15120015d1
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23800 AMAPOLO CT UNIT V3
CONTRACTOR: BAY AREA ENTERPRISE PERMIT NO: 15120015
OWNER'S NAME: DEKRAKER GLENN M TRUSTEE & ET AL
2110 MANGIN WAY DATE ISSUED: 12/03/2015
OWNE PHONE: 6505371523
SAN JOSE, CA 95148 PHONE NO: (408)238-5043
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑
VILLA 3 - ADD 9 (N) RECESSED LIGHTS, REPLACE 2
License Class® Lie. 4.,/ (r% 54-7
BATHROOM FANS & 34 OUTLETS/16 SWITCHES
(� f�[ iL/
Contractor Date
,d+ c
I hereby arm 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 corder 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
Iecave and will maintain Worker's Compensation Insurance, as provided for by
tion 3700 of the Labor Code, for the performance of the work for which this
APN Number: 34254003.00
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 OF PERMIT 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 DAYS FR CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue gainst said City in consequence of the
Date: 1 2 3
granting of this permit. Add' ionally the applicant understands and will comply
ss
with all non -point source re ulation er the Cupertino Municipal Code, Section
RE -ROOFS:
9.18.-
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Signature Date 0 Z I
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 thq 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. 1 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 Cuper, mo Mu al Code, Chapter 9.12 and
I 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
the Health & Safety Code, Sections 2 5, 2553 , and 25534. 2
— lu/
Date.
Owner or authorized agent:
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
X11
CONSTRUCTION PERMIT APPLICATION-'
COMMUNITYDEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTIINO (408) 777-3228 • FAX (408) 777-3333 - build ingt7a cupertino.oLS / 2 60 /5
❑ NEW CONSTRUCTION ❑ ADDITION 1LTERATION I TI ❑ REVISION i DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 1.1 I �m �/ O d C- rI APN = -
-60
Ot\^AER NAME PHO\T_ E-MAIL 'Th @ :FftYu iA
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STREET ADDRESS CITY, STATE, ZIP FAX
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USE TYPE OCC_
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT W CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNANME•`�
LICENS I [ �, 1 R LICENSE
BUS. LIC 0 1
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COMPANY NAME
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FAX
STREET ADDRESS
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CITY, STATE, ZIP
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PHON
ARCHITECTIENGINEER NAME
LICENSE NUMBER
BUS, LIC 4
COMPANY NAME
L -M UL
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FAX
OTHER
❑ PUBLIC WORKS
STREET ADDRESSCrTY,
STATE, ZIP
PHONE
DESCRIPTIONOF s
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EXIS SE
PROPOSED USE CONSTR.TYP..
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property for inspection pt
Signature of Applicant/Agent:
j' Date:
1 �(
USE TYPE OCC_
SQ.[ -r-
VALUATION (S)
FSISTG
NEW FLOOR
DEMO
TOTAL
❑ BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
AREA
AREA
AREA
NET AREA
❑ EXPRr•_SS
BATHROOM
KITCHEN
OTHER
❑ PUBLIC WORKS
REMODEI.AREA
REMODELAREA
REMODEL AREA
e
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting With Planning prior to
PORCH AREA
DECKAREA
TOTAL DECKNORCH AREA
GARAGE AREA: DETACH
I
❑ ATTACH
❑ ENVIRONMENTAL HEALTH
P DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
IEINCADDED? []NO
ADDITION? ❑NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES VED ATION:
PLANNING APPL II ❑ NO PLANNING APPROVAL LETTER
EICHLER HOhIE? ❑ NO
By my Signature below, I certify to each of the folloAv g: i am the propertyWner or author" gent to oper wner's behalf. Yliave read this
application and the information I have provided is co et. I llav ead t11e Description o ork and v accurate agree to comply with all applicabW1
ordinances and state laws relating to building con coon. I a Drize representatives of Cupertino
to ent ve-Identified
property for inspection pt
Signature of Applicant/Agent:
j' Date:
1 �(
SUPPL.EMENTf,L INFORMATION REQUIRED
LAN CHECK TYPE
ROLrTING 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.
❑ EXPRr•_SS
❑ PLANNING PLAN' REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
form if anv Hazardous Materials are being used as part of this project.
0
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting With Planning prior to
❑ tilnaoR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
B1d&1 pp=2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
i0iADDRESS.
23800 AMAPOLO CT V3
DATE: 12/02/2015
REVIEWED BY: MELISSA
APN: 342 54 003
BP#:
*VALUATION: 1$3,800
*'PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi -Family g Dwellin
USE:
Buildina is
>3 Stories 0 Yes E) No
PENTAMATION 1 REAP11
PERMIT TYPE:
WORK
VILLA 3 -ADD 9 N RECESSED LIGHTS REPLACE 2 BATHROOM FANS & 34 OUTLETS/16
SCOPE
SWITCHES
U 1.11.I?mb, Insp, z`t.t..
' .
NOTE: This estimate does not include fees due to other Departments (ie. Planning, Public Works, fire, Sanitary Sewer District, School
nicfrirf ofo 1 Thoco foot aro hand nn tho nro/inzinary infarnzadan available and are nzzly an estimate. Contact the Dent for addn'1 into.
FEE ITEMS (Fee Resolution 11-053 E . 7/1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$72.00
Electrical
1BREMFIXT Fixtures, Lighting
Suppl. PC Fee: (j) Reg. 0 OT
1 0.0
hrs
$0.00
PME Plan Check:
$0.00
=
$198.00
Electrical
IBREMRECEP Recep/Switch/Outlets
Permit Fee:
$0.00
Suppl. Insp. Fee -(F) Reg. Q OT
0.0
hrs
$0.00
= # Mechanical
$50.00 1BREMVENF Ventilation Fan
PME Unit Fee:
$0.00
PME Permit Fee:
$96.00
g
Tax:
Administrative Fee: 1ADMIN
$45.00
0
0
Work Without Permit? O Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
0
i
Travel Documentation Fee: 1TRAVDOC
$48.00
Strom Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS: -.
$190.501
$320.00
TOTAL FEE:
$510.50
Revised: 10/01/2015