13030110CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR
CONTRACTOR: BAY AREA ENTERPRISE
PERMIT NO: 13030110
OWNER'S NAME: THE FORUM RANCHO SAN ANTONIO
2110 MANGIN WAY
DATE ISSUED: 03/21/2013
O 'S PHONE: 6505371523
SAN JOSE, CA 95148
PHONE NO: (408)238-5043
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
Lic.
MAIN LOBBY- ADD 20 AMP CIRCUIT IN PLANT
License Class 1� #
OPERATION
Contractor. & dt Aneen 67/+'f Dates 7 2 _20 13
OFFICE
I hereby affirm th t I am licensed 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: $1000
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 34254999.00
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 city and county ordinances and state laws relating
WITHIN 80 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DA F OM LAST CALLED INSP CT ON.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
against City in of the
�3
costs, and expe ses which may crue said consequence
Issued by: Date
granting of th' permit. Additi ally, a applicant understands and will comply
with all non oint source re ations jerLthCupertino Municipal Code, Section
RE -ROOFS:
is
9.18.
A ` � Z Z 7041
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.
❑ OWNER-BUIL ER 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
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATER LS ISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
uir e s under Chapter 6.95 of the
I have read the hazardous mateJe
California Health & Safety Codns 55 , 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cnicipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section s Id I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should i ent or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with tunicipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sect, 533, and 25534.
�'
Section 3700 of the Labor.Code, for the performance of the work for which this�%
Owner or authorized agent: Date: I�+
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
CONSTRUCTION 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
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(Mcuoertino.org
—IPLUMRTNG FIA ECHANICAL IY"fELECTRICAL nJMISCELLANEOUS
PROJECT ADDRESS 17—e�
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2 5t4 qq'I
OWNER NAME_ / n
I i� t'O V(T lin OL '` R p C `I $6y
P'HO`N
E-MAII.
STREET ADDRESS" , t^�b C r� S I� J
CITYcj , STATE,ZIPu 47 f'ri 6 C
FAX
CONTACT NAMEFr,e ` He r h G H do 7
PHONE / 5--0 5 37 - 115-
�O
1
z
STREET ADDRESS
CITY, STATE, ZIP
`
FAX
OwNER-BUILDER NERAGENT CON UCTOR ❑CONTRACTORAGEI.'T 11ARCHITECT ElENGiNEER 11DEVELOPER ❑TENANT
11owNER El 11 OW
CONN'TRA.CTOR NAME ^ /� CG• 4 h /. `LIC SENUMBER / c//
+ �,/
IC,
LICENSE �E
BUS. LIC #
COMPANY I�TAME /+ V` 2
l� t
I E-MAIL rd S C a
FAX
STREET ADDRESS Z I d VPHONE /�tr h I'rl W
J
2.
ARCHITECT/ENGLNEER NAME LICENSE NUNIBER
BUS. LIC #
COMPANY NAME '
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD . DUPLEX ❑ MULTI -FAMILY
BUILDING: ElCOMMERCIAL
PROJECT INWILDLAND ElYES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
S7/-- ri D GT
TOTAL VALUATION:
RECEIVED BY:
By my signature below, I certify to each of the following: I am r
application and the information I have provided is correct. I hav read
ordinances and state laws relating to building construction. I a orize
Signature of Applicant/Agent:
erty owner o authorized agent to act on the pr rtY o�xmer's behalf. I have read this
e Descripti Work and verify it is accurate. I agree to comply with all applicable local
presents ' yes of Cupertino to enter the above-idflepropi y d for inspection purposes.
Date: 3en ' Z Z Z D I
SUPPLEMENTAL OtRMATION REQUIRED
OFFICE NLY
�'
01" -THE -COUNTER
❑ EXPRESS
U
v
U
❑ STANDARD
❑ LARGE
❑ MAJOR
MEPAliscApp_2011.doc revised 06121/11
CITY OF CUPERTINO
1VIVU FcrrnvrATnR _RIT11.11INf DIVISION
�1ech. Plan Check
Ifech. PertuitFee:
)cher .,Vech. Insp.
