B-2018-11847
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO:B-2018-1184
23500 CRISTO REY DR UNIT 107B CUPERTINO, CA 95014-6520 (342 53 004)
BAY AREA
ENTERPRISE
SAN JOSE, CA 95148
OWNER'S NAME: MEANS MARY W TRUSTEE
DATE ISSUED: 07/16/2018
OWNER'S PHONE:
PHONE NO: (408) 238-5043
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO -
License Class B Lic. #817817
Contractor BAY AREA ENTERPRISE Date 03/31/2019
X BLDG X ELECT —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:
UNIT 107B -REPLACE (5) LIGHTS
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
C_ performance of the work for which this permit is issued.
i 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
Sq. Ft Floor Area:
Valuation: $1500.00
permit is issued.
APPLICANT CERTIFICATION
[_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
34253 004
representatives-bf 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 WORD 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 erstands wi mply with all non -point
source
7-16-2018
Issued by: Kim Dunbar
--�
Date: 07/16/2018
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
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: 7-16-201
I 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
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
a. 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 Qualit nagement District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Muni ' Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety .
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date, 7-16-2018
1 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.
1 understand my plans shall be used as public records.
Licensed
Signature Date 7-16-2018
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION -B
l
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255IM
(408) 777-3228 • building@cupertino.or;< PBMIT #B - ZV
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ ADDITION ❑X ALTERATION ❑ T.I. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS
APN #
23500 Cristo Rev Dr #107B 1
342-53-004
OWNER NAME PHONE
E-MAIL
Means MarV 650-537-1523
N/A
STREET ADDRESS
CITY, STATE, ZIP
23500 Cristo Rey Dr #107B
Cupertino, CA 95014
® CONTRACTOR NAME ❑ OWNER -BUILDER COMPANY
NAME
LICENSE NUMBER
NSE TYPE
Greg Feist Bay
Area Enterprise
817817
TB
STREET ADDRESS
CITY, STATE, ZIP
2110 Mangin Way
San Jose, CA 95148
E-MAIL
PHONE BUS. LIC # ,
gregfeist@comcast.net
408-238-5043 400806
❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT ❑ CONTRACTOR AGENT❑ ENGINEER ❑ DEVELOPER ❑ TENANTl,
CONTACT NAME
E-MAIL
t
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTON
Upgrade Misc. 1 Chane #5 recessed CFL lights with LED fights.
,
t
❑SINGLE-FAMILY/DUPLEX EIMULTI-FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
EXISTING SF
NEW FLOOR SF
PORCH
SF DECK SF
DEMO SF
I STORIES #
JT0rrALNETSF
REMODEL
REMODEL KITCHEN
REMODEL OTHR
GARAGE ❑ ATTACHED
r-
BATHROOM SF
SF
SF
SF ❑ DETACHED
.t
EXISING ❑ YES
EICHLER ❑ YES
SECOND STORY ADDITION ❑ YES
FIRE SPRINKLERS [INO
❑ NO
❑ NO
DWELLING SECOND DWELLING ❑ YES ❑ ATTACHED ❑ DETACHED OTHER
UNITS # UNIT ADDITON: ❑ NO S F
I I
'
POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL - SF SPA - SF SPA ATTACHED [I YES ❑ NO TOTAL - SF
RE D BY
TOTAL VALUATION:
Commercial or Multi -Family Buildings with Public Swimming Pools requires Department of Environmental Heath amrroval
%
11,500.00
RE -ROOF
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES❑ WOOD SHAKES ❑
WOOD SHINGLES ❑ TILE OTHER (SPECIFY)
REMOVE /REPLACE Q NO
IF NO
PLYWOOD ❑'h" ❑ 3/8" PLYWOOD
TYPE:
PITCH:
12
ROOF CLASS
❑YES
# OF LAYERS
THICKNESS ❑ 5/8" OTHER
❑OSB ❑ CDX OTHER
A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
*Provide a signed copy of the Cupertino's Tear -Off Policy SF #of SQUARES
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. I acknowledge and authorize all information contained on this application form
to be made available for public record.
Signature of Applicant/Agent: Greg Feist Date: 7/9/2018
SUPPLEMENTAL INFORMATION REQUIRED
*New SFD/Second Dwelling Units/Multifamily Dwellings: A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA-Provide a letter of approval from the Home Owner's Association % % i d v
BldgApp 2017.doe revised 08101117