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B-2017-1114CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1114 23500 CRISTO REY DR UNIT 119B CUPERTINO, CA 95014-6522 (342 53 014) BAY AREA ENTERPRISE SAN JOSE, CA 95148 OWNER'S NAME: RUFF MILDRED E TRUSTEE DATE ISSUED: 07/12/2017 OWNER'S PHONE: 650-537-1523 PHONE NO: (408) 238-5043 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #$17817 Contractor BAY AREA ENTERPRISE Date 03/31/2019 X BLDG X ELECT —PLUMB — 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: UNIT 119B - INSTALL (I) LED RECESSED LIGHTS (5); OUTLETS I hereby affirm under penalty of perjury one of the following two declarations: (19); SWITCHES (8); BATHROOM REMODEL (50 SF) r. 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. z. 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 71 C—permit is issued. Sq. Ft Floor Area: Valuation: $5500.00 APPLICANT CERTIFICATION 1 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 "N Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 342 53 014 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 IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applicant unde ands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations pert ertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 07-12-2017 Issued by: Kim Dunbar OWNER -BUILDER DECLARATION Date: 07/12/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the R&ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is r. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I 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) i. I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 07-12-2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS 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 z. 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 store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 07-12-2017 I certify that I have read this application and state that the above information is CON TRI CTIO/IXN61NGAGENCY 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, Civ 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. Signature Date 07-12-2017 Licensed professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildiinng(W-cupertino.org ElNEW CONSTRUCTION ❑ ADDITION El ALTERATION/ TI L"J REVISION / DEF(jERRRED ORIGINAL PERMI t # PR07E CT ADDRESS ��O APN# S-UO ``l[ I� Pte- -11I) OWNERI (i I PHONE .�3 y �� e E-MAIL C� CC l STREET ADDRESS 1_3 Seo `F,�'(b l2e VIZ (- l CITY, STATE, ZIP Ct, y- 0 CA 501 FAX CONTACT NAME /°,;, �, ,�� 1" 1 PHONE u _ 2 3 , J ;7C, [f /- E-MAIL,,g re`S , C o M C O STREET ADDRESS Z aye ; vl G.1 CR CITY, S'�ATE, ZIP S J C fir- al S FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME rLC4 Pet�� LICENSE NUMBER 2 g11-7 LICENSE T E / - 1 BUS. C g COMPANY NAllM77E gat ` E-MAILI77 r�� 4t S��Cor� FAX J v"et_ v �i _qf IAle STREET ADDRESS �I I o naves r ✓� 1,.1U CITY, STATE, ZIP s a (\-�o s� �v� 9S/l/ nunNF. o8` 23� ARCHITECT/ENGINEERNAME LICENSENUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 11 b r l�c:h7 IL� i11Lf �� 1'S i V`uG�e a� L[ l �Ld r C ra C6, Cie +'k Lod 115 va ew W, - tk EXISTING USE PROPOSED USE CONSTR TYPE # STORIES 1 USE TYPE OCC. SQ.FT. V DATION (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: El DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNrr ❑ YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RE Y: TIAL VLUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I a`ve read this application and the information I have provided Is gorrect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin couctlon. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: `'J Date: -7 it 1 SUPPLEMENTAL INF RMAT) ON 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. ❑ 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. El LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting With Planning prior to ❑ MAJOR ❑ SANFFARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp 2011.doc revised 06/21/11 o 1V s -()V3 / SMOKE / CARBON MONOXIDE ALARMS TP1 OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildinqAcupertino.orq PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN COMPLETED,SIGNED,AND RETURNED TO THE BUILDING DIVISION PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314,2013 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 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 X X the bedroom(s) On every level of a dwelling unit including basements 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. ? $ 'O C '' p f Permit No. (7 f-1 I I Specify Number of Alarms: #Smoke Alarms. EMI #Carbon Monoxide Detectors. i have read and a'ree to coo:r' ith the terms and conditions of this statement Owner(or Owner Agent's)Name: / - Signature . Date--/ (7 Contractor Name: Signature Lic.# Date: Smoke and CO form.doc revised 09/27/16