Ile& Insp. Fee:
Plumb. flan Check
Plumb. Permit l ee:
Other Plumb Insp. Li
Plumb. Insp. Fee:
Elec. Plan Check 10.0 1 hrs $0.00
Elec. Permit Fee: IEPERMIT
Other Elec. Insp.0.0 hrs $45.00
Eler. Insp. I iee:
NOTE: This estimate does not includefees due to other uepartments y. e. riannmg, ruotic Pv urAs, mere, aunesury aewcr Lwe, eu, �•wvo
District, etc). These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info.
ADDRESS: 23500 CRISTOREY DR
DATE: 03/21/2013
REVIEWED BY: MENDEZ
MISC ITEMS
APN:
BP#:
*VALUATION: 1$1,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
p
$0.00
PENTAMATION 1 REAP2
PERMIT TYPE:
USE:
Permit Fee:
WORK
MAIN LOBBY- ADD 20 AMP CIRCUIT IN PLANT OPERATION OFFICE
0,0
hrs
SCOPE
�1ech. Plan Check
Ifech. PertuitFee:
)cher .,Vech. Insp.
Ile& Insp. Fee:
Plumb. flan Check
Plumb. Permit l ee:
Other Plumb Insp. Li
Plumb. Insp. Fee:
Elec. Plan Check 10.0 1 hrs $0.00
Elec. Permit Fee: IEPERMIT
Other Elec. Insp.0.0 hrs $45.00
Eler. Insp. I iee:
NOTE: This estimate does not includefees due to other uepartments y. e. riannmg, ruotic Pv urAs, mere, aunesury aewcr Lwe, eu, �•wvo
District, etc). These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7�f 11112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
F 20 amps Electrical
$45.00 IBELEC200 Services
Suppl. PC Fee:. Reg. Q OT
0.0
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
(:onswuction :Tax:
Administrative. Fee: 1ADMIN
$42.00
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee.
$0.00
Select a Non -Residential G
Building or Structure
Travel Documentation Fee: ITRAVDOC
$45.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
$133.50 $45.00 _ ` $178.50
Revised: 01/01/2013
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1
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR
CONTRACTOR: BAY AREA ENTERPRISE
PERMIT NO: 13030110
OWNER'S NAME: THE FORUM RANCHO SAN ANTONIO
2110 MANGIN WAY
DATE ISSUED: 03/21/2013
O 'S PHONE: 6505371523
SAN JOSE, CA 95148
PHONE NO: (408)238-5043
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
Lic.
MAIN LOBBY- ADD 20 AMP CIRCUIT IN PLANT
License Class 1� #
OPERATION
Contractor. & dt Aneen 67/+'f Dates 7 2 _20 13
OFFICE
I hereby affirm th t I am licensed 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: $1000
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 34254999.00
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 city and county ordinances and state laws relating
WITHIN 80 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DA F OM LAST CALLED INSP CT ON.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
against City in of the
�3
costs, and expe ses which may crue said consequence
Issued by: Date
granting of th' permit. Additi ally, a applicant understands and will comply
with all non oint source re ations jerLthCupertino Municipal Code, Section
RE -ROOFS:
is
9.18.
A ` � Z Z 7041
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.
❑ OWNER-BUIL ER 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
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATER LS ISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
uir e s under Chapter 6.95 of the
I have read the hazardous mateJe
California Health & Safety Codns 55 , 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cnicipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section s Id I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should i ent or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with tunicipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sect, 533, and 25534.
�'
Section 3700 of the Labor.Code, for the performance of the work for which this�%
Owner or authorized agent: Date: I�+
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
CONSTRUCTION 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
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(Mcuoertino.org
—IPLUMRTNG FIA ECHANICAL IY"fELECTRICAL nJMISCELLANEOUS
PROJECT ADDRESS 17—e�
A
FA7P-7
2 5t4 qq'I
OWNER NAME_ / n
I i� t'O V(T lin OL '` R p C `I $6y
P'HO`N
E-MAII.
STREET ADDRESS" , t^�b C r� S I� J
CITYcj , STATE,ZIPu 47 f'ri 6 C
FAX
CONTACT NAMEFr,e ` He r h G H do 7
PHONE / 5--0 5 37 - 115-
�O
1
z
STREET ADDRESS
CITY, STATE, ZIP
`
FAX
OwNER-BUILDER NERAGENT CON UCTOR ❑CONTRACTORAGEI.'T 11ARCHITECT ElENGiNEER 11DEVELOPER ❑TENANT
11owNER El 11 OW
CONN'TRA.CTOR NAME ^ /� CG• 4 h /. `LIC SENUMBER / c//
+ �,/
IC,
LICENSE �E
BUS. LIC #
COMPANY I�TAME /+ V` 2
l� t
I E-MAIL rd S C a
FAX
STREET ADDRESS Z I d VPHONE /�tr h I'rl W
J
2.
