151200101
CITY OF CUPERTINO BUILDING PERMIT -
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 318D
CONTRACTOR: BAY AREA ENTERPRISE
PERMIT NO: 15120010
OWNER'S NAME: MINKIN BERNICE TRUSTEE
2110 MANGIN WAY
DATE ISSUED: 12/03/2015
OWNER'S PHONE: 6505371523
SAN JOSE, CA 95148
PHONE NO: (408)238-5043
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
UNIT 318D - ADD 7 (N) RECESSED LIGHTS, REPLACE 2
License Class �' Lic. -1-0`; l
BATHROOM FANS & 27 OUTLETS/14 SWITCHES
/�1
Contract ` r c Date"l-b[ - y _V
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
Sq. Ft Floor Area:
Valuation: $2800
erformance of the work for which this permit is issued.
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
APN Number: 34253097.00
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
WITIiIN 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
I LED 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
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granting of this permit. Additionally, the applicant understands and will comply
Issued Date: 2 3
with all non -point source regulations the Cupertino Municipal Code, Section
'
9.18. -
Z�
RE -ROOFS:
Signatuff 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 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 (Sce.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 equipmen o devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the a A Quality Management District I
performance of the work for which this permit is issued.
CBay
will maintain compliance with the u ono Municipal Code, Chapter 9.12 and
I 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
the Health & Safety Code, Sections 55 5, 2553 ud-25534. 1
121
Owner or authorized agent:® Da�l
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
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
CONSTRUCTION PERMIT APPLICATION—
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE m CUPERTINO, CA 95014-3255
CIl1PlERTBN® (408) 777-3228 • FAX (408) 777-3333 e building a( �.cupertino.org / Z � a/o
❑ NEW CONSTRUCTION .- 0 ---ADDITION -5�LTERATION / TI ❑ REVISION I DEFERRED ORIGINAL PERMIT #
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT IW CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
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USE TYPE OCC_ sw-I'. VALUATIUN(S)
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TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
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REMODEI. AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKMORCH AREA
GARAGE AREA: DETACH
❑ ATTACH.
I
-YES'
9 DWELLING UNITS:
IS A SECOND UNIT []YES
SECONDSTORY
BEING ADDED? ❑ NO
ADDITION? E]NO
IS THE BLDG AN ESEIVED B - VALUATION:
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
PLANNING APPL P []NO P4INNING APPROVAL LETTER
EICHLER HOME? ❑ NO o
By my signature below, I certify to each, of the follow g: I am dle property owner or authorized agent to act on the property owner's behalf. I lave read this
application and the information I have provided is co et. I hav ead the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building con ction.T a Drize representatives of Cupertino to enter the above -identified property for inspection pure ses.
Signature of Applicant/Agent:Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE. ROUTING SLIP
❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
_ New SFD Or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ rXPRESS ❑ PLANNTNC PLAN'Rr,ir,v
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD ❑ PUBLIC WORKS
form if anv Hazardous Materials are being used as part of this project.
❑ ❑
n 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
41dg,4pp=201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FORM7 FF,F, ESTIMATOR — BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
n.mt,•.�t om 1 Thoma foom aro hamod an the meliminary information availahle and are azly an estimate. Contact the Dent for addn'l into.
FEE ITEMS (Fee Resolution 11-053 E . 711113J
23500 CRISTO REY DR 318D
DATE: 12/02/2015
REVIEWED BY: MELISSA
lialADDRESS:
APN: 342 53 097
BP#:
*VALUATION: 1$2,800
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi -Family Dwelling
USE:
Building is
1 >3 Stories 0 Yes 0 No
PENTAMATION 1 REAP11
PERMIT TYPE:
WORK
UNIT 318D -ADD 7 N RECESSED LIGHTS REPLACE 2 BATHROOM FANS & 27 OUTLETS/14
SCOPE
SWITCHES
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
n.mt,•.�t om 1 Thoma foom aro hamod an the meliminary information availahle and are azly an estimate. Contact the Dent for addn'l into.
FEE ITEMS (Fee Resolution 11-053 E . 711113J
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
�7 #
$72.00
Electrical
1BREMFIXT Fixtures, Lighting
Suppl. PC Fee: ) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
41
$153.00IBRE;l
Electrical
ECEP Recep/Switch/Outlets
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. OOT
0.0
hrs
$0.00
=# Mechanical
$50.00 1BREMVENF Ventilation Fan
PME Unit Fee:
$0.00
PME Permit Fee:
$96.00
Tax:
F
Administrative Fee: 1ADMIN
$45.00
0
G
Work Without Permit? 0 Yes D No.
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
i
Travel Documentation Fee: 1TRAVDOC
$48.00
Strong Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$190.50
$275.00
TOTAL FEEc ;
$465.50
Revised: 10/01/2015