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B-2016-3116
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3116 23500 CRISTO REY DR UNIT 312D CUPERTINO,CA 95014-6527(342 53 093) BAY AREA ENTERPRISE SAN JOSE,CA 95148 OWNER'S NAME: KNAPP GEORGE G P TRUSTEE DATE ISSUED:11/16/2016 OWNER'S PHONE:650-537-1523 PHONE NO:(408)238-5043 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lic.#817817 Contractor BAY AREA ENTERPRISE Date 03/31/2017 X BLDG __ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —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: REPLACE EXISTING SHOWER PAN,WALLS&SHOWER VALVE I hereby affirm under penalty of perjury one of the following two declarations: 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. 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 permit is issued. Sq.Ft Floor Area: Valuation:$3900.00 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 342 53 093 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 app' ant Li.:- stands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulatio• p-r ' r pertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature—` Date 11/16/2016 Issued by: rI L S Date: 11/16/2016 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 roofmg 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 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 of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:11/16/2016 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 3. 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 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 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 i.,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:11/16/2016 ' - I certify that I have read this application and state that the above information is CONSTRU TION 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. I understand my plans shall be used as public records. Licensed Signature Date 11/16/2016 Professional av vvl t f TUT' PERMIT PPUUATIo ��:� P4 — _ ,4,,v- ,7// ' COMMUNITY DEVELOPMENT DEPARTMENT.'BUILDING DIVISION RP 45°t, i ` 10300 TORRE AVENUE o CUPERTINO,CA 95014-3255 .,. �,0,---�` I P G RT!P E (408)777-3228-FAX(408)777-3333-building c©cupertino.orq C0 NEW CONSTRUCTION 0 ADDITION ►. TERATioN/TI 0 REVISION/DEFERRED ORIGINAL PERMIT If P 3ECT�AgDDRES(�/7/� tee[�j� ;yy� 7 IJ� 1 � 7 U N V 11:-‘ �iFT 311'- 1! APN# 3,1./..7 „�4 F Ob1 NA Y v G-P( "! �.11 4.5-0-537r. 1 23 Free( 'tie Y"Y a 6.4.-.444 6 RSC-Cdec i' STREET ADDRCITY, I '1 ?el boh/j n j - 64-r a.� CA- x'6-0/7 0 . FAX CONTACT NAME...- PHONE E-Iv ... t•-e 3 ce (~s 4o,g-2.3e - 03 gig& cet. c.ON STREETADDRESS CITY,STATE,ZIP FAX Z i!C7 )q a vt6 AA W 01 f S T't t_I4- 4 SJ V O OWNER 0 OWNER-BUILDER 0 OWNER AGENT leCONTRACTOR El CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER El DEVELOPER 0 TENANT COPTRACTORNAME LICENSE NUMBER LICENSETYPE BUS_LIC COMPANY NAME E-MAIL FAX. ?4 ftvci E� --�v-f•Sto 1r.5 }� %s--•COM STREET ADDRESS CrrY,STATE,ZiP PHONE 2-11 D , A . .. a ,. ' 57 8 go;r— 23 —09'1 ARCHITECT/ENGINEERNAME LICENSENUMBER BUS_LICE COMPANYNAME E-MAIL FAX STREETADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK tie. (0 c of a/ st om e- pq/I Wei//s 1 sAGv r t/dG e 1+1/ k c(A-P--(z-vy d Ptak ble /21dI 4GI/e S a - Y EXISTING USE PROPOSED USE - CONSTILTYPE if STORIES USE TYPE OCC_ SQ_FT. VALUATION(5). EXISTO NEW FLOOR I DEMO TOTAL , AREA AREA {f AREA NET AREA - - BATHROOM KITCHEN OTHER ' REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK.AREA TOTAL DECK/PORCH AREA GARAGE AREA: °DETACH - - - DATTACH It DWELLING UNITS: IS A SECOND UNTT DYES SECOND STORI' YES BEINGADDED? ONO ADDITION? _ONO PRE-APPLICATION DYES IFYES,PROVIDE COPY OF IS THE BLDG AN D YES. REC DBI:, (p AL VALUATION: - PLANNINGAPPLI/ LINO PLANNING APPROVAL LEI thR EICHLER ROME? I/OO , (, /J �_ c1jif3� E',Y/7� ,, _ - fry( j IO CI. By my signature below,I certify to each of the folio , g: 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 c./t ct. I hay ead the Description of Work and verify itis accurate. I , e to comply with all applicable local q ordinances and state laws relating to building co r ction. :`.1orize representatives of Cupertino to enter the above I= ',lied property fir'asp:: -t +urposes/ ate:4 . iiri ii Signature ofAgplicant/Agent: `� i...� }D_,-,h_ SUPPI,FMENTINFORMATION REQUIRED PLAN C:i CT/TYPE ROUTING SLIP New SID or Multifamily dwellings: Apply for demolition permit for 1] OVER-aHL-C' OUNTER 0 BIHLDINGFLAIR REVII W existing building(s). Demolition permit is required prior to issuance of building permit for new building. Cl EXPRESS Q PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 STANDARD 0 :PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. 0 LARGE 0 FIVE DI?rt _Copy of Planning Approval Letter or Meeting with Planning prior to MAJOR_ D SANITARY SEWER DISTRICT submittal of Building Permit application. 0 ENVIRONMENTAL'HEALTH BldgApp 2011.doc revised 06121!11