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12110061CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR P415E CONTRACTOR: BAY AREA ENTERPRISE PERMIT NO: 12110061 OWNER'S NAME: ANNA YACOE 2110MANGIN WAY DATE ISSUED: 11 /132012 OWNER'S PIIONE: 6505371523 SAN JOSE, CA 95148 PIIONF.NO: (4081238-5043 ❑ 1 LICENSED CONTRACfOR'S DECCLARRATION C Cl r / k117 BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class N ;5 f / r r r _Lie. ,f G / /�&(i N1ECII RESIDENTIAL COMMERCIAL Contractor Date / -� • r hereby affirm t at I am licensed under the provisions of Chapter 9 JOBDESCRIPTION: REMOVE SHOWER TILE WALL AND INSTALL NEW (commencing with Section 7000) of Division 3 of the Business & Professions SHOWER VALVE AND MARBLE IN STALL Code and that me license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 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. , 1 have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Aren: Valuation: $3500 Section 3706 of the Labor Code, for the performance of the work for which this pemtit is issued APN Number: 34253161.00 OccupancyType: ' • API'I.ICAN'I'CER'I'IIICA'I'ION I certify that I have read This application and stale 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 sue PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which ruby accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply with all non -point sour a re lations per the Cupertino Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. - Signature ,II Date Issued by: ��TG Date: ❑ OWNER - BUILDER DECLARATION RE- ROOFS: hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is the following two reasons: installed without first obtaining an inspection, 1 agree to remove all new materials for 1, as owner of the property, or my employees with wages as their sole compensation, inspection. will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business & Professions Code) Signature of Applicant: Dale: I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sce.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1 hereby affirm under penalq•bf perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self - insure for Worker's HAZARDOUS MATERIA S DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the 1 have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Ilealth & Safely Code, Sections 25505, 25533, and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance, as provided for by cam pliance with the Cupertin Iunfcipal Code, Chapter 9.12 and The Ilealth & Section 3700 of the Labor Cade, for the performance of the work for which this Safety Code. Section 2553'_( should 1 store or handle hazardous material. Additionally, should I use e m rent or devices which emit hazardous air permit is issued. contaminants as dehned by t �Itoy Area Air Qualily Management District I will I certify that in the performance of die work forwhich this permit is issued, I shall maintain compliance with a Cupertino Municipal Code. Chapter 9.12 and the not employ my person in any manner so as to become subject to the Worker's Ilealth & Safeq Co e, Se ions 25505, 25533, and 25534. Compensation laws ofCalifomia. If. after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, 1 muss Owner or au wiz ge t: '' /r , •� / /'� I Dale: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY \PI'LICAN'f CF:R'1'IFICATION I certify ihat I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of �wrk's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.) to building construction, and hereby authorize representatives of this city to enter Lender's Name - upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply ARCII ITECT'S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO "I FEE ESTIMATOR — BUILDING DIVISION igADDRESS: FEE ID 23500 Crista Rey Dr Q'1'1' DATE: 11113/2012 REVIEIVED BY: Sean Elec. Permit ree: APN: 1BPFIXTURE BP #: 1 VALUATION: $3,500 *PERbDT TYPE: Plumbing Permit PLAN CIIECK TYPE: Alteration / Addition / Repair PREMARY USE: SFD or Duplex PENTAAIATION PER,IIITTYPE: 1RPFIX 11'ORIh Unit 415 E: Remove shower tile walls and install new shower valve and new culture marble wall in SCOPE shower. Construction Tax: APPLIANCE / EQUIP Tl'PE FEE ID Plumb. Plan Check 0.0 hrs $0.00 Q'1'1' UNITS BP FEES Elec. Permit ree: Fixture or Trap 