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12080220CITY OF CUPERTINO 13UILDING PERMIT BUILDING ADDRESS: 23500CRISTO REY DR UNIT 10313 CONI'RAC'MR: BAY AREA ENTERPRISE PERMITNO: 12080220 OWNER'S NAME: DONALD NABSB'I'll 2110 MANGIN NN\' DATE ISSUED: 08212012 OWNER'S PHONE: 6509440118 SAN.IOSF., CA 95148 PHONE NO: (408)238-5043 ❑ (LICENSED CONMACFOR''7S D(E/CL/A-1RA'T'ION PERMIT INFO: 13LDC r ELECT r PLUAIB 17 License Class W Lie.9 J`/17 d 1 BUILDING r r r �r`� NIECII RIiSIDENTLAL C01L\IERCLAL crmrictrr��y E�fi- D:nem/z//za/Z JOB DESCRIPTION: REPLACE SHOWER PAN AND WALLS -wkA14— 103 a hereby affirm that I am licensed under the pnicisiuns of Chapter') (non mencing with Section 7000) of DIN ision 3 of the Business & Professions Code and That nnc license is in full force and effect. I herehy affirm under penalty of perjury one of the following two declarations: I have and will maintain a certif icate 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. Sy. FI Floor Arca: Valuation: $4500 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of die work for which (his APN Number: 34253002.00 OccupancyType: permit is issued APPLICANT CERTIFICATION I certify that I have read this application and state (hal the above information is correct. I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnity and keep harmless the City of Cupertino against liabilities, judgments, 180 DAYS FROM LAS ALLED INSPECTION. costs, and expenses which may accrue against said City in consequence of the grunting of (his permit. Addition v, the applicant understands and will comply p �n t/ with all non -point source uh ms per the Cupertino Municipal Code, Section Issued by: h 7Uale: 9.18. i� 1iD� g/ �� ' •/ Signature Date Ou RF -ROOFS: ❑ OWNER -131111.11111 DECLARATION All roofs shall be inspected prior to any roofing material being installed. If a roof is installed withom first obtaining mi inspection, I agree to remove all new materials for here[), affirm that 1 am esem pt from the Contractor's License Law for one of inspection. the following Iwo reasons: I, as owner of the property, or my employees with wages as their sole compensation, Signmure of Applicane Date: will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to AL1. ROOF COVERINGS TO BE CLASS "A" OR BEI-fER construct the project(Sec.7044, Business & Professions Code). hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate o'Consent to self -insure for Worker's Califonria (health & Sarety Code. Sections 25505, 25533, and 25534. I will maintain Compensation, as provided for by Section 3700 of the Labor Code, for the compliance with the Cupertino Municipal Cade, Chapter 9.12 and the health & performance of the work for mhich this permit is issued Safety Code, Section 25532(a) should 1 store or handle hazardous material. I have and will maintain Worker's Compensation Insurance, as provided for by Additionally. should I use equipment or devices which emit hazardous air Section 3700 of (he Labor Code; for the performance of (he work for which this contaminants as defined by the (fay Area Air Quality Management District I will F coni( is issued, maintain compliance with the Cupertino ;Municipal Code, Chapter 9.12 and the health & Safety Code. Sections 25505, 25533, and 25534. 1 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 Ounce or authorized uu-t-hoorriizzed n nl: r 7-0 Compensation laws of California. IL after making this certificate ofexemplion,I Uate: became subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deenied revoked \` CONSTRUCI'10N LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CI.RI'I FICATION for which this penmit is issued (Sec. 3097, Civ C.) I certify that I have read this application mid state that the above information is Lender's Name correct. I agree to comply with all city and comity ordinances and state Encs relating to building construction, and hereby authorize representatives of this city to enter Leader's Address upon the above mentioned property for inspection purposes. (11'e) agree to save indennniN and keep harmless the City ca Cupertino against liabilities, judgments, costs, and expenses which may accme against said City in consequence of the ARCHITEC1"S DECLARA'T'ION granting of this permit. Additionally, the applicant understands and will comply I understand my plans shall be used as public records. with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Licensed