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15120109-FP'4 CITY OF CU PERTINO BUILDING ]PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 406F CONTRACTOR: BAY AREA ENTERPRISE PERMIT NO: 15120109 OWNER'S NAME: LARSON CARL V TRUSTEE & ET AL 2110 MANGIN WAY DATE ISSUED: 12/14/2015 OW 'ER'S PHONE: 6505371523 SAN JOSE, CA 95148 PHONE NO: (408)238 -5043 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL License Class 1" Lic. # ty� UNIT 404E dpi 406E - COMBINE UNITS (OTHER REMODEL AREA 50 S.E.)& AD D 13 RECESSED LIGHTS IN BEDROOM, ^ � �� ,� LIVING Rliril & HALL LIVING Contractor Date Yvl 1 hereby affirm that P.m 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: 1 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: $12000 performance of the work for which this permit is issued. l 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: 34253173.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 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 �� ®� PERMIT ISSUANCE ®� to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property r inspection purposes. (We) agree to save 180 DAYS ZERO C D IN S PECTION. indemnify and keep harmless the C y of Cupertino against liabilities, judgments, costs, and expenses which may ace a against said City in consequence of the ®� granting of this permit. itionall , the applicant understands and will comply a with all non - points urc egulation per the Cupertino Municipal Code, Section 9.18. OOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. if a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. ❑ OW ER- 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 ASS "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 MATER ALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 have read the hazardous materials requi ements under Chapter 6.95 of the California Health & Safety Code, Section 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino unicipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a uld I store or handle hazardous I have and will maintain a Certificate of Consent to self - insure for Worker's material. Additionally, should I use e u p ent or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the y r a Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the no Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Section 255 5, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: i 1 I L 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 CONSTRU T10 LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a cons uctio lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issu (Se . 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 C OO MSTRUC` M pEG°31PUT PPUCAIIOO �v = COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION 10300 TORRE AVENUE o CUPERTINO, CA 95014 -3255 12 CCdD�18fftt�0l�l® (408) 777 -3228 • FAX (408) 777 -3333 • build inq(- cuaertino.or4 115-170 /0 '9 ❑ NEW CONSTRUCTION ❑ ADDITION LTERATION / TI' ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS A �n}� ��6 y APN! �C♦J� �y ff _ 0is ONTIER`ANTE / � � HO, E -MAR. 7 %Q�Pb G C�° ° 8�� l�v a �Q •c�a� STREET ADDRESS �• fl CI we &l� FAX CONTACT NAME IY o PHONE E N C ®( STREET ADDRESS CITY, STATE, ZIP Fkx x110 K Or. Vi ,Y% 51 ❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT C9 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAND I LICENSE NUMBER LICENSE TYPE BUS. LIC COMPANY NAME E -MAIL FAX STREET ADDRESS CITY K STATE, ZIP - '.- 11 h t-4 A — A .'4- 1. I ea l e -C-T' r ARCHITTEC IENGINr_ER NAME LICENSE NUMBER BUS. LIC d COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIIT OF WORK 0 lf�v _' /.' /i 1 I G tt 11 I f �i l �/� �^ r �=f'l l ( NC C t Me EXISTING USE PROPOSED USE CONSTR. TYPE 1 4 STORIES USE TYPE OCC. SQ.FT. I VALUATION (S) F.XISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA L VALUATION: rf;ff behalf. I havL' read this o comply With all applicable local property for inspection purposes. ROUTING SLIP ❑ BUILDING PLAN REVIEW ❑ PLANYING PLAN RENEW ❑ PUBLIC WORMS ❑ FIRE DEPT ❑ SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH 81dgApp_201 Ldoc revised 06121111 ❑ ATTACH q DWELLING UNrrS: ISASECONDUNIT ❑YES SECONDSTORY ❑YES BEING ADDED? ONO ADDITION? ONO PRE - APPLICATION ❑ YFS IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES .� PLANNING APPL N ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? By my signature below, I certify to each of the folio - g: I am the property er or autlwrized agent to act on the property application and the information I have provided is c ct. I ha d the Description of Work and verify it is accurate. I a ordinances and slate laws relating to building con coon. representatives Of Cupertino to enter the above -i f frize Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ❑ OVER- THE-COUNTER _ 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. ❑ EXPRESS Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD _ form if anv Hazardous Materials are being used as part of this project. ❑ LARCE _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR submittal of Building Permit application. L VALUATION: rf;ff behalf. I havL' read this o comply With all applicable local property for inspection purposes. ROUTING SLIP ❑ BUILDING PLAN REVIEW ❑ PLANYING PLAN RENEW ❑ PUBLIC WORMS ❑ FIRE DEPT ❑ SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH 81dgApp_201 Ldoc revised 06121111 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the reliminar information available and are only an estimate. Contact the De t or addn't in o. FEE ITEMS (Fee Resolution 11 -053 Eff. 7/1/131 kL_ 1 ll ]1 up U O IL IK 11 J11N U FEE ]EMMATOR - BUILDING DIVISION QTY/FEE ADDRESS: 23500 CRISTO REY DR #406F DATE: 1211412015 REVIEWEID BY: MELISSA !'h�,.,t,. 1'ir:,z t'h��c APN: 342 53 173 BP #: *VALUATION: 1$12,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi- Family Dwelling USE. Buildina is PENTAMATION 1GENRES >3 Stories Yes (2) No PERMIT TYPE: WORK UNIT 404F & 406F - COMBINE UNITS OTHER REMODEL AREA 50 S.F. & ADD 13 RECESSED SCOPE LIGHTS IN BEDROOM, LIVING RM & HALL NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the reliminar information available and are only an estimate. Contact the De t or addn't in o. FEE ITEMS (Fee Resolution 11 -053 Eff. 7/1/131 FEE QTY/FEE MISC ITEMS M're j ,. r for ( "°hef, -.b !'h�,.,t,. 1'ir:,z t'h��c Elec. Plan Check 0.0 hrs $0.00 $0.00 Elec. Permit Fee: 1EPERMIT :Ll�.�ri . is,.� /f. C1; ir, i'iurub /eJ,c Other Elec. Insp. 0.0 hrs $48.00 hrs it q', T �e: ['!Cc. la , i ec: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the reliminar information available and are only an estimate. Contact the De t or addn't in o. FEE ITEMS (Fee Resolution 11 -053 Eff. 7/1/131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg /Structure 1 or Element of a Building Suppl. PC Fee: (2) Reg. C) OT 0.0 hrs $0.00 PME Plan Check: $0.00 50 s.f. $431.00 Remodel, Other 1REMRESOTH Permit Fee: $0.00 Suppl. Insp. Fee: Reg. OT 0.0 hrs $0.00 16 Electrical $72.00 1 BREA4F'IXT Fixtures, Lighting PME Unit Fee: $0.00 PME Permit Fee: $48.00 TVA"' Administrative Fee: 1ADM1N $45.00 G Work Without Permit? C) Yes E) No $0.00 Advanced Pla! Fee: $0.00 Select a Non - Residential Building or Structure d Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $1.56 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $143.56 $503.00 TOTAL FEE: $646.56 i Revised: 10/01/2015