15100049/_
I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 202C I CONTRACTOR: BAY AREA ENTERPRISE I PERMIT NO: 15100049
OWNER'S NAME: COMPTON ROBERT R TRUSTEE & ET AL 12110 MANGIN WAY I DATE ISSUED: 10/07/2015 1
I OWNER'S PHONE: 650537153 I SAN JOSE, CA 95148 I PHONE NO: (408)238-5043 1
0 LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # 2 117 �? 17
Contractor i4y'-e. Lew r Date Io/�-
1 hereby affirm that 1 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.
1 ereby 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.
1z 1 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
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state th the above information is
correct. I agree to comply with all city and county r finances and state laws relating
to building construction, and hereby authorize r9froentatives of this city to enter
upon the above mentionedgrope for inspect' n urposes. (We) agree to save
indemnify and keep harmless ity oL gainst liabilities, judgment y
costs, and expenses which m crue aty in consequence of the
granting of this permit. A ' 'ovally, thnderstands and will comply with
all non -point source regu t' ns per the nicipal Code, Section 9.18.
Signature A_Date /6 ?-D/fes
1 hereby affirm that I atjr exempt from the Contractor's License Law for one of
the following two reasons:
t. 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)
z. I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three 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.
z. 1 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
permit is issued.
I I certify that in the performance of the work for which this permit is issued, l 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
become subject to the Worker's Compensation provisions of the Labor Code, I
must forthwith comply with such provisions or this permit shall be deemed
revoked.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is
correct. 1 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,
costs, and expenses which may accrue against said City in consequence of the
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.
Date
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
UNIT 202C - REPLACE 18 OUTLETS, 10 SWITCHES, ADD 5
(N) RECESSED LIGHTS & REPLACE SHOWER PAN & REPLACE
BATH FAN
Sq. Ft Floor Area: I Valuation: $6000
%PN Nlnnhcr: 34253038.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS-MPERMIT ISSUANCE OR
ROM -LAST CALLED INSPECTION.
Date: U
RE -ROOFS:
SII roofs shall be inspected prior to any roofing material being installed. If a roof is
nstalled without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
',ignature of Applicant:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) s ould I store or handle hazardous material.
Additionally, should I use equ0#1ent or devices which emit hazardous air
contaminants as defined t sy Area Air Quality Management District 1 will
maintain compliance 'i t e Cupertino Municipal Code, Chapter 9.12 and the
Ilealth & Safety CotMe, ee ons 25505, 25533, and 25534.
Owner or a
Date: 1V/� I 2-L,;-- /5�
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 950143255
(408) 777-3228 - FAX (408) 777-3333 - buildino(&cupertino.orci o
❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
#1
PROIF.fT ADDRF_SSL3 5—OO Cr-;' T � ^ D 1L 'Z O Z C_
,
A # 307? 3?
OWN= N\Str P-J\pe/ - cow -e
PHONE
'T
-\LULTFL-1-41 wl 254
—5-17Z3
Frn n
STREET ADDRESS
`C
CITY, STATE, ZIP
FAX
CU rh
CONTACT NAMEG-b4\IL
lS
PRONG O
�
T
re
I Co
STREr.TADDRESS
ule .
