14100196CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 201C
CONTRACTOR: CLINE CONSTRUCTION
PERMIT NO: 14100196
OWNER'S NAME:
SAN JOSE, CA 95123
PHONE NO: (408) 924-0204
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑
INSTALL (6) CANNED LED LIGHTS THROUGH OUT UNIT
[/�J <Z
23
License Class Lic.# p l7 G�
14 r
Contractor (, l 14 '@ L OYI s Date i 0 "3 0" l Lf
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
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $2000
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 34253037.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT S IF RK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHINDAYS OF PE IT 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 DAYM LAST CALLED INSPECTION.
7FR
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Issued by: Date: 10
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
--
9 18.
OV C -f
RE-ROOFS:
Signature , Date ��'3
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
1, 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)
1, 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
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
-- L4
Owner or authorized agent: W Date:
permit is issued.
permit
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
G N'= -'PA L P E -R, Wl I T ri",� tr I iF I L I G A T ION
COMMUNITY DEVELOPMENT DEPART MENIT - BUILDING DIVISIONI (AU
10300 TORRE AVENUE - CUPER.—i 11\10, CA 95014-3255
(408) 777-3228 - FAX (4083) 777-33313 - building O-guDstCno.oi g.
71 -,.T I TUMZI�Iir-.
U N 1r 20
r -I 'kA'Pr-;: A VTr-" A 7. 17F�I.rC1Z1 CAT
00,
F74 i C 7-11 -A X --E (YL 3 S
ADDRESS 3 500
—Z C Dz o
A-IIDDP Ms
CON-lAcr NANS
H
?; ONEI
- I
- -
CW.ZL AD 0-M--,-3-QM,-MML Ol-?MLA
co\-m-kmo?,
OR I\A-IZF,
\,SB r. ul
LIC! 23 54t
IBUIS.
13
111C I
FAOI
C77=1 ADDRESS i
MY, STA77- -72
57cLvi-)o se-
BU-S.LIC'4
B-Wun.
S T ? T . ADDRMS
I CITY, STA717, Zr?
or Du..=
--",CLAL
Y=-
Ll, —I ---RFA=-A2SA ❑ ?\,o
I P? OTS _-- In ❑ -a-s
—MDOD ZONE ED No
I is —1= P LD rl AN L7 %--s
BIMMI HOME?
DESCRIPTION OF -,wo--a
JA 4s
To-- AIT VAL LT,4mol\*,:
M is:
WM—Z�UW
S iz,-"
By my sfgnatum bel ow, I cel-.Vto each. ofth-- •followin.- I am the -o-opz-,y o-��mr or ai--LhoT-lz!Ld pnt to -act on the prop-, t tlus
L
aPD!icarfon End tl.,!: ipfonmFtion 1 hav� T mltd is co- -- 1 hwv: r -ad thie Descri L;on of-W`o-k and 'venify i tttoc -m pp, !;Cab] e I ocal
Uj- i � - q --Y Zol- L-IM-CrMoil DUTPOSCS.
0, dmances ?--)d ststel:Vlls rt!E'Ll to li Gh -11C ,
I I
Sid -,ztu7--
LEEMENTALT RK—FORIMATIONIT R:EQTJ=ED
. . . . . . . . .
. .
ON
MMIRMIM
J' 471M
CITY OF CUPERTINO
ORR FFF FRTIMATOR — BUILDING DIVISION
imADDRESS: 23500 cristo rey dr unit 201c
DATE: 10/30/2014
REVIEWED BY: Mendez
APN:
BP#:
EVALUATION: 1$2,000
PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 REAP1
PERMIT TYPE:
WORK
install 6 canned led lights throu h out unit
SCOPE
1leri ,it
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Fixtures, Lighting 1BREMFIxT 6 # $72
TOTALS: $72.00
cai, h �r f.'hr ,ck i'/tw;b. Ph%,i C hocl Elec. Plan Check 10.0 1 hrs $0.00
—lee" a. 1'2;°r W Fee: ht`i mh. N, -,mit 1w: Elec. Permit Fee: 1 EPERMIT
0j,/,e:v ;i cch, tra:�P oflwi flymb Ins'a Ll Other Elea Insp. 0.0 1 hrs t $48.00
P2�j
i°ee., 11ha nh. Insp. Fee.- 1Jec, Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Mctri�t otr 1 Thoco foot aro hacod an the nrPliminary infnrmatcnn available_ and are oniv an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan £ 'lack 1 F'e e:
StIppl. PC' 1"Ce
PME Plan Check:
$0.00
1leri ,it
SIfjy1,
PME Unit Fee:
$72.00
PME Permit Fee:
$48.00
C o aria t,rction T<i :
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? 0 Yes 0 No
$0.00
Ad,rczn"ecl f'Ittaa ar"rte l es:
Travel Documentation Fee: ITRAVDOC
$48.00
Strom Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
� y
$214.50
$0.00 y "'$ y„ „ TOIAI. FEE:
$214.50
Revised: 08/20/2014
2..3500 Ae—J Djz- Curd d ti c�
� guilt�it!� D
r
2014
3 Q GOpt"1 ASCEot sem;
Wk
on Comer LSrirs
,i
-2'
_ I3W x TV
- Face
TWRt or
Cng Room
Bedrom
11'9 x 12''
6'lo x610'
_
_ -
' c
y
T x
` Hca Ce fang_
at Top riloor
•
CotAMUtd(TY
DEVELO�M1; CU CFc r"T
BUILDING DIViS1ON - l
�''�. �► ke t at the
t n .and specifications — to make any
This c
lob Situ,on a.:s oh same, or to de1diate
changes or alta i from theiiidi^:
riithout approvuE IST
theref,om,
The
lu`n and Sp� 1 }�� L'•;'.,; : Li U"�
tae Sf�mA4nt e an app'ual ot�r
e+d t0 e'm's Of t0 d u; lui,Co
r of an
Ct
G
T
isZ
j1T Na