12110041CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 302D
OWNIiR'S NAME: ARIKO BARRY M TRUSTEE R FT AL
OWNER'S PHONE: 6509440100
❑ LICENSED CONTRACT'OR'S DECLARATION
License Class eff — I a Lie. # 7 '10 1 3 -2-
Contractor h, SSr� J (/ ft_60r-r/ �� Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business S Professions
Code and that my license is in full force and effect.
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 die Labor Code, for the
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 die performance of the work for which this
permit is issued. '
APPLICANTCIiRI'I FICATION
I certify that 1 have read this application and state that the above iniminatior 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
indemnify and keep hamiless the City of Cupenino 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
with all non -paints ce regulations per the Cupertino Municipal Code; Section
9.18. J
Date ' Z
❑ O\VNER-BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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 (See.7044,
Business & Professions Code)
I, as owner of the propeny, am exclusively contracting with licensed contractors to
construct the project (See.7044, Business & Professions Code).
1 hereby aflirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Cenificate 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.
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
permit is issued.
I certify that in the performance of the work for which this pcmnit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation Imus of California. If, after making this ccrtifncate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, 1 must
forthwith comply with such provisions or this permit shall be deemed revoked.
APP LIC\NI' CERTIFICA'T'ION
I certify that I have read this application and state that the above information is
correct. 1 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may acenie against said City in consequence of the
granting of this pemnit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18,
CON fRACI'OR: MISSION VALLEY PERMIT NO: 12110041
ELECTRIC INC
PO BOX 3332 DATE ISSUED: 11/07P-012
FRIiMONT. C\ 94539 fI [ONE NO: (510) 745-8847
BUILDING PER,\IIT INFO: BLDG r ELECT r PLUNIB r
MECH r RESIDENTIAL r. COM\IERCIAL -
.TOB DESCRIPTION: INSTALL (3) UNDER CABINEI' 1'LOURESCEN'I' I-IGIi'I'S,
INSTALL(I)FLOURESCENT LIC IT AT EN TRY CLOSET,
REPLACE(2)LIGIITS IN BEDROOMS.
Sq. Ft Floor Area: I Valualion: 51200
APNNumher: 34253087.00 ) Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:.. Date: 7 1
RE -ROOFS:
All roofs shall be inspected prior to ny roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove nil new materials for
inspection.
Signature of Applimne Date:
ALL, ROOF COVERINGS TO BIS CLASS "A" OR BETITR
HAZARDOUS MATERIALS DISCLOSURE
have read the hazardous materials requirements under Chapter 6.95 of the
California Beath & Safety Cade. Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code. Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should 1 store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Ray Area Air Quality Management District 1 will
maintain compliance with the Cupertino ;Municipal Code. Chapter 9.12 and the
Health & Safety' Code. Sections 25505, 25533, and 25534.
O uthorized nC (Z
CONSTRUCTION LENDING AGENCY
I hereby atTmn that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCIII'I'ECI"S DECLARATION
I understand my plans shall be used as public records.
Signature Date I Licensed
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 9501-x3255
(408) 777-3228 • FAX (108) 777-3333 • buildinc r(�. cuoertino.ora
I Ipr Truro Ur. nassrv,vr.: 'f Cr :r,r n.n
ILII (,�Wy I
Ilysisc
PROJt2 ADD mon �Is�
-----
- ------ -
L) 1
OWNER NAME
/k ILo
E-�
Z
6 So -- oloD
S!=. ADDRESS
I CRY. SLAT -c Lip
FAX
CONTACT NAME
PHOS
MAfl
l
' 3 D Z
DRESS
CLfY, AT'S ZP
-
FAX
see
se-� S -dZ.
❑ Ov.:- ❑ OWNER-BIRIDER ❑ OWNEt AGEYr
CONTRACiDR ❑CON,, A=RAGEM' ❑ ARCTtT ❑ DEVM' PER ❑ T_+JANT
CONTIi AC iOR NAME
LiCENSENUMBER
LICENS`c M°
BLS.LIC4
336
+> lat
1/7o1'1
6-- IC)
COMPA�I' NAME
�
1 E -MALI.
1 ✓<,.r �
FAX
Id • 7 L
S o P- Lac Lc
G-i7ae r(r e.� �a tstr ✓ e• � ,�
f'S'a Y
S?REEL ADORs.s5_
o i5ox 3 3 Z
CrfY,S ATE,ZP Ge �y
, 4 7/S 3
PHONE
S /0 3d Y(37 7-Z,
ABC=R/ENGWEER NAME
I LICENSE NUMBER
BUS. LICA
COAfPANY NAME
E-MAIL
FAX
STRac-M ADDRESS
I CRY, STATE, ZIP
PHONE
USE OF D SM � DUPLEX MULTI-FANm.Y
PO=I ❑YES
AN
�O
BUMOING: [] COM.MERCW.
