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B-2017-0667CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 210E CUPERTINO, CA 95014-6524 (34253 078) CONTRACTOR: PERMIT NO: B-2017-0667 BAY AREA SAN JOSE, CA 95148 OWNER'S NAME: STOWE CECILE M TRUSTEE DATE ISSUED: 05/02/2017 OWNER'S PHONE: 408-206-4697 PHONE NO: (408) 238-5043 LICENSED CONTRACTOR'S D Cr ARATNIN BUILDING PERMIT INFO: License Class g Lic. #3j1_81 7 Contractor BAY AREA ENTERPRISE Date 03/31/2019 I hereby affirm that I am 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. I have and will maintain a certificate of consent to self -insure for Worker's BLDG X ELECT _ PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: UNIT 210E - INSTALL (I) LED RECESSED LIGHTS (5); OUTLETS (21); SWITCHES (9); REPLACE BATHROOM FANS (2) Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Wiz! I have and will maintain Worker's Compensation Insurance, as provided for by i Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area. Valuation: $2900.00 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 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applica nderstands and will comply with all non -point s p e source regulationCupertino Municipal Code, Section 9.18. Signatur Date 05/02/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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 APN Number: Occupancy Type: 342 53 078 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials 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: 05/02/2017 I hereby affirm under penalty of perjury one of the following three 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. s. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 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 indemnify and keep harmless the City of Cupertino against liabilities, 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 Code, Section 9.18. Signature Date 05/02/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cuper ' Municipal Code, Chapter 9.12 and the Health & Safety Cod ,, g ons 25505' and 25534. Owner or authorized adnt �> Date: 05/02/2017 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address AR HIT DECL_AR TION I understand my plans shall be used as public records. Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • bu11d1ng(j'c)cupertino.org �f -- ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / Ti n REVISION / DEFERRED ORTCHNAL PF.RMTT # PROJECT ADDRESS. L.' Cr(s' ' �- ��O� APN# .3(42- —S--3 — 0-T? OWNER NAME5 q V o C� � ct L? v t I vrt /L " H�-1 og) (/' 1J E-MAIL STREET ADDRESS /^ (�. I y� (� CITY, STATE, ZIP ! �y FAX CONTACT NAMESki PHO �ly,ff)�✓�('I^Cn3 �( (ZIP1 STREET ADD t f �y / CITY,` ✓ / G� FAX ❑ OWNER ❑ OWNER -BUILDER❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ETTENANT CONTRACTOR NAME / � P� r 1j ( LICENSE NUMBER (% t ( (� l �f�Ct LICENSEE BUS. LIC # COMPANY NAMi�� E Mit .k - STREET RESS t, CITY, SQA V, ZIP p , / e ARCHITECT/ENGINEER NAME 0 LICENSE NUMBER BUS. LIC # COMPANY NAME. E-MAM FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK //V ij / I NJ L�Ef C ��5 E LA / SLA-) ( + �alcs EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM KITCHEN REMODEL AREA REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LIDETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES BEING ADDED? []NO SECOND STORY []YES ADDITION? [:]NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN El YES .RECE 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 correct. 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 building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: ' Date: i SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECKTYPE ROUTING SLIP El 'OVER-THE-COUNTER ©_ aUELDING PLaivREvJEw _ 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 Q' P%AlvxavGPLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El"§TA"ARI) � PUBLIcwORxs form if any Hazardous Materials are being used as part of this project. TARGE 0: FIREDEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ IdIA10R, ©_SANITAl2YSEV4EI2DISTRICT - submittal of Building Permit application. ❑ = ENVIRONMENTAL HEALTH BldgApp 2011.doc revised 06/21/11 C SMOKE I CARBON MONOXIDE ALARMS rip OWNER CERTIFICATE OF COMPLIANCE s" ' COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION i iv 5 10300 TORRE AVENUE CUPERTINO,CA 95014-3255 i CUPERStfl (408)777-3228 FAX(408)777-3333 buifdina@cuaertino.org RTIEICATE'-H� j ' BTTII�I)ING�I,,ISIOI\ it IRl\ZLT CANNOT��FILIAI , PE r £TED, ,,»:44,-V7, G O T--- E1)4D TO'I I3E `g �� nEofall required Smoke and Carbon Monoxide Alarms for PURPOS complianceTh cis a self-certification016CRCcon R 14,R315, tion q with 2016 CRC Section2016 CBC Sections 420 6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION and multi-family dwellings shall be provided with Smoke Alarms andCarbon exceeds ale-family dwelling Existing single-family alterations,or repairs to existing Monoxide alarms. When the valuation of additions, CRC Section R314,R315, and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or $1000 00, Carbon Monoxide Alarms be installed in the following loca ons' SMOKE ALARM CO ALARM L AREA ediate vicinity of the X Outside of each separate sleeping area in the imm X X A. —(Smoke alarms shall not be located thin 3 an feet f bathroom a oattics door) Onbedroom(s) g unit including basements hX Within every level e a dwelling ' 1111111111111111 each slee•in:room appliances and that do ornot an Monoxide alarms are not required in dwellings which do not with smokeuelblaring hap comply with C Carbon monoxide alarms con CBC havenot 420 t6aandhall be approved roved by the Office of the State Fire Marshal. erectionmaybe solely battery operated. units with no commercial power supply, alarm(s) do Power Supply-dwelling In dwelling permitted to be solely battery operated where orf pairsor basementaor crawl notIn existing rresult inherunits,alarms are tthe removal of wall and ceiling finishes 90there 4 and 420 6.2.o access means An electrical permit is required for spcesul space.Refer to CRC Section ted to the buildingons jv ring alarms which must be ave been s referenced above has/have the above-referenced property,I hereby certify that the alarm(s)As owner of manufacturer's instructions and in compliance with the e California ilding of the installed in accordance Residential -with the Californiaa Residential Codes The alarms specified below have been tested __ '_-4'--'--- _ � and Ca � f� date signed below Permit i\o. ' f� Address Specify number of Alarms _ Carbon Monoxide Detectors IION t Smoke Alarms ill' i have read and agree to comply with the terms and conditions of this statement Date: ••• Owner(or Owner Agent's)Name. Si nature of Nam Lic Date: • Co , Signa c % Smoke and COform-doc revised 01/10/201