15120009CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 312D
CONTRACTOR: BAY AREA ENTERPRISE
PERMIT NO: 15120009
OWNER'S NAME: KNAPP GEORGE G P TRUSTEE
2110 MANGIN WAY
DATE ISSUED: 12/03/2015
OWN R'S PHONE: 6505371523
SAN JOSE, CA 95148
PHONE NO: (408)238-5043
KLICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
f f,
UNIT 312D - ADD 5 (N) RECESSED LIGHTS, REPLACE 1
License Classy Lic. #`� �I
BATHROOM FAN & 20 OUTLETS/8 SWITCHES
�� L Datel 2 3!%
Contrac� ,'I-
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: $2500
HP flormance of the work for which this permit is issued.
•rave
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: 34253093.00
Occupancy Type:
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 relating
WITHIN 180 DAYS IT 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
IS AY + D 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: r k
granting of this permit. Additionally, the applicant understands and will c
ssu
with all non -point source r gulations per the Cupertino Municipal Code, Section
9.18.
r
Signatu Date
RE -ROOFS:
All roofs sha nspected 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 Cu erti unicipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 15, 5533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
— trL
Owner or authorized agent Dater
permit is issued.
f -
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
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CONSTRUCTION PERMIT APPLICATION—'
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE _ CUPERTINO, CA 95014-3255 [�
ClDPERTIN® (408) 777-3228 • FAX (408) 777-3333 • build ingCcDcuperfino.org I J�� oc 7
❑ NEW CONSTRUCTION ❑ ADDITION _5�ALTERATION 1 TI ❑ REVISION 1 DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS SCA' a C S * Cl ?"e C� APN 4!p�
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT W CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CON'TRACTORNAME-
LICENSE NUMBER LICENSE TYPE
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REMODEL AREA
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ARCHITECT/ENGINEER NAME
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STREET ADDRESS
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-"PROPOSED USE CONSTR
ordinances and state laws relating to building cons ction. i a orize representatives ofCupertino to enter the above -identified
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Signature of Applicant/Agent: +; Date:
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SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
—New SFD or Multifamily dwellings: Apply for demolition permit for
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
existing building(s)- Demolition permit is required prior to issuance of building
TYPE OCC_
S'Q.FT_
VALUATION (S)
EXISTG
NEW FLOOR
-DEMO
TOTAL
❑ PUBLIC WORKS
form if anv Hazardous Materials are being used as part of this project-
❑ LARGE
❑ FIRE DEPT
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
-
PORCH AREA
DECK AREA
TOTAL DECKMORCH AREA
GARAGE AREA DETACH
[]ATTACH.
f! DWELLING UNITS:
IS A SECOND UNIT []YES
SECOND STORY []YES -
BEING ADDED? []NO
ADDITION? ❑ NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YESD
BY: TAL VALUATION:
PLANNING ADPL 11 ❑ NO PLANNING APPROVAL LETTER
EICHLER HONIE? ❑ NO
law
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By my signature below, I certify to each of the follow g- I am the property owner or authorized agent to�the property owner's behalf. I have read this
application and the information I have provided is ct. I hav ead the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building cons ction. i a orize representatives ofCupertino to enter the above -identified
property far inspection purpos s.
Signature of Applicant/Agent: +; Date:
� /
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
—New SFD or Multifamily dwellings: Apply for demolition permit for
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
existing building(s)- Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN RrVJr1v
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
form if anv 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-
❑ ENVIRONNTENTAL HEALTH
Bldg4p,p 201 Ldoc i-evised 06/21/11
CITY OF CUPERTINO
FFF, FSTIMATOR — BUILDING DIVISION
1';hmub, Insp.F'ee.,
Etk c . tr 4°7' 1" e£':
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, hire, ,Yalzitazy Yewer uzsti zct, scnool
ll.of.... * ab. 1 Thom iaao ora hncad ora than nrolinriran1h7 infarmatiatt avnilnhho and ate a th, an owfir tatP._ Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 711/13)
ADDRESS: 23500 CRISTO REY DR 312D
DATE: 12/02/2015
REVIEWED BY: MELISSA
APN: 342 53 093
BP#:
*VALUATION: 1$2,500
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi -Family Dwelling
USE:
Buildina is
3 Stories 0 Yes (E) No
PENTAMATION 1 REAP11
PERMIT TYPE: A
WORK
UNIT 312D - ADD 5 N RECESSED LIGHTS REPLACE 1 BATHROOM FAN & 20 OUTLETS/8
SCOPE
SWITCHES
1';hmub, Insp.F'ee.,
Etk c . tr 4°7' 1" e£':
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, hire, ,Yalzitazy Yewer uzsti zct, scnool
ll.of.... * ab. 1 Thom iaao ora hncad ora than nrolinriran1h7 infarmatiatt avnilnhho and ate a th, an owfir tatP._ Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 711/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= #
$72.00
Electrical
1BREMFIXT Fixtures, Lighting
Suppl. PC Fee: Q Reg. 0 OT
Fo .0
hrs
$0.00
PME Plan Check:
$0.00
=
$88.00
Electrical
1BREAMECEP Recep/Switch/Outlets
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0 OT0,0
hrs
$0.00
= # Mechanical
$25.00 IBREMVENF Ventilation Fan
PME Unit Feer
$0.00
PME Permit Fee:
$96.00
Administrative Fee: IADMIN
$45.00
0
G
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
i
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$190.50
$185.00
:TOTAL' FEEc
$375.50
Revised: 10/01/2015