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12070165CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 1038 CONPRACI'OR: MISSION VALLEY ELECTRIC INC PERMIT N0: 12070165 OWNER'S NAME: DONALD NABSE'I'Ii PO BOX 3332 DA'Z'E ISSUED: 07202012 OWNER'S PHONE: 6509440100 FREMONT, CA 94539 PHONE NO: (510) 745-8847 ❑ LICENSED CON RACI'OR'S DIiC-LARATION •1011 DESCRIPTION: RF,SIDIWFIAL COMMERCIAL❑ License Class C - t D Lich L(iD 1-5 Z REPLACE 2 BATHROOM EXHAUST FANS, INSTALL 7 ,(� CmumctorhtSS/off1/p� �Gaa•rzl8atc 7- ZO - lZ LIGHTS AT KITCHEN LOCAL, REPLACE SWITCHES AND hereby affirm that 1 am licensed under the pros'isions of Chaluer 9 RECEPTACLES. (cmunmeneing e'ilh Section 7000) of Division 3 of the Rosiness S Professions Code and that my license is in full force and effect. hereby affirm under penalty of perjury one of the following hyo declarations: 1 have and will maintain a cenilicate 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: $3000 performance of the work for which this permit is issued 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for die perlbnnance of Elie Work for which this permit is issued. \I'N Number: 34253002.00 occapxney'fype: A PPLIC\NT CF,RTI FICATION 1 certify that 1 have read this application mid slate that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinmhces mid suite laws relating to building construction, and hereby authorize representatives of this city to enter WITHIN 0 AYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (bile) agree save 180 DA F 011 LAST CALLED IN'SPEC'- indemnifi• and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses Which may accrue against said City in consequence of the "1� - 117, granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point s ce regulations per the Cupertino Municipal Code. Section 7-7 9.18. _ \ �.-�,(� Signature Date _ RI '-ROOFS: All roofs shall be inspected prior Eo 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-DIIILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License haw for one of the following two reasons: ALL ROOF COYF,RINGS TO BE CLASS "A" OR BEI-I'ER I, as owner of the property or niy employees with wages as their sole compensation, will do the work, mid the structure is not intended or offered Cor sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to IIAJ kRDO(1S MATERIALS DISCLOSURE, construct the project (Sec.7044, Business K Professions Code). I have read the hazardous materials requirements muter Chapter 6.95 of the California Health .X Safety Code. Sections 25505, 25533, and 25534. I will. 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cuperlino Municipal Code. Chapter 9.12 and the declarations: health 3 Safely Code, Section 25532(x) should Istore 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, Ibr the air conlaminat s 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 Cu vino Municipal Code. Chapter 9.12 and I have and Will maintain Worker's Compensation Insurance, as provided far by the health S Safety Code. Sections 5 5.25533 and 25534. Section 3700 of the Labor Code, for the perlbrmance of the work for which this Owner or uulhnrized agent: - ate: 7-Zo-I Z permit is issued. I certify than in the performance of the work for which this permit is issued, I shall not cnhploy any person in any manner sons to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONST RUCI'ION 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. w'ork's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name \I'I'I,IC.\NT CISIt'1'IPIG\"1'111\ Lender's Address I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances mid suite laws relating to building construction, and hereby authorize representatives of this city to enter upon die above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgmcnts, ARCl11TECI"S DECLARATION 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 mid will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18, Signature Date Licensed Professional ,W��� CITY OF CUPERTINO INFEE ESTIMATOR - BUILDING DIVISION I&FADDR17S: 23500 Cristo reY dr. #103 -b DATE: 07/20/2012 RLVIEWED BY: bob s. Niech. Permit Fee: /AIPERAIIT APN: BP#: 'VALUATION: $3,000 *PERMITTYPE: Building Permit PLAN CUECK'1'1'PE: Alteration / Repair PRIMARY USE: SFD or Duplex I'[ac. /lisp, Fee: PENTAPIATION PElimi't-TYPE: 1RMAP8 WORK replace 2 bathroom exhaust fans install 7 lights at kitchen local replace switches and rece tacels SCOPE throughtout. NOTE: This eslinmle does not include fees title to other Deparanents-(i.e. Planning, Public Works. Fire, Sanitary Selver District. School Divtrirt. nrr_ ). 