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15050168L CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 513H CONTRACTOR: BAY AREA ENTERPRISE PERMIT NO: 15050168 OWNER'S NAME: TODT MARGARET E TRUSTEE 2110 MANGIN WAY DATE ISSUED: 05/28/2015 OWNER'S PHONE: 6505371523 SAN JOSE, CA 95148 PHONE NO: (408)238-5043 7,10 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] UNIT 513H - REPLACE 22 OUTLETS, 12 SWITCHES, 2 License Class Lic. BATH FANS, ADD/REPLACE 20 LIGHT FIXTURES, CLOSE OPENING TO DEN & CREATE (N) OPENING (50 S.F.) Contractor 3 u ,{Fvec, �H .�-c,�- Date ��"�•�t-g - �-a� 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 sation, asprovided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $3700 ance of the work for which this permit is issued. and will maintain Worker's Compensation Insurance, as provided for by r 3700 of the Labor Code, for the performance of the work for which this APN Number: 34253252.00 Occupancy Type: s issued. APPLICANT CERTIFICATION I certify that I have read this application -/ lstate that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city ancounty, ordinances and state laws relating WITHIN 180 DAYS T ISSUANCE OR to building construction, and hereby autl r1 representatives of this city to enter upon the above mentioned property for ' spection purposes. (We) agree to save 180 LED INSPECTION. indemnify and keep harmless City 9f Cupertino against liabilities, judgments, costs, and expenses which accrue/against said City in consequence of the �� Z J� granting of this permit. A rtionally, rthe applicant understands and will comply Date: with all non -point source egulations per the Cupertino Municipal Code, Section RE -ROOFS: 9 18. —2� -"--o 'r Signature DateJ Allroofs 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. F1O .ER -B I DER DECLARATION ti 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 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 Section 3700 Labor Code, for the for this the Health & Safety Code, Sections 2550 , 533 . n 534. of the the performance of work which - 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 LENDING 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 5' CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildincl(a)cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI EI REVISION / DEFERRED B so5o(6's ORIGINAL PERMIT # PROJECT ADORES ,S%� CSI �� APN# 3 2- ,j � Z_ .231M s a �c OWNER NAME / � � /L � �' _ 1 rG'Y-(,� 1Y1 E � I (ter PI o STREET ADDRESS 3-5--o(s) Cr1` V. ke o pl J J IL CC STAB ,ZB' FAX q CONTACT NAME L PHONE[.� "©� E-MAII. .r C LpL�tC.i S . P -G 7 5 y O til STREET ADDRESS t Z)fv !(AVt IVt L CITY7�STATE, ZIP 55 C..10�- 114 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT COgACTOR NAME LICENSE NUMBER - LICENSE TYPE BUS. LIC # Lir�e '� el`5 S i COMPANYNAME` E-MAIL\ �e FAX a ft y—e Ian ,Y r, ?,orcc�r / S� clokt 1J I STREET ADDRESS umtniia . 8STA� s ,e e V . Q 51 �/ PHONE 08 -a. �;-g 5-0 4 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME B -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WO /t Cr I ry 1L j 4 14 ° eutJP - 6uIr A C e 020 hlr✓cle- l2eC.0J !I close Gle11 opm"41a 4 ORO & n ISYI > loeC.l " a EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES 1 USE TYPE OCC. SQ.FT. 7VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH #DWELLING UNITS: ISASECONDUNIT ❑YES SECON TO Y OYES BEING ADDED? ONO ADDIT N? ❑NO PRF APPLICATION OYES IF YES, PROVIDE COPY F IS T4 BL AN ❑ YES REC TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVALTIER EIC OME? ❑ NOG�- By my signature below, I certify to each of th llowmg: I the property owner or auth zed t ct th operty owner's behalf. I have read this