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151200071� CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 104B CONTRACTOR: BAY AREA ENTERPRISE PERMIT NO: 15120007 OWNER'S NAME: TROLLMAN HELEN S TRUSTEE 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 E] 7 UNIT 104B - ADD 7 (N) RECESSED LIGHTS, REPLACE 2 License ClassO Lic_. BATHROOM FANS & 23 OUTLETS/12 SWITCHES Contracgr✓ A- 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: $3000 p rformance of the work for which this permit is issued. 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: 34253003.00 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 ERMIT 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 AYS F T CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of b / ?_Z 3 / granting of this permit. Additionally, the applicant understands and will comply I e: with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18. / Z13(j(L Signage Date I JJJ 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 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 theerfor mance of the work for which this p Owner or authorized agelI: Date: �/ permit is issued. NJ 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 CONSTRUCTION PERMIT APPLICATION -- COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 CUPEFiTlN® (408) 777-3228 -FAX (408) 777-3333 - building aC7cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION _1LTERATION /TI n REVISION /DHFFRRFD nRmrNAT_ PFRrAIT U n PROJECT ADDRESS Z SesC2' C V l 7 �CL3 IL'- - - - -- OWNLR i" �- PHONE %\I.AIL 'Tl1Q ta for?✓o /dU Fe aa+. -eSC -Csct CITY, STATE, ZIP 7r A! CONTACT NA1t4E rC , ,5 j P ii r - a. ® _ .a oq-3 E-MAILT'CE �� C O N 'Y 6 STREETADDRESS 'K CITY, STATE, ZIP FAX C> r Gly s s, ❑ OWNER ❑ O\VNFR-13UILDER ❑ OWNER AGENT 2 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT COe TRACTOR i lA 4IL LICENSE NZ 11E R LICENSE T]PE BUS. LIC CO:\IPANY NAME a � rye w EVA r 5 E-MAIL ne!q an. STREET ADDRESS CL CITY, STATE, ZiP c 57 67 PHON Ifo - ARCHITEC (ENGINEER NAME LICENSE NUMBER BUS. LIC COMPANY NAME E-NIA1L FAX n STREET ADDRESS _ CITY, STATE, ZIP PHONE DESCRIPTION OF W RK W'eW L �-c e ( tLpqrdde 80+� R®®int `►,. P (4124f0de- e 'ccl, - le. s wi�VsT . auQ i'K TP ` 1 M. S SE ROPOSED USE CONSTR kST USE TYPE OCC- S1Q.Fr. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: EIDETACH ❑ ATTACH. I DWELLING UNITS: ISA SECOND UNIT OYES SECONDSTORY ❑YES BEING ADDED? []NO ADDITION? ❑ NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF ISTHEBLDGAN RECEIVED ATION: PLANNING APPL H []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each oft] follig: I am Ute property ownerorau ri� a ac[ on the progeny owner's behalf I hav read this application and the information I have provided ict. I hav ead the Description of W t verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building conon. I a orize representatives of Cupertino to enter the above -identified property for inspection pu oses - Signature of Applicant/Agent: : Dater- i % �.�% TiT SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(sj. Demolition permit is required prior to issuance of building permit for new building. ❑ , EXPRESS ❑ PLANN�NC PLAN Rr•.vrrw _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ DIAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dg.4pp=201 Ldoc revised 06/21/11 CITY OF CUPERTINO r.%_W__07 FFF FISTIMATOR — RITILDING DIVISION 191 ADDRESS. 23500 CRISTO REY DR 104B DATE: 12/02/2015 REVIEWED BY: MELISSA APN: 342 53 00 3 BP#: *VALUATION: 1$3,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi -Family Dwelling USE: Building is >3 Stories 0 Yes (D No PENTAMATION 1 REAP11 PERMIT TYPE: A WORK UNIT 104B -ADD 7 N RECESSED LIGHTS REPLACE 2 BATHROOM FANS & 23 OUTLETS/12 SCOPE SWITCHES NOTE. -This estimate does not include fees due to other Deparhnents (Le. Planning, Public Works, Fire, Sanitary Sewer District, School n h -, t atr 1 Thoca foot m -o hncod nn tho nrolinfinmry infm7nntinn availahle and are only an estimate. Contact the Dent for addlt'l into. FEE ITEMS (Fee Resolution 11-053 E . 7/1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # $72.00 Electrical IBREMFIXT Fixtures, Lighting Suppl. PC Fee: (E) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 35 $123.00 Electrical 1 1BREMRECEP Recep/Switch/Outlets Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00 = # Mechanical $50.00 1BREMVENF Ventilation Fan PME Unit Fee: $0.00 PME Permit Fee: $96.00 (,"omt,yvcn'011 'TL x,- F7 Administrative Fee: /ADMIN $45.00 0 G Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G 0 i Travel Documentation Fee: 1TR4VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $190.50 $245.00 "'. TOTAL'-:FEE:.$435.50 Revised: 10/01/2015