12070092CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22555 CRISTO REY DR
CONTRACTOR: ROMAN CATHOLIC
PERMIT NO: 12070092
BISHOP OF SAN JOSE
OWNER'S NAME: ROMAN CATHOLIC BISHOP OF SAN JOSE
22555 CRISTO REY DR
DATE ISSUED: 01/03/2013
OWNER'S PHONE: 4089830100
LOS ALTOS, CA 94024
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
License Class Lic. #
REPLACE ENTRY GAVE AND CHAIN LINK FENCE, ADD
MONUMENT SIGN AND CORNER SIGN, WORK SMALL
Contractor Date
INCLUDE
I hereby affirm that I am licensed under the provisions of Chapter 9
IRRIGATION, AND LANDSCAPING
(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
Sq. Ft Floor Area: Valuation: $15000
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
APN Number: 34263005.00 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
VVITHII�T 180 DAYS OF PERMIT ISSUANCE OR
building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAr OM LAST CALLED INSPECTION.
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
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.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
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, amexclusively 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 C perti o Municipal Code, Chapter 9.12 and
I have and -will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sectio 55,5, ,and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date:
permit is issued.
-
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 L DING 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.] 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 so is re lations per the Cupertino Municipal Code, Section
Licensed Professional_ 1�
9.18..
Signature / Date-1-3 —15
6&�,fSan,
CONSTRUCTON PER MT APPUCATM
Is COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION }
10300 TORRE AVENUE o CUPERTINO, CA 95014-3255''
CCdAP ERTUNO (408) 777-3228 o FAX (408) 777-3333 o buildingCa)-cupertino.org
X-4131 ❑ ADDITION E ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL /PERMIT
!!#
PROJECT ADDRESS APN
22555 Cristo Rey Drive
OWNER NAME
PHONE
E-MAIL
Roman Catholic Diocese of San Jose
(408) 983-0100
webmaster@dsi.org
STREET ADDRESS
CTI -Y, STATE, ZIP
FAX
1150 North 1 st Street, Suite 100
San Jose, CA 95112
(408) 983-0295
CONTACT NAME
PHONE
E-MAIL
Irving A. Gonzales, AIA, CGBP
415.776.8065, Ext. 1#
irAng@gonzalesarchitects.com
STREET ADDRESS 67A Water Street
CITY, STATE, ZIP San Francisco, CA 94133
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT 13 ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
TBD
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
Irving A. Gonzales AIA I CGBP
C-19332
COMPANY NAME
E-MAIL
FAX
Gonzales Architects
irving@gonzalesarchitects.com
STREET ADDRESS
CITY, STATE, ZIP
PHONE
67A Water Street
San Francisco, CA 94133
415.776.8065, Ext. 1#
DESCRIPTION OF WORK
Removal and replacement of the existing entry gate and signage at the main entry and corner sign with new motorized, wrought iron gates. Replacement of the existing chain
link fencing with wrought iron adjacent to entry gates. Work shall also include landscape, irrigation, and minor electrical work.
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
Cemetery
Cemetery
N/A
I
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 DECKIPORCH AREA
GARAGE AREA: DETACH
ATTACH
# DWELLING UNITS:
IS A SECOND UNrF []YES
SECOND STORY ❑ YES
N/A
BEING ADDED? ONO
ADDITION? ONO
PRE -APPLICATION [@YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIVED BY:
TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ONO
/34
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 beha f 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 construct n. 1 authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent:9@�� - Date: July 12, 2012
SUPPLEMENTAL INFO A ION REQUIRED
PLAN CHECK TYPE ROUTING SLIP
❑ OVER-THE-COUNTER BUILDING PLAN REVIEW
_ 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.
PREssP�ING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
;�STANDARDLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ ZME
LARGE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR ❑ SANITARY SEWERDISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
B1dgApp_201 Ldoc revised 06/21/11
Ai'79,15-
d"TTiI !LT d"y T7OY _ff,% VM Td -w
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E(. 7/1/11)
%1+11 I %jr %..Urr._MjLjLiaU
FEE ES'TIMA'TOR - BUILDING DIVISI®N
Plumb. Plan Chec•b
ADDRESS: 22555 cristo rey dr. DATE: 07/12/2012 REVIEWED BY: bobs.
7_111,71 Permit Fee:
APN:
BP#: 4zo 00
*VALUATION: 1$15,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Commercial Building
PENTAMATION 1GENCOM
USE:
PERMIT TYPE:
WORK
replace entry ate and chain link fence add monument sign and corner sin work shall include
SCOPE
irrigation, and landscaping.
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E(. 7/1/11)
;lfec•h. Plan Check
Plumb. Plan Chec•b
F_ ut% Plan Check
7_111,71 Permit Fee:
Plumb. Permit Fee"
lace. Permit Fee:
Other afech. Insp.
Other Plumb Insp.
Other F,Icc, Insp. C
AIcch. Insp. Fee:
Plumb. h,sp. Fee:
Elcc. lnsp. Fee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E(. 7/1/11)
FEE
QTY/FEET
MISC ITEMS
Plan Check Fee:
$0.00
100 1.£
$666.00
Fence
IFENCEMAS> Fence, Masonry >6'
Suppl. PC Fee: O Reg. o OT
0.0 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. O OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Administrative Fee:
E)
Work Without Permit? O Yes O No
$0.00
Advanced Plannin Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
G.
