B-2016-1454CITY OF CUPERTINO BUILDINGG PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1454
23500 CRISTO REY DR UNIT 309F CUPERTINO, CA 95014-6527 (342 54 999)
( BAY AREA
ENTERPRISE)
SAN JOSE, CA 95148
OWNER'S NAME: HECKMAN JANE L TRUSTEE
DATE ISSUED: 03/07/2016
OWNER'S PHONE: 650-537-1523
PHONE NO: 408-238-5043
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lic. # 17897
Contractor (_ BAY AREA ENTERPRISE) Date Q3/07/16
X BLDG X ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
X MECH X RESIDENTIAL _ COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
UNIT 309F- 7 (N) LED RECESSED LIGHTS, 2 BATHROOM FANS,
ereby affirm under penalty of perjury one of the follo9wing two declarations:
IREPLACE
22 (E) ELECTRICAL OUTLETS AND 12 (E) LIGHT
r. I have and will maintain a certificate of consent to self -insure for Worker's
SWITCHES
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
z I have and will maintain Worker's Compensation Insurance, as provided for
by Section 3700 of the L or Code, for the performance of the work for which
this permit is issued.
Sq. Ft Floor Area:
Valuation: $3000.00
APPLI T E IFICATI N
I certify that ,I have read this application and state that the above
APN Number:
Occupancy Types
information is correct. I agree to c mply with all city and county
ordinances and state laws relatin to building construction, and hereby
342 54 999
his c y to enter upon the above mentioned
authorize represenerpd
property for inspeces. We) agree to save indemnify and keep
harmless the City o aga n'P li ''judgments, costs, and
PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which maga' aid City in consequence of theWITHIN
granting ofthis penall� the applicant understands and willcomply
180 DAYS OF PERMIT ISSUANCE OR
with all noc r ulations per the Cupertino Municipal
180 DAYS FROM LAST CALLED INSPECTION.
Code, Section 9.1Issued
by: ABBYAYENDE
SgnatureDate 03/07/16
Date: 03/07/16
OWNER -BUILDER DF LARATION
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
following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
r. 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: 03/07/16
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
r. 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 C pter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety Code, Sections 25505, 25533, a d 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, C apter 9.12 and the
this permit is issued.
Health & Safety Code; Section 25532(a) should I store or angle hazardous
3. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices w ich emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay M nagementDistrictI
Worker's Compensation laws ofCalifornia. If, after making this certificate of
#A*Quty
will maintain compliance with the Cuperl Co e, Chapter 9.12 and
the Health & Safety Code, Sec533 and -25534.
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
w n
Owner or authorized agent:
be deemed revoked. r'
Date: 03/07/16
JC
APPLICANT CERTIFICATIONCONSTRUCTION
L G AGE
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construpg6n len ing age cy for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is iss ed (Sec. 3097, iv C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant
ARCHITECT'S DECLARATION
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
Signature Date 03/07/16
Professional
I
CONSTRUCTION PERMIT APPLICATIO�--"
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORREAVENNUE - CUPEUINO, CA 95014-3255
CUPERTIfSIO (408) 777-3226 - FAX (408) 777-3333 - buildingecupertino.oEg
NENNI CONSTRUCTION 0 ADDITION TERATION/TJ 0 REVISION /DEFERRED ORIGINAL PERP&T #
B
PROJECTADDRESS'APMA
a3 ZOO an�J-b Pr
OAV%T-P "'Amr PHONE EMAIL
-a4hey-0awck:ka)
4
STREETADDRESS ZIP FAX
&I S—W.-_l�f pl&4 41-,Wn CA 1-/ 1
CONTACT NANIE E-MAIL
r ye st 1, C-0
69 1,P q�_-
STREETe DDRESS J CITY, STATE, W FAX
I-JC.VAr44'V%
V
r7lAXVNrR-r.TzNT LerGNTRACToR OCONTRACTOR AGENT 13 APcHrfEcT 0 ENGINEER 0 DEVELOPER 0 TENANT
Li
CONTRACTOR NANME E NUMBE-R.
6t,e Fe t'!5
-
CONSM TYYE
BUS-Licii
C2 12 �7 3
COINIPANY NAIU
L-NLUL
FAST
Q Lt A Y'e C' 1E
--
VALUATIONS)
EXISTG
AREA
STREET ADDRESS"'
-JPHO
C1TY'STATE,zf'P
Pok:'! - OY3
Q
ARCHITEMENG WEER NAME
LiCENSENtIMBER
BUS. LIC
COMPANY NAME
E-NIt
FAX
STREET ADDRESS
CITY S,ZIP
PHONE
DESCRIPTION OF
L
T Z
-- -
PROPOSE—USE
-
CONSM TYYE
11 — -
#Sf
-
USE
I
TYPE
--
occ.
