B-2018-0024 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0024
23500 CRISTO REY DR UNIT 209C CUPERTINO,CA 95014-6523(342 53 043)123500 BAY AREA
CRISTO REY DR UNIT 207C CUPERTINO,CA 95014-6523(342 53 04 1) ENTERPRISE
SAN JOSE,CA 95148
OWNER'S NAME:ROSS SARAH LTRUSTEE DATE ISSUED:01/26/2018
OWNER'S PHONE: PHONE NO:(408)239-5043
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#817817
Contractor BAY AREA ENTERPRISE Date 03/31/2019 X BLDG—ELECT—PLUMB
I hereby affirm that I am licensed under the provisions of Ch spier 9(commencing —MECH zX RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Prot'essioas Code and that my
license is in full force and effect. JOB DESCRIPTION:
MERGE UNITS 207C AND 209C BY CREATING A T OPENING
I hereby affirm under penalty of perjury one of the following two declarations: BETWEEN DINING ROOM WALLS;CONVERT UNIT 207C KITCHEN
t. I have and will maintain a certificate of consent to self-insure for Worker's TO(N)STUDY(82 ST.);ADD(4)OUTLETS AT DINNING ROOM
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
z. 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
permit is issued. Sq.Ft Flaar Area: Valuation:$7500.00
( 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 stale laws relating to building construction,and hereby authorize 34253 041
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 unders nds and will comply with all non-point
source regulations bertha
C rtino Munici al Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 01-26-2018 Issued by:Kim Dunbar
Date:01/26/2018
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
r. 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. L as owner of the property,am exclusively contracting with licensed Signature of Applicant
contractors to construct the project(Sec.7044,Business&Professions Code), Date:0 1-26-20 18
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. 1 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
z. 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 Cade,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,end 25534.1 will
permit is issued. maintain compfuuce with the Cupertino Municipal Code,Chapter 9.12 and the
s. 1 certify that in the perhermanceofthe work for which this permit is issued,I Health&Safety Code,Section 25532(.)should I stere or handle hazardous
to
shall not em manner subject
an
Additionally,should I use equipment or devices which emit hazardous
employ any person in any man so as to become J to the air contaminants as defined by the Bay Area Air tty Management Uistrict l
Worker's Compensation laws of California.If,after making this certificate of will maintain cumpliance with tlee C, r[i to nicipal Codc,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Sa£e�9 r'�e'ft 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized
APPLICANTCERT Date:01-26-2018
I certify that I have read this application and State that the above information is CONSTRUCTION LENDtNC AGF,NCY
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 ARCHI'P
EC'1^S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 01-26-2018 Professional