D-mv/ Doemnentalion Fees:
Strong Motion Fee: IBSEISMICO
$3.15
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$4.151
$666.00
TOTAL FEE: $670.15
Revised: 07/01/2012
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
SIGN TYPE
ADDRESS: 22555 Cristo rey dr.
DATE: 07/12/2012
RIEVIEWED BY: bobs.
:it1111,. Perini! Fee:
APN:
BP#: ��
*VALUATION: Iso
*PERMIT TYPE: Building Permit
PL,1N CHECK 7'YI'E:
PRIMARY
USE. Sign
Plumb. hisp. Tei::
PENTAMATION
PERMIT TYPE: 10EAP5
WORK
replace entry ate and chain link fence add monument sign and corner sin work shall include
SCOPE
irrigation, and landscaping.
SIGN TYPE
FEE ID
Plumb. Plun Check
QTY
:it1111,. Perini! Fee:
SIGN FEE
IESIGN Elec. Permit Fee: IEPERMIT
Other Sign
1SIGNOTHER
Other Elec. Insp. 0.0 $45.00
1
Plumb. hisp. Tei::
$334
Ground Sign
1SIGNGR/RF
Suppl. Insp. Feer Reg. Q OT
1
hrs
$334
PME Unit Fee:
$45.00
PME Permit Fee:
$45.00
Construction 7-0x:
Adininistrotive Fee.
Work Without Permit? Yes 0 No
$0.00
Sign Master Plan: O Yes (F) No
TOTALS:
k
a
Travel Documentation Fee: ITRAVDOC
$45.00
$668.00
$0.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/.11)
Xfech. Plan Chcck
Plumb. Plun Check
# Branch Clrcults 1 $45.00
:it1111,. Perini! Fee:
Plumb. Permit Fec:
IESIGN Elec. Permit Fee: IEPERMIT
Other ,,Ifech. Insp.Ll
Other Plumb Insp.
Other Elec. Insp. 0.0 $45.00
.11ech. Imp. Fee:
Plumb. hisp. Tei::
Eley. 1nsp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/.11)
FEE
QTY/FEE
MISC STEMS
Plan, Check Fee:
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
Plumb . j11ech.;Elec
Permit Fee:
$668.00
Suppl. Insp. Feer Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$45.00
PME Permit Fee:
$45.00
Construction 7-0x:
Adininistrotive Fee.
Work Without Permit? Yes 0 No
$0.00
Sign Master Plan: O Yes (F) No
$0.00
k
a
Travel Documentation Fee: ITRAVDOC
$45.00
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldjz Stds Commission Fee:
$0.00
SUBTOTALS:
$803.00
$0.00 TOTAL FEE: $803.00
Revised: 07/01/2012
CUPERTINO
Cn]di'If�'IF f; G= �1111L[1) SE FOO fffl
COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION
10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255
(408) 777-3228 ^ FAX (408) 777-3333 ^ building(a woertino.ora
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
SITE ADDRESS •L7 Z:5SS �( i$'to
�e �r
APfN
BP#
OW ER INAME-iT� "i—
v
j_
C��
OWNER ADDRESS
DESCRIPTION OF WORK:
(Pv",-evy
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We
will not issue a building permit until you have read, initialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT ARID VERIFICATION OF INFORMATION
(DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.)
FIT 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -
Builder' building permit that erroneously implies that the property owner is providing his or her own labor and material
personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my
insurance coverage for injuries to workers on my property.
fJf-2. 1 understand building permits are not required to be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contractor to assume this responsibility.
fj�3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may
protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
name instead of my own.
��74. I understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
T I L5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be
considered an "employer' under state and federal law.
Ot-6. I understand if I am considered an "employer' under state and federal law, I must register with the state and
federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
�Z7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is performed under contract with a licensed general building Contractor.
'J Z7--8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction
defects in the workmanship or materials.
OwnerBuilderFonn 2010.doc revised 04/14/10
EL4. I understand I may obtain more information regarding my obligations as an "employer" from the Internal
Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments,
and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State
License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed
contractors.
4�1_60. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I
am the party legally and financially responsible for proposed construction activity at the site address listed above.
EL11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
by all applicable laws and requirements that govern Owner -Builders as well as employers.
EZ,12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If
you contract with someone who does not have a license, the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed
Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while working on your property, you may be held liable for damages. If
you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not
those Contractors are properly licensed and the status of their workers' compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECTIONS: Please complete the following construction lending agency information.)
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name: Lender Address:
Before a building permit can be issued, this form must be completed and signed by the property owner and
returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license,
form notarization, or other verificatio�acc pt le to the city may be required to be presented when the permit is issued
to verify the Property owner's signafur�. _
Property Owner's Signature: CDate: (" (� ��
---------------------------------------------------------------------------------------------------------------------------------------------
(NOTE: The following Authorization Form is required to be completed by the property owner only when designating an
agent of the property owner to apply for a construction permit for the Owner -Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY Y O@>R NER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an
Owner -Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other
verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's
signature.
Property Owner's Signature:
Date:
OwnerBuilderForn7 2010.doc revised 04/14/10