13030064CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: "23500 CRISTO REY DR UNIT 414E
CONTRACTOR: BAY AREA ENTERPRISE
PERMIT NO: 13030064 "
OWNER'S NAME: REGINA FISHER
2110 MANGIN WAY
DATE ISSUED: 03/13/2013
OWNER'S PHONE: 6505371523
SAN JOSE, CA 95148
PHONE NO: (408)238-5043
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALE]
❑ LICENSED CONTRACTOR'S DECLARATION
I t W)
414E-- REMOVE AND REPLACE SHOWER VALVE AND
License Class Lic. #
f� �I�
CLEAN
_
Contractor Date_ _
UP SURROUNDS
I hereby affirm tat I am licensed under the provisions of Chapter 9
(commencing withSection7000) 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: 34253160.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all cid and:county ordinances and state laws relating
WITHIN 18 DAYS OF PERMIT ISSUANCE OR
to building construction,.and here' uthorize representatives of this city to enter
upon the above mentioned ope or ins purposes. (We) agree to save
180 DAYS LAST CALLED INSPECTION.
indemnify and keep the ity of Cupertino against liabilities, judgments,
costs, and expenses hic ay a _rue against said City in consequence of the
Issued by: Date �� %
granting of this pe ditio ly, the applicant understands and will comply
with all non -point s u re er the Cupertino Municipal Code, Section
RE -ROOFS:
9.18. �^
el Ze ( ✓
Signature Date
All roofs shall be inspected prior to any roofing material being installed If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER -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 CLASS "A" OR BETTER
1, 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 MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements nder Chapter 6.95 of the
California Health & Safety Code, Section 550 5533, a 25534. Y will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino u ' ' al Co , hapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) oul store andle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use eq ' e t or d ices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay ea Air Q lity Management District I
performance of the work for which this permit is issued.
will maintain compliance' th u rd M al Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
od , Sections 505, 55 , nd 25534.
the Health & Safety Codi
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized gent' Date: 3
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
ONSTRUCTION LENDING AGENCY
Compensation laws of California. If, aftermaking 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. 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
,3
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE- CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building(&cupertino.oro
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS
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APN#
OWNERNAME '
J
3 -7• 1 ��
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
CONTACT NAME v Lc?✓t
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PHONE
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E-MAIL / 7
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STREET ADDRESS CITY, STATE, ZIP _ 1. FAX
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❑ OWNER ❑ OWNER-BUILDEROWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
S
FLICENSENUMBER
TLICENSETYPE
BUS. LIC #
COMPANY NAME6 f�-)l �rc1
EMAIL Y� �1 � CC3W1
FAX
STREET ADDRE�� Q
CITY, STATE, ZIPS C
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PHONE 2
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
C k
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NETAREA
BATHROOM
KITCHEN
OTHER
REMODELAREA
REMODELAREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTALDECK/PORCH AREA
GARAGE AREA: 0 DETACH
[]ATTACH
I
# DWELLING UNITS:
ISA SECOND UNrr ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ❑ NO
ADDITION? []NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPL # []NO PLANNING APPROVAL LEITER
IS THE BLDG AN O
EICHLER HOME?
RECEIVEIZBY1 TOT
�;
By my signature below, I certify to each of the following: I am roperty o or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I hav ead the De option of Work and verify it is accurate. I agree to comply with all applicable local
i
ordinances and state laws relating to building construction I a orize repr ntatives of Cupertino to enter the above -i entified perty for ' spection purposes.
Signature of Applicant/Agent: Date: J 3 �d
SUPPLEMENTAL INFO ION REQ
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ BUILDINCPLANREVIEW
_ 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
❑ 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
❑ MAJOR
El SANITARY SEWER
submittal of Building Permit application.
DISTRICT
❑ ENVIRONMENTAL HEALTH
BldgApp_201 1. doc revised 06/21/11
Sa .,rec..,,
CITY OF CUPERTINO
MOM 11TUIV UQgr7A4 A rrnID — RTTTT ."INC nIVIR><nN
Xtech. Plan Check Plumb. Plan Check 0.0 1 hrs $0.00 E'lec. Plan Check
Gtech. Pernril Fee: Plumb. Permit Fee: IPPERMIT Elec. Permit Tee:
Other Alech. Insp. Other Plumb Insp. 0.0 hrs $45.00 Other Glee. Insp.
:13ech. Insp. Fee: Plumb. Insp. fee: Glee. Insp. Fee:
NnTF.r This ectimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
D' Th are based on the nrolimista information available and are only an estimate contact the ue t for aaan .t en o.
zstrtct, eta . ese ees
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12)
ADDRESS: 23500 cristo rey
QTY/FEE
DATE: 03/13/2013
REVIEWED BY: mendez
Plan Check Fee:
APN:
BP#:
*VALUATION:
$3,000
%PERMIT TYPE: Building Permit
Suppl. PC Fee: Q Reg. 0 OT
PLAN CHECK TYPE: Alteration / Repair. ,
PRIMARY .
SFD or Duplex
$0.00
PENTAMATION 1 RPFIX
PERMIT TYPE: i
USE:
$0.00
WORK
-REMOVE AND REPLACE SHOWER VALVE AND CLEAN UP SURROUNDS
$0.00
Suppl. Insp. FeeQ Reg. Q OT
0,0
SCOPE
$0.00
Xtech. Plan Check Plumb. Plan Check 0.0 1 hrs $0.00 E'lec. Plan Check
Gtech. Pernril Fee: Plumb. Permit Fee: IPPERMIT Elec. Permit Tee:
Other Alech. Insp. Other Plumb Insp. 0.0 hrs $45.00 Other Glee. Insp.
:13ech. Insp. Fee: Plumb. Insp. fee: Glee. Insp. Fee:
NnTF.r This ectimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
D' Th are based on the nrolimista information available and are only an estimate contact the ue t for aaan .t en o.
zstrtct, eta . ese ees
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
#
$10.00
Plumbing
1BPFIXTURE. Fixture or Trap
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. FeeQ Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$45.00
L L
Construction Tax:
F71
Administrative Fee: IADMIN
$42.00
L
0
Work Without Permit? 0 Yes (F) 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
$10.00 .,w1 $143.50
Bldg Stds Commission Fee: IBCBSC
010-111,100 ._E9
$1.00
$133.50
Revised: 01/01/2013