14060070CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 331E
CONTRACTOR: BAY AREA ENTERPRISE
PERMIT NO: 14060070
OWNER'S NAME: ALBERT CLANCY
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 ❑
License Class_ Lic. #�i
UNIT 331E- REMOVE AND REPLACE SHOWER PAN, WITH
NEW
�
Contractor a k�" cwT` Date ta�t
VALVES
I hereby affirm tha 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: $4500
performance of the work for which this permit is issued.
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
APN Number: 34253128.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT F WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 1 AYS O 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 DAYS FRO ASTCALLED INSPECTION.
indemnify and keep harmless the City o Cupertino against liabilities, judgments,
costs, and expenses which may accrue ainst said City in consequence of the
(� �o? /C—/.
�
granting of this permit. Additionally, t applicant understands and will comply
Issued by: Date: -
with all non-point source reg lations p the Cupertino Municipal Code, Section
9 18.
RE-ROOFS:
Signature Date
All 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- UILD R ECLARATION
Signature of Applicant: Date:
I hereby affirm that I am empt fr n the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1, as owner of the property, o my employees with wages as their sole compensation,
will do the work, and the struc re 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 USCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requiremes rider Chapter 6.95 of the
California Health & Safety Code, Sections 255 , 533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Muni ip 1 Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) shoul I tore or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's
material. Additionally, should I use equipme t r 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 ' Quality Management Di s't I
performance of the work for which this permit is issued.
will maintain compliance with the u tin unicipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sectio 25 5, 2 533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: 12 '
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
CONSTRUC N 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 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
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
0/
CONS--JCTION PERMIT APPLICATM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255. ®e,Q
(408) 777-3228 • FAX 1408) 777-3333 • buildin-g0-puger ino.ong 1
LI NEW CONSTRUCTIONtt ❑ AMMON ❑ ALTERATION / TI VI
UPI
REVISION / DEFE MM ORIGINAL PERMIT #
PROJECT ADS�DRESS �Lt � UP ( nPx # 3-3 v ✓[-1 Z 5-3 f 2—O ' 61""!
OWNERNAME NJ
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C� frit PHONE �5D �3�3 " /SZ3 E->vla'u �re
d /� a ndi 3 35
STREET' D ES �yS CITY, ZIP FAX
CONTACT NAME 't PHONFs V g
STREEfADDREsS! . 0 /14Qh !'61 EWA: C'�i'C ��,—/ FAX`J T
❑ OwNER ❑ owNERBUnmER ❑ owNERAGENT VCMMACTOR ❑ CONIRACTORAGENT - ❑ ARC MWr ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME /t � ! e S e I IC S f ENun
LICENSE T� BUS. LICrvj #
coMPANYNAME f3R !q`/' 0.. 6h kr/'r 5 2 E-MAIL y r e� v' e r'S f a �� FAx
STREET ADDRESS Crr},STATE. ZIPPHONE
2110 mamgl h
ARCHUECTIENGMERNAME LICENSENUMBER ane rir+
COMPANY NAME E FAX
STREET ADDRESS MY. STATE, ZIP PHONE
DESCRIP170N OF WORK
p �l ��i.Ot v Q/� • fs 11AAW2
XJLW- MOP4 G'N.el- tyAn d cel/I
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JIVKICJ
USE TYPE
OCC.
SQYT.
VALUATION (5)
0=0
NEW FLOOR
DEMO '
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
Kncll>at
OTIM
REMODELAREA
KEMODE[.AREA
REMODELAREA
PORCHAREA
DECKAREA
TOTALD =.'ORCHARFA
11 GARAGEAREA: 0DErACH
❑ATTACH
#DWELLINGUNnS:
ISA
ONDUN17' ❑YES
SECOND STORY ❑YES
&EINCf.ADOW. ❑NQ
AbOMON? EINO
PRE -APPLICATION ❑ YES g yES, pgO�E Copy OF
PLANNINGAPPL# ❑NO PLANNiNGAPPROVALLErrF3t
ISTM BLUE AN ❑ YES
EICHLERHOBM E] NO
s? C " c
TOTAL V LUATION:
By my signature below, I certify to:each of the following: I am the property owner or authorized agent to act on a property owner's behalf I have read this
application and the infomnation I have pmvi ad is connect I hav!#d the Description of Work and verify itis accurate. I agree to comply with all applicable local
ordinances and state laws relating;o bail construction. I a tatives of Cupertino m enter the above -i nti5 pro fotipn ses.
Signature of Applicant/Agent
Date:
ff
SUPPLEMENTAL INFO ON REQUIRED
PLANCHECKTYPE �
�
_ New SFD or Multifamily dwellings: Apply for demolition permit for
iy
p
ROUTII�GSLIP
existing building(s). Demolition permit is required prior to issuance of building
OVER coUISTER
s
❑ BUILDING PLAN REVIEW
permit for new building.
"EXPRESS
❑ pLAA �INGPLAN RE\ IE\i
_ Commercial BIdgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC RKS
form if any Hazardous Materials are being used as part of this project
El G L RGE_
❑ 'FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
�1❑ SAAITARY SEuBR DISTRICT -'
:r
❑ =' EMN IROMMME A'- HEALTH
BldgApp 201 Ldoc revised 06/21/11
1"t S
Copt,
CITY OF CUPERTINO
FM_7 FEE ESTIMATOR — BUILDING DIVISION
NUI E: I his estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District_ etc 1. 1 --tent tho Wont
FEE ITEMS fFee Resolution 11-053 E f 7/1/13)
ADDRESS: 23500 Cristo rey dr unit 331e
DATE: 06/12/2014
REVIEWED BY: Mendez
JI&
APN:
BP#:
*VALUATION: $4,500
*PERMIT TYPE: Building Permit I
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Suppl. PC Fee: (E)Reg. ® OT
PENTAMATION
PERMIT TYPE:
WORK
unit 331 e- remove and replace shower pan, with new valves
SCOPE
NUI E: I his estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District_ etc 1. 1 --tent tho Wont
FEE ITEMS fFee Resolution 11-053 E f 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: (E)Reg. ® OT
FO.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes Q No
$0.00
Suppl. Insp. Fee: Reg. ® OT
1 0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
�.rili:S7r'e,`C"FttI17 IC%}:
E)
Work Without Permit? ® Yes (F) No
$0.00
Advanced Planning Fee.
$0.00
Select a Non -Residential
Building or Structure
G
0
7i-aivl Doll rtraew viori Tees:
Strong Motion Fee: 1BSEISMICR
$0.50
2.0 hrs
$278.00
Inspections
ISTINSP Inspection, Hourly
Bldg* Stds Commission Fee: IBCBSC
$1.00
$1.50
$278.00."
TOTS L FEE:
$279.50
Revised: 04/01/2014