14040126CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 212E
CONTRACTOR: BAY AREA ENTERPRISE
PERMIT NO: 14040126
OWNER'S NAME: AGNES UTTERBACK TRUSTEE
2110 MANGIN WAY
DATE ISSUED: 04/21/2014
OWNER'S PHONE: 6505371523
SAN JOSE, CA 95148
PHONE NO: (408)238-5043
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
nn ll
UNIT 212E - REPLACE 19 OUTLETS, 10 SWITCHES, 2
License Class Lic. 4 1
BATHROOM FANS & 1 EMERGY LIGHT
(�I>
Contractor Date —2- l
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
Sq. Ft Floor Area:
Valuation: $2900
erformance of the work for which this permit is issued.
I ave and will maintain Worker's Compensation Insurance, as provided for by
ction 3700 of the Labor Code, for the performance of the work for which this
APN Number: 34253080 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 ci and county ordinances and state laws relating
WITHIN 180 DAYS OF P + ISSUANCE OR
to building construction, and hereby uthorize representatives of this city to enter
upon the above mentioned property ftr inspection purposes. (We) agree to save
180 DAYS F ST D INSPEC ION.
indemnify and keep harmless the Crof Cupertino against liabilities, judgments,
costs, and expenses which in acc a against said City in consequence of the
7i
granting of this permit. t nal y, the applicant understands and will com y
e
with all non -point source a atio s per the Cupertino Municipal ode, Sect'
9 18.
RE -ROOFS:
Signature Date
11 roofs shall be inspected prior to any roofing material being installed. If a roof is
nstalled 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 1ASCLOSURE
construct the project (Sec.7044, Business & Professions Code).
s nder Chapter 6.95 of the
I have read the hazardous materials req 'rein
California Health & Safety Code, Secti 2 5533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertin uA Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a s otore or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use eq i mr devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay 'ea Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the rtinonicipal Code, Chapter 9. 2 andI
have and will maintain Worker's Compensation Insurance, as provided for by
the Health &Safety Code, Sections 55 5,2and 25534. r
�"j1
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: 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
Compensation laws of California. If, after making this certificate of exemption, I
CONSTRUCTION�EN�D`ING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
ing agency for the performance of
I hereby affirm that there is a construction 11,97,
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 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
CUPERTINO
CONSTRUCTION PERMIT APPLICATION 'k 6\
0
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255. �O
(408) 777-3228 • FAX 1408) 777-3333 - buildinge-cuoertino.Oro
LJ NEW CONSTRUCTION ❑ ADDI7jON
❑ ALTERATION / TI REVISION/ DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS
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❑'�PVBLrc �i�oRlcs
OWNER 7T2US
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STREET ADDRESS
CITY, STATE, ZIP FAX
CONTACT NAME %� I
PHONE, ,V -239-5
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FAX
❑ OwNER ❑ Owm.Burinat ❑ owNiRAGENT
17 fONTRACTOR ❑ CONIRACTORAGENT . ❑ ARCHRECT ❑ ENGIlVEER ❑ DEVII OPIIt
❑TENANT
CONTRACTOR NAME �j /t y
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PHOA'E
ARCHtTECT/ENGINEERNAME
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COMPANY NAME
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FAX
STREET ADDRESS
CTIY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
N. 'c
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USE
TYPE I OCC. I SQ -FT. I VALUATION (S)
PRE -APPLICATION 13YES1F YE$PROVIDECOPYOF ISTHEBLDGAN ❑YES _ VALUATION:
PLANNINGAPPL# ❑NO PLANNINGAPPROVALLEITER EICHLERHOME? []I.-_
BY mY signature below, I certify to each of the following I am the property owner or authorized agent act on the !! erty owner's behalf. I have read this
application and the information I have psovi is cotr+eck I have the Description of Work and er eatrcutate. I agree to comply with all applicable local
ordinances and state laws relating to burl ' conshuction 1 a tatives of Cupertino to enter the above -i ed p perry for inspection purposes.
Signature of Applicant/Agent 2 f7
Date:
_ 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.
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application
Y=
❑ BUILDING PLAN REYIEw
❑ PLA!\11NGPLANRE�7E1V �'
❑'�PVBLrc �i�oRlcs
❑ `EIRE DEET
❑' 5AAITARYSE�FERDISTRICT
❑ ' ENVIRONhrENTAL HEALTH ::.
BldgApp 2011.doc revised 06/21/11
AW5
Cop,
CITY OF CUPERTINO
r..r TcvTTAT ♦ Tl177 DTTTT T1T1V!`_ TiTT*7TCT"N
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ADDRESS: 23500 CRISTO REY DR UNIT 212 DATE: 04/21/2014
APN: 342 53 080 BP#:
Plan Check Fee:
-
REVIEWED BY: MELISSA
*VALUATION: $2,900
%PERMIT TYPE: Building Permit PLAN CHECK TYPE:
PRIMARY
USE: SFD or Duplex
Alteration /Repair
17�NTAMATIONE1 REAP 11
PERMIT TYPE: i
WORK
SCOPE
UNIT 212E -REPLACE 19 OUTLETS 10 SWITCHES 2 BATHROOM FANS & 1 EMERGY LIGHT
PME Plan Check:
$0.00
2 # Mechanical
$BREMVENF Ventilation Fan
48.00 I
Permit Fee:
$0.00
0.0
hrs
$0.00
29 Electrical
$92.00 1BREMRECEP Recep/Switch/Outlets
Suppl. Insp. Fee:Q Reg. Q OT
PME Unit Fee:
$0.00
PME Permit Fee:
$94.00
Mech. Plan Check 0.0 hrs $0.00 1'hr ;h- P,10" Chc z. k
Mech. Permit Fee: IMPERMIT T [rrmr. Icer nir 1<F':
0.0 hrs $47.00
rther Mech. Insp. C offer Plumb Insp.
1).
Elec. Plan Check 0.0 hrs $0.00
Elec. Permit Fee: IEPERMIT
Other Elec. Insp . 0.0 hrs $47.00
NOTE: This estimate does not include fees due to other Departments (i.e. r[anning, ruauc rr u-3, ... r, �u•••u• r ��•• �• - • -• -- - - -
District, etc.. These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee ResoCution 11-053 Eff. 7/1/132 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
$0.00
=1 # Electrical
$70.00 1BREMFIXT Fixtures, Lighting i
Suppl. PC Fee: Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
2 # Mechanical
$BREMVENF Ventilation Fan
48.00 I
Permit Fee:
$0.00
0.0
hrs
$0.00
29 Electrical
$92.00 1BREMRECEP Recep/Switch/Outlets
Suppl. Insp. Fee:Q Reg. Q OT
PME Unit Fee:
$0.00
PME Permit Fee:
$94.00
t.`OnsInIc�iion CIN
Administrative Fee: 1ADMIN
$44.00
Work Without Permit? 0 Yes 0 No
Advanced Plannin& Fee:
$0.00
$0.00
Travel Documentation Fee:1 TRAVDOC
$47.00
Strong Motion Fee: 1 BSEISMICR
$0.50
Bldg Stds Commission Fee: IBCBSC
$1.00
O A:S.
1.
' $186.50
Select allon-Residential
Building or Structure
Select an Administrative Item
$210.00 TOTAL FEE: $396.50
Revised: 04/01/2014