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B-2016-2243CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2243 23500 CRISTO REY DR UNIT 317D CUPERTINO, CA 95014-6528 (342 53 096) BAY AREA ENTERPRISE SAN JOSE, CA 95148 OWNER'S NAME: BRAUNGER BETTIE B TRUSTEE DATE ISSUED: 06/30/2016 OWNER'S PHONE: 650-537-1523 PHONE NO: (408)238-5043 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #a17817 Contractor BAY AREA ENTERPRISE Date 03/31/2017 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: INSTALL (6) (N) LED LIGHTS; REPLACE (2) BATHROOM FANS; I hereby affirm under penalty of perjury one of the following two declarations: UPGRADE (23) OUTLETS & (9) LIGHT SWITC ' ES. 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. �22. 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 permit is issued. Sq. Ft Floor Area: Valuation: $3000.00 APPLICANT CERTIFICATION 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 342 53 096 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. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non -point source regulations per t " peruno Municipal Code, Section 9.18. 180 DAYS FROM LAS CAL .ED INSPECTION. r Sig`Sig e�Az�. Date 6/30/2016 Issued by: Alex Vallelunea ? y Date: 06/30/2016 ;, OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS,- E-ROOFS:following followingtwo reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I. agree to rmove allnew materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. 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: 6/30/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL IdOOF COVERINGS TO BE CLASS " "'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 DIS SURE 2. I haveand will maintain Worker's Compensation Insurance,. as provided for by I have read the hazardous materials requiref05, der 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 2533, and 25534. I will permit is issued. maintain compliance with the Cupertino Muni de, Chapter 9.12 and the -e 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(x) sho or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment es which emit hazardous air contaminants as defined by the Bay rea AQuality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cup tino M1 Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health &Safety Co ; ns 2� 33, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or-authorized-ageJ: Date: 6/30/20T6 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is MNSR CTION LE AGENCY I hereby affirm that there is\a construction lending, agency for the performance 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' 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 MunicipalARCHITECT'S DE LARATI LN - Code, Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 6/30/2016 Professional >, F CONSTRUCTION PERMIT APPLICATION- COMMUNITY DEVELOPMENT DEPARTMENT a BUILDING DIVISION mufti 10300 TORRE AVENUE a CUPERTINO, CA 95014-3255 CUPEFi"I'INO (408) 777-3225 • FAX (408) 777-3333 , buifdinig0eulsertino.oLa J-Soltv-2204�3 El NEW CONSTm[ unw ❑ ADDITION TERATION f Ti ❑ REVISION 1 DEFERRED t3RIGINAL PERM£I' it PROTECT ADDRESS.... APN # ".. OWNER NAME _ -. - Omni HONE 3 050-5317- E-MAiL _.. 'T & 4R f6Y4 M SC g dna % t3- - 15"2.3 . f e � .e •cart STREET ADDRESS e, CITY, STATE, 23P (o ay ..�, s „ ,,, (r (NIAI FAX CONTACT NAME ire Fe ' S't PHONE q804- 23 a -S bO3 E D re -�et3 C attii -STREET ADDRESSCITY, .m STATE; ZIP FAX Zile> r G� s s-j O OWNER :O OWNER-BUILDER © OWNERAGENT � CONTRACTOR ❑CONTRACTORAGENT 13 ARCHITECT 0 ENGINEER ❑ DEVELOPER ❑ TENANT CO FTRACTORNAME LICENSENUMBER LICENSETYPE BUS. LIC ff ,2R2 t73COMPANYNAAg `5 E-MAIL - .Gr rte -C41 Q Y�2f, K +r a -C- C IS STREETADDRESS CITY,STATE,ZSP ` ST 8 PFID 0o Z3 ?-%10 > - ARCHITECUENGINEER NAME LICENSE NUMBER BUS. LIC #. COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESC TION OF WORK ., N#.ct LEE D iZa �vea roil 3..%ectvrC }ea YeSeS�'w� b ale°fs t — Yrl� ji"Ih rw4cLt EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC_ SQ.FT. " V kLUATION (S) EXISTG NEW FLOOR DEMO.. TOTAL AREA AREA AREA NETAREA BATHROOM T KITCHEN OTHER - REMODELAREA REMODEL AREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA DETACH O ATTACH # DWELLING UNITS_ ISASECONDUNIT OYES BEINCADDED? ONO SECONDSTORY OYES ADDITION? ONO PRE-APPLICATION AYES IF YES, PROVIDE COPY OF IS THE BLDG AN OYES RECEIVED BY:- -.-. it e TOTAL VALU TION' PLANNINGAPPLff ONO PLANMNG APPROVAL LETTER EICHLERHOPME? ONO By my signature below, I certify to each of the folio g: I am the property owner or authorized agent act an the pr$perty owner's hehalf i have re this application and the information I have provided is c ct. I ha ead the Description of Work and verify it is accurate. I agree i to comply with all APO ble local ordinances and state laws relating to building con ction. a Drize representatives of Cupertino to enter the above-identified property for inspection purposes- Signature of Applicant/Agem: SUPPLEMENT INFORMATION REQUMD PLWCH ECKTYPE ROUT]NGI SLYP [j OVER TjIIE-CCOUNTFR MRUILDWGPLANREVIEW 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. CI TLANNING PLAN .. ., Commercial Bldgs: Provide a completed Hazardous Materials Disclosure .0 _ STANDARD ❑ PURLIC WORKS _ form if any Hazardous Materials are being used as part of this project. I AxcE 0 FIRE DST Copy of Planning Approval letter or Meeting with Planning prior to El MAJOR_ CI 'saNtT RY sew DlsTiucT sub_mittal of Building Permit application. i ENVEILONMENTA HEALTH BldgApp 2011.doc re ,ised Ob/21/11