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14040011CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 526G CONTRACTOR: BAY AREA ENTERPRISE PERMIT NO: 14040011 OWNER'S NAME: RUTH LEVETT 2110 MANGIN WAY DATE ISSUED: 04/02/2014 O NER'S PHONE: 6505371523 SAN JOSE, CA 95148 PHONE NO: (408)238-5043 JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL LICENSED CONTRACTOR'S DECLARATION 526G- REMOVE AND REPLACE 10 SWITCHES, 22 License Class_ Lic. # U r OUTLETS, `r REMOVE SHOWER TILE WALL AND INSTALL NEW Contractor PJ veu n Date SHOWER I hereby affirm that am licensed under the provisions of Chapter 9 VALVE, REPLACE HEAT PUMP AND DUCTING- (commencing with Section 7000) of Division 3 of the Business & Professions MAINTENANCE 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: $45000 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 34253240 00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLIANT CERTIFICATION I certify that I have read this apLa and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply withd county ordinances and state laws relating WITHIN DAYS OF PERMIT ISSUANCE OR to building construction, and hehorize representatives of this city to enter upon the above mentioned propinspection purposes. (We) agree to save 180 DAY M LAST CALLED INSP CTION. indemnify and keep harmless tf Cupertino against liabilities, judgments, costs, and expenses which ayagainst said City in consequence of theIssued by:Dgranting of thispermit. itie applicant understands and will comply with all non-point source g lr the Cupertino Municipal Code, Section 9 18..r0f RE-ROOFS: SignatureDate ry -. 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. ❑ O ER-BUILDER .ECLARATION Signature of Applicant: Date: I hereby affirm that No 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 MA E IALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials re ui ments under Chapter 6.95 of the California Health & Safety Code, Sect' ns 5505, 25533, and 25534. 1 will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cuperti o unicipal Code, Chapter 9.12 and the declarations: Health &Safety Code, Section 25532(a s ould I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use eq ipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by th Bay rea Air Quality Management District I will maintain compliance with t e upe tino Municipal 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, Secti 2550 , 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized a nt: 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 CONSTRUCTION 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. 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 CUPER'TINO CONSTRUCTION PERMIT -APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 . (408) 777-3228 • FAX ?408) 777-3333 - buildinata'�.cuDertino.org ❑ NEW CONSTRUCTION ❑ ADDM* ON ❑ ALTERATION / TI [W REVISION / DEFERRED 1�B,Ob Jib ORIGINAL PERMIT 0 PROTECT ADS �� %�t t n'ji � U�APN4 2 1 Z 53 Z ! _ , /�i PHONE ° �,,'eV6 3 1 S23 wec( her • a dt c STREET ADDRESS OLS V* -e ' CITY, STATE, ZIP ` f' FAX CONTACT NAME f PHONE _ E_MAIL STREET ADDRESS CITY, STATE ZIP FAX Z M ❑ OWNER ❑ OwNER-BtmDER ❑ OWNERAGENT CONTRACTOR ❑ CONMCTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR N LICENSE NUMBEk',, O' LICENSE TYPE BUS. LIC # COMPANYN� E -MAH L { :G ' FAX STREET ADDRESS'ito �� CITY, STATE,�T C v PHONEKoulb _ —�� 46, ARCHITECT/ENGINEER NAME LICENSENUMBER BUS. LIC # COMPANY NAME E MAII FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRB'TION OF WORK 11 ` ee4 y - 646 -mW',; V��I�- dtwQkt` ovkle� S stynepin c.e tiz�(,. vv - W --EXISTING USE PROPOSEDUREJ CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODELAREA PORCHAREA DECKAREA TOTALDECK/PORCHAREA GARAGEAREA EIIIATACH 91ATT I # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY BEINGADDED? ONO ADDITION? ❑ PRE-APP11CATION ❑ YES IF YES, PROVIDE COPY OFYES PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER BLDG ❑ HO ❑ NO r BYrt ` R>s C ' TTA VALUATION: . VVV By my signature below, I certify to each of the followinw p owner or authorized agent to act on the property owner's behalf. I hav ad this application and the information I have provided is conp& I e reathe Description of Work and verify it is accurate. I a to co ply with all ap li b1e cal ordinances and state laws relating to building construction. autho ' representatives of Cupertino to enter the abov i fled f�>;inspecti n es. Signature of Apphcant/Agent Date: 7 SUPPLEMENTAL. INFORMAnO RE - _ New SFD or Multifamily dwellings: Apply for demo Itron permit for -�` VER7IIE COIIl�TER ❑ . BUII DING PLAN REQ IEIi' existing building(s). Demolition permit is required prior to issuance of buildm s permit for new building. O ❑ PLAnnLNePLaiv%9EW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure D srAI�aRD ❑ PUBLIC ii oRxs form if any Hazardous Materials are being used as part of this project 'FIRE LAItc>F ❑ DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to 1►WJOl ❑ submittal of Building Permit application SAT\ITARY SE�i�R DISTRICT ENVIRoNI%1EN`TAL:HEALTH ;. Bld.-App 1011.doc revised 06/11/11 CITY OF CUPERTINO WA rrr, raminir A rrnn R1T71'n11V(_ DIVIQION Mech. Plan Check 0.0 1 hrs $0.00 1'I<fipjh. Plan C'ttecA Elec. Plan Check 0.0 hrs $0.00 Mech. Permit Fee: IMPERMIT F'&omb. Permit Fee: Elec. Permit Fee: IEPERMIT rt'her Mech. Insp. 0.0t'l mb Irr.VV. Other Elec. Insp.Tf $47.00 >C: PT�rs,�Iz kNww IvC. tater_ fns 3. f<�e: _ .c_ n__- 0,....s,..... Q,.....,.. Tl:ct.•:nt Qrhnnt NOTE: This estimate does not metuaefees aue to otner vepurtmerm (t.r. _ ea,.1. .5, _ ���r. •• �• - _., __.. _ _ ___ tho vont fnr nddn'1 info. District, etc). mese ees are aaseu un me rrrrrrur.ur FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) err �rrr....., •r w.»��-� FEE .. _. _ QTY/FEE .__ ____ _ MISC ITEMS 23500 Cristo Rey Dr. # 526 DATE: 04/02/2014 REVIEWED BY: Mendez JulADDRESS: APN: BP#:I "VALUATION: $45,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex $0.00 PENTAMATION 1REAP10 PERMIT TYPE: A USE: Permit Fee: Hourly Only? ® Yes (F) No WORK 1526 G REMOVE AND REPLACE 10 SWITCHES 22 OUTLETS REMOVE SHOWER TILE WALL AND SCOPE I INSTALL NEW SHOWER VALVE, REPLACE HEAT PUMP AND DUCTING- MAINTENANCE and p Mech. Plan Check 0.0 1 hrs $0.00 1'I<fipjh. Plan C'ttecA Elec. Plan Check 0.0 hrs $0.00 Mech. Permit Fee: IMPERMIT F'&omb. Permit Fee: Elec. Permit Fee: IEPERMIT rt'her Mech. Insp. 0.0t'l mb Irr.VV. Other Elec. Insp.Tf $47.00 >C: PT�rs,�Iz kNww IvC. tater_ fns 3. f<�e: _ .c_ n__- 0,....s,..... Q,.....,.. Tl:ct.•:nt Qrhnnt NOTE: This estimate does not metuaefees aue to otner vepurtmerm (t.r. _ ea,.1. .5, _ ���r. •• �• - _., __.. _ _ ___ tho vont fnr nddn'1 info. District, etc). mese ees are aaseu un me rrrrrrur.ur FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) err �rrr....., •r w.»��-� FEE .. _. _ QTY/FEE .__ ____ _ MISC ITEMS Plan Check Fee: $0.00 =# $107.00 Electrical 1BREMRECEP Recep/Switch/Outlets Suppl. PC Fee: 0 Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Lj # $M00j Mechanical IBREMAIR A/C Units (<=1OK cfm) Permit Fee: Hourly Only? ® Yes (F) No $0.00 Suppl. Insp. Fee -.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $94.00 (,`ou,sf7'iwiion 1.471': Administrative Fee: /ADMIN $44.00 1 0 G Work Without Permit? ® Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 i Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $4.50F$139.00 hrs Inspections ISTINSP Inspection, Hourly Bldy Stds Commission .Fee: IBCBSC $2.00 O'S $191.50 $316.00 TOTAL FEE: $507.50 M(1_V1 eu. UVw u4w ti