LIT1-SI:\IL. Lill FAX110
rt 51 �'
❑ OWNER ❑ OWNER-BUILDF7t ❑ OWNERAGENT f CONTRACrOR ❑ CONTRACTOR AGENT ❑ ARCIIrrF(T ❑ FNrINFFR ❑ DEVELOPER ❑ TFVA rr
CONTRACTOR NAh1E
LICENSE NIJNIBER
SI`!'girl
LICENSE TYPE
BUS. LIC #
L'UAfI'r\Nl' NM1L•
Rcqj r2 'Se
IrATAIL
r S -f`. C 1-1
FAX
STREET ADDRESS g I I O M Q 1CITY,
CK
STATE. ZIP
C'q �l
PHONE
Sa h 9 8
O –Z
ARCIIITL'CTIENGINEL'R NANIL
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
L MAIL
FAX
STREET ADDRESS CITY, STATE. ZIP PHONE
DESCRIPTION OF
— – Re< es S4cLl I? ti�1 S N �r�/11–
!� VCtn.. �Iec `J oh
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
F.XISTG
NFW FI OOR
DFMO
TOTAL
AREA
ARLA
AREA
MET AREA
BATHROOM
KTrCHEN
REMODEL. AREA
REMODELAREA
DEL AREA
7=0
PORCII AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
ATTACH
# DWELLING UNITS:
IS A SECOND UNIT YES
SECOND STORY OYES
aEI.GAUUED? ONO
ADDITION? NO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
IS THE BLDG AN YES TAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HO NO
�• C C�
By my signature below, i certify to each of the fo owing: I am the pro a caner&oaut orizeda on tl�p a er's behalf. i have rwd this
application and the information I have provided correct. 1 cad a Des d vc �a c. I afire to comply with all applicable local
ordinances and state laws relating to buildi o struction. 1a resentatCupertino to enter the above -identified property for ingpectitm purr"sm.
Signature of Applicant/Agent: / Date: 10 / 7/ � S
SUPPLEAL INFORMATTO REQ ED
PLAN CHECK TYPE.
ROUTING STIP
_ New SFD or Multifa ily dwellings: Apply f r demolition perm[ Dr
❑ OVER-TH&couNTER
❑ BUILDING PLAN REVIEW
existing building(s). Dc olition permit is re u' d prior to issuancc of building
permit for new building.
❑ F.YPnESS
❑ PLAN -Mr. ri.,\V Rn'TM. '
—Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
E]STANDARD
11PUBLIC WORKS
form if any -Hazardous Materials are being used as part of this project
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
C1 dIA�oR
❑ SANITARY SEWER
ubmittal of Building Permit application.
ll151'ftlCl'
❑ ENVIRONMENTAL HEALTH
B/dgApp_20 / /. doc revised 0612 ///1
iLcN
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Puhlic Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are onl j, an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-03 Fk. ;;7/131
23500 CRISTO REY DR # 202C
DATE: 10/07/2015
REVIEWED BY: MELISSA
OP&ERDDRESS:
PN: 342 53 038
BP#:
"VALUATION:
$6,000
MITTY
TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi -Family Dwelling __[Buildina
USE:
is
3 Stories 0 Yes E) No
PENTAMATION 1 REAP10
PERMIT TYPE:
WORK
UNIT 202C -REPLACE 18 OUTLETS 10 SWITCHES ADD 5 N RECESSED LIGHTS & REPLACE
SCOPE
SHOWER PAN & REPLACE BATH FAN
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Puhlic Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are onl j, an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-03 Fk. ;;7/131
FEE
QTY/FEE
MISC ITEMS
Mech. Plan Check"00 $0.00
Fmech. Permit Fee: IMPERMIT
Other Mech. Insp.0.0 hrs $48.00
Plumb. Plan Check 0.0 1 hrs
Plumb. Permit Fee:
Other Plumb Insp. 0.0 hrs
$0.00
IPPERMIT
$48.00
Elec. Plan Check 0.0 1 lirs
Elec. Permit Fee:
Other Elec. Insp. 10-01hrs
$0.00
IEPERA111
$48.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Puhlic Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are onl j, an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-03 Fk. ;;7/131
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
=#
$88.00
Electrical
IBREMRECEP Recep/Switch/Outlets
Suppl. PC Fee: Q Reg. O OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
5
$72.00
Electrical
1 IBREMFmT Fixtures, Lighting
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
1 # Plumbing
$10.00 IBPFIXTURE Fixture or Trap
PME Unit Fee:
$0.00
PME Permit Fee:
$144.00
0 # Mechanical
$25.00 IBREMVENF I Ventilation Fan
C(mNl •ucliml /a,
Administrative Fee: ]ADMIN
$45.00
Q
0
Work Without Permit? O Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
i
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.78
Select an Administrative Item
Bldy Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$238.78
$195.00
TOTAL FEE:
$433.78
Revised: 10/01/2015