15110190it! .U1= 5r
CITY OF CUPERTINO BUILDING PERMIT
t.,
BUI t1D)pRESs, X3500 CRISTO REY DR UNIT 412F
CONTRACTOR: BAY AREA ENTERPRISE PERMIT NO: 15110190
OWNER+S NAME'' SUNDEJtBRUCH RUTH TRUSTEE
2110 MANGIN WAY DATE ISSUED: 11/30/2015
O R!0-PHdNp, 6505371523 r-
SAN JOSE, CA 95148 PHONE NO: (408)238-5043
❑ ''1' ''.!I, lit,.; ,. SEh`
€i � l'',tLICEND: CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
UNIT # 412F - INSTALL 5 (N) LIGHT FINXTURES, 20
License'Class `'''i�� r13''fi t I,''Iicl# 11l %
OUTLETS & 7 SWITCHES. REPLACE & UPGRADE (E)
It,
f
-. ' 1 �` h
SHOWER
Contractor I . Date
I ,: i ,t
PAN, VALVE & WALL FINISH
I 11 y
I hereby'a arm,+„ M4kin;hcen§ed under;the provisions of Chapter 9
(commeuc►ng with ISection 7000) of Division 3 of the Business &Professions
Code and`thatntiy hcene;is in full force, and effect.
I her liy'affirm under penaltynof perjury one of the following two declarations:
I have and`wi l imamtam aiceri ficate of consent to self -insure for Worker's
Co ensa wn ' as provided for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $6000
rformance of ttte yvQrk .orryvhtch , i, s permit is issued.
ave ill �miiiritau►' Wlorkers. Compensation Insurance, as provided for by
ec 3:70Q'o flie,Y abot p e, for the performance of the work for which this
t
perms} ts.,X 4ed
APN Number: 34253176.00
Occupancy Type:
� LkiS n rG'ti1,' i t
I : r d li l" E'I "APPLICANT CERTIFICATION
fli
I certify that I haye,T��d,this,application and state that the above information is
PERMIT EXP + RK IS NOT STARTED
correet :Iagreelto. comply,: Yyith all city and county ordinances and state laws relating
WIT AY PERMIT ISSUANCE OR
to building const uc on and t e'reby auth ize,representatives of this city to enter
upon th'e above;iiten oned;pcoperty for ' pection purposes. (We) agree to save
YS F ED INSPECTION.
indemnify,and,keepIbarniless the, City f upertino against liabilities, judgments,
costs', and expenses -w6 'cc 'against said City in consequence of the
Date:
granting of this per�rt:, Additt all ;the`applicant understands and will comply
Issued b y'
with allnon-point source, regp do ertino Municipal Code, Section
RE-ROOFS:
p
9 10, II I '1 rd b(I ly , Q
`I#I; I �O
Iq
Stgnatur?: Date
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
�
❑ ! l; lil'o E UH'DERDECLARATION
,°
I hereby,affirgi th0l ;,exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the'follovng two reas•:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I, asowner of the; progerf} :or!my.employees with wages as their sole compensation,
will do the work;°�anldl`thestrtucture'isanot iniended or offered for sale (Sec.7044,
l i;i , I
Business.& go�essions Code) ,;
s:
I asowneir ofl the;prloperty„Iram exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLO E
construct the ($ 7044usiness &Professions Code).
r;.d 00 • y, , : ,
I have read the hazardous materials requirements unde apter 6.95 of the
�pXolrect
,E , ,�'lee :
California Health & Safety Code, Sections 2 505, 2553 , and 25534. I will
I hereby'affirm''undet`penalty,.of perjury one of the following three
maintain compliance with the Cupertino nicipal C de, Chapter 9.12 and the
declaratiops, i,
Health & Safety Code, Section 25532(a) should I stor or handle hazardous
I have and will Imamtam a Certificate'of Consent to self -insure for Worker's
material. Additionally, should I use equip ent or vices which emit hazardous
Compensation;�as prpvidei} for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay A a Air Quality Management District J
i'an `' wd ` `
performanc7.e of the work for,wl}ich this permitis'issued.
have and will tam Workers Compensation Insurance, as provided for bythe
P � P � P1
will maintain compliance with the ert no Municipal Code Chapter �ZZ
Health &Safety Code, Sectio 25505 nd 25534./luI
3700 of the abor ode for to performance of the work for which this
z
[Section /
F r ; t,
permit, lis issue0,,ngl�t
Owner or authorized age t: Da e:
I certifjithat m the p rformanoe of the work for which this permit is issued, I shall
AQNLNDING
,
become to the Worker's
not employ ann prson, t}t any manner: so as'to. subject
Compensation: ayvs' of Califo(rn�a , If, after making this certificate of exemption,. I
CONSTRUC AGENCY
become sui'iibject;f4'tl}g Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
' i " E' ' ^
forthwith coplyiwtthsuch provisions or this permit shall be deemed revoked.
work's for which this permit is issued Sec. 3097, Civ C.