- -- - -
SQX-T-
--
VALUATIONS)
EXISTG
AREA
NEW FLOOR
AREA
-DE310
AREA
TOTAL
NET AREA
BATHROOM KITCHEN
REMODELAREA REMODEL AREA
OTHER
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: ODETACH
[ATTACH_
11DWELLING UNITS:
ISASECONDUNIT OYES
BEINGADDEIJ? ONO
SECONDSTORY r1YES
ADDITION? ONO
PRE -APPLICATION OYES IF YES, PROVIDE COPYOF
ISTHEBLUGAN 11 YES
-C-LERHONIF? 0 NO
RECEIVED BY-
L
PL-ANNINGAPPI.9 ONO PLANNING APPROVAL LETTER
By my signature below, I certify to each of the 15, 11 1 am the property Owner Or authorized agent to act on the properLy ovaieils behalf. I have read this
local
010 all applicable
application and the information I have provided is r, ci. I ha the Description of and verify it is accurate, I agree to comply with
IqWorize representatives of Cupertino to enter the a ove-i enV e prop y for purposes -
I b id 'fi d M orinspe t
�Wvti
ordinances and state laws relating to building cons ion.
1�
J�--
-7— —2--10 4
41
Signature of Applicant/Agent:
SUPPLEMENT 4(L INFORMATION REQUIRED
PLAN CHECK TM
I
ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
C3 BU-ILDINC. PLAN REVMV
F0OVE:R-THF&-001UJNTE-R
existing building(s)- Demolition permit is required prior to issuance of building
'SS
rxPnESS
" RE
GI TLXNI,1ING PL.AIN Rr1='VV
pen -nit for new building.
,
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
PUBLIC NVORKS
form if any Hazardous Materials are being used as part ofthis project.
0 LARGE
0 r1RE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
0 NWOR
0 SANITARY SEWER DISTRICT;u-Fmnitta!
of Building Permit application.
ENVIRONIVIENTAL HEALTH
BldgApp--201 Ldoc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
23500 CRISTO RAY DR
DATE: 03/01/2016
REVIEWED BY: ABBY
JI&IADDRESS:
APN: 342 53 135
BP#: B-2016-1454
`VALUATION:
1$3,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: Multi -Family Dwelling
Buildina is
>3 Stories 0 Yes (E)No
PENTAMATION
PERMIT TYPE: 1 REAP11
WORK
UNIT 309F - 7 N LED RECESSED LIGHTS, 2 BATHROOM FANS, REPLACE 22 E ELECTRICAL
SCOPE
OUTLETS AND 12 (E) LIGHT SWITCHES
Mech. Plan Check 1 0.0 1 hrs $0.001 1111u h, Ilian C'iaec!,
Mech. Permit Fee: IMPERMIT I
Other Mech. Insp. 1 0.0 1 hrs 1 $48.00 O hay .t" armor Irt.sn
�?<:t;z Irr ,t�. �°t°�:°: I �"�r,r,•i",. 1r s�� F;`csc;
NOTE: This estimate does not include fees due to other Departments (Le.
Elec. Plan Check 10.0 1 hrs $0.00
Elec. Permit Fee: 1EPERMIT I
Other Elec. Insp. 0.0 hrs $48.00
IDec:. hts'12.111ee.
Public Works, Fire, Sanitaiy Sewer District, School
Dkfa inf of, 1 Th—a foot nra hacad nn tho nrolinfinnry informatian avoilahle and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$72.00
Electrical
1BREMFIXT Fixtures, Lighting
Suppl. PC Fee: Q Reg. 0 OT0.0
hrs
$0.00
PME Plan Check:
$0.00
=
$118.00
Electrical
I 1BREMRE'CEP Recep/Switch/Outlets
Permit Fee:
$0.00
Suppl. Insp. Fee:(E) Reg. 0 OT
0.0
1 hrs
$0.00
0 # Mechanical
$144.00 1MRAPFVNT Vent, Appliance (only)
PME Unit Fee:
$0.00
PME Permit Fee:
$96.00
Gonstruciion Tax:
F
Administrative Fee: IADMIN
$45.00
L
O
E
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
Travel Documentation Fee: ITRAVDOC
$48.00
Strom Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
� SUBTOTALS
$190.50
$334.00
TOTAL FEE �
$524.50
Revised: 01/0112016