15110189el
I ° t CITY OF CUPERTINO BUILDING PERMIT
'(
BUILDING ADIjRESSs00 CRISTO REY DR UNIT 401F
D
CONTRACTOR: BAY AREA ENTERPRISE
PERMIT NO: 15110189
OWNER'S AMEN STEARNS DAVID M TRUSTEE & ET AL
2110 MANGIN WAY
DATE ISSUED: 11/30/2015
OWN '� PHONE 6505,371$23
SAN JOSE, CA 95148
PHONE NO: (408)238-5043
LICENS°ED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
�� J
License Ctrs It; :; ` 'S ! Lc #� �(''�
UNIT # 401F - REPLACE & UPGRADE (E) SHOWER PAN,
VALVE & WALL FINISH
..
Contractomnl/klc� 'i34 �x
I hereby affir. aml:licensed under the provisions of Chapter 9
(Ithl�t,i
(eommencmg(wtth 7000)'of Division 3 of the Business & Professions
iSechon
Code andlihat;', tteenseis'in Full force and'effect.
! I I 1 dllI'�t5..:1
here y affirm under'pretlalty of perjury one of the following two declarations:
e' and will'mhmxaih a; certificate of consent to self -insure for Worker's
mpensation,las;pro ,ided for by, Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation., $3500
ormance Of the'work for yvh�cli this permit is issued.
v6.. and,,wiII majn;ain; Worker's Compensation Insurance, as provided for by
ection 3790',,01 the L.6borCode for the performance of the work for which this
permit is issued,',,� tlF h »' ;
APN Number: 34253168.00
Occupancy Type:
APPLICANT CERTIFICATION
I certO,tliat I have {dad this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct !'I';agree:to�'comply. wjth all city and.county ordinances and state laws relating
WITHIN 180 D ERMIT ISSUANCE OR
to building constiucti" r" and hereby authorize representatives of this city to enter
. , .., .II "I, ,.:. .. ,, ::
upowthe al ove i lentioned proP'erty for inspection purposes. (We) agree to save
180 DA O CALLED INSPECTION.
indemnif 'tand'keep;harmless the Crtyof Cupertino against liabilities, judgments,
costs and expenseswhich may accrue against said City in consequence of theffi
granti ig o�tthis'. a t, Addrtionally;'the applicant understands and will comply
�t's'
ued b Date: �1
with all non-po rce°regu ,tions per the Cupertino Municipal Code, Section
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
9.18.,
'
Sig ' ! '! Daie` 4-n
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ � ; � � ' [• Iryl I OWNER UILDER •DECLARATION
I hereby affirm thatf' am exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following tw:p reasons:'` : i; -: ; '
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I, as' o`<Vner ;of.' e'prdpeO;; or!m employees with wages as their sole compensation,
Will do theawark,4; mdAestructu a isnot intended or offered for sale (Sec.7044,
Business &' Professions, Coded
'pc '� !' ; '
I, as'owner ofthei " roert:y,'am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the roJect ($66.7,044' Business &Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
li ''•.t,'I:,I•a,
I her 1`0 of one of the following three
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
Cupertino Municipal Code, Chapter 9.12 and the
eb'y'aftir;i..�,un peuall� perjury
declarations; p,?!L'I 'Oj.j! ,i!,,�? � ; , .:..:
maintain compliance with the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I havndawhl in`au a'Certificate of Consent to self -insure for Worker's
e' a
material. Additionally, should I use equipment or devices which emit hazardous
Compensation,l- provided, for, by, Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
"'' I ' 16,
performance of the work for which this permit is'issued.
will maintain compliance with the Cupertino unici al Code Chapter 9.12 and
P P P P
T, , i I I, I - I '
I have s Compensation Insurance, as provided for by
!Irl$.
Section 3700 the Labor Code,for.the of the work for which this
the Health & Safe Code, Sections 2 5 5 5534.
! of performance
Owner or authorized agent: 0 Date:
mI certify that m the perforance of the work for which this permit is issued, I shall
not employ any'jpersof , in any;manuer; so as to become subject to the Worker's
dp t . 4.'
Compegsationila�ys'�of Califorhia.' If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
Wpensation provisions of the Labor Code, I must
become`subJect d the rker's Comp
I hereby affirm that there is a construction lending agency for the performance of
forthwith corriply wityi`sucli provisions or'this pennit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPILICANT CERTIFICATION
I have: that the information is
Lender's Address
certify,,that:'t; read.this'application and state above
correct !fI gree to'com�ly with all city and county ordinances and state laws relating
to building constructiph and hereby authorize representatives of this city to enter
upon the inspection purposes. (We) agree to save
indemnify and keepharmlesstheCi �of Cu ertino a ainst liabilities, Jud
' ',
ARCHITECT'S DECLARATION
l.ab:.o,vhe•,; lmaelnti�o:n,e.:d'prolperty ,for
costs; and expenses',i�hieh may accrue against said City in consequence of the
I understand my plans shall be used as public records.