ARCHITECT/ENGLNEER NAME LICENSE NUNIBER
BUS. LIC #
COMPANY NAME '
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD . DUPLEX ❑ MULTI -FAMILY
BUILDING: ElCOMMERCIAL
PROJECT INWILDLAND ElYES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
S7/-- ri D GT
TOTAL VALUATION:
RECEIVED BY:
By my signature below, I certify to each of the following: I am r
application and the information I have provided is correct. I hav read
ordinances and state laws relating to building construction. I a orize
Signature of Applicant/Agent:
erty owner o authorized agent to act on the pr rtY o�xmer's behalf. I have read this
e Descripti Work and verify it is accurate. I agree to comply with all applicable local
presents ' yes of Cupertino to enter the above-idflepropi y d for inspection purposes.
Date: 3en ' Z Z Z D I
SUPPLEMENTAL OtRMATION REQUIRED
OFFICE NLY
�'
01" -THE -COUNTER
❑ EXPRESS
U
v
U
❑ STANDARD
❑ LARGE
❑ MAJOR
MEPAliscApp_2011.doc revised 06121/11
CITY OF CUPERTINO
1VIVU FcrrnvrATnR _RIT11.11INf DIVISION
�1ech. Plan Check
Ifech. PertuitFee:
)cher .,Vech. Insp.
Ile& Insp. Fee:
Plumb. flan Check
Plumb. Permit l ee:
Other Plumb Insp. Li
Plumb. Insp. Fee:
Elec. Plan Check 10.0 1 hrs $0.00
Elec. Permit Fee: IEPERMIT
Other Elec. Insp.0.0 hrs $45.00
Eler. Insp. I iee:
NOTE: This estimate does not includefees due to other uepartments y. e. riannmg, ruotic Pv urAs, mere, aunesury aewcr Lwe, eu, �•wvo
District, etc). These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info.
ADDRESS: 23500 CRISTOREY DR
DATE: 03/21/2013
REVIEWED BY: MENDEZ
MISC ITEMS
APN:
BP#:
*VALUATION: 1$1,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
p
$0.00
PENTAMATION 1 REAP2
PERMIT TYPE:
USE:
Permit Fee:
WORK
MAIN LOBBY- ADD 20 AMP CIRCUIT IN PLANT OPERATION OFFICE
0,0
hrs
SCOPE
�1ech. Plan Check
Ifech. PertuitFee:
)cher .,Vech. Insp.
Ile& Insp. Fee:
Plumb. flan Check
Plumb. Permit l ee:
Other Plumb Insp. Li
Plumb. Insp. Fee:
Elec. Plan Check 10.0 1 hrs $0.00
Elec. Permit Fee: IEPERMIT
Other Elec. Insp.0.0 hrs $45.00
Eler. Insp. I iee:
NOTE: This estimate does not includefees due to other uepartments y. e. riannmg, ruotic Pv urAs, mere, aunesury aewcr Lwe, eu, �•wvo
District, etc). These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7�f 11112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
F 20 amps Electrical
$45.00 IBELEC200 Services
Suppl. PC Fee:. Reg. Q OT
0.0
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
(:onswuction :Tax:
Administrative. Fee: 1ADMIN
$42.00
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee.
$0.00
Select a Non -Residential G
Building or Structure
Travel Documentation Fee: ITRAVDOC
$45.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
$133.50 $45.00 _ ` $178.50
Revised: 01/01/2013
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p- if -
r&
fIr& G� - 4 Al 4f- V 0 � `t -C
�t00►
�s +
PGi,Ooa C k�rg � •�� S �'� b4t
Q
c� c 1 o t j2 cz h L h�j sc li! ,�AT'Olf�
c
J10
-
F- 0-0 _�_T p Morn Labe
C SD
< ::3 -/
#1 erho
�d�G�2 -
`z 3 P
EV - -
7aw
� ns wle
o -tic r � � a
Q-
ev c>
} `° h M3
I
as„
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