B-2017-1445 '. CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1445
23500 CRISTO REY DR UNIT 420F CUPERTINO,CA 95014-6533(342 53 184) BAY AREA
ENTERPRISE
SAN JOSE,CA 95148 '
OWNER'S NAME: WHITE HELEN M TRUSTEE DATE ISSUED:08/31/2017
OWNER'S PHONE:650-537-1523 PHONE NO:(408)238-5043
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#817817
Contractor 13AY AREA ENTERPRISE Date 03/31/2019 X BLDG _ELECT X PLUMB
MECH X RESIDENTIAL_COMMERCIAL
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. JOB DESCRIPTION:
UPGRADE SHOWER,INCLUDE PAN AND WALLS TO CULTURED
I hereby affirm under penalty of perjury one of the following two declarations: MARBLE;(N)VALVE
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.
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:$4500.00
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 53 184
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 the ertino Mu 'cipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION..
i gnature a 8/31/2017 Issued by:Jasmine Archbold
Date:08/31/2017
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
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:8/31%2017
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
s. 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 2550 - ,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owne r authorized agen . �/
APPLICANT CERTIFICATION D 8/31/2017 .
I certify that I have read this application and state that the above information is e. 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 tobuilding 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.
Signature Date 8/31/2017 Licensed
Professional
' L.CV CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
�s�.,nss 10300 TORRE AVENUE••CUPERTINO, CA 95014-3255 1))-7.011--
1`,,,
CUPERTINO ,p
(408)777-3228•FAX(408)777-3333•buildinciCa�cupertino.orcl
❑NEW CONSTRUCTION//� ID ADDITION 111RE
ALTERATION/TI IJ VISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADr1 1 tz 00
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I APN tt 3 L -5-3 - 1 BL
OWNER NAME II e i n v\ �I��^ PHONE b V ��,.y ��Z� E-MAIL
STREET ADDRESS 'C779�,,,, ,� •
U �/ CrrY,STATE ZIP J / FAX
1-3c00Ci('sIU 12e-ii P)Y`r, l��l" Cu Y--. ✓Id LA X501
CONTACT NAME P,d�,�, r e c PHONE Ds-Z 3 s.......6 vj E-MAIL /�,re� ,S Com M e O N-e -f
STREET ADDRESS l T J CITY,STATE,ZIP ` FAX
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❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC k
C mei Per Sf ! 1`7 gl.`7 LT'
COMPANY NAME .J na11 `�]rte`i_ Eh ��r/ E-MAIL Q r�� c S���Cd tq ye� FAX
STREET ADDRESS tJ f�" CITY,STATE,ZIP I(� nUnNE
7—I 1 O TA i A 'Lir-, Li S a c" ' '- -O So_ Cr'F (757eig ' - tag- 238 --- soyaARCHITECT/ENGINEERNAME J LICENSE NUMBER BUS.LIC if
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OFWORKS4.aWv(...7i:±7-
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EXISTING USE PROPOSED USE CONSTIL TYPE /I STORIES ,
USE , TYPE OCC. SQ-FT. VALUATION($). ,
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA ,
PORCH AREA ' DECK AREA TOTAL DECK/PORCH AREA i GARAGE AREA: O DETACH ,
O ATTACH
l
If DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES ,
BEING ADDED? ONO ADDITION? 0 N
PRE-APPLICATION OYES. IF YES,PROVIDE COPY OF IS THE BLDGAN ❑YES I By TOTAL VALUATION:. '
PLANNING APPL P ONO PLANNING APPROVAL LETTER EICHLER HOME? 0 NO r_{,j A t ;i
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 halve read this ,
application and the information I have provided iscorrect I have!read,the Description of Work and verify it is accurate. I agree to comply with all applicable'local '
ordinances and slate laws relating to buildi co ction. I authorize representatives of Cupertino to enter the above-iddcn- ed prope for inspection purposes.
Signature of Applicant/Agent - Date: CJ29 2.0
SUPPLEMENTAL INF RMATION REQUIRED :?-,9,-__,_ `"" V'-....i.'.',:- l .
.< PLAN(HFKTYPE ;r,-. ,ROUTING SLIP t
New'SFD or Multifamily dwellings: Apply for demolition permit for
❑ OVER THE-COUNTER ❑ BX7ILDIIYG PLKIV REVIEVI' 0 I
existing building(s). Demolition,permit is required prior to issuance of building 3 t F -„„:-2,,-,:$4,,,.^,,-, I ,
lk� .
permit for new building. I ❑ 'EXPRESS- r 0 PLANNING PLAN REVIEW 'C i"
_Commercial Bldgs: Provide'a completed Hazardous Materials Disclosure ❑;STANDARD ❑ PUBLIC WORKS ;-.:.„,,,z,42:,,,,4,31:,,'
form if any Hazardous Materials'are being used as part of this project. -❑ nilGl 1 ❑ Fnis DEPT ;,1a
Copy of Planning Approval Letter or'Meeting with Planning prior'to ' .> ,i$s ;f�.
.I1 ❑ MAJOR ❑ SANITARY SEWER DISTRICT ,
submittal of Building Permit application. It~ -:_t2';.:141.'-,P, it
,' _ x. .0.ENVIROIVNIENTAL.REAL u- 'ir%', I,
1- >l � BldgApp_2011.doc revised'06/21/11
- SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinq a(�cupertino.orq
PERMIT CANNOT BE:FINALED!NM TOTS CERTIFICATE HAS BEEN
COMPLETED,SIGNED.AIM])RETURNED T0-THE BUILDING;DIVISION
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms
for compliance with 2016 CRC Section R314,2016 CBC Sections 420 6 and 907.2.11.2 where no interior access
for inspections are required.
GENERAL INFORMATION
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations,or repairs to existing dwelling units exceeds
$1000.00,CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of X X
the bedroom(s)
On every level of a dwelling unit including basements X X
Within each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CSC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl
space.Refer to CRC Section R314 and CBC Sections 907.2.114 and 420 6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above-referenced property,I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below
Address ) Permit Nom/ �l Lf 17'5
Specify Number of Alarms: #Smoke Alarms. _� #Carbon Monoxide Detectors. Fri
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name. -
. ......... . - .
Contractor Name.
Signature Lic.# Date:
Smoke and CO fonn.doc revised 12/15/16