B-2016-1265CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1265
23500 CRISTO REY DR UNIT 220E CUPERTINO, CA 95014-6525 (342 54 999) ( BAY AREA
ENTERPRISE)
SAN JOSE, CA 95148
OWNER'S NAME: CRILL PHILIP D TRUSTEE DATE ISSUED: 01/27/2016
OWNER'S PHONE: 650-537-1523 PHONE NO: 408-238-5043
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic. # 1$ 7817 X BLDG X ELECT X PLUMB
Contractor ( BAY AREA ENTERPRISE ) Date 01 /27/2016 —
MECH X RESIDENTIAL -COMMERCIAL
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. JOB DESCRIPTION:
ADD 5 (I) LIGHTS, UPGRADE 18 OUTLETS & 9 SWITCHES.
I hereby affirm - under penalty of perjury one of the following two declarations: UPGRADE BATHROOM FAN & SHOWER PAN, VALVE & FINISH
1. 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.
2e 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
Irl- this permit is issued. Sq. Ft Floor Area: Valuation: $8000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN Number: Occupancy e:
p y TYp
information is correct. I agree to comply with all city and county
342 54 999
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, costs, and PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will
comply with all non -point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION.
Code, Section 9.18.
Issued by: MELISSA N
Signature Date 01/27/2016 Date: 01/27/2016
OWNER- im DER DECLARATION RE -ROOFS.,
I hereby affirm that I am exempt from the Contractor's License Law for one of the 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
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole inspection.
compensation, will do the work, and the structure is not intended or offered
for sale (Sec.7044, Business & Professions Code) Signature of Applicant:
2. I, as owner of the property, am exclusively contracting with licensed Date: 01/27/2016
contractors to construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance, as provided for California Health & Safety Code, Sections 25505, 25533, and 25534. I will
by Section 3700 of the Labor Code, for the performance of the work for which maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
this permit is issued. material. Additionally, should I use equipment or devices which emit hazardous
a. I certify that in the performance of the work for which this permit is issued, I
air contaminants as defined by the Bay Area Air Quali anagement District I
shall not employ any person in any manner so as to become subject tthe will maintain compliance with the Cupertino MyUp4c1pal Code, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of the Health & Safety C e; ge ' 50 533, and 534.
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall Owner or authorized agent:
be deemed revoked. Date: 01/27/2016
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
correct. I agree to comply with all city and county ordinances and state laws
Lender's Name
relating to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Address
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally, the applicant
understands and will comply with all non -point source regulations per the I understand my plans shall be used as public records.
Cupertino Municipal Code, Section 9.18.
Licensed
Professional
Signature Date 01/27/2016
CUPERTINO
❑ NEW CONSTRUCTION
CONSTRUCTION PERMIT APPLICATION—'
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building(i-)cupertino.org'7 / 7
❑ ADDITION 1LTERATION / TI ❑ REVISION I DEFERRED ORIGINAL PERMIT f la
PROJECT ADDRESS`
02 3 Sva ✓l S CZ 2 .
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APN °
OWNER NAMEPI
PROPOSED USE CONSTR
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CONTACT NAMEC
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STREETADDRESS
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CITY. STATE, ZIP FAX
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AREA
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT
W CONTRACTOR ❑ CONTRACTOR AGENT ❑ ' ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANr
CONTRACTOR.NA'MEV `�
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LICE NS ; N i R LICENSETYPE•
BUS. LIC ii
COMPANY NAME
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FAX
STREET ADDRESS
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CITY, STATE, ZIP
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PHON _
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ARCHITECTIENGINEER NAME
LICENSE NUMBER
BUS. LIC
COMPANY NAME
DECK AREA
E-NIAIL
FAX "
STREET ADDRESS
CITY, STATE, ZIP
PHONE
H DWELLING UNITS:
IS A SECOND UNIT []YES
DESCRIPTION OI: W RK /
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EXl SE
PROPOSED USE CONSTR
TYPt
RST
USE TYPEOCC_
SQ.FT_
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REN40DEL AREA
REMODEL AREA
REMODEL AREA
a
PORCH AREA
DECK AREA
TOTAL DECKNORCH AREA
GARAGE AREA: LJDETACH
❑ ATTACH
I
H DWELLING UNITS:
IS A SECOND UNIT []YES
SECOND STORY []YES
BEING ADDED? []NO
ADDITION? ❑ NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
ED BY: TOTAL VALUATION:
PLANNING APPL U []NO PLAi`INING APPROVAL LETTER
EICHLER HOSIE? ❑ NO�-
3
By my signature below, I certify to each of the follow g: I am the property owner or authorized agent to act roperty owner's behalf. I h e read this
application and the information I have provided is co et. I havcjead the Description of Work and verify -Ws accurate. I agree to comply with all applicable local
ordinances and state laws relating to building cons ction. I a prize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/AgenC Date: ; % _ 2-0 2_a, ! 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(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRrsS
❑ PLANNING PLAN Rr%`1UW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
11 STANDARD
❑ PUBLICWORKS
form if anv Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
Bldgflpp 201 Ldoc revised 06121/11
CITY OF CUPERTINO
[P—M7 FF,E ESTIMATOR — BUILDING DIVISION
Heck l'='an Plumb. Plan Check 10.0 1 hrs $0.00 Elec. Plan Check 10.0 1 hrs $0.00
''>:f'C7i. 1'c>ri=t7t It-�-:• Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: IEPERMIT
Other Plumb Insp. LLO hrs $48.00 Other Elec. Insp.El hrs $48.00
ili/eC:c7(. Phonb, liuf, Fee 17ci, Ir.ct), Fe,':
NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Selver District, School
n:ch•;rt otr 1 Thoco foot m•o hacod an tho n olinjinary infarsnation availahle and are Only an estimate. Contact the Dent for addn'1 into.
