1512010011
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 41OF
CONTRACTOR: BAY AREA ENTERPRISE
PERMIT NO: 15120100
OWNER'S NAME: CLARK RUTH L TRUSTEE
2110 MANGIN WAY
DATE ISSUED: 12/11/2015
OWN R'S PHONE: 8312069665
SAN JOSE, CA 95148
PHONE NO: (408)238-5043
LICENSE, CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
I
INSTALL 14 (N) RECESSED LIGHTS; CREATE OPENING
License Mass Lic. # 1
FROM DINING ROOM INTO BEDROOM (NON LOAD
BEARING
Contractor )0 oVi ��� Date 1' I'� 11
WALL)
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: $8000
erformance 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: 34253174.00
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 FROM LAST CALLED INS N.
indemnify and keep harmles the City of Cupertino against liabilities, judgments,
costs, and expenses which y accru against said City in consequence of the
4ETI
f 1q I
®
granting of this permit. Ad itionally the applicant understands and will comply
Issued ' '"" Date:�
with all non -point source ulations per the Cupertino Municipal Code, Sectio
9.18. # I
I 1
Date
RE -ROOFS:
Signature
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 BEC kSS "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 MATERIAL DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials rcquireme is under Chapter 6.95 of the
California Health & Safety Code, Sections ' 50 , 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino I nic pal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) sl or Id store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equi nt r devices which.emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Air Quali , nagement District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupe ti Mu . al Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sns 255 lid 25534. t
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date:12 `
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 LE G GENCY
agency
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending 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
❑ NEW CONSTRUCTION
CONSTRUCTION PERMIT APPLICATI®I—' �5 0 \
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-32
(408) 777-3228 - FAX (408) 777-3333 - buildin ertino.o
❑ ADDITION - I LTERATION / TIREVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS �APN
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STREET ADDRESS
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CITY, STATE, ZIP
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT 421"CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
PROPOSED USE CONSTR
LICE NS 1 N iBf R
LICENSE TYPE
BUS. LIC It
COMPANY NAINIEE-I%L41L
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ARCHITECTIENGINEER NAME
-DEMO
LICENSE NUMBER
BUS. LIC it
COMPANY NAL1E
E-MAIL
AREA -
FAX
STREET ADDRESS
NET AREA
CITY, STATE, ZIP
PHONE
D "S PTION OF WORK
N� VJ % q LED +,,co_eS S ec( /Vo/l/ cmc Yl f� rit%G C
EXISTING USE
PROPOSED USE CONSTR
TYPE
S STORIES
'
1
USE
TYPE
OCC.
SQ.FT_
VALUATION (S)
F.XISTG
NEW FLOOR
-DEMO
TOTAL
AREA -
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA
ODETACH
❑ ATTACH
[7AREA:
It DWELLING UNITS:
IS A SECOND UNIT []YES
SECOND STORY []YES
BEINGADDED? ONO
ADDITION? ONO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
ED BY:!LLLJQ/ y
TOTAL VALUAT10- _
PLANNING APPL 11 ❑ NO PLANNING APPROVAL LETTER
EICHLER HOM1IE? ❑ NO
1`
' . =
. - �—
�, LODE
By my signature below, I certify to each of the follo� g: I am the property owner or authorized agent to act on the property owner's behalf I live read this
application and the information I have provided is co ct. I ha 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 con ction. fajWbrize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: i"Date: I
SUPPLEMENTA INFORMATION REQUIRED PLAN CHECK TYPE ROUTING 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 any 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.
❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
❑ EXPRESS ❑ PLANNING PLAN_R_ EVIF.W
STANDARD ❑ PUBLIC WORKS
❑ LARGE ❑ FIRE DEPT
❑ NLNJORI ElSANITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
BldgApp_201 1. doc revised 06/21/11
CITY OF CUPERTINO [51a01()0--1
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 23500 Cristo Rey Dr Unit 410 F
DATE: 12/1112015
REVIEWED BY: PAUL
APN: 342 53 214
BP#:
*VALUATION: 1$8,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
1 hrs
PENTAMATION IREAP11
PERMIT TYPE: 'A
WORK
Install 14 (N) recessed lights; Create opening from dining room into Bedroom (Non load bearing wall)
SCOPE
$0.00
Alech.
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Elec. Plan Check
0.0
1 hrs
$0.00
Suppl. PC Fee: (D Reg. 0 OT
'4
1 hrs
$0.00
PME Plan Check:
$0.00
Elec. Permit Fee:
]EPERMIT
Permit Fee: Hourly Only? 0 Yes (E) No
$0.00
Suppl. Insp. Fee: (2) Reg. 0
OT
10.0-1
hrs
$0.00
Other Elec. Insp.
0.0
-hs
�$4 8. 0 0
$48.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). Iliese.fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resohition 11-053 Af-Z/1/13
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
14 #
$72.00
Electrical
IBREMFIXT Fixtures, Lighting
Suppl. PC Fee: (D Reg. 0 OT
1 0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes (E) No
$0.00
Suppl. Insp. Fee: (2) Reg. 0
OT
10.0-1
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
Administrative Fee:
JADMIN
$45.00
0
G
Work Without Permit? 0 Yes0 No
$0.00
Advanced Planning Fee.
hours
$286.00
Inspections
ISTINSP Inspection, Hourly
G
0
A
Travel Documentation Fee: ITRAVDOC
-$0.00
$48.0G,/
Strong Motion Fee:
IBSEISMICR
$1.04
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS
$143.04,
$358.00
TOTAL FEE:
$501,041
Revised: 10/01/2015
. t)( "S -V 'o f V oao2
RECEIVET)
CUPERTINO
Building Department
y R DEC 11 2015
REVIEWED FOR CODE COMPLIANCE �7
Reviewed By: - ku (m -d
4t, r
OFFICE
15'10° z 7'0" ` ----
This set of plans and specifications MUST be kept at the
job site curing construction. It is unlawful to maka any
c`rhanges or alterations on sane, orto deviate
therefrom, without approval from the Building Official.
Tho stamping of this plan and specifications SHALL NOT
he hold to.porrnit or to be an approval or the violation
o provisions of any City Ordinance or ,Stam Law.
DAT-
E --ffl, — – -
M R t tip,S w EMI H 1 i
3 sob
ems, s jLes
AT RANCHO SAN ANTONIO "
Prr wc4-,tdJreSs -Z3Q00CIr,sj
Hall
c -r -P -j9 Te, 5• -
J-)Og — Z 3 3 --g-
INTERIOR LIVING SPACE
1,090 Square Feet
BALCONY SPACE
110 Square Feet
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/4
s 4dd 5 xe o xle td 0- . v s,,
6 6 move -Q-1-g4ArL,ccLt 10c rLe t�l 0 -Pt
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Lv e,
bg open frj�
MAM
15' 101"MO-
-vin ..Rdo:
M
:14'6"z 11-7-:1
bedroom e rob , m
B
1 1V X, 15'4"
13
Ej
Ln -x '37- ------
op
F
Cit'.'
2 0
4'9'!x 1T6;
t
6'8"- x 5'6" 1
ci
0 -�—!-wltchen 0
x
CUPERTINO -
Building Department
I IMMI DEC I 1 2015
REVIEWED FOR CODE COMPLIANCE
R— INTERIOR LIVING SPACE
410 F 1,090 Square Feet
BALCONY SPACE
IAT RANCHO SAN ANTONIO 110 Square Feet
I Prcw c 4--,Tddves:s
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