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B-2016-1886CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMI NO: B-2016-1886 23500 CRISTO REY DR UNIT 405E CUPERTINO, CA 95014-6531 (342 53 154) BAY AREA ENTERPRISE SAN JOSE, CA 95148 OWNER'S NAME: SUMMIT ROGER K TRUSTEE & ET AL DATE ISSUED: 05/05/2016 OWNER'S PHONE: 6505371523 PHONE P 10: (408) 238-5043 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #817817 Contractor BAY AREA ENTERPRISE Date 03/31/2017 X BLDG X ELECT —PLUMB X MECH X RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: INSTALL 5 (N) LED RECESS D LIGHTS; UPGRADE 17 OUTLETS & 7 I hereby affirm under penalty of perjury one of the following two declarations: SWITCHES; AND UPGRADE I BATHROOM FAN 1. 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. 2. 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 Sq. Ft Floor Area: Valuatio : $3700.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above Number: Occupa cy Type: information is correct. I agree to comply with all city and county ordinances 342 53 154 3 42 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 PERMIT EXPIRES I F WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS F PERMIT ISSUANCE OR Additionally, the applicant understarl s and will comply with all non -point source regulations per the Cuperti o M nicipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. I Signature Date 05/05/2016 Issued by: PAUL O'SULLIVA flit Date. 05/05/2016 OWNER -BUILDER DE AiRATION I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior t RE -ROOFS: . any roofing material being installed. If a roof is following two reasons: 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, l agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 05/05/2016 1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERIN S TO BE CLASS "A" OR BETTER 1. 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. HAZARDOUS MATERIALS DISCLOSURE i. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous matt rials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Cc de, Sections 25505, 25533, and 25534. I will maintain compliance with the Ctl pertino Municipal Code, Chapter 9.12 and the permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous s. I certify that in the performance of the work for which this permit is issued, I material. Additionally, should I use equi ment ondevices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay ea Air uality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with th Cu r no Muni ' al Code, Chapter 9.12 a d exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code,. ions 25505, 2 33, and I Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked: Owner or authorized agent: ` '� C N ENDINGAGENCY APPLICANT CERTIFICATION Date: 05/05/2016 C N C certify that I have read this application and state that the above information is is col I hereby affirm that there is is lending agency for the performance ssued correct. I agree to comply with all city and county ordinances and state laws i of work's for which this permit is issued (Sec. 3097, Civ C ( relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep) harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against, said City in consequence of the granting of this permit. Additionally, the applicant understands ARCHIT CT'S DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal I understand my plans shall be Used as public records. Code, Section 9.18. Licensed Signature Date 05/05/2016 Professional CUP ERTINO 1 I NRW rnmR,rw i 'TFnM CONSTRUCTION PERMIT APPLICATION— COMMUNITY DEVELOPMENT DEPARTMENT a BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - buiidinafa?cutzertino.org --- - PROJECT ADDRESS J 00/ a v14V�[lYt1L [-L'llLYll l if APN 9 0 124 OWNER NAME PHONE h4iC 11 1 1 (A b- - f SZ3 rnl,crL Q a Gi - cis 1`l STREETADDRESS CITY, STATE', ZIP PAX •. CONTACT NAtvit-� G1 {'tiQNL• - L•-�fAIL /+ s'!'IiEETAD¢RESS `K Cl'i'S7'A-i'L, Zil' FAX ZIICs Gn SI Q OWNER © OWNEIt-H.MOM OIYNCRAGENT eCONTRACTOR 0couritACTORAUENT 11 ARCHrrC-LT O L•N iNLTR 13 DI3V LOPI;R O TrNANT CONTRACT01MAME /'LICLNSE {ale. Ftr°� NUMBER LiCGNSE'rYPE Bus. LIC s1 CO\1PANY NA1iG Ar Yke C4.. n LIS-eA}+ i IYIA14cA �. t1 �C l� .0 O FAX STREETADDRCSS CITY, STATB,ZIP liNs 9 4 ARCIRIT6GIMN0INCER NAME: .37 LICENSE NUMBER -... BUS, LIC S ` - COMPANY'NAIVIE E-MAIL PAl STREETADDRESS .. .ti CITY,STxrp,ZIP PHONE DESCRII'TION QI' 1Y RK f id !W LCO 8a+4 `;rk ir-c- e 'dra a QaIK I ,ra 'c e, c- to s wt�ktit T -((T. 7 r �! W 1 um SE RoPOSCD IISE CONSTR. TY • 11 STOWS 11SC TYPB OCC. SQ.PT. VALUATIONS) EXISTG NEW FLOOR -DEMO TOTAL. - - AREA AREA AREA NET AREA DATI-IROOM KITCHEN OTHER REMODEL AREA -RMODELARCA RCMODELAREA POtiCHAREA DECK ARCA 'rOTALOECWORCHARE A GARAOEAREA: - - 8DETACH AITACH nDWF:LLINGONiTS: ISASWONDUNrr OYES SF.CONDSTORY [LYES nE1NOADDED? []NO ADDITION7 ONO / PRE -APPLICATION ©VCS IF YES, PROVIDE COPY OF PLANNINGAPPL1t rINQ PI.ANNING APPROVAL I,E1`IER ISTIMBLDGA'N .OYES EICHL@R INOME? ©NO RECEVBDBY: OTALVA UAT0 �f - By my sigliolum below, I certify to each of the follow 1g: I ant the property owner or authorized agent to act an file property 0-1-icr's belialf. I have read this application and the information I!lave provided is co 'ct. I ha ead the Description ofWork and verify it is accurate. i agree t l comply tvitb all applicable local ordinances RIRI stale tsttYs relating Ui building cons ction. ISI t arizerepresentatives or Cupertino to enter stbove-identified roperty io`r(inspection purposes. Signature o€Applicant/Agenf; Dhte: Jai `L SUPPLEMENT4T' INFORMATION REQUIRED PLAN CHECK TYPE I101JTINU SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REY[ElY New Sl'I) or Multifamily dwellings: Apply for demolition permit for existing building(sj. Demolition permit iS required prior to issuance of building permit for new building. © tsSPRR35 © PI,AN'N1;4G PLAN REVIEIV Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ NVANDARD ❑ PUBLIC WORKS form if any hazardous Materials are being used as part of this project. ❑ LARGir ❑ rmr nevr —Copy of Planning Approval Letter or Meeting with Planning prior to © MAJOR❑ SANITARY SEWER DIMICr submittal of Building Permit application. CJ ENVIRONntF.NTAI.FIEAL9'H Bli IgAppJ01J.docreirlsed 06121111 P'71=17 y.Y