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15120014 CITE' OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23300 VIA ESPLENDOR UNIT V60 CONTRACTOR:BAY AREA ENTERPRISE PERMIT NO: 15120014 OWNER'S NAME: FULLER ROBERT H TRUSTEE&ET AL 2110 MANGIN WAY DATE ISSUED: 12/03/2015 OW ER'S PHONE: 6505371523 SAN JOSE,CA 95148 PHONE NO:(408)238-5043 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL VILLA 60-ADD 9 (N)RECESSED LIGHTS,REPLACE 2 License ClassP Lic � n BATHROOM FANS&34 OUTLETS/16 SWITCHES � n � Contractor Date 2 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$3800 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:34255045.00 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 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 1 FROM LAS LLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue m t said City in consequence of the S� granting of thispermit. itionally,the applicant understands and will comply with all non-point so► ce gulations per th Cupertino Municipal Code,Section 9.18. ��- L ROOFS. Signat9rdo Dt �� 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 CuPi�041unici de,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2 ,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this ,!! z /(+ Owner or authorized agent? D 'te: J 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 malting 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 CONSTRUCTION PERMIT APPLICATI®nr COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPER•i 118® (408)777-3228•FAX(408)777-3333•buildinge_cupertino_orq 1�� Z-0 O ❑NEW CONSTRUCTION ❑ ADDITION LTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT/r PROJECTADDRESS .a-3-5 co �l LAS6 e-A- e. f APN' 3.� ON\TIER Nr1tiL• PH0\L- E-MAIL T� Y'u D o2� /fDS SC •C6K STREET ADDRESS CITY,STATE,ZIP FAX col.Tr,cr NAMEr YE' Fe- ,' -5i PID C —23 g ��Y.3 E-<tniL 0-P.—(74'a C Dtry STREET ADDRESS CITY,STATE,ZIP FAXzitd F G� 'K s sl ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT LaCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CON17RACfOR NAME• `� LICENS;N MER LICENSE TN PE BUS.LIC it CONIPAINY Nil"ME, E\MAILFAX ae Y+2 GI_ Yl r r e3. 1. -L O STREET ADDRESS CITY,STATE,ZIP PHO Z`1 d rt CL C sr B vol- ARCHITEC(ENGINEER NAME LICENSE-NUMBER BUS.LIC COMPANY NAME E-IMAIL FAX ° STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF tK ("Rrdd Ne LC I- ce e fi5 a 'ga+� Room b ray C ec 'cam to s uai�l�T .�-- u r-d owh et s u iK TP [XIS SC -PROPOSED USE CONSTR Il ST - USE TYPE OCC- S-Q_FT_ VALUATION(S) F:xISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEI.AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKNPORCH AREA I GARAGE AREA: DETACH ❑ATTACH P DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEINGADDED? ❑NO ADDITION? [:]NO PRE-APPLICATION ❑YFS IF YES,PROVIDE COPY OF IS TILE BLDG AN ❑YES LVEDI TION: PL,UN'NING APPL II []NO PLANNING APPROV AL LETTER EICHLER HOME? I-]NO 3. By my signature below,I certify to each of the follo�� g: I am the property owner or autliorize agent to act on the pro vner's behalf. have read this application and the information I have provided is co t. I(lav ead the Description of Work an may-iris- urate. I agree to comply with all applicable,local ordinances and state laws relating to building con coon. I a orize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for REVIEWovER OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. 71 t;l'PRr•.ss ❑ PLANNING PLAN RrIirNY _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS I form if anv Hazardous Materials are being used as part of this project- n ❑ LARGE ❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. El rNVIRONIiiENTAL HEALTH Bld&lpp 201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 23300 VIA ESPLENDOR V60 DATE: 12/02/2015 REVIEWED BY: MELISSA APN: 342 55 045 BP#: *VALUATION: 1$3,800 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1 REAP11 USE: 1 >3 Stories 0 Yes (E) No PERMIT TYPE: A WORK VILLA 60 -ADD 9 N RECESSED LIGHTS REPLACE 2 BATHROOM FANS & 34 OUTLETS/16 SCOPE SWITCHES Mech.Plan Check FO.0 hrs $0.00 f1havb.1'1't n C:hey k Elec.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: 1MPERMIT ph"i 7?17.Pc rrnic Fre: Elec.Permit Fee: IEPERMIT Other Mech.Insp. 0.0 hrs $48.00 of::rr 1'rirP?ir:/: ;, Other Elec.Insp. 0.0 hrs $48.00 Ur 1t 1. tY::ia=7. t'c. Phanb. '?sj:? 1`t'.t?: T:,....lT 4t: <'£'c. NOTE: This esthnate does not include fees due to other Departments(be.Planning,Public Works,Fire,Sanitazy Server District,School District,etc.). These ees are based on the prelindnin information motion available and are only an estimate. Contact the Det or addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Electrical Suppl.PC Fee: ) Reg. 0 OT 0.0 hrs $0.00 $72.00 1BREMFIXT Fixtures,Lighting PME Plan Check: $0.00 = Electrical Permit Fee: $0.00 $198.00 IBREMECEP Recep/Switch/Outlets Suppl. Insp.Feer Reg. Q OT 0.0 hrs $0.00 = # Mechanical PME Unit Fee: $0.00 $50.00 1BREMVENF Ventilation Fan PME Pen-nit Fee: $96.00 C{37?g'2r7.lcfioi'! 'Tax: _T_ - Administrative Fee: IADMIN $45.00 0 Work Without Permit? 0 Yes (E) No $0.00 G Advanced Planning Fee. $0.00 Select a Non-Residential 0 Travel Documentation Fee: 1TRAVDOC $48.00 Building or Structure 0 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $190.50 $320.00 TOTAL FEE.: $510.50 Revised: 10/01/2015