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B-2016-2242CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2242 23500 CRISTO REY DR UNIT 522H CUPERTINO, CA 95014-6537 (342 53 258) BAY AREA ENTERPRISE SAN JOSE, CA 95148 OWNER'S NAME: ANDERSON MARJORIE J TRUSTEE DATE ISSUED: 06/30/2016 OWNER'S PHONE: 650-537-1523 PHONE NO: (408) 238-5043 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lie. #817817 Contractor BAY AREA ENTERPRISE Date 03/31/2017 X BLDG X ELECT—PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing X MECH X RESIDENTIAL _ COMMERCIAL— _ with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: INSTALL (11) (N) LED LIGHTS, REPLACE (2) B THROOM FANS, I hereby affirm under penalty of perjury one of the following two declarations:. UPGRADE (24) OUTLETS & (10) LIGHT SWITC S; AND UPGRADE 1. I have and will maintain a certificate of consent to self-insure for Worker's (1) LAUNDRY DRYER WIRING TO COPPER Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. /// 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 permit is issued. Sq. Ft Floor Area: Valuation: $5500.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 342 53 258 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 liabiliti judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in onsequen to of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR AdditioAallnd r tands and will comply with all noxi-pointsourceCu ertino Municipal Code, Section 9.18. 180 DAYS FROM LAS CA E SPECTION. -SignatoDate 6/30/2016 Issued by: Alex ValleluneaDate: 06/30/2016 OWNSARATION I hereb affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following o reasons: All roofs shall be inspected prior to any roofing material eing installed. If a roof is 1. I; as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to re ove 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: 6/30/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS " " 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 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials 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 Code, Sections, 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I stoi a or handle hazardous material. Additionally, should I use equipment or devi es 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 Area Air Qu ily Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the-Cupertin Muni i Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, SectignA 2550 5 533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall VI be deemed revoked. Owner-ox�uth"orized=ageM� ' APPLICANT CERTIFICATION Date: 6/30/2016 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDINGAG NCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, C iv C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 6/30/2016 Professional CONSTRUCTION PERMIT APPLICAT,164-- COMMUNITY DEVELOPMEN71 DEPARTMENT -BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 PFRTINO '401,1111228 - FAX (408) 777-3333 - building(cDcupertino.oEq C Id " NEW CONSTRUCTION LJ ADDITION TERATION / Tl LJ Rmsm / DEFERRED ORIGINAL PERMIT 4 PROJECTV-ES� 00 FAPN 3+71 - 5 OWNMINANT413 MARJOR16 AADERMbj PHONE (050-5317- is- 3 E-MAIL 'T$,4L f6r1A ?A 1FeeC(her*4LmCJ-e3& Psc.cdr% 'ST=ADDRESS cny, STATE, ZIP FAX CONTACT NAAMe F 5 -t Ir — S a qPH09 E- - 7-.3 J ST" -FT ADDRESS 1 CITY, STATE, ZIP FAX t--1"r44,V% W" Z I I o C- 4 C Ig - :S ;r V Q I 11 OWNER 171 OWNER -BUILDER 1-1 OWNER AGENT 0"CONTRACTOR OCONTRAcToRAGENT 0 ARCHITECT OENGENEEP, . 0 DEvELOPEz OTENANT CONTRACTORNANIE JCENSE NUMBER '?Irl RIP7 LICENSE TYPE BUS. LIE' g q COMPANYNATVIE reg FAX T9 C, Lt PC Ye C, fki" v - (,:S an sTREffrADDREssJ CITY, STATE-, Z11P-4 B PHONE 1/or 2-110 lft&kLa "in, 2�s I <*:5 , CSJ ARCHITECTIENGWEER NAME LICENSE NUMBER BUS. LIC 9, COMPANYNAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK if- 01it'j, L -GD 6K L,' 1,01.5' PacefS-ee covkS -7- fialA S 1% 7- Ole J 11 EXISTING USE PRIDPOSED USE 'fCONSTILTYPE "ITSTDRIES USE TYPE occ. SQXT. V, kLUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM kITCHEN REMODEL AREA REMODEL AREA OTHER REMODEL AREA PORCMREA DECKAREA TOTAL DECKIPORCH AREA I GARAGEAREA- QDETACH OAXTACH IfDWELLINGUNITS- NtSLASECONDUNIT OYES SECOND STORY - OYES • BEING ADDED? ONO E.'AD ADDITION'. ONO A PRE -APPLICATION OYES IF YES, PROVIDE COPY OF IS THE BLDG AN 0 YES RECE :1-1 _TOTAL VALU MON: - PLANNINGAPPLO ONO. PLANNING APPROVAL LETTER EICEILERHOlVIE7 ONO I I I - V By my signature below, I certify to each of the follo g: I am the property owner or authorizeMagef to act bff , the property owner's behalf. I have I this Ile 'Ouo I I nc - up -Y 'I Description applicationandthe informationi haveprmoyided is c ct. I havcTead the Description ofWork- and verify it is accurate. I agree to comply with all appli.-able local � Xles ordinances and state laws relating to building S ction. a ze representatives of Cupertino to enter the above4dentified property for inspection purposes. co Oize Signature of Applicant(Agent. I SUPPLEMENT A INFORMATION REQUIRED PLA 1 -N CMCKT I YPE ROUTING SLIP OVER-THF-ConW191t RmI:DING PLAN I FVWW New SFD or Mulffmily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance, of building permit for new building. Ex,pp:ss ❑IWVII�W, Commercial Bldgs_ Provide a completed hazardous Materials Disclosure ❑ STANDAPS PUBLIC WORKS -form if any Hazardous Materials are being used as part of this project. D LARGE ❑ FIRE -DEPT Copy of Planning Approval Letter or Meeting with Planning prior to -MAJOR- O.SANITAX�SK*ERDISTRICT , ;u—binittal of Building Permit application. BldgApp201 Ldoc revised 06121111 rd-