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B-2016-1615CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1615 23500 CRISTO REY DR UNIT 330E CUPERTINO, CA 95014-6529 (342 53 127) BAY AREA ENTERPRISE SAN JOSE, CA 95148 OWNER'S NAME: GOTT HERSCHEL L TRUSTEE DATE ISSUED: 03/28/2016 OWNER'S PHONE: 650-537-1523 PHONE NO: (408) 238-5043 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #817817 Contractor BAY AREA ENTERPRISE Date 03/31/2017 X BLDG _ELECT _PLUMB X 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: UPGRADE 2 (E) BATHROOM FANS I hereby affirm under penalty of perjury one of the following two declarations: t. 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. 2. 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 this is issued. permit Sq. Ft Floor Area: Valuation: $1000.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 34253 127 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 expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applicant underst�ds and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulatioonns- er . e iCertino Municipal Code, Section 9.18. 180 DAYS FROM LAST C {�ED INSP CTION. Signatures Date 03/28/2016 1 % C Issued by: ALEX VALLELUNGA 1 Date: 03/28/2016 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is t. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) z. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 03/28/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California. Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the s. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardousld,u shall not employ any person any manner so as to become subject tthe material. Additionally, shouse equipment or devices which emit hazardous air contaminants as d�n y theyB y Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with,t elf"-CTpertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the JTeaIth &Safety Co tions 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed -- - revoked.��— Owner_oatatl�as_rrta- APPLICANT CERTIFICATION 10a e: 0� 3/28/2016 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 03/28/2016 Professional �gt79'rs CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT s BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 CUPER'TINO I (408) 777-3228 • FAX (408) 777-3333 - building(a—)cupertino.org Z- 2�51(e - I La IS "NEW CONSTRUCTION ❑ ADDITION TERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS ; 3s�� APN # 3 L/ / OWNER NAME T �^} I PHONE E-MAILa'2 T %@ lf6v-u to ✓�V SC C6 P%tS�.3 Fr a ar. e STREETADDRESS�� %\ CI ow l V qtr +:' fro C q / CONTACT NAME G PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ZllC P an ' SS �1 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT pa CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME-Gr II.� Fet LICENSE NUMBER LICENSE TYPE BUS. LIC # C28-2 �73 COMPANY NAME -13 E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP ti 1 d e 5-7 8 PHONE Yo - 2-3 0 y a ARCHITEC (ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAI, FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK n C � Q VV EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES 1 USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA 1 BATHROOM KITCHEN OTHER ' REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: 0 DETACH ❑ ATTACH I H DWELLING UNITS: IS A SECOND UNIT OYES SECOND STORY ❑YES BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL 11 NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO RECEIVED BY: TOT41,- VALUATION: R --, ❑ ,Q[/o By my signature below, I certify to each of the follow" lg. I am the property owner or authorized agent to act on the property owner's behalf. I ave read this application and the information I have provided is co ct. I hav ead the Description of Work and verify it is accurate. I agree to comply -wilh all applicable local ordinances and state laws relating to building con ction. T a orize representatives of Cupertino to enter the above -identified pro erty-f Inspection p rposes. Signature of Applicant/Agent: SUPPLEMENTA INFORMATION REQUIRED PLAN CHECI TYPE ROUTRQG 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. ❑ _ Ea -PRESS ❑ PLANNING PLAN REWEw _ 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 ❑ XIAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp 2011.doc revised 06121111