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B-2016-2936CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2936 23500 CRISTO REY DR UNIT 301D CUPERTINO, CA 95014-6526 (342 53 086) BAYAREA ENTERPRISE SAN JOSE, CA 95148 OWNER'S NAME: MCCALEB JOYCE D TRUSTEE DATE ISSUED: 10/18/2016 OWNER'S PHONE: 650-537-1523 PHONE NO: (408) 238-5043 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lie. # 17 17 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: UNIT 301D; UPGRADE OUTLETS, SWITCHES (33); BATHROOM I hereby affirm under penalty of perjury one of the following two declarations: FANS (2)' RECESSED LIGHTS (5) 1. I have and will maintain a certificate of consent to self -insure for Worker's REV # 1 - ADD (10) ADDITIONAL RECESSED LIGHTS - ISSUED Compensation, as provided for by Section 3700 of the Labor Code, for the 12/16/16 performance of the work for which this permit is issued. 2. ( //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 Sq. Ft Floor Area: Valuation: $2100.00 permit is issued. 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 342 53 086 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 th pertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature"" Date 12/16/2016 Issued by: N OWNER -BUILDER DECLARATION Date: 10/18/2016 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 fust 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) 2. I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 12/16/2016 1 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 a. I certify that in the performance of the work for which this permit is issued I Health & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject tthe air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: , APPLICANT CERTIFICATION Date: 12/16/2016 I certify that I have read this application and state that the above information is LENDING 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 of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city 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, Lender's Address judgments, costs, and expenses which may accrue against said City in 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 I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 12/16/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI Ji=VI' SIO DEFERRED ORIGINAL PERMIT # PLOJECT APDRESS APS # a ®e�; OWNE NGAM�G�� PHONE E-MAIL S T ADDRESS y¢ CITY, STATE, ZIP n q FAX CONTACT NAME /yam g HONE 2` ! J �M+A p� �y G T G/ STREET ADDRESS - .Q• OVkV,4K IC? E,ZIP� 6 FAX ❑ OWNER ❑�OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR . ❑I CONrRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTtACTOR N LICEN?E NUMB -7 LIGE TYPE BUIL{ C C PANYNAME �% _ �✓,�p�_ _// .�Q r /E-�L_ % FAX STREET ADDRESS A/J ,Q If ¢ /� _ 2 f6 /04Ifl+ /0��%u CITY, STATE, ZIP 2,7f Z111iZ5�" PHO7Z,6r a ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANYNAME E-MAIL FAX STREET ADDRESS' CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 1-16/f T"5- TO Q 624 e7 EXISTING USESQ.FT. PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑NO ADDITION? PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE AN ❑ YES IVED BY: - , TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is co ect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b ' c ion. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: / — / SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP" 0 OVER-THE-COUNTER BUILDINGPLANREVJEW _ 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. 0 EXPRESS Q PLANNING PLAN REVIEW " _ 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 D FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to p MAJOR SANITARY SEWERDISTRICT submittal of Building Permit application. 0 ENVH26NAIENTALHEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 301E CUPERTINO, CA 95014-6526 (342 53 108) CONTRACTOR: BAYAREA PERMIT NO: B-2016-2936 ENTERPRISE SAN JOSE, CA 95148 OWNER'S NAME: HART NORMAN J TRUSTEE DATE ISSUED: 10/18/2016 OWNER'S PHONE: 650-537-1523 PHONE NO: (408) 238-5043 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. # 17 17 Contractor BAYAREA 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: I hereby affirm under penalty of perjury one of the following two declarations: UNIT 301E; UPGRADE OUTLETS, SWITCHES (33); BATHROOM FANS (2); RECESSED LIGHTS (5) i. I have and will maintain a certificate of consent to self -insure for Worker's q Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.. 