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13030063CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO, REY DR UNIT 316F CONTRACTOR: BAY AREA ENTERPRISE PERMIT NO: 13030063 OWNER'S NAME: VIVIENNE SAUNDERS 2110 MANGIN WAY DATE ISSUED: 03/13/2013 OWNER'S PHONE: 6505371523 SAN JOSE, CA 95148 PHONE NO: (408)238-5043 . JOB DESCRIPTION: RESIDENTIAL[] COMMERCIALS LICENSED CONTRACTOR'S DEC TION License Class Lic. # 1 316F- REMOVE AND REPLACE SHOWER VALVE AND , Z I�a ��`� 6t4e � CLEAN UP Contractor D SURROUNDS I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division3 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 performance of the work for which this permit issued. Sq. Ft Floor Area: Valuation: $3000 I have and will maintain Worker's mpensation Insurance, as provided for by APN Number: 34253139.00 Occupancy Type: Section 3700 of the Labor Code,f e performance of the work for which this permit is issued. APPLIC CERTIFICATION I certify that I have read this apps a on and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with al ty and county ordinances and state laws relating WITHIN 80 DAYS OF PERMIT ISSUANCE OR to building construction, d he y authorize representatives of this city to enter upon the above mentioned rope for inspection purposes. (We) agree to save 180 DA F OM LAST CALLED INSP TON. indemnify and keep harml s the ity of Cupertino against liabilities, judgments, ich said City in of the costs; and expenses w ay a crue against Issued by Date granting of this permit. A . 'tion Rly, the applicant understands and will comply with all non-poin our re lati rthe Cupertino Municipal Code, Section RE -ROOFS: is 9.18. Signature Date / All roofs shall be inspected prior to any roofing material being installed. If a roof installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ QWNER-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 CLA 'A" OR BETTER 1; as owner of the property, or my employees with wages as then 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, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS I CLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requiremen under Chapter 6.95 of the California Health & Safety Code, Sections 25509.25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino M ici al Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) sho Id I tore or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipm nt devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay r it uality Management District I performance of the work for which this permit is issued. will maintain compliance wit r in 'cipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health &Safety Code, ctions 25 5 33 and 25534. n Section 3700 of the Labor Code; for the performance of the work for which this Owner or authorized ager : 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 CONST CTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I 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. l 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 source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • buildinaCc�cupertino.ong CUPERTINO ' ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESSav n l� — ,J APN #� �y �` •yll� —+ O w IVA e� I - Q � � J �• 5 3 E-MAIL STREET ADDRESS CITY, STATE, ZIP pAX CONTACT NAME Fe ..// �`C. I7�Yj1Q�q PHONE SD S3% IS 2 3 E-MAIL L STREET ADDRESS Q ! 6 CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER 1ZOWNEAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEn �� /T LICENSE NUMBER + `� 91 LICENSE TYPE iJ BUS. LICloa� # COMPANY NAME �+ E-MAIL QDFAX STREET ADDRESS 21(C) c w CITY, STATE, ZIP e:;. -$- IS-Iq PHONE tjoQ� 23 Fl_ ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR- TYPE # STORIES I USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: 0 DETACH I ❑ ATTACH I # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY EyffN BEING ADDED? ❑ NO ADDITION? 11INY PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG YES EICHLER = NO TOTAJJY / p r'n i the to I am the p rty owner or authorized agent to act on the property owner's behalf. I have read this By my signature below, I certiZhavprovided.is application and the information orre I have rea the Description ofWork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatng co cti n. I authori a representatives of Cupertino to enter the above-iden 'flied pr perty for ins ection purposes. Signature of Applicant/Agent Date: J/% 3 / Z "/ T SUPPLEME TAL INFORMATION RE IRED j PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply ford blition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to _ submittal of Building Permit application. ❑ MAJOR ❑ SANITARY SEWER DISTRICT ❑ ENVIRONiviENTALREALTH BldgApp_MLdoe revised 06/21/11 S-�, �Ce-- ny---:E� CITY OF CUPERTINO 1 ' ilJ'I I F.F. F.QTIMATnR — RITII,DING DIVISION I1ech. flan ('heck V1eCh. Permit Fee: Other• Alech. Insp. : I1ech. Insp. Fee: Plumb. Plan Check 10.0 1 hrs $0.00 Elec..Plan Check Plumb. Permit Fee: IPPERMIT Flec. Permit Fee: Other Plumb Insp. 0.0 hrs $45.00 Oiher F.lec. In v. Plurrth. Intik. Fee• Elec. Insp. Fee: IvwE: This estimate Goes not inetuae fees aue to orner veparrments Ctie. rlwliui�g, ru�«� .. �.n�, �, .,�,.��..•r ��•��• --��• •��, --� •��- %'nNtart tho Dont far addn'l info. Liu LI 6a.L, •.e... • a.•.n.v vvu w, •. .. w.. �.. .... ...——_______ ____ FEE ITEMS (Fee Resolution 11-053 E . 711112) ADDRESS: 23500 cristo rey DATE: 03/13/2013 REVIEWED BY: mendez APN: BP#: *VALUATION: 1$3,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Du lex p hrs PENTAMATION 1 RPFIX USE: PERMIT TYPE: WORK - REMOVE AND REPLACE SHOWER VALVE AND CLEAN UP SURROUNDS Permit Fee: $0.00 SCOPE 0.0 I1ech. flan ('heck V1eCh. Permit Fee: Other• Alech. Insp. : I1ech. Insp. Fee: Plumb. Plan Check 10.0 1 hrs $0.00 Elec..Plan Check Plumb. Permit Fee: IPPERMIT Flec. Permit Fee: Other Plumb Insp. 0.0 hrs $45.00 Oiher F.lec. In v. Plurrth. Intik. Fee• Elec. Insp. Fee: IvwE: This estimate Goes not inetuae fees aue to orner veparrments Ctie. rlwliui�g, ru�«� .. �.n�, �, .,�,.��..•r ��•��• --��• •��, --� •��- %'nNtart tho Dont far addn'l info. Liu LI 6a.L, •.e... • a.•.n.v vvu w, •. .. w.. �.. .... ...——_______ ____ FEE ITEMS (Fee Resolution 11-053 E . 711112) ___ FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # Plumbing $10.00 IBPFIXTURE Fixture or Trap Suppl. PC Fee: (F) Reg. ® OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 Construction Tax: T7_ Administrative Fee: IADMIN $42.00 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 1 ®, Travel Documentation Feer ITRAVDOC $45.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $133.50 $10.00r $143.50 Revised: 01/01/2013