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14040025CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 333E CONTRACTOR: MISSION VALLEY PERMIT NO: 14040025 ELECTRIC INC OWNER'S NAME: STEPHEN CONLEY PO BOX 3332 DATE ISSUED: 04/03/2014 OWNER'S PHONE: 5107723152 FREMONT, CA 94539 PHONE NO: (510) 745-8847 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL LICENSED CONTRACTOR'S DECLARATION UNIT 333E - INSTALL 10 (N) LIGHT FIXTURES (4 IN License Class Lic. # V 7e % 3 Z- ENTRY & 6 IN OFFICE/GUEST RM) & 3 (N) DIMMER }� < SWITCHES Contractor /'(!SS/d /sCE+�1$site LX I hereby affirm that 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 rformance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $30000 have and will maintain Worker's Compensation Insurance, as provided for by h Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 34253129 00 Occupancy Type: 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 180 DAYS OF T ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 DAYS F AST C D INSPECTION. upon the above mentioned property for inspection purposes. (We) agree to save 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 ate: granting of this perm. Additionally, the applicant understands and will comply with all non -point ur regulatio per the Cupertino Municipal Code, Sectio 9 18. t r Signature Date_�4_ � RE -ROOFS: 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 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 MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should 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 equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I with the Cupertino Municipal Code, Chapter 9.12 and performance of the work for which this permit is issued. will maintain compliance the Health & Safety Code, SZ:Z;� I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: te: �y 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 (1 V GENERAL PERMIT APPLICATION �v EP A M I %CS C CUPERTINO r- i .. Ilia rr a �rrn a r .. -1% i� � T7T RrTRT(-A T n MTCC:F.T.T_ANEOUS COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION O 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 •FAX (408) 777-3333 • buildinaCa�cupertino.ora U YLU1VL611VU L,J 1raa:0..itcaa�a\..laa+ 00 II&F `1> ----- APN # PROJECT ADDRESS 2 3 S -o d f �-� -LEY E C- �.J *1 r OWNER NAME h� a Cp Le PHONE�0 - 1Z Z- C7Z -MAIL STREET ADDRESS CITY, STATE Gu i R- t ItJ D . FAX 2'35�j v c i5 33`3 CONTACT NAME( \ C_ � P+-, �i I - S �� Q PHONE GS '�'S�I` 7 Z"� YPN`Do ISSt6fI1�{�(tE �CE QIL , STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OV,'NER-BUILDER ❑ OA'NERAGENT / CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT C CTOR NAME ^-� LIC 'SE NUMBER LICENSE TYPE BUS. LIC # If3 J I. L)p COMPANY NAME %-MAIL M 6 fie} V p c it L �C -1- c N G f`Rdlwl�E/{t+ FAX S ETADDREss 33�Z C AU �ON ) - W� �1' �� / P lc9 -7 0 O % ARCHITECT/ENGINEER NAME LICENSE NUMBER. BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WIIALAND ❑ YES PROJECT IN ❑ YES ❑ IS THE BLDG AN ❑ YES EICHI.ER HOME? ❑ NO BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE NO DESCRIPTION OF WORK b L s=- j y,7-5- [5 / - -7 ,. h TOTAL VALUATION: 3( /OO Via. 3 � z ccxi By my signature below, I certify to each of -flowing: I am the property owner or authorized agent to act on the property own s behalf. have read this application and the information I have p ide is correc I have read the Description of Work and verify it is accurate. I agr o corn ith all applicable local ordinances and state laws relating t b 11 • construe ' I authorize ' of Cupertino to enter the above-identi for inspection purposes. �represen f /ery 7 '�/ ySignature of Applicant/Agent: Date: —r S PL NTAL ATIO REQUIRED Q E 1-0 a K A�ERSH1<COI7LiTER -g num- - Yr. MEPMiscApp_201 Ldoc revised 06/21/11 r -6'L7 CITY OF CUPERTINO TTT 1009PIA/f A Tl11D -_ 112TTTT "INC' 'nlVTClnN APPLIANCE / EQUIP TYPE i' yi Lv i PNIU QTY UNITS ADDRESS: 23500 CRISTO REY DR 333E DATE: 04/03/2014 REVIEWED BY: MELISSA 1BREMFIXT APN: 342 53 129 BP#: *VALUATION: $3,000 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex 1BREMRECEP PENTAMA I ION 1 REAP 11 PERMIT TYPE: USE: # $47 WORK UNIT 333E - INSTALL 10 N LIGHT FIXTURES 4 IN ENTRY & 6 IN OFFICE/GUEST RM & 3 N SCOPE DIMMER SWITCHES APPLIANCE / EQUIP TYPE FEE ID PNIU QTY UNITS BP FEES Fixtures, Lighting 1BREMFIXT NO, ^T . 10 # $70 Recep/Switch/Outlets 1BREMRECEP .4upp/, hr.y) 1"-c'e 3 # $47 Elec. Plan Check 0.0 hrs $0.00 "'k,(h om r� 1 ("onso-acTion /ax: Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes 0 No $0.00 TOTALS: i Travel Documentation Fee: ITRAVDOC $117.00 Strony Motion Fee: 1BSEISMICR NOTE: This estimate does not mctuaejees aue to omor uepuruneins tae. 1 ,ur,,,,,s, ��,� •• •�, _ •• __, __.. __ _ ___ District,etc.). mese fees are oaseu an the rias—rcu,----------- FEE ITEMS (Fee Resolution 11-053 Eff 711/13) FEE PNIU MISC ITEMS l thin Check f""C'. 4ttPI)!, PL.. 1`ee NO, ^T . . $0.00 Pt 1. .4upp/, hr.y) 1"-c'e Phind). IPlurt C'/recA Elec. Plan Check 0.0 hrs $0.00 "'k,(h om r� 1 ("onso-acTion /ax: Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes 0 No $0.00 '164WHCe d P °laroTt1'1g Fees: i Travel Documentation Fee: ITRAVDOC $47.00 Strony Motion Fee: 1BSEISMICR $0.50 Phfmh. Permit Fee: Bldg Stds Commission Fee: 1BCBSC $1.00 Elec. Permit Fee: IEPERMIT $256.50 $0.00 TOTAL FEE: $256.50 Other Elea Insp. 0.0 hrs $47.00 Oijil r- Plum!) Inv? dl€c ftp ',v F"ineb. hispz Tec_, NOTE: This estimate does not mctuaejees aue to omor uepuruneins tae. 1 ,ur,,,,,s, ��,� •• •�, _ •• __, __.. __ _ ___ District,etc.). mese fees are oaseu an the rias—rcu,----------- FEE ITEMS (Fee Resolution 11-053 Eff 711/13) FEE QTY/FEE MISC ITEMS l thin Check f""C'. 4ttPI)!, PL.. 1`ee PME Plan Check: $0.00 1Perinil ' ec .4upp/, hr.y) 1"-c'e PME Unit Fee: $117.00 PME Permit Fee: $47.00 ("onso-acTion /ax: Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes 0 No $0.00 '164WHCe d P °laroTt1'1g Fees: i Travel Documentation Fee: ITRAVDOC $47.00 Strony Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 ¢�,SeiTBTOTils ." $256.50 $0.00 TOTAL FEE: $256.50 mt1vibuu. v+iv 114U i-+