The URL can be used to link to this page

15120012CITE' OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 331E CONTRACTOR: BAY AREA ENTERPRISE PERMIT NO: 15120012 OWNER'S NAME: CLANCY KEVIN S TRUSTEE -2110 MANGIN WAY DATE ISSUED: 12/03/2015 OWNER'S PHONE: 6505371523 / SAN JOSE, CA 95148 PHONE NO: (408)238-5043 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ UNIT 331E - ADD 7 (N) RECESSED LIGHTS, REPLACE 2 icense Clas5,0 Lic. # 1-7 qr'Ir BATHROOM FANS & 27 OUTLETS/14 SWITCHES Contractor 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: $2800 of the work for which this permit is issued. _performance Save 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: 34253128.00 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 D 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 180 D 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 r Date: b granting of this permit. Additionally, the applicant understands and will compl with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signatures Da L I RE -ROOFS: 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) 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(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 Owner or authorized agent ( Date" f 2,/7 !X 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 I? k CONSTRUCTION PERMIT APPLICATION - COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - buildinci aecupertino.org / 5_/ 2 00 F-1 A nT)T-Mn\T _FZ/ , T -rvo A 1111 , I—I PROJECT ADDRESS,? 3 66 ��t �� vAL_- — APN = 3V Z-6 3 •_Iz-E� uk'i— 33Ian ❑ STANDARD ❑ LARGE T%,t -TR NAAI. /� - / PHOLTL \ UL7/ TYPE OCC_ SIQ.FT_ Fee icdl hQ a K RSC • C6 et STREET ADDRESS l �r � u r-4 L,7 Pur-4, � CITY, STATE, ZIP.q Sam FAX i� .. . 1 � LZ /le CONTACT NAME�— C>>re Te , 1 P vs �^� E-MAIL AREA STREETADDRESS r � z I I C> C. K NETARE•A CITY. STATE, ZIP s 5-1 NJ FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT YU CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT I CONTRACTOR NAME d r Vt__0 KITCHEN LICENSE NUM R LICENSE TNTE BUS. LIC it CONIP:1N1" Nr\q iar i%eN r5 E-\L•\1L ne qna 9, FAX STREET A+DDD E d a U ,REMODEL AREA -R -E -T -M CrI-Y, STATE, ZIP PHON . ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC = :1 CO\7PANY NANIE GARAGE A DETACH E-NIA11, FAX H STREET ADDRESS - ❑ ATTACH. I CITY, STATE, ZIP PHONE 9 DWELLING UNITS: 9 DESCRIPTION OF IRK MeW LCD e-ec-esse-c( "t-5)(LLp9racie ga+� Ra.K -Z- Ito rat & Elex_+Wca, I o_uAtet3 wAV, 23 WA ' T P 1 CX1S SE -PROPOSED USE CONSTR k ST ❑ F.\PRESS ❑ PLANNrNG PLAN REVIEW ❑ STANDARD ❑ LARGE ❑ FIRE DEPT USE TYPE OCC_ SIQ.FT_ VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL - AREA AREA AREA NETARE•A BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA ,REMODEL AREA -R -E -T -M PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE A DETACH ❑ ATTACH. I 9 DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY []YES BEING ADDED? ❑ NO ADDITION? []NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS TIIE BLDG AN ❑ YES -- T DATION: PLANNING APPL It []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ N !�CEIV�EDBY. I,- �y Lsy my Signature nelow, 1 cerluy to each of me tolto\� g: 1 am the property owner or authorized went to acTon the proper[ tier's behalf I have read this application and the information I have provided is co et. I Ilav ead the Description of Work and verify it is accurate. gree to comply With all applicable local ordinances and state laws relating to building cons coon. T a orize representatives ofCuperlino to enter the abo\ -Identified property for inspection perp ses. Signature of Applicant/Agent: Date:: SUPPLEMENT,KL INFORMATION REQUIRED PLAN CHECK TYPE ROIiTIN(S SLiP _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. —Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if anv Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. �SVER-THE-COUNTER ❑ BUILDING PLAN REVIEW ❑ F.\PRESS ❑ PLANNrNG PLAN REVIEW ❑ STANDARD ❑ PUBLIC WORKS ❑ LARGE ❑ FIRE DEPT ❑ MAJOR ❑ SANITARY SEWER DISTRICT ❑ ENVIRONNIF.NTA 1. LIRA I -TN B1dgApp 2011.doc revised 06/21/11 ell F§�W_W CITY OF CUPERTINO FFF F,STTMATOR — RIJILDING DIVISION NOTE: This estimate does not include fees due to otherDepartments (i.e. Planning, Public Works, hire, Sanitary Fewer District, school %1Cch•:nt afn 1 Thca faac m•a hncad na fh g nralintinary infnrmntimf availahle, and are an1v an echinate_ rmitact the Dent for addn'I into. FEE ITEMS (Fee Resolution 11-053 E . 711113) ADDRESS. 23500 CRISTO REY DR 331E DATE: 12/02/2015 REVIEWED BY: MELISSA APN: 342 53 128 BP#: *VALUATION: 1$2,800 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi -Family Dwelling USE: Building is 1 >3 Stories 0 Yes E) No PENTAMATION 1 REAP11 PERMIT TYPE: WORK UNIT 331E -ADD 7 N RECESSED LIGHTS REPLACE 2 BATHROOM FANS &27 OUTLETS/14 SCOPE SWITCHES NOTE: This estimate does not include fees due to otherDepartments (i.e. Planning, Public Works, hire, Sanitary Fewer District, school %1Cch•:nt afn 1 Thca faac m•a hncad na fh g nralintinary infnrmntimf availahle, and are an1v an echinate_ rmitact the Dent for addn'I into. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # $72.00 Electrical 1BREMFIXT Fixtures, Lighting Suppl. PC Fee: (j) Reg. 0 OT 0,0 hrs $0.00 PME Plan Check: $0.00 41 $153.00 Electrical 1 IBREA RECEP Recep/Switch/Outlets Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 0 # Mechanical $50.00 IBREMVENF Ventilation Fan PME Unit Fee: $0.00 PME Permit Fee: $96.00 (."C13ds'Zrucil'on 'Tox' Administrative Fee: /ADMIN $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 0 i Travel Documentation Fee: 1TRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS ' $190.50 $275.00 TOTAL`FEE: $465.50 Revised: 10/01/2015