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B-2016-3267
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3267 23500 CRISTO REY DR UNIT 419E CUPERTINO,CA 95014-6533(342 53 165) BAY AREA ENTERPRISE SAN JOSE,CA 95148 OWNER'S NAME: SAVAGE RUTH W TRUSTEE DATE ISSUED:12/14/2016 OWNER'S PHONE:650-537-1523 PHONE NO:(408)238-5043 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#817817 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: i UNIT 419E;UPGRADE;OUTLETS/SWITCHES(37);BATHROOM I hereby affirm under penalty of perjury one of the following two declarations: FANS(2);RECESSED LIGHTS(7) 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. v% 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:$2600.00 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: Occupy cy Type: and state laws relating to building construction,and hereby authorize 342 53 165 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 WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS F PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations e the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM L ST CALLED INSPECTION. �� Date 12/14/2016 Issuedb . L Y.A .1 I S Signature' E y Date: 12/14/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the it I I I • following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is i. 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:12/14/2016 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 mat+ials 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 C pertino 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 se 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 th•Cupertino Mu 'cipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co on 0 3,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall 1 be deemed revoked. Owner or authorized agent: - APPLICANT CERTIFICATION Date:12/14/2016 I 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. I understand my plans shall be tsed as public records. Signature Date 12/14/2016 Licensed Si g Professional \ / CONSTRUCTION PERMITAPPLICATION— ,.,,,,y PPL CATI -- 1� COMMUNITY DEVELOPMENT DEPARTMENT=BUILDING DIVISIONB S.r:rp�r 10300 TORRE AVENUE a CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228^FAX(408)777-3333.buildincAcupertino.orq . r/' -&,6- -- [I NEW CONSTRUCTION ❑ ADDITION ►: TERATION I TI ❑ REVISION 1 DEFERRED 0 GINAL PERMIT# PROJECT ADDRESS 4 c b x it gig e APN# g z ^ 5 3 ' 1 6 I O� NAME PHONE E-MAIL �C�.LI Q /2 (44-11_ �, (.50-537- 1r 3 Free(herr�aw4436-11111Z-767A STREET AD RESS pp .0 CITY,STATE ZIP FAX 3 6.7.°19 tr;5 ' P� 419E COr+- `n0 Ch- ei, "©11 CONTACT NAME v-- PHONE t Cr Fe i 5t 4fos -23 a -5743 E f ilLeA tct i -cets c of i STREET ADDRESS J CITY,STATE,ZIP FAX Z.I 1 a 11 G Pt ten wOA* 53-; c#4- 9 Sl c e ❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT V CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER ❑TENANT CON rRACTORNAb1E 6 E to 5 LICENSE IriNUMBER gl LICENSE TYPE SUS_LIC#� COMPANY NAME a S¢Q�,E-MAIL -!Q� FAX 1,7r3 et 4 � -6-1,0 r, s e4 nal) , s4--.c 0 ir-c STREET ADDRESS CITY,STATE,ZIP PHONE. 'z 11 0 MaV1-81.0% iL'42-. S'a , Cry 4 wile 4001- 138-5 / ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#. COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK �{ a gyp/ j i .� UMr0410- ielC(0`J501 le0144-5 LC ® 7.. yr- o �/.ghqt ��l/i,d 72. � ,� 48reCt "1 h eja + 5kir 414 - t If I Of)to he A /2-cdo , 1,^t 3- t57 _ EXISTING USE PROPOSED USE CONSTR._TYPE If STORIES USE TYPE OCC. SQ_FT_ VALUATION(S) I 1. EXISTG NEW FLOOR DEMO TOTAL - AREA AREA AREA NET AREA BATHROOM KITCHEN I OTHER REMODEL AREA REMODEL AREA Ilj REMODEL AREA PORCH AREA DECK AREA ' TOTAL DECK/PORCH AREA GARAGE AREA: 0 DETACH ❑ATTACH #DWELLING UNITS: IS ASECOND UNIT OYES SECOND STORY ❑YES BEING ADDED? ONO ADDITION? ONO d! � PRE-APPLICATION ❑YES IF YES.PROVIDE COPY OF IS THE BLDG AN OYES ®- - - I TOTAL VALUATION: PLANNING APPL4/ ONO PLANNING APPROVAL LETTER EICHLERHOME? 0 NO "-- .- --.011111." •.' p„ By my signature below,I certify to each of the folio - g: I am the property owner or-. I iized agent to ac the property o I er's behalf.. I'... read this application and the information I have provided is c.��.et. I hav ead the Description of Work and ve' •it is accurate. ..- e to comply with all pplicable local ordinances and state laws relating to building con g!etion. I a prize representatives of Cupertino to=• --identifi property for inspection purposes. Signature of Applicant/Agent. hDate::"3 i I 5- ( I i9 SUPPLEMENT' INFORMATION REQUIRED PLAN CHECICTYPE 1" ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for I] OVER-THE-COUNTER - ❑ BuILDING PLAN REVIEW 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 0`STANDARD 0 -PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE - - - - ❑ EIRE DEPT - Copy of Planning Approval Letter or Meeting with Planning prior to IVIAJOR. - SANITARY SEW ERDISTIUCT submittal of Building Permit application 0 ENVIRONMENTALHEALTH 1dgelpp 2011.doc revised 06121/11