14060069CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY UNIT 507H
CONTRACTOR: BAY AREA ENTERPRISE
PERMIT NO: 14060069
OWNER'S NAME: MIRIAM FELDSTEIN
2110 MANGIN WAY
DATE ISSUED: 06/12/2014
OWNER'S PHONE: 6505371523
SAN JOSE, CA 95148
PHONE NO: (408)238-5043
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
UNIT 50711- REPLACE 18 OUTLETS, 6SWITHCES, 7
License Class Lie.
LIIGHTS , 2 NEW LIGHTS, ADD 4 LED LIGTHS IN
nt
6c11'
KITCHEN
Contractor HJ&nfA!fate�
I hereby affirm th t I am licensed under t e 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: $4700
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
ection 3700 of the Labor Code, for the performance of the work for which this
APN Number: 34253246 00
Occupancy Type:
p emit is issued.
APPLICN CERTIFICATION
I certify that I have read this appli do and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all ity d -county ordinances and state laws relating
WITHIN OF PERMIT ISSUANCE OR
to building construction, and hereb au orize representatives of this city to enter
upon the above menti d prope for inspection purposes. (We) agree to save
180 DA LAST CALLED INSPECTION.
indemnify and keep less the of Cupertino against liabilities, judgments,
costs, and expenses ich may ace a against said City in consequence of the
/n �a /�
granting of this perm Additional the applicant understands and will comply
Issued by: Date: I6 r
with all non -point regulatio s er Cupertino Municipal Code, Section
9 18.
le
/I)
RE -ROOFS:
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.
OWN B DER ECLARATION
Signature of Applicant: Date:
I hereby affirm that I an exempt rom 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 (See.7044,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS 14LOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requiremen der Chapter 6.95 of the
California Health & Safety Code, Sections 2550 , 533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Muni i I Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) shoul I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I usequipme or devices which emit hazardous
Compensation, as provided for by Section 3700 of tyfe Labor Code, for the
air contaminants as defined by the y ea it Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the C r ino unicipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 5, 25 33, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date:--- 2(
permit is issued.
L '
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
CONSTRUC ION LEN ING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lendiA 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
Fr
CONS�;L-JCTION PERMIT-APPLICAT— �0�
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300TORRE AVENUE • CUPERTINO, CA 950143255.
(408)'777-3228 • FAX ('408) 777-3333 • building(ft aertino ora \�
LJ NEW CONSTRUCTION ❑ ADD1TiON
❑ ALTERATION / TI REVISION / DEFERRED ORIGINAL, PERMIT #
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TYPE I OCC. I SQ -Fr I VALUATION (S)
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PLANNMAPPL# ONO PLANNING APPROYALIZUTER. EICHMNOM" ❑Nd �5 _ AL VALUATION:
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By my signature below, I certify to each of the fo I am the ° 4
application and the information I have.°� or authorized agent to on the p owner's behalf I e read this
provi . is correct �:v Ste Description of Work and ved rt is a agree to mPly with all app 'cable Local
ordinances and state laws relating to conshuction es of Ctirpertino abov i ed
,v'�,ipsPe�biO purposes.
Signature of ApplicanVAgent /L9- Date: X / 1 l
SUPPLEMENTAL DWORMrON:REQUMM
_ 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.
a
B1d9ripp 201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 23500 Cristo rey dr
FEE
DATE: 06/12/2014
REVIEWED BY: Mendez
APN:
BP#:
Plumb. Permit Fee,
*VALUATION: 1$4,700
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
thcch. fasp1°7rtz:
Plumb. huI:. ["Ce:
PENTAMATION 1 REAP10
PERMIT TYPE: 19
WORK
replace 18 outlets 6swithces 7 flights, 2 new lights, add 4 led li the in kitchen
SCOPE
[Qg!L507h-
13
$47.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These fees are based on the prelimina information available and are only an estimate Contact the Dept or addh 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13)
FEE
kc,,Iz. T'" Un 'heck
Phinih. Plan C'hccA
Elec. Plan Check 0.0 hrs $0.00
:,97117 7?twttt Fee!
Plumb. Permit Fee,
Elec. Permit Fee: IEPERMIT
Ch)aer �l lt,c fi. In. --v)
Other Plumb Insp.
Other Elec. Insp. 0.0 hrs $47.00
thcch. fasp1°7rtz:
Plumb. huI:. ["Ce:
1,11,611. Insp, FCC.
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These fees are based on the prelimina information available and are only an estimate Contact the Dept or addh 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
24 #
$67.00
Electrical
IBREMRECEP Recep/Switch/Outlets
Suppl. PC Fee: (F) Reg. ( OT
0.0
I hrs
$0.00
PME Plan Check:
$0.00
13
$47.00
Electrical
IBREMRECEP Recep/Switch/Outlets
Permit Fee:
$0.00
Suppl. Insp. Fee:(F) Reg. 0 OT
10.01
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$47.00
(."C)??.wrticlio Ktv:
Administrative Fee: 1ADMIN
$44.00
0
E)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
0
i
Travel Documentation Fee: ITPA VDOC
$47.00
Strom Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
$139.50
$114.00 a°TOTAL FEE:
$253.50
Revised: 04/01/2014
SMOKE / CARSON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
e,stt'; COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildincl a(�cupertino.orq
PERMIT CANNOT.13E, NALED UNTIL.THIS CERTIFICATE IIA :BEEN
COMPLETED,SIGNED AND RETURNED TO THE BUILDINGDIVISION
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2016 CRC Section R314,R315,2016 CBC Sections 420.6 and 907.2.11.2 where no interior access
for inspections are required.
GENERAL INFORMATION
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations,or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314,R315, and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or
Carbon Monoxide Alarms be installed in the following locations.
AREA SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)-(Smoke alarms shall not be located within 3 feet of bathroom door)
On every level of a dwelling unit including basements and habitable attics X X
Within each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply In dwelling units with no commercial power supply, alaint(s)may be solely battery operated.
In existing dwelling units,alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl
space.Refer to CRC Section R314 and CBC Sections 907.2.114 and 420.6.2.An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below _
Address Z,7 r6.7.0 � � ' f7//VO Permit No./4(d e"c'6
Specify Number of Alarms #Smoke Alarms I I #Carbon Monoxide Detectors I K I
/have read and agree to comply_v M1 erms and conditions of this statement
Owner(or Owner Agent's)Name: !/'
e ature Dao _f�— /
Contractor Name:
Signature Licit Date:
Smoke and COforin.doc revised 01/10/2017