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151200061 CITY OF CUPERTINO BUILDING PERMIT BUILDI ADDRESS: 23500 CRISTO REY DR UNIT 41 OF CONTRACTOR: BAY AREA ENTERPRISE PERMIT NO: 15120006 OWN 'S NAME: CLARK RUTH L TRUSTEE 2110 MANGIN WAY DATE ISSUED: 12/02/2015 OW ER'S PHONE: 6505371523 SAN JOSE, CA 95148 PRONE NO: (408)238-5043 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ ((rr UNIT 41 OF - REPLACE 2 (E) SHOWER PANS, VALVES & License Clas Lic. #,ow T�� REPLACE TILE WITH MARBEL Contractor I hereby affirm that 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: $7000 performance of the work for which this permit is issued. , ave and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of tine Labor Code, for the performance of the work for which this APN Number: 34253174.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF 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-34—LAS w. ASL INSPECTION. 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. Additi nally, the applicant understands and will comply with all non -point source regu tions per the Cupertino Municipal Code, Section RE 9.18. � 2� -ROOFS: Signatur� Date 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 BETTED. 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) 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 2550 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Muni pal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) shoul I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's t or devices which emit hazardous material.- Additionally, should I use equipm[aAir Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay AreQuality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cup tinMunicipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 5 05, 233, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: 'Z 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 0 CONSTRUCTION PERMIT APPLICATIONO COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 e build ing(ftupertinD.Ong / / ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 0 Y/ JTv /`e /. �[`I�( ,® 2J�d — APN# •'} ` 1_ � 19 OWNER NAME j� r/� PHONE E-MAIL red e V- v► a V1&hle,3 (G�-,/ ( r r 5a 53°7 ., I S" z 3 T e VC: wt r 5 C,, c 6 ,,.A / STREET ADDRESS �i'fY ,8'I' P `7 (/ v CONTACT NAME �r+ ^ P//HONE yo - Z 3 -JS-2 E-MAIL Ye 49fo STREET ADDRESS CITY, STATE, ZIP FAX 7-110 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME� (,S� f-o UU'- LICENSE NUMBER LICENSE, TYPE BUS. LIC# COMPANY NAME E-MAIL �D ef FAX STREET ADDRESS CITY, ST -ZIP � PHONE Z 11 t7 � a r'rl wo- ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK n 1,tic� �(S 9Ko crr uX b C- 4 u u EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK(PORCH AREA GARAGE AREA: DETACH []ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY []YES BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COW OF IS THE BLDG AN ❑ YES R .:Fp TOTAL VALUATION: �A PLANNING APPL # ❑ NO PLANNING APPROV LETTER EICHLER HOIV E? ❑ NO / By my signature below, I certify to ea a following: I am thee neror ized agent to a I th peti'y owner's behalf. I ha a read this application and the information I hav provid d is correct. I have ription of Work and veri it i ate. I agree to comply with all applicable local ordinances and state laws relatin onstruction. I authfives of�pertino to enter the above -identified property for inspection purposes. Signature of Applicant/ ent Date: s q l S PLEMENTAL INFORMATI UIR D PLAN CHECK TYPE ROUTING SLIP _ New S or Multifamily dwellings: App f r demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW existing b ding(s). Demolition permit is requi d 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 ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 23500 CRISTO REY DR# 41 OF DATE: 12/02/2015 REVIEWED BY: MELISSA 119 APN: 342 53174 1 BP#: *VALUATION: 1$7,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi -Family Dwelling USE: Buildina is >3 Stories 0 Yes (j) No PENTAMATION 1 RPFIX PERMIT TYPE: WORK REPLACE 2 (E) SHOWER PANS, VALVES & REPLACE TILE WITH MARBEL SCOPE $0.00 71 Afec!". llljZin (:'heck Plumb, Plan Check 1 0. 0 1 hrs $0.00 Ph�rl Check I I — , I I 14 ��,�h 1*!',�,O: Plumb. Permit Fee: IPPERMIT lec, J,ep.."1,4f Fee: I . Other Plumb Insp. 0.0 hrs NOTE: This estimate does not include fees due to other Departments (i.e. Planning. Public Works. Fire. Sanitary Sewer District. School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Aff. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 $20.00 Plumbing IBPFLYTU;E�j Fixture set on One Trap Suppl. PC Fee: (j) Reg. 0 OT 1 0.0 hrs $0.00 PXM Plan Check: $0.00 2 # $20.00 Plumbing MPFIXTURE Fixture or Trap Permit Fee: $0.00 Suppl. Insp. Fee: (F) Reg. 0 OT"00 hrs $0.00 PME Unit Fee: $0.00 PNM Permit Fee: $48.00 ("Onsirucihm Kn.; Administrative Fee: JADMIN $46.00 0 E) Work Without Permit? 0 Yes (F) No $0.00 Advanced Planajqgjg�ej $0.00 Select a Non -Residential Building or Structure G 0 Travel Documentation Fee: I TRA VD OC $48.00 Strong Motion Fee: IBSEISMICR $0.91 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC' $1.00 SUBTOTALS: A $142.91 $40.00 0T"ALFEE: $182.91] Revised: 10/01/2015 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE �., COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTtNC� (408)777-3228•FAX(408)777-3333•building a(icupertino.orq PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE:HAS BEEN COMIUTED SIGNED.,AND RETUNED TO THE"BUILDING DI"V=ISION PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314,R315,2016 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations,or repairs to existing dwelling units exceeds $1000 00, CRC Section R314,R315, and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations. AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s)-(Smoke alarms shall not be located within 3 feet of bathroom door) On every level of a dwelling unit including basements and habitable attics X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply In dwelling units with no commercial power supply, alarm(s)may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl space.Refer to CRC Section R314 and CBC Sections 907.2.114 and 420 6.2.An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms specified below have been tested and are operational, as of the date signed below Address: �j �/2J � 7( (6 i f7 7.<1'ova Permit No./57.2,Q Specify Number of Alarms. #Smoke E-671----. #Carbon Monoxide Detectors Fri I have read and agree t. e ply with the terms and conditions of this statement Owner(or Owner Agent's)Name: Si. . ... . %' .. Date—� / C Contractor Name: Signature Lic.# Date: . . Smoke and COform.doc revised 01/10/2017