14080253 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23300 VIA ESPLENDOR UNIT V59 CONTRACTOR:CLINE CONSTRUCTION PERMIT NO: 14080253
OWNER'S NAME: AUDREY TSANG 5875 WINFIELD BLVD DATE ISSUED:08/26/2014
OWNER'S PHONE: 6505371523 SAN JOSE,CA 95123 PHONE NO:(408)924-0204
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E]
UNIT#59-INSTALL(14)CAN LIGHTS,(3)FANS,(1)
License Class Lic.# ?623 5 ,-1 SHOWER VALVE
Contractor C (1yt COK5 4 Date D p-Z - (('S
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:
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
5erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$4000
Jave 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 APN Number:34255044 00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 18 SOF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS OM LAS CALLED INSPE TION.
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 Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signature -� Date 2� �"i 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.
ElOWNER-BUILDERDECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 5505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this jiC." Date: -Z� y
permit is issued. Owner or authorized agent:
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9 18.
Signature Date
IVIEP
- GENERAL PERMIT APPLICATION .
�.•.` �. CONiNUNITY DEVELOPMENT DEPAR I MENT• BUILDING DIVISION
Y 10300 TORRE AVENUE• CUPERTINO, CA 85014-3255El
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TOTIT V.?UA-27ON:
By my sienatLre belo;,Ice b of the follo;;dr�: I un u`re property ot;•�ers ` oriZed agent to act on`^P_pe.: o;;ner s beba- I have read this
application and the info:. :on I hive provided is cored I hive read the Description of Z ror -d ve " ': s accu-4, . 'gree fo ce aply v2fh it applicable local
ordinances and state la s relating to build' L't]ciion I aULhoru'ieDreSenfa VBS OfCLpe`� enter the above-lderifli:e pr - '1^S 6 On pL pOSeS.
Si�at.rre of Applica ?gent: ate: y
Uh/ERTTAL LNFORMATION REQUi` I-D
eRESS M
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1✓EPAjisa1-pp 2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 23300 via esplendor v59 DATE: 08/26/2014 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$4,000
YPERMIT TYPE: Building PermitPLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD Or DUPENTAMATION
USE: Duplex PERMIT TYPE: 1 REAP1
WORK unit#59- install 14 can lights, 3 fans 1 shower valve
SCOPE
h 5
"'Lo"t`hc<, Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check 0.0 hrs $0.00
/ec1�- t'�,;wr r Fee: Plumb.Permit Fee: 1PPERM7 Elec.Permit Fee: 1EPERMIT
Other Plumb Insp. 1-2-01 hrs $48.00 Other Elec.Insp. 0.0 hrs $48.00
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These ees are based on the prelinddna information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 0 # Electrical
Suppl. PC Fee: (j) Reg. ® OT0.0 hrs $0.00 $48.00 1BREMRECEP I Recep/Switch/Outlets
PME Plan Check: $0.00 = Electrical
Permit Fee: $0.00 $72.00 1BREMFIXT Fixtures,Lighting
Suppl. Insp. Fee: Reg. () OT 0.0 1 hrs $0.001= # Plumbing
PME Unit Fee: $0.00 $10.00 1BPFIXTURE Fixture or Trap
PME Permit Fee: $96.00
Coyl.,7',`t,. t i o t 7'a :
Administrative Fee: IADMIN $45.00 Q
Work Without Permit? ® Yes (j) No $0.00 G
Advanced Planning Fee. $0.00 Select a Non-Residential 0
or Structure
Travel Documentation Fee: ITRAVDOC $48.00 Building �
Strong;Motion Fee: IBSEISMICR $0.52 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
xri
` AS $190.52 $130.00 TOTALFEE: $320.52
Revised: 07/10/2014
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ity Ordina ce or State Law.
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