URBAN Drrw- A MFA NO I FLOOD NE O
I EICA.ER Ho
DESCF=ON OF WOR:C
S� -e_ S
u Nuc tZ G B I t - 3 i 1 e I -r
_ T)s- w - L
D
TOTAL VALUATION:
a: -,7e I RECEIVED BY: C�
By my signature below„I certify m each of [he following:
I am the property owner or atrhoriud agent to act an the propery ownneerI s behalf. 1 have read this
application and the information I bave provided' orrecL I have rid the Description of Work and verify it is ac=ram. I agrceto comply with all applicable local
ordinances and sate laws relating to buil 'n or tvedm n;bons represeradves of Cuperti.p :a :❑:e: Lie ,Mve-idrnd5ed pmpe. ,• for inspection pu;posu.
Sigraira2 ofApplicant(Agcat `(
Date:
SUPP r ENTAL tt
,LATION REQUaED
USEONLY
v
/OFFICE
:\ OVER-THE-COUNTER
❑ EXPRESS
C
U
❑ SrA,NDARD
V
❑ I-ARCE
Z
❑ NI JOR
rl-IFPMrsc{pp_1011.doc rz ised 06/11/]1
91
CITY OF CUPERTINO
r"R FEE ESTIMATOR—BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 23500 Cristo Rey Drive
DATE: 11/07/2012
REVIEWED BY: Sean
UNITS
APN:
BP#:
`VALUATION:
1$1,200
*PERMIT TYPE: Electrical Permit
PLAN CIIECK Tl'PE: Alteration / Addition / Repair
PRIMARY Multi -Family Dwelling
USE:
Buildina is
>3 Stories Q Yes Q No
PENTAIIIA"PION 1REAP11
I PERMITTYPE:
WORK
Install 3 under cabinet flourescent lights, install 1 flourescent light at entry closet re lace 2 li hts in
SCOPE
bedrooms.
APPLIANCE / EQUIP TYPE
FEE ID
Plumb. Plan Check
Qn,
UNITS
BP FEES
Elec. Permit Fee: 1 F.PERAIIT
Fixtures, Lighting
1BREMFIXT
Other Elec. Insp. 0.0 hrs$45.00
6
#
$67
Permit Fee:
Suppl. Insp Fee
PME Unit Fee:
$67.00
PME Permit Fee:
$45.00
Construction Tax:
Administrative Fee: (ADMIN
$42.00
Work Without Permit? O Yes Q No
$0.00
TOTALS:
A
Tavel Documentation Fee: ITRAVDOC
$67.00
Strome Motion Fee: IBSEISHICR
NOTE: This estimate does not include jeer due to alter Departments (i.e. Planning, Public lVarks, Fire, Sanitary Sewer District, School
District, etc.). These fees are hared on the nrelitninan• information awilahle and are onh, an estinmte. Contact lite Dent for aaldn'I into.
FEE ITEMS (Fee Resolution 11-053 Elf 7/1/12)
S/ech. Plan Check
Plumb. Plan Check
Elec. Plan Check 0.0 1 hrs $0.00
Mesh. Permit Fee:
Pl..nh. Permit Fee.'
Elec. Permit Fee: 1 F.PERAIIT
Other Mech. Insp.
Other Plumb Insp.
Other Elec. Insp. 0.0 hrs$45.00
,Neth. hip. Fee:
Plumb. hasp. Fee:
Elec. Insp. Fec:
NOTE: This estimate does not include jeer due to alter Departments (i.e. Planning, Public lVarks, Fire, Sanitary Sewer District, School
District, etc.). These fees are hared on the nrelitninan• information awilahle and are onh, an estinmte. Contact lite Dent for aaldn'I into.
FEE ITEMS (Fee Resolution 11-053 Elf 7/1/12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl. PC/ ee
PME Plan Check:
$0.00
Permit Fee:
Suppl. Insp Fee
PME Unit Fee:
$67.00
PME Permit Fee:
$45.00
Construction Tax:
Administrative Fee: (ADMIN
$42.00
Work Without Permit? O Yes Q No
$0.00
Advanced Planning Fces:
A
Tavel Documentation Fee: ITRAVDOC
$45.00
Strome Motion Fee: IBSEISHICR
$0.50
Select an Administrative Item
Bldg Sids Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$200.50
$0.001TOTAL
FEE:
$200.50
Revised: 10/01/2012
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building- Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: 3 SDS C upi7
PERMIT #
OWNER'S NAME:
PHONE#
GENERAL CONTRACTOR: ),5570 a —��
BUSINESS LICENSE #
ADDRESS: V.. Q ._ 33 3 y
CITY/ZIPCODE: '
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR'FINAL OCCUPANCIINSPECTION(S) WILL BE SCHEDULED UNTIL -I'HE
GENERAL CONTRACTOR AND ALL CONTRACTORS HAVE OBTAINIi1) A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors..
Signat re Date
Please check applicable subcontractors and complete the following information:
• Owner/ Contractor Signature
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
• Owner/ Contractor Signature
Date