor Code, for the performance of the work for which this
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 relating6180
ITHIN 180 ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
R LED 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 the
Date: Z
granting of this permit. Additionally, the applicant understands and will comply
y:
with all non -point source regulations per the Cupertino Municipal Code, Section
RE -ROOFS:
9.18.1.213 'L f% 5
Signature"I J, At
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(x) 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 Cade, for the
air contaminants as defined by the Bay Arc uality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cu er ' o + unicipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 2 50 , 5 34.
Section 3700 of the Labor Code, for the performance of the work for which thisi2/
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
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
CUPERTINO
1-1 NEW CONSTRUCTION
CONSTRUCTION PERMIT APPLICATION—
COMMUNITY
PPLICATIONCOMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildinge-cuperiino.orq ( d v
ADDITION - 1LTFRATT0XI /TT F-1 RFVISICL'v /TIFFFRRFTI ORTC rNAi PFR76,t11rR
PROJECT ADDRESS ;,3 5-00§,.,CpJf L S+b - e
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT 1{!J CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAIIE•� `�
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC r:
COMPANY NAME
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EXISTIN40SE PROPOSED USE CONSTR. TYPt >: ST
USE TYPE OCC_ SQ.FI_ VALUATION (S)
FXISTG
NC•1V FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKIPORC14 AREA
GARAGE AREA: DETACH
❑ ATTACH _
# DWELLING UNITS:
IS A SECOND UNIT []YES
SECOND STORY ❑YES
BEINGADDED? ❑ NO
ADDITION? ❑ NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
1S THE BLDG AN ❑ YES RECE BY' TOTAL VALUATION:
PI-ANNING APPL 11 ❑ NO PLANNING APPROVAL LETTER
EICHLER ROME? ❑ NO
: I am the property owner u r 's be la ,e read this
By my signature below, I certify to each of the fol;Rg
application and the information I have provided isct. 1 hav ead the Descriptio of Work an Is accurate ee to comply with all app 1 cal
ordinances and state laws relating to building conon. T�rizerepresentatives of Ct 0 to enter the -Identified property for inspection
purpose .
Signature of Applicant/Agent!:Date:-. t
SUPPLEMENTA INFORMATION REQUIRED
PLAN CHECK TYPE ROUTING SLIP
El BUILDING PLAN REVIEW
_ New SFD or Multifamily dwellings: Apply for demolition permit forOVER-THE-COUNTER
existing building(s)- Demolition permit is required prior to issuance of building
-
permit for new building.
❑ 1.XPRFSS ❑ PLANNING PLAN REVIEIY
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD ❑ PUBLICWORKS
form if anv Hazardous Materials are being used as part of this project.
❑ LARGE ❑ FIRE DEI-1-
EPT_
-Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
B1dg.4pp_201 Ldoc revised 06/21/11
CITY OF CUPERTINO
wi,_�07FEE ESTIMATOR — BUILDING DIVISION
IVulC: inns esmnare apes nor ureruue.jees uue eu ucner "epurcncenes tae. reureneng, ruuacc rrurnay l'c/G, UufTttuty UGrvG/ Lcou eu, .,waves
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l into.
FEE ITEMS (Fee Resolution 11-053 E .. 7/1/13)
ADDRESS: 23500 CRISTO REY DR 210D
DATE: 12/02/2015
REVIEWED BY: MELISSA
APN: 342 53 061
BP#:
*VALUATION:
1$3,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi -Family Dwelling
USE:
Building isPENTAMATION
3 Stories 0 Yes (E) No
1 REAP11
PERMIT TYPE: A
WORK
UNIT 210D -ADD 7 N RECESSED LIGHTS REPLACE 2 BATHROOM FANS & 23 OUTLETS/12
SCOPE
SWITCHES
IVulC: inns esmnare apes nor ureruue.jees uue eu ucner "epurcncenes tae. reureneng, ruuacc rrurnay l'c/G, UufTttuty UGrvG/ Lcou eu, .,waves
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l into.
FEE ITEMS (Fee Resolution 11-053 E .. 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= #
$72.00
Electrical
IBREMFIXT Fixtures, Lighting
Suppl. PC Fee: (2)Reg. 0 OT
0,01lirs
$0.00
PME Plan Check:
$0.00
35
$123.00
Electrical
1BREARECEP Recep/Switch/Outlets
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q
OT
1 0.0
1 hrs
$0.00
= # Mechanical
$50.00 1BREMVENF Ventilation Fan
PME Unit Fee:
$0.00
PME Permit Fee:
$96.00
Administrative Fee:
IADMIN
$45.00
0
E)
Work Without Permit? 0 Yes (D No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
i
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee:
1BSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:.,
$190.50
$245.00.
TQTAL FEE;"
$435.50
Revised: 10/01/2015