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15100050 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23800 AMAPOLO CT UNIT V6 CONTRACTOR:BAY AREA ENTERPRISE PERMIT NO: 15100050 OWNER'S NAME: JACK KAY T TRUSTEE 2110 MANGIN WAY DATE ISSUED: 10/07/2015 OWNER'S PHONE: 6509440118 SAN JOSE,CA 95148 PHONE NO:(408)238-5043 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ ?? r1 �1 UNIT V6-INSTALL 3(N)LIGHT FIXTURES&REPLACE License Class b Lic.# 7/"1 91/7 KITCHEN SINK&TWO BATHROOM SINKS Contractor Date th I hereby affirm tdat 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: Sq.Ft Floor Area: Valuation:g-tnnn t. 1 have and will maintain a certificate of consent to self-insure for Worker's ompensation,as provided for by Section 3700 of the Labor Code,for the APN Number:34254006.00 Occupancy Type: rformance of the work for which this permit is issued. Afiave 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 permit is issued. PERMIT EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION WITHI F PERMIT ISSUANCE OR I certify that 1 have read this application and state that the above information is AY ALLED INSPECTION. correct.I agree to comply with all city and county ordinances and state laws rela' to building construction,and hereby authorize representatives of this city ter upon the above mentioned property for inspection purposes. (We)agr "to save ed by: Date: indemnify and keep harmless the City of Cupertino against liabilities,judgmen costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additiona y,the applicant understands and will comply with RE-ROOFS: all non-point source regulatio r the C rtino Municipal Code,Section 9.18. All roofs shall be inspected prior to any roofing material being installed.If a roof is Signature Date �o/ 7/-y.o/� installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I licreby affirm that 1 am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE sale(Sec.7044,Business&Professions Code) 1 have read the hazardous materials requirements under Chapter 6.95 of the 2. I,as owner of the property,am exclusively contracting with licensed contractors to California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain construct the project(Sec.7044,Business&Professions Code). compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(x)should I store or handle hazardous material. 1 hereby affirm under penalty of perjury one of the following three declarations: Additionally,should I use a ipment or devices which emit hazardous air I. I have and will maintain a Certificate of Consent to self-insure for Worker's contaminants as defined a Bay Area Air Quality Management District I N%ill Compensation,as provided for by Section 3700 of the Labor Code,for the maintain compliance with a Cupertino Municipal Code,Chapter 9.12 and Clic Health&Safety Code c'ons 25505,25533,and 25534. performance of the work for which this permit is issued. 2. 1 have and will maintain Worker's Compensation Insurance,as provided for by Owner or author' ed Section 3700 of the Labor Code,for the performance of the work for which this Date: permit is issued. 3. 1 certify that in the performance of the work for which this permit is issued,l shall �NSTRUCTION LENDING AGENCY 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,1 I hereby affirm c t there is a construction lending agency for the performance of work's for which this pe it is issued(Sec.3097,Civ C.) become subject to the Worker's Compensation provisions of the Labor Code,1 Lender's Name must forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Address APPLICANT CERTIFICATION ARCHITECT'S DECLARATION I certify that I have read this application and state that the above information is I understand my plans shall be used as public records. 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 Licensed Professional 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. Signature Date CONSTRUCTION PERMIT APPLICATION is COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildingCcDcupertino.ora ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED( ORIGINAL PERMIT# ^ SS + FPRQIE_rT A�I Ad l �i ,C •n . LIT APN a2 J. ER NAME . _ 1 �� t{ + -- �a� 7MAIL (j STREET ADDRESS , O �L11 a CNS/T`A-TCOZ Ar C4. _`spq3 p D FAX CONTACT NAME PHONE E-MAIL _Z f- IL r• Fey• Ila STREET ADDRESS CITY,STATE,ZIP FAX 2_110aV% "K Wei ca q S/ ❑OWNER ❑ OWNFR-BUILDER ❑ OWNER AGFNT I CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCItIT cr ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRA(gOR NAME LICENSE NU ER LICENS_JtPE BUS.LIC a (-" COMPANY NA E Eh r E-MAIL FAX STREET AODDREM d k/d CITY STATE•C ' P Np ✓L� —3'a a y - ARCHITECT/ENGINEER AME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREE ESS CITY,STATE.,ZIP PHONE. a• D RI O'WOR w^ . Z- 4 0 f� 2 von, c •J,r 3 l vw.,bl x-�Y-mss EXISTING USE PROPOSED USE CONSTR.TYPE aSTORIES USE TYPE OCC. SQ.Fr., VALUATION(S) F.XISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTItER REMODELAREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTALDECK/PORCH AREA GARAGE AREA' DETACH ATTACH a DW ELLING UNITS- Is A SECOND UNIT YES SECOND STORV YES BEING ADDED? ❑NO ADDITION' PRE-APPLICATION ❑YIS IF YES,PROVIDE COPY OF /AN ❑ ES e AECEIVED gy r..T.. .......r.,,. PLA"APPL a ❑NO PLANNING fPROVAL LEl"1'ER EICH HO O LlI ���, By my signature below,l certify hof the following: I the prop rty o her or authorized agent ton the propert ner's benattJl haYF read this application and the information I av provided is t. I e re a or and verify it is accurate. rce to comply with all applicable local ordinances and state laws relati to ildin�cgns tion. tho' s tatives of Cupertino to enter the abov ti ied p erty for inspectiO rposes. Signature of ApplicanUA ,/{`�/l Date: 3 / SUP EMENTAL INFOR ATION REQUIRED PLAN CHECK TYPE. ROtITING SLIP New SFD or Multifamily dwellings: pply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is equired prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FtRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. ❑ MAJOR ❑ SANITARY SEWER DISTRIc I ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/1/ CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION [APN: DDRESS: 23800 AMAPOLO CT #V6 DATE: 10/07/2015 REVIEWED BY: MELISSA 342 54 006 BP#: `VALUATION: 1$4,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi-Family Dwelling Building is PENTAMATION 1GENRES USE: 3 Stories O Yes 0 No PERMIT TYPE: WORK UNIT V6 - INSTALL 3 N LIGHT FIXTURES & REPLACE KITCHEN SINK & TWO BATHROOM SCOPE SINKS Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check 0.0 1 hrs $0.00 Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: IEPERMIT Other Plumb Insp. 0.0 hrs $48.00 Other Elec. Insp. 0.0 lirs L $48.00 NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the preliminart information available and are only an estimate. Contact the Dept-for addn7 info. FEE ITEMS (Fee Resolution /1-053 Eff '/1/73) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure Suppl. PC Fee: (F) Reg. © OT 0.0 hrs $0.00 1 or Element of a Building PME Plan Check: $0.00 F 3 Electrical Permit Fee: $0.00 $72.00 IBREMFIXT I Fixtures, Lighting Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 3 4 Plumbing PME Unit Fee: $0.00 $30.00 IBPFLYTURE Fixture set on One Trap PME Permit Fee: $96.00 Administrative Fee: (ADMIN $45.00 Q Work Without Permit? O Yes (F) No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential G) Travel Documentation Fee: ITRA VDOC $48.00 Building or Structure O A Strong Motion Fee: IBSEISMICR $0.52 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: F $190.52 $102.00 TOTAL FEE: $292.52 Revised: 10/01/2015