application and the information I ha ov ed s correct. I ve read the Description of Work and verify i urate. I agree to comply with all applicable local ordinances. and. state laws relati . to.T c traction- I authorize.representatives of Cupertino to. enter the above-identifie property for' ectionpurposes_ 2� Signature of ApplicanUAgen . Date: ALINFORMATIO REQUIRED SUPPLEFolition Plat`cirECRTYPE: `:'_ �:_°:RoUrnvc.sirn ❑ � OVER THE COUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multidwellings: Apply for demolition permit for existing building(s). Dpermit is required prior to issuance of building permit for new building. ❑ EXPItES$ +. ❑ ,%PI ANNING'PLAN �REVIE\i _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑', STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ElLARGE ❑ ' FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior totj MAJOR'` El"SANIiARN;SEW,Eft DISTRICT " submittal of Building Permit application. .,,:� _, ... °.,. ,.:` ❑.,EIWIRONpIENTALREALTH.:" ..,...-.- BldgApp_2011.doc revised 06/21111 SP�C�a CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 23500 CRISTO REY DR #513H DATE: 05/28/2015 REVIEWED BY: MELISSA APN: 342 53 252 BP#: "VALUATION: $3,700 PETIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY Building is PENTAMATION 1 R2REM USE: Multi -Family Dwelling >3 Stories 0 Yes No PERMIT TYPE: i WORK UNIT 513H - REPLACE 22 OUTLETS 12 SWITCHES 2 BATH FANS ADD/REPLACE 20 LIGHT SCOPE FIXTURES, CLOSE OPENING TO DEN & CREATE (N) OPENING (50 S.F.) Mech. Plan Check 0.0 hrs $0.00 I'tumb. Ilton Chea; Elec. Plan Check 0.0 hrs $0.00 Mech. Permit Fee: IMPERMIT I'Itamb. Per -mil Fee: Elec. Permit Fee: 1EPERMIT Other Mech. Insp. 0.0 hrs $48.00 Other Plumb Inst. Other Elea Insp. 0.0 hrs $48.00 L1z ch Insp. Fee: e: I Pham#. Insp. 1 "ee: I I.. lec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer Distract, School District, etc . These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'1 info. f FEE ITEMS (Fee Resolution 11-053 Ef 7/ 1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 50 s.f. $0.00 $431.00 Remodel, Other IREMRESOTH Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs PME Plan Check: $0.00 L—?--] # $0.00 $50.00 Mechanical 1BREMVENF Ventilation Fan Permit Fee: Suppl. Insp. Fee -(j) Reg. Q OT 0,0 hrs $0.00 $0.00 PME Unit Fee: PME Permit Fee: $96.00 34 # Electrical $118.00 1BREMRECEP Recep/Switch/Outlets Construction Tux: Administrative Fee: IADMIN $45.00 20 # $0.00 $72.00 Electrical 1BREMFIXT Fixtures, Lighting 0 Work Without Permit? 0 Yes No Advanced Plannin& Fee: $0.00 Select a Non -Residential Building or Structure E) Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion. Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUsoTAs ` $190.50 $671.00 TOTAL FEE: $861.50 Revised: 05/07/2015 UQLi + G VITT r 0"-f r �. u�r-f AL- Z 3 S'no C vt'c+afey 't�,Z �i'i 3 fi I - CUPERTINO i;ilding Department sof i`_, I-' T- T- -!;,T,-T-- F -F REVIEINELLF=1 E GOM�P I I lFt-1 0I0,M9 it l - 1 • • • e :OPMENT DEPARTNIEN BION - CUPERTINO ROVED ?ifications MUST be ke t at th 007 t -(stun; aw a -tormae an )sj-orrsar ie or -t? -d viate Ivai-from-t -e-ollding l fficial 4p :,� e p i f l'C nsSH NO e an apprl?va of the ,i Iatio e or Stat Law. 6'11"'x 8'1 S cot e % Ck�v.g�. 22 l�l�e iectl esi{ ) 12 j�5h� S QTc �i—zS� Z+oo{lnra v Qd�l /r•eplac a 2a� �e r^Gci'.a_Q ®re c e S S aCf C i W Emergency Response System ® Electrical Outlet 0 Cable Television Outlet TP Telephone Outlet I = 1 foot Model B INTERIOR LIVING SPACE 950 Square Feet One Bedroom - One and One -Half Bath o Den BALCONY SPACE 106 Square Feet AT RANCHO SAN ANTONIO Floor plans are representative. Actual measurements and layout may vary. RV%