1BPFIXTURE Other Occ. Insp. 1 # $10 Permit Fee: SuppL Insp Fee PME Unit Fee: $10.00 PME Permit Fee: $178.00 Construction Tax: Administrative Fee: IADAIIN $42.00 Work Without Permit? O Yes (F) No $0.00 TOTALS: i Travel Documentation Fee: ITRAI DOC $10.00 Strong Motion Fee: IBSEISAIICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public (Forks, Fire, Smtimrr Sewer District, School District, etc.). These fees are based on the preliminan, information arailahle and are onll! an estimate. Contact the Dept for addn'I info. FEE iTEMS (Fee Resoherion I1 -053 EfL 711112) Afech. Plat Check Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check A/,ch. Permit Fec: Plumb. Permit Fee: IPPERA17T Elec. Permit ree: Other Meek Insp. Other Plumb Insp. 1.0 hrs $45.00 Other Occ. Insp. Afech. Insp. Fee: Plumb. Insp. Fee: IPLAIBIA'SP $133.00 Eke. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public (Forks, Fire, Smtimrr Sewer District, School District, etc.). These fees are based on the preliminan, information arailahle and are onll! an estimate. Contact the Dept for addn'I info. FEE iTEMS (Fee Resoherion I1 -053 EfL 711112) FEE QTY /FEE DIISC ITEMS Plan Check Fee: SuppL PC Fee PME Plan Check: $0.00 Permit Fee: SuppL Insp Fee PME Unit Fee: $10.00 PME Permit Fee: $178.00 Construction Tax: Administrative Fee: IADAIIN $42.00 Work Without Permit? O Yes (F) No $0.00 Advanced Planning Fees: i Travel Documentation Fee: ITRAI DOC $45.00 Strong Motion Fee: IBSEISAIICR $0.50 Select an Administrative Item 1 Bldg Stds Commission Fee: IBCBSC $1.001 SUBTOTALS: 1 $276.501 $0.001 rOTAL FEE: 1 $276.50 Revised: 10101/2012 CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 950143255 (408) 777 -3228 • FAX (408) 777 -3333 • buildino0cuoerino.org LU'.SING ❑MECF_-.MCAL ❑ELECTPJCAL ❑1.risc— I.LA.NEOUS MEP M Isc la 1/006 �ROrrAnDR�ss � -3 -5-co ✓I Sh6 Az/ � 71 ' Np 3 .1 .3 — O� Unt E OWNER N C{COe PrUhf I PHONE/aSo -.S3 -1S2-3 1 E- ve .11er.,o -%r�wtr sTR�'ADwiss `'> 1" S G . STA - I 07 tz �C Gt �r'kghO Co- � FAx CANTACr NAME G �� r ,( - lJ JJ PHONE ^ Z 3 8 57 r.� n MAJL �/ K r S • CO I .�-p STTLF-TADDRESS 2 I 1 0' b n I'r W STATE Z'iO L G S 1 y FAX ❑ owz;t ❑ ovJ .BUT -DER ❑ Ow'NER A(vs'T'T' ICCOMAACFOR ❑COM ACfORAOET, EI AJICFTCT ❑ INOD�= ❑ D.V PER ❑ i�1ANT CDNTRACTOR NAME /tY (.� �` ll['_''.'SE NL1tArJt I'.7CrT'SE M °_ I Bus. uCa ...P� LTJN.PANY NAM9 a itlat� E t E -MAIL I re yert5 C0/( STR.ci: ADDR =2 11 L rU I7 L , n U QTY. �,! 1 � L? C- 9 � � ?F.0 O —zTO 6 AACYTc[- IF_VGD3Ec'R NAAfE UC7J5:NUNMa - I Bus. llCa COMPANYNAME' I E -MAIL I FAX STR.E T ADDRESS I CIY, STATE Z3 I PHONE USE OF ❑ SFD. DUPL X r MUL, FA1.G1.Y B1I11DING: 0 COMMERCIAL I PROJECT IN wGDL.ND ❑ Yes URBAN INTER!'ACE AREA PROJECT IN ❑ 1^Si I FLOOD ZONE . 0 IS TlIE B]DG AN ❑ 1 Es EICNJ.FA HOME'] DESCRDTION OF WORK ' RQI�,peL� Slz�t.✓e �• Wi, /�S o''nd in S'�F (� new S 12o1e/ev vca IV{ new orb la h TOTAL VALUATION: I RECEIVED BY: F /v By Day signettnre below, I certify to each o L's f application and the information I have pr 'tied ordinaices and state laws relating m bu' di. Sig: zn.•-e of .Applicant/Agcnn ]owi I 3e pmpery owner c, anLhodmd agent to act on the pmpery owner's behalf. I have read this s cosec 1 have read the Description o: Work and verity it is acc=1c. I agree w comply 15 th all zpplica'ule local suvctio I authorize representatives o; Cupettino to enter the above -id- ti5edpmoc.—,Y for inspection puiposes. Dax: z -PPLEbEh —tNTFOR.MATION REQUIRED OFFICE USE ONLY r ^ U J OVER- THE-COUNTER ❑ EXPRESS ❑ STANDARD ❑ LARCE ❑ MAJOR .>.CP.MUc4pp_20Jl.doc revEred 06/21/11 a • [o). 3 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 FasL 408- 777 -3333 JOB ADDRESS: 'y 35'pp ✓ t ;� PERMIT # OWNER'S NAME:. PHONE# D$ —Z3S GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS:2Nlo Mu 'a CITY /ZIPCODE: 5'3 c.rt 99-1 *Our municipal code requires all busin"s working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY li' PECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCO TR TORS HAVE OBTAINED A CITY OF CUP RTINO BUSINESS LICENSE. /r I am not using any subcontractors: gnature Date Please check applicable subcontractors and complete the following information: Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE# Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Date