grants ig ofthisipermit Additionally, the applicant understands and will comply
with all' non pom}IS604Iregulations per the Cupertino Municipal Code, Section
Licensed Professional
Signaturell i I! jl ! i,` +; Date
t , .. _: iii m C. r: ! ,. ,�.. •. . I. ..,
>/I
CUPERTONO
❑ NEW CONSTRUCTION
COMMUNITY DEVELOPMENT DEPARTii4ENT o BUILDING DIVISION
10300 TORRE AVEi NUE - CUPERTINO, CA 95014-32:55 )
(408) 777-3228 • FAX (408) 777-3333 - buildinaf cuDertino-ora
❑ ADDITION LTERATION / TI ❑ REVISION /DEFERRED /
- —
PROJECT -ADDRESS -2-3`� Ctl�a+j �� I ORIGINAL PERMIT #
APN
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STRELTADDRESS �LL I�� CITY, STATE, ZIP FAX
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comr.,Cr NAME PHONE
re9 - ?- 34
s EETADDRESS CITY. STATE. GIP 1:; I
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❑ OWNER ❑ OWNER BUILDER ❑ OWNER AGENT W CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TF +IANT
n COIrTRACTORNAME
�
LTC ENS> � � II3�L-R
LICENSE TYPE
BUS. LTC 9
C0 iP.:NY x: '13ir-JlL•liL
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STREET ADDRESS CI7 Y, STATE, ZIP
I' W C C O 57
PHON_
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ARCHITEC r/ENG(NEER NAME LICENSE NUMBER
BUS. LTC
{
i3 COMPANY NA10
L IMIUL
FAX
STRELT ADDRESS _ ` CITY, STATE, ZIP PHONE
DESCRIPTION OF %v IRx =
'
EXISTt(4usC•`fiROPOSED USE CONSIR TTW ST
USE TYPE OCC. SQ -FT- VALUATION (S)
EXIST(,
NEW FLOOR
.DEMO
TOTAL
AREA
AREA
AREA
NETAREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
,
PORCH AREA
DECK AREA
TOTAL DECKMORCH AREA
GARAGE AREA: U DETACH
❑ ATTACH
I
P DWELLING UNITS: ISASECONDUNIT OYES
SECONDSTORV ❑YES '-
BEINGADDED? ONO
ADDITION? [:]No
PRE -APPLICATION OYES IF YES, PROVIDE COPY OF
p(.rLWi ING APPL U ❑ NO PL•LNNING APPROVAL LETTER
IS THE BLDG AN ED TOTAL VALUATION-
EICHLER HOhI
(� B
By my signature below, I certify to each of the fo110 g. I am the property owner or authorized agen o act on the property owner's behalf. I !ave read this
application and Elie information I have provided is coy�ct. I 11a�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 Drize representatives of Cupertino to the
enter above -identified m erq, Foor�inspect�rposes-
Signature of ApplicanUAgent: Date: ��✓ -
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
❑ OVER
El
building(s).- Demolition permit is required prior to issuance of building
-THF -COUNTER
BUILDING PLAN REVIEW
permit for new, building.
❑ rxrRESS
❑ PLANNE113 PLAN RrL-rm1
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
form if anv Hazardous Materials are being used as part of this project. -
El LARGE
❑ FiRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER
submittal of Building Permit application_
DISTRICT
❑ ENVIRONMENTAI.t .AI.TH
B1d&Jpp 201 Ldoc revised 06/21/11
(Ltk+.wl
tA&Vbt
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
NOTE:; This estimate does not include fees due to other Departments (i. e. Planning, Public Works, etre, �'anttary Fewer �tscrtcy �cnoor
District;",`'etc.) J :`These fees are based on the preliminary information available and are only an estimate. Contact the Dept Jor addn'l info.
FEE4TEMS {Fee'Resolution 11-053 E . 7/1/13)
',ADDRESS: 23500 CRISTO REYDR#401F
DATE: 11/30/2015
REVIEWED BY: MELISSAial'
APN:`. 342 53 168
BP#:
'EVALUATION: $3,500
*PERMIT�TYPE:`;`,:. ; Building Permit
.Buildind
PLAN CHECK TYPE: Alteration /Repair
PRIMARY. ,Mulfi-Family Dwelling
USE• `
is
>3 Stori es 0 Yes � No
PENTAMATION 1 RPFIX
PERMIT TYPE:
WORK'
UNIT.# 40.417- REPLACE & UPGRADE E SHOWER PAN VALVE & WALL FINISH
SCOPE
NOTE:; This estimate does not include fees due to other Departments (i. e. Planning, Public Works, etre, �'anttary Fewer �tscrtcy �cnoor
District;",`'etc.) J :`These fees are based on the preliminary information available and are only an estimate. Contact the Dept Jor addn'l info.
FEE4TEMS {Fee'Resolution 11-053 E . 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plaw'Cheek Fee::.::
$0.00
1 #
$10.00
Plumbing
IBPF=URE Fixture set on One Trap
Suppl. PC Fee:. Q Reg., 0 OT
0,0
hrs
$0.00
PME P1an,Check::',
$0.00
Permit'Fee:
$0.00
,.
Suppl: Insp. F(E) Reg. 0 OTF0.0
hrs
$0.00
PNM Unit Fee:
$0.00
P1VIE:Permif Fee:.
$48.00
�.,YC1i1.1Z7"?ACflf?f`�'.�L7JC.; ,
Administrative Fee, :.: . ]ADMIN
$45.00
0
G
Work Without Permit? 0 Yes (D No
$0.00
Advanced Plannidg Fee:
$0.00
Select a Non -Residential
Building or Structure
Travel Documentation Fee: 1TRAVDOC
$48.00
Strom Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS ,;
$142.50
$10.00;
TOTAL FEE:,'11
$152.50
Revised: 10/01/2015