13030062CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 323E
CONTRACTOR: BAY AREA ENTERPRISE
PERMIT NO: 13030062
OWNER'S NAME: LILLIAN OTOOLE
2110 MANGIN WAY
DATE ISSUED: 03/13/2013
OWNER'S PHONE: 6505377152
SAN JOSE, CA 95148
PHONE NO: (408)238-5043
JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIALU
❑ LICENSED CONTRACTOR'S DECLARATION
License Class_ Lic. # �qf
UNIT 323E- REMOVE AND REPLACE SHOWER VALVE
*� f
Contractor 6 >�� Yate ,
AND
CLEAN UP SURROUNDS
I hereby affirm that I am li ensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 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 is issued.
Sq. Ft Floor Area:
Valuation: $3000
I have and will maintain Worker's Compensation .Insurance, as provided for by
APN Number: 34253122.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT C TIFICATION
his application d state hat_the above information is
I certify that I ha4an
PE RMIT E MES IF WORK IS NOT STARTED
correct. I agree twith all city. n. county ordinances and state laws relating
WITHIN 0 DAYS OF PERMIT ISSUANCE OR
to building constd hereby a rize representatives of this city to enter
upon the above mproperty f ' spection purposes: (We) agree to save
180 DAY M LAST CALLED INSP CTindemnify
and kless the Ci Cupertino against liabilities, judgments,costs,
and expenm y accru against said City in consequence of the
Issued by Dategranting
of this pd tionall the applicant understands and will comply
with all non-poinlati er the Cupertino Municipal Code,Section
9.18.
1 I I
RE -ROOFS:
is
SignatureDate
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.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Da
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 " ' OR BETTER
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 (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIAL D SCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials req ireme is under Chapter.695 of the
California Health & Safety Code, Sectio s 255 5, 25533, and 25534. I will.
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertin Muni ipal Code, Chapter 9.12 and the
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Health & Safety Code, Section 25532 shoul I store or handle hazardous
material. Additionally, should se me r devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined b t e ay it Quality Management District I
will maintain compliance wit th Cuperti unicipal Code, Chapter 9.12 and
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health &Safety Code, cti ns 25505, 2 3, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agen : 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
CO TRUCTION 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 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. 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
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 �-
12 COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 Okii
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildingCftypertino.ora
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / Tl ❑ RFVTSTnN / T)FFFRRFT) OPT( -THAT PFRUTT H
PROJECT ADDRESS13 2 3 t
3 57-c=, C vi SFS
APN # ` 1
'DtZ-
OWNERNAME ! � �1 , Q P tF50— 7,-7' 1.y
�'wj
i• 'l 1 V E-MAIL
STREET ADDRESS FAX
G Me G s Q O CITY, S STATE,
,T
�Y2 JyQy
CONTACT NAME U h^
PHONE
7-2-3
E-MAIL
Fr,e f (•e s �- of
b S 6- S— 3 1
i
STREET ADDRESSZ 3 �6 /��i ,,�
CTfY, STATE, ZIP
FAX
`
❑ OWNER ❑ OWNER -BUILDER 21OWNEPAGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER r
j a f V— 'Cif ' 7 1 \
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
1r'1
STREET ADDRESS
2 I� AoV, to w
L , STATE, ZIPPHONE
�7 -4-,- Lf
O -�.3
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK /. AP kl„e-Y a <-44pr j(r ) I(— � D
EXISTING USE
PROPOSED USE CONSTR.
TYPE
-W—STORIES
I
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NEPAREA
BATHROOM
KITCHEN
OTHER
REMODELAREA
REMODELAREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAI AREA: ODETACH
I
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNrr ❑ YES
SECON ORY ❑ YES
BEING ADDED? ❑ NO
ADDIT ? ❑ NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS TH9 4DG AN va
RECE .
T L
PLANNINGAPPL# ONO PLANNING APPROVAL LETT
ir
EICH HOME? ONO
By my signature below, I certify to each of the f e property owner authorized agent on the property owner's behalf. I have read this
application and the information I have pcov' is orrect. av read the Descripti of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buil g co truction. I orize repr s o Cupertino to enter the above -id ' ed prop for inspe ulposes.
Signature of Applicant/Agent: Date: � ��
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
El OVER-THE-COUNTER
El BUILDING PLAN REVIEW
_ New SFD or Multifamily dwellings: Apply for demolition 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
ElSTANDARD
❑ 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.
El MAJOR
❑ SANITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
BldgApp_201 Ldoc revised 06121111
F.r kA rSA-
r
�� CITY OF CUPERTINO
rimim ivio r71tT A 9rnID _ T2TTTT .n1T%T _' Dl[VlQlnN
Mech. flan Check
;L1ech. Permit Fee:
Other Alech. Insp.
rttech. Insp. Fee.
Plumb. Plan Check 10.0 1 hrs $0.00 Elec. Plan (.;heck
Plumb. Permit Fee: 1PPERMIT Elec. Permit Fee:
Other Plumb Insp. 0.0 hrs $45.00 Other Elea. Insp.
Plumb. Insp. Fee: Elec. Insp. Fee:
NOTE: This estimate does not tnctuae fees aue ro orne—epurtmenls (tie. r.urt.«rex, A „• n.,, . -....r -• -. _ _ _. ___, _ ___ _ _ _
Th bd n the relinlina information available and are onl an estimate. Contact the De t or addn'l info.
murict, etc . ese ees are ase o
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12)
23500 cristo rey
QTY/FEE
DATE: 03/13/2013
REVIEWED BY: mendez
1wiADDRESS:
APN:
BP#:
*VALUATION:
1$3,000
*PERMIT TYPE: Building .Permit
0.0
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex
PME Plan Check:
PENTAMATION 1 RPFIX
PERMIT TYPE: J
WORK
-REMOVE AND REPLACE SHOWER VALVE AND CLEANUP SURROUNDS
SCOPE
Permit Fee:
Mech. flan Check
;L1ech. Permit Fee:
Other Alech. Insp.
rttech. Insp. Fee.
Plumb. Plan Check 10.0 1 hrs $0.00 Elec. Plan (.;heck
Plumb. Permit Fee: 1PPERMIT Elec. Permit Fee:
Other Plumb Insp. 0.0 hrs $45.00 Other Elea. Insp.
Plumb. Insp. Fee: Elec. Insp. Fee:
NOTE: This estimate does not tnctuae fees aue ro orne—epurtmenls (tie. r.urt.«rex, A „• n.,, . -....r -• -. _ _ _. ___, _ ___ _ _ _
Th bd n the relinlina information available and are onl an estimate. Contact the De t or addn'l info.
murict, etc . ese ees are ase o
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 #
$10.00
Plumbing
1BPF=RE Fixture or Trap
Supp/. PC Fee: Reg. ®OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -.O Reg. ® OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$45.00
Consir-uction 1 ax: J-7
Administrative Fee: IADMIN
$42.00
Work Without Permit? ® Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
Travel Documentation Fee: ITRAVDOC
$45.00
Strong Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
$133 .50
$10 .00
,a '
$143.5 0
Revised: 01/01/2013