7'hava fi... v are haved an the nreliminary information available and are onlr an estitnnte. Contact the Dent for addn'l info. FEE ITEMS RLec Risohilioa 11-053 F.(f 71111 /) Nlech. Plan Check 0.0 hrs $0.00 Minh. Plan Check Elec. Plan Check 0.0 hrs $0.00 Niech. Permit Fee: /AIPERAIIT Plumb. Permit lel: Elec. Permit Fee: /EPE'R,11/T Other Mech. Insp. 0.0 firs $45.00 Ocher /'hunh /ntyi. Other Elec. Insp. 0.0 hrs $45.00 A ech hap. F,•,•: Plumb. Imp. Fee: I'[ac. /lisp, Fee: NOTE: This eslinmle does not include fees title to other Deparanents-(i.e. Planning, Public Works. Fire, Sanitary Selver District. School Divtrirt. nrr_ ). 7'hava fi... v are haved an the nreliminary information available and are onlr an estitnnte. Contact the Dent for addn'l info. FEE ITEMS RLec Risohilioa 11-053 F.(f 71111 /) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 2 # $46.00 Mechanical IBREAlKENP Ventilation Fan Suppl. PC Fee: (D Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 35 $105.00 Electrical 1 1BREAIR6CEP Recep/Switch/Outlets Permit Fee: $0.00 Suppl. Insp. Fee Q Reg. Q OT 1 0.0 1 hrs $0.00 9 Electrical $67.001 /BREAIFEIT I Fixtures. Lighting PME Unit Fee: $0.00 PML' Permit Fee: $90.00 C onslruction Tar: Administrative Fee: I,10AUN $42.00 Work Without Permit? I) Yes (D No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure i Travel Documentation Fee: ITRA I'DOC $45.00 Stone Motion Fee: /BSF.ISAUCR $0.50 Select an Administrative Item Blda Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $178.50 $218.001 TOTAL FEE: T $396.50 Revised: 07/01/2012 .l lgnawre-- — Uale I"Licensed l•rulessNnal I C-�UPERTINO I rI I •NFVJ CnNJSTR i rrnnN CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) —777-3228 • FAX (408) 777-3333 • buildina(cDcuoerbno ora I I AnnMnN 1 1 AT Tp ennN in n B1dgApp_201 Ldoc revised 06/21/11 C=) PROJECT ADDRESS 23sY7d c �- �. APNa x/ � • �� 103-13 -3z{2 53 0x02 OWNER NAME p OoIJaL�I�IS'C'�n' 1H0 E.MAII. 0 J li-kSv • 4 - O STREET ADDRESS CITY, SA7=ZIP I FAX . CONTACT NAME �E PHONE c„�� 2-tj p I 'S f0 - 30 - L2Li SiL. DRESS CTT Y, STATE, ZIP FAY i� I�jox 33s Z I T C YS3QI fo-7y5 oLY$' ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT XCONTRACTOR ❑CONTRACTORAGEM ❑ ARCICTE= ❑ ENGM,, ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMELICENSE NUMBER LICENSE TYPE I LI BUS. C A 15 r0 %11%LECEC fG 14 70 L -!U COMPANY NAME I E MAC I FAX • i Y S- o z y ?' . STREET ADDREss CITY, STATE, ZIP PHONE 17 O. Bo x 33-S F,zEP+or T-- CP qS 3 I S10 -7y5 -YflY7 ARCH7TEC i/ENGLNLsR NAME t10ENSE NUMBER BUS. LIC p COMPANY NAME E -MAC FAX STRE.R' ADDRESS I CTT. STATE ZIP I PHONE DESCRIPTION OF WORK E L G C AV P.)5 Z7'Y>r.e._ EG EST e` Lf M i LP-Gt u.rrK E A eECc PrrC C-, SS Fz Ee4” -G ✓PNI LAIR fFr Cy- E (STING USE PROPOS-e7 USE CONSTR TYPE a STORffS I USE I TYPE I OCC SOFT. VALUATION (S) EXSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET.VIEA _ HATHROGM KliCtiFN OT}{E; REMODEI.AREA REMODEL AREA REMODEL AREA PORCHAREA DECXAREA TOTALOECIc/PORCTIAREA GARAGEAREA LJOETACH ❑ATTACH I p DwELLDRG UMTS: is A SECOND UNTT ❑ YS SECOND STORY ❑ YS BEING ADDED? ONO ADDMON? - ONO PPRE-APPLICAT'.ON OYES IF YES, PROVIDE COPY OF I ISTHEBLDGAN 0;�5tUCEIVED EIC LANNPIG APPLS ONO PLANNIIIG APPROVAL LETTER m F9 HOME? ONOVo By. - TOTAL VALUATION: �I 3 ovD . By my signan rc below, I crrthry to each of the following. 1 am the Property owner er authorized agent to act on the prppe y owner's behalf. I havc read this application and the inforrnaaon I have p 'tied is correcL I have read cSc Description of Work and verify it is accurate. I agree W cornply with all applicable local ordinances and scare laws rclatin to g construc�on. I thorirc representatives Of Cupe-dno m enter the above -identified propr..y tor inspection purposes. Signatrne of AppficantlAgenn r r Das: SUPPLEI'Y=AL iNFOP-MATTON REQU`aED 4 PLN CHECK TYPE I ROCrctcsl.n• New SFD or Multifamily dwellings: Apply for demolitionpermit for ❑ OVIIt.rHE-cDrnTzx ❑ existing building(s). Demolition permit iS required prior to issuance of building BUD.DLYG PLAN REVIEW permit for new building. CI POtPNFSs ❑ PLA.YNLYG PLAY REYp:w Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STA,"ARD ❑ form if any Hazardous Materials are being used as part of Ibis project. PUBLIC WORta Cl LARGE - ❑ FIRE DEPT Copy of Planning Approval Let, _ er or Meering with Planning prior to ❑ SubmittalofBuildingPermitapplication MAJOR ❑ SA.NITARYSEWERDISTRICT 1:1 - ENVIRONMENT.AL HEALTH B1dgApp_201 Ldoc revised 06/21/11 C=)