15120108CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 403E CONTRACTOR: BAY AREA ENTERPRISE PERMIT NO: 15120108
fucense
AME: SUMMIT ROGER K TRUSTEE & ET AL 2110 MANGIN WAY DATE ISSUED: 12/14/2015
NER'S PHONE: 6505371523 SAN JOSE, CA 95148 PHONE NO: (408)238-5043
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E]COMMERCIALUNIT 403E & 405E - COMBINE UNITS (RECONFIGURE 200
Class Lic. # S n q � q S.F.), REMODEL KITCHEN (4033 ONLY -120 S.F.) & ADD
Contractor
1 Date l� 16 RECESSED LIGHTS IN BEDROOMS
I hereby affirm that I am licensed under t e provisions of 6aptcr 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
performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $35000
°j I have and will maintain Worker's Compensation Insurance, as provided for by
a Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 34253152,00 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 -PE- II 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 DAA' -S FROM LAS ED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the Date:
granting ofthis permit. A ditionally, the applicant understands and will co m ss_
with all non -point source r gulations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS
SignatureJV__
Date ; 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 BE CLASS "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 roe y g HAZARDOUS MATERIALS DISCLOSURE
property, rty, am exclusive] contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Hearth & Safety Code, Sections 25505, 25 33, and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipa -ode, Chapter 9.12 and the
declarations: Health &Safety Code, Section 25532(x) should I re or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the BayArea Ai Ouality Management District I
performance of the work for which this permit is issued. will maintain compliance with the . rtino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections Cu205, 2 ,.and 25534.
1 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 1 Date: ( r
Owner or authorized agent:
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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code; I must I hereby affirm that there i a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's forr 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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
CONSTRUCTION IT APPLICATION—'
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPER 1 INO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buiIdina €tiz cue€ iiro.oro
CION ❑ ADDITION N TERATION 1 TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
--
MPN- #
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0117NEt NAME PHONE
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STREETADDRESS SA A C 3TA
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CONTACT NAME ..- _ E-MAIL
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STREET ADDRESS. -
d yt ' CITE', STATE; ZIP , FAX
K T- Si
OWNER 11 OWNER -BUILDER ❑ OWNERAGENT ia CON"IRACTOR ❑ CONTRACTOR AGENT 13 ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CON'TRACTOR NATME
l'
-
CE
LINSE NUMBER
L17 R11
LICENSE TYPE
BUS. LIC #,
C01UPANY NASTE. - t
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a re c� n 5 �'� d �.► _� o
FAX
STREET ADDRESS . CITY, STATE, ZIP
PHON r1
ARCHITECTlENGINEER NAME LICENSE NUMBER
BUS. LIC a
COMPANY NAME
E-MAIL _ -.
FAX
STREET ADDRESS
CITY, STATE; ZIP
PHONE
DESCRIPTION OF WORK
CreAt h*/l alq 4..-.Apve.e A "#'r ,l
09ee *Tee .e.' 4-tr. AX -4 P -e ,v t An �e I `ye ' e% se
r,
&A6 Co A, -w n 6cfst,ed, De ?,v la.W
EXISTING USE
PROPOSED USE
CONSTR. TYPE
II STORIES
- -
-
I
USE TYPE OCC. SQ.FT;
VALUATION ($)
F.XISTG
AREA
NEW FLOOR
AREA
-DEMO
AREA
'TOTAL
NETAREA
-
BATHROOM MCHEN -OTHER
REMODEL AREA REMODEL AREA jr REMODEL AREA'00 0
PORCH AREA
DFCK AREA
TOTAL DECKIPORCH AREA
- GARAGE AREA: DETACH
❑ ATTACH..