P ( )
;4 I ai,i` i
Lender's Name
Lender's Address
�) ! • ra APPLICANT CERTIFICATION
I
I certify.that I hf ke ie#d ihisj4plicatipii and state that the above information is
laws
correct. I agree to,�gomply with all,city and county ordinances and state relating
to building conlstruct` and hereby authorize representatives of this.city to enter
uponime apovYlrite stoned' ;operty for inspection purposes. (We) agree to save
1 k: t I r
eeplharrnless the City of Cupertino against liabilities, judgments,
ARCHITECTS DECLARATION
mdei►inify,an�li
costs, and expepses whici'may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this; pe_ i it;,:, itionally, the applicant understands and will comply
with alnonpointsil urce regulations per the Cupertino Municipal Code, Section
Licensed Professional
al ,
��ilT
'Iti,Iti i d iliiy i,,,i P�I{'t I '
Slgnariue( I >Ili?3 I r' I�ia'I>[ it Date
CONSTRUCTION PERMIT APPLICATION --
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 _ FAX (408) 777-3333 - build ing(ED-cupertino.oro
❑ NEW CONSTRUCTION ❑ ADDITION 1LTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECTADDRESS G rl;L:;7;1;L:;7;10 a—
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APN = 3YZ-
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(Ji1^iER NAME // PHO 4'E
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STREET ADDRESS CITY, STATE, ZIP > _ FAX
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PHONE — S —S
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STREET ADDRESST
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT K0 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER❑TENANT
CONTRACTOR NAME LICENSE NUNIBER LICENSE TITE
BUS. LIC
CONIPANY NAME
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STREET ADDRESS
2-11-0 tkyt_a
CITY, STATE, ZIP
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PHON
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ARCHITECT/ENGINEER NANIE
LECENSE NUNIBER
BUS. LIC s
COMiPANY N ANTE
E-MAIL
FAX x
STREET ADDRESS
CITY, STATE, ZIP
PHONE
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DESCRIPTION OF W ItK
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Lk 12!R Y-0Cec 'cam � (e S wt 1,T /% u ra '� c5ss< u i� TP
C 1^ i W i di S "� @rd �9C1+1� 1i �ll� 1�@ G.VL E !18/ s 1
EXIS SE
PROPOSED USE CONSTR.
TYAI
k ST
USE TYPE OCC-
SQ_FC.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REN1ODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECWPORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
I
N DWELLING UNITS:
IS A SECOND UNIT []YES
SECOND STORY ❑YES
BEINGADDED? ONO
ADDITION: ❑NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN FS D BY: TOTAL VAI ON:
I
PLANNING APPL ❑ ❑ NO PLANNING APPROVAL LEI -MR
EICHLER H031E? Fl NO _S
I `!
By my signature below, I certify to each of the follow g: I am the property owner or autho agent on the property owner's behalf. I have read this
application and the information I have provided is co ct. 1 havgead the Description of' ork and ven it is accurate. I agree to comply With all applicable local
ordinances and state laws relating to building con coon. 1 aVorize representatives orCupertino to enter the above -identified property for inspection purposes.
-
Signature of Applicant/Agent: ;,'Date: _
SUPPLEMENTA 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,
❑ F.\rRrss
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLICWORKS
form if anv Hazardous Materials are being used as part of this project. b
❑ LArtGe
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ NIAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp 201 Ldoc revised 06/21/11
Cla1{try #f
tAWIDt
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CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 23500 CRISTO REY DR #412F DATE- 11/30/2015 REVIEWED BY: MELISSA
;-'34-2 53 176 BP#: *VALUATION: 1$6,000
fT
*PE11M YPE--, Building Permit PLAN CHECK TYPE: Alteration Repair
PRIMARY'";:"
Buildina is
PENTAMATION
MUIti-'Family Dwelling
1 RPFIX
USE: >3 Stories 0 Yes (S No PERMIT TYPE:
WORK;' - INSTALL 5 (N) LIGHT FINXTURES, 20 OUTLETS & 7 SWITCHES. REPLACE &
SCOPE? UPGRADE q!3ADE (E) SHOWER PAN, VALVE & WALL FINISH
Plumb. Plan Check 0.0 1 hrs $0.00 Elec. Plan Check 10.0 1 hrs $0.00
e0: Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: 1EPERMIT
Other Plumb Ins 0.0 hrs $48.00 Other Elec. Insp. 0.0 hrs
Phi, 4b,bist,% E' e. lrsp. heC:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, sanitary sewer District, scilool
District, et6d.! 'These fees are, based on the preliWdina
information available and are only an estimate.
Contact the Depifor addnl info,
�i, I
FEEITEMSffee Resolution 11-053 Aff. 711113
FEE
QTY/FEE
MISC ITEMS
P'Check Fee'
ld �
$0.00
=
# Plumbing
Supp. P"C :Reg. OT
Fee:
.. (E) 0
1 0.0
hrs
$0.00
$10. 0 01
1BPF=UJZE
Fixture set on One Trap
P
PME;PianCfie6k: il";
$0.00
27
Electrical
G
Permit e6
$0.00
$83.00
IBREMRECEP
Recep/Switch/Outlets
Suppl. In , s0.:Tee.0:R6g." 0 OT
0,0
hrs
$0.00
Electrical
PME'Unitfe'e: , . I
$0.00
$72.001
IBREMFMT
Fixtures, Lighting
PME:Permit Fee::
$96.00
Adm`'nist!r�t&e Fee;;,:.''
IADM17V
$45.00
0
, Permit?
Work Without
0 Yes (D No
$0.00
F
G
Advanced Planning Fee:
$0.00
Select a Non -Residential
is
Travel Documentation Fee:
ITRAVDOC
$48.00
Building or Structure
Strong M 0tioh Fee:,,..
IBSEISMICR
$0.78
Select an Administrative Item
BW Stds Commission Fee:
IBCBSC
$1.00
SUBTOTALS
$190.78
$165.00
TOTAL F
$355.78
Revised: 10/01/2015