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: $2100.00 APPLICANT CERTIFICATION certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 34253 108 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 this permit. Additionally, the applicant nderstands and will comply with af non -point all source regulations per t�Cuppeert rLg-M: • ', ' 1 Code, Section 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Signature ` Date 10/18/2016 Issued by: MELISSA NAMES Date: 10/18/2016 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 i. 1, 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: 10/18/2016 I hereby affirm under penalty of perjury one of the following three declarations: i. I have and will maintain a Certificate of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 3. 1 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 hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air QnalitrManagement District I will maintain compliance with the Cupertino Moral Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sectt6nsZ5505, 25533a 534. Labor Code, I must forthwith comply with such provisions or this permit shall � ` be deemed revoked. Owner or authorized agen : i.°°"'� ,�.. �'��•�� APPLICANT CERTIFICATION (110a te: 10/18/2016 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. Signature Date 10/18/2016 Licensed Professional CONSTRUCTION PERMIT PCI - COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION w— 10300 TORRE AVENUE - CUPERTINO, CA 950143255 p — PE �"� [ (40111777-3228 - FAX (4%08} 777-3333 - buildina@cupertino orc� .3 t. A NF.Ljf ( nw—'TRT Tr` rif-mT t I x ryn r— — 1-2 L tW (4 S i iYCia lcrc L. UKIIJINAPERMiT# �I--Y1JYVly/u PROIECTADDRESSZ ?J `�L7 l 4 t7jiia _. _ - .. APN t 3 y _ USE TYPE OCC_ SQFi'_ VALUATION* (S) EXTSTG NENV FLOOR DEMO QThhtEii CAlIE T C 11 �-� PHONE L--Ai�IIL �i�t � �QYL1 jd► - / �t Q- - 1'-Z-' 0- +t d �t d SC -Cott //•� STREET ADDRESS l tr ©� 1 e CITY, STATE ZIP r FAX T NIAME &I -e �t `S� - ��E-�3� —s603 E-MAIL =�er3��0 ADDRESS � I''Vt Fit. CrTTSTATE ZIP OTHER - ECJ O\VNER-BUILDER 4iVNER AGENT �2 CONTRACTOR 13 CONTRACTOR AGENT 0 ARCHITECT O ENGINEER Q DEVELOPER ❑ TENANT CO�,'TR YCTORINANIE ; REMODEL AREA LICENSE IIJAMER REMODEL AREA LICENSE T -j PE BUS_ LIC k co?,iPANY 4 4 n rC ;ss E�.;LAIC �� __ a _f G ez FAX STREET ADDRESS . CITY, STATE, ZIP PORCH AREA DECK AREA PHO ARCHrrECTIENGINEER NAME LICENSE NUMBER - BUS, LIC m COMPANY c1'AMC - - ... E 1tiL1IL 0 ATrACH_ I - r:Ut STREET ADDRESS CITY, STATE, ZIP ISASECONDUNIT OYES SECOND STORK ]YES PHONE BEINGADDED? ONO ADDITION? .ONO L tW (4 S i EXIS SE - ROPOSED USE CONSTR n STIES _. _ - .. _ USE TYPE OCC_ SQFi'_ VALUATION* (S) EXTSTG NENV FLOOR DEMO TOTAL - - AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER - REMODEL AREA REMODEL AREA REMODEL AREA - 3 PORCH AREA DECK AREA TOTAL DECWORCH AREA GARAGE AREA: ODFTACH - - - 0 ATrACH_ I 9DLVELLING UNITS_ ISASECONDUNIT OYES SECOND STORK ]YES - BEINGADDED? ONO ADDITION? .ONO PRE -APPLICATION O YES IF YES, PROVIDE COPY OF IS THE BLDG AN 0 TAL VALUATION_ PLANNmNGAPPLY ONO PLAkN'NING APPROVAL LETTER EICHLERHOiIM- O „e—yh �_ By my signature below, I certify to each of the foIIOIN g. I am the property owner or authorized agent l Ir, the property oixmer's behalf l have read this application and the information I have provided isco et. I ha,d the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building cons cti".. representatives of Cupertino to enter the above-identifi property for inspection purposes. rze Signature of ApplicantlAgent: SUPPLEMENT INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP p OVER-THE-COUNTER CI 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 pertlmit for new building. 11 r: -'PRESS © PLAtvNING PLAN REVTEl —Commercial Bldgs: Provide a completed Hazardous Materials Disclosure B STAND -UM D PUBLICAVORKS farm if any Hazardous Materials are being used as part of this project C1 LARGE 0 rME DST _ Copy of Planning Approval Letter or Meeting with Planning prior to 0 MAJOR 0 SANITAnY SEWER DISTRICT submittal of Building Permit application. 0 ENYIRONNIENTAL HEALTH Bld&lpp 201I.doc revised 06./21111