# DWELLING UNITS:
TSA SECOND UNIT OYES
SECOND STORY OYES
-
BEINGADDED? ONO
ADDITION? ONO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
PLANNINGAPPL II ❑NO PLANNING APPROVAL LETTER
IS THE BLDG AN IZE _ VALUATION_
EICHLERHOME?��T
®
By my signature below, I certify to each of the follow' r g: I am the property owneutllori• e property owner's behalf. I have this
application and the information I have provided is c t I ha ead the Description$€V�K td verify it is accurate. I agree to.comply with all applicable local
ordinances and state laws relating to building con ction. I a Drize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant(Agent: D i .a ! • J D r 2 0/ "
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIT'
❑ OVEi?'-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.
❑ r_xPRrss;
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs; Provide a completed Hazardous Materials Disclosure
❑ STANDARD
ElPUBLIc 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 PIanning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application-
❑ ENVIRONMENTAL HEALTH
Bldg4pp_201 Ldne revised 06/21/11
CITY OF CUPERTINO
low Fi F.'P '.CTT1Vf ATnR _ RITIT ,IIING DIVISION
ADDRESS: 23500 CRISTO REY DR #403E
DATE: 12/1412015
REVIEWED BY: MELISSA
$0.00
APN: 342 53152
BP#:
VALUATION:
1$35,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE:
Alteration / Repair
PRIMARY
Multi-Famil Dwellin
USE: Y 9
Buildina is
>3 Stories Yes No
PENTAMATION
1 R2REM
PERMIT TYPE:
WORK
UNIT 403E & 405E - COMBINE UNITS RECONFIGURE 200 S.F.),REMODEL
KITCHEN 40
SCOPE
ONLY -120 S.F.) & ADD 16 RECESSEDLIGHTS IN BEDROOMS
Administrative Fee:
District, etc.. These ees are based on the preliminary
FEE ITEMS (Fee Resolution 11-053 Eff. 711/13)
Plan Check Fee:
$0.00
Suppl. PC Fee. Reg. 0
PME Plan Check:
OTT 0.0hrs
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. Q
OT
0,0
Elec. Plan Check
0.0
hrs
$0.00
Administrative Fee:
]ADMIN
Work Without Permit?
Yes (F) No
Advanced Planniq F.
Travel Documentation Fee:
Strong ]Motion Fee:
1TRAVDOC
IBSEISMICR
Bldg Stds Commission Fee:
IBCBSC
SUBT()TAL�:
Elec. Permit Fee:
IEPERMIT
,.
Other Elec. Insp.
O.Q
hrs
$48.00
-
,: �,,.•,•r.. •r�. e,. ,......__,..,..-a,,,... ,...,,. ;H,.�...7 fn�� dein M nfhar nannrtnnontc (i. e. Plannine. Public Works, Fire, Sanitary Sewer District, School
District, etc.. These ees are based on the preliminary
FEE ITEMS (Fee Resolution 11-053 Eff. 711/13)
Plan Check Fee:
$0.00
Suppl. PC Fee. Reg. 0
PME Plan Check:
OTT 0.0hrs
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. Q
OT
0,0
.hrs
PME Unit Fee:
$0.00
PME Permit Fee:
Administrative Fee:
]ADMIN
Work Without Permit?
Yes (F) No
Advanced Planniq F.
Travel Documentation Fee:
Strong ]Motion Fee:
1TRAVDOC
IBSEISMICR
Bldg Stds Commission Fee:
IBCBSC
SUBT()TAL�:
+rmation available and are only an estimate. Contact the Dept for addn'l
FEE
QTY/FEE
1, MISC ITEMS
$0.00
120 s.f.
Remodel, Kitchen (<=300 sfl
IREMRESKIT
$0.00s645.00
$0.00
200 s.f.
$431.00
Remodel, Other
IREMRESOTH
$0.00
$0.0016
Electrical
$72.00 IBREMF= Fixtures, Lighting
$0.00
$48.00
$0.00
$0.00
$48.00
$4.55
$2.00
$147.55 $1,148.00
Select a Non -Residential
-� Building or Structure
Select an Administrative Item
$1,295.55"I
In
/n4 171)1 L:
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