FEE ITEMS (Fee Resolution 11-053 E . 7/1113)
ADDRESS: 23500 CRISTO REY DR 220E
DATE: 01/27/2016
REVIEWED BY: MELISSA
MISC ITEMS
APN: 342 54 999
BP#:
*VALUATION: 1$8,000
*PERNM TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 REAP1
PERNUT TYPE:
WORK
ADD 5 N LIGHTS, UPGRADE 18 OUTLETS & 9 SWITCHES. UPGRADE BATHROOM FAN &
SCOPE
SHOWER PAN, VALVE & FINISH
Heck l'='an Plumb. Plan Check 10.0 1 hrs $0.00 Elec. Plan Check 10.0 1 hrs $0.00
''>:f'C7i. 1'c>ri=t7t It-�-:• Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: IEPERMIT
Other Plumb Insp. LLO hrs $48.00 Other Elec. Insp.El hrs $48.00
ili/eC:c7(. Phonb, liuf, Fee 17ci, Ir.ct), Fe,':
NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Selver District, School
n:ch•;rt otr 1 Thoco foot m•o hacod an tho n olinjinary infarsnation availahle and are Only 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
= # Electrical
$83.00 IBREMZECEP
Recep/Switch/Outlets
Suppl. PC Fee: (j) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
0 Electrical
$72.00 1 IBREA=T
Fixtures, Lighting
Pen -nit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q
OT0
0
hrs
$0.00
1� Electrical
$25.00 1ERESAPP
Appliances
PME Unit Fee:
$0.00
PME Permit Fee:
$96.00
0 # Plumbing
$10.00 IBPFIXTURE
Fixture set on One Trap
f.."Onsfruc;tion I'm(
I
T
Administrative Fee:
1ADMIN
$45.00
0
G
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a
Non -Residential
Building or Structure
0
i
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee:
IBSEISMICR
$1.04
Select
an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$191.04
$190.00 TOTAL; FEE:
$381.04
Revised: 01/01/2016
PURPOSE
'SMOKE I ` ARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMP. ANCE
COMMUNITY DEVELOPMENT DEPARTMENT •'BUILDING DIVISION
10300 TOR'RE AVENUE • CUPERTI'NO, CA 95014-3255
(408) 777-3228 o FAX (408) 777-3333 • building oftupertino.mg
-. _6W -eke: ,�' _ �Carizou-Mono�zde•
PERMIT CANNOT BE FINALED A COMPLETED UNTIL THIS CERTIFICATE
HAS E ��" C° OD
OWW D `SII+ 13I7CIrIIIRv DII
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATIOI
Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
X
X
On every level of a dwelling unit including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in. the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section 8314 and CBC Sections 907.2.11.4 and 420-.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and Calffonua Residential Codes, The alarms have been tested and are operational, as of the date signed
below.
G
I hava read and agree to: comply with, the teems and condifiam of this statement
Smoke mid CO fonm d'ac revised 03/1t8110
na% ......... --.'f............. 3at
.......... ........... ..............
Contracfor t�lamec
Sanature. ..... ...... ....,... ......L�3 :...... D.afe`
Smoke mid CO fonm d'ac revised 03/1t8110
CUPERTINO
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
40477_7-3228 FAX (408 7 3333 buildingAcuper inq,o ffi f
Owner Name (r'
Permtt Noy.
Addressl�l`''�
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
L -
7[a -No Go to Question 2.
2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its
plumbing, installation of water -conserving plumbing fixtures is not technically feasible?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
,J0 No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
I/ Yes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign _
bottom of form..
5. Please check ONE of the following:
My property is a single-family residential real property. See Civil Code Section 1101A
On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures
to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non-
compliant plumbing fixtures shall be replaced with water -conserving plumbing; fixtures (regardless of whether
property undergoes alterations or improvements).
0 My property is a. multifamily residential real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water -
conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
❑ My property is a commercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non—compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements).
I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's
installation requirements, and that the wa serving plumbing fixtures comply with the requirements as indicated in the
table on the following page.
0 Owner or Owner Agent's Signature;' Data: ` 2 `<5 `1(�
completing and signing this Certificate, please return it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08/26115