Professional Signature Date ��WI��""jj CITY OF CUPERTINO N] FEE ESTIMATOR -BUILDING DIVISION W` ADDRESS: 23500 Cristo rey dr #1036 DATE: 08/21/2012 REl'IEII'ED Bl': larrys btech. Permit Fee: APN: F.lec. Permit Fee: I 'VALUATION: $4,500 *PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY SFD or Duplex USE: Elee. Insp. Fee: PENTAIIATION 1R3SFF PERMIT TYPE: WORT: bathroom remodel / SCOPE $0.00 A'u I E: Ines esunmte does not incholejees doe to other Departments (i.e. Planning, Public Works, Fire; Sanitary Sewer District, School District etc.). These feev are based on the prelintinan information available and are onh• an estimate. Contact lite Dent for addn'l into FEE ITEMS (Fee Resohi ion 1/-053 L/7.'7/////) Meeh. flan Check PhonA. Plan Check Flee.. Plan Check btech. Permit Fee: Phnnh. Permit Fee: F.lec. Permit Fee: Other dlech. lisp. Other Plamh Insa.Ll I Other Flee. Insp. Ue.ch. Insp, Fee: Phonh. lost. Fee: Elee. Insp. Fee: A'u I E: Ines esunmte does not incholejees doe to other Departments (i.e. Planning, Public Works, Fire; Sanitary Sewer District, School District etc.). These feev are based on the prelintinan information available and are onh• an estimate. Contact lite Dent for addn'l into FEE ITEMS (Fee Resohi ion 1/-053 L/7.'7/////) FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 = s. F. $600.00 Remodel, Bath (<=300 so IR&WRESBAT Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PNIE Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:O Reg. Q OT 0.0 hrs $0.00 PME Unit Pee: $0.00 PME Permit Fee: $0.00 Construction Tar: Adininisontive Fee: 0 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fcc: $0.00 Select a Non -Residential Building or Structure 0 A Travel Docitinenmtion Fees: Stronc Motion Fee: IBSF/SMICR $0.50 Select an Administrative Item Bide Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $600.00 TOTAL FEE: 7$601.50J Revised: 07/01/2012 1� CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 7-3333 • buildings Dc'/u/��peecrtino.org FION El ADD]- ALTERATION/TI;ET REVISION/DEFERRED ORIGINAL PERMIT4 PROJECTADDRFSS 5� r/�� YLG I/ hJr ID 36 APNH OWNERNAME So PHONE E-MAIL v 0 STREET ADDRESS ITl', STATE, ZIP FAX z Do CONTACT NAME PHONE E- IL Er V"W STREET ADDRESS Z/!a Maa %h Gds CITY, STATF. ZIP S 9S/ FAX t1�—lcl3—ZSf ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ��Ci1 ❑ CONTRACTOR OCclirti AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �Cr%� LICENSE NUMBER LICENSETYPE BUS. LICK rl 1 COMPANY NAME E-MAIL(,7 FAX 9o8-�O/3-Z�y9• Atr Sa . �n STREET ADDRESS CITY, STATE, ZIP PHONE 21%o �r L-1 a SS CA- 9 / o _ 3B -S 3 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK � 1 r v V v n pe EXISTING USE PROPOSED USE CONsrRI TYPE P STORIES USE TYPE OCC. SQ.FI'. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM IJTCIQN OTHER REMODELAREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH a DWELLING UNITS: IS A SECOND UNIT ❑YES SECONDSTORY C] YES OEING ADDED? []NO ADD111ON" ❑NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE IILDG AN El YES 'RECEIVED BY: _ TOTAL VALUATION: PLANNINGAPPLM []NO PLANNING APPROVAL LETTER I:ICHLERHOMII' []NO - By try signature below, I certify to ea h o she folloY IPg: I am the property owner or authorized agent to act on the property owner's behalf. 1 have read this application and the information 1 hav o'ided is co Tees. I have read the Description of Work mid verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relatin ' d g cc Stn coon. 1 authorize representatives of Cupertino to enter the abov ntifie property for inspection purposes. ZI�Z�12 Signature ofApplicmt/Agen. Date: SUPPLENIFNTAL INFORMATION REQUIRED riAN cui:cs ivre. uourlN'c sclP _ New SPU or Multifamily dwellings: Apply for demolition permit for - -HE, - ❑ r ❑ existing building(s). Demolition permit is required prior to issuance of building OVER-'I'COIIN'1'ER nI111.DINC i'IA$.RE\'IP:\Y permit for new, building. ❑ . EXPRESS ❑ PLAN:NINC PLAN REVIEW - _ Commercial Bldgs: Provide a completed IlaTardous Materials Disclosure ❑ STANDARD ❑ PUHLiC WORKS form if any Hazardous Materials are being used as pan of this project. I ❑ LYRCF.: ❑ FIRE beer _ Copy of Planning Approval Letter or Meeting With Planning prior to submittal of Building Permit application. ❑ MAJOR - ❑' sn�ITa er seWeRlilsi'Rtcr - - - - . ❑•. P:,C\'IRONAIF].XT)U:116\Lrll_ B/dgApp_2011.doc revised 06/2/111