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13010046CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 519G CONTRACTORr�- PERMIT NO: 13010046 D OWNER'S NAME: MEGAN GEORGE 0 '1 C I r DATE ISSUED: 01/08/2013 OWNER'S PHONE: 6509651648 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL License Class L. Lic. # q L f 3 INSTALL (6) 4" CAN LIGHT FIXTURES & (1) DIMMER � Contractor >bn�EkI e4o L Date ( 2S SWITCH IN LIVING RM AREA 1 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: $1400 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 APN Number: 34253235.00 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 WITHIN 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 180 DAYS �ED INSPECT�73 indemnify and keep harmless the City of Cupertino against liabilities, judgments, -- costs, and expenses which may accrue against said City in consequence of the Date: granting of this permit. Addif ally, the applicant understands and will comply with all non -point sour ti the ertino Municipal Code, Section 9.18. % — RE -ROOFS: Signature Date �� All roofs shall be inspected prior to any roofing material being installed. if a roof is installed without fust 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 (Sec.7044, Business & Professions Code) 1, 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 equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505rnd 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date:l"',g permit is issued. i 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 CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • build inaaa.cuoertino.orq ❑ PLUMBING ❑ MECHANICAL ELECTRICAL �0 v �9 - ❑ MISCELLANEOUS MEP misc PROTECT ADDRESS 9" -`�f S1 � a PN � 3 -12- 53 _ '2 3 OWNER NAME /w i] C� ` ' /^ � C' / P J `,' / 6-5 6 / ,S E-MAIL \ STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME rnY 7 OC ,?u(r,�j_ E-MAIL PTC),? STREET .ADDRESS CITY, STATE, ZIP ❑ OWNER ❑ OWNER -BUMMER ❑ O)AWER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER[ ❑ DEVELOPER ❑ TENANT CO d _ 1�f, _ / 1 J��^ G� `� /" /C� LIC ENSE�NUMB 3 -7 LICENSE v BUS. LIC C t P h- lec— 1 %fit c� E �� /JSC h/ lC FAX STREt ADDRESS 1�� s�� 4�® STATE, G _ss s' PHO yv 3s i - ��77 ARCHITEMENGINEn"ii NAM LICENSE NUMBER BUS. LIC # COMPANY NAME ' E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI-FAMMY BUILDING: ❑ COMMERCTAL PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO I IS THE BLDG AN ❑ YES EICHL.ER HOME? ❑ NO DESCRIPTION OF WORK J" TOTAL VALUATION: / G GLV RECEIVED BYv'' By my signature below, I certify to each of the following: I am the p operty owner o ,authorized agent to act on th!xperty owner's ehalf. I have read this application and the information I have provided is 5orrect., av the Descri 'o f Work and verify it is acc,uate. I agree to comply with all applicable local ordinances and state laws relating to ng c cti u ooze repr�ese ti of Cupert no to enter the above-identi_Sed prope for inspection purposes. Signature of Applicant/Agent: /%� Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY ❑ OVER-THE-COUNTER V ❑ EXPRESS U ❑ STANDARD U ❑ LARGE ❑ MAJOR LLPA, ucApp_1011.doc revised 06121111 F&O—Wo CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION i9ADDRESS: 23500 CRISTO REY DR #519G DATE: 01/08/2013 REVIEWED BY: MELISSA _11 APN: 342 53 235 BP#: "VALUATION: 1$1,400 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: Multi -Family Dwelling Building is >3 Stories 0 Yes Q No PENTAMATION PERMIT TYPE: 1 REAP1 WORK INSTALL 6 4" CAN LIGHT FIXTURES & 1 DIMMER SWITCH IN LIVING RM AREA SCOPE 1 APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check QTY UNITS BP FEES Elec. Permit Fee: IEPERMIT Fixtures, Lighting 1BREMFIXT Other Elec. Insp. 0.0 hrs $45.00 6 # $67 Recep/Switch/Outlets 1BREMRECEP Suppl. Irrsp Fee 1 # $45 PME Unit Fee: $112.00 PME Permit Fee: $45.00 Construction Tax: Administrative Fee: IADMIN $42.00 Work Without Permit? 0 Yes 0 No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $112.00 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (Ge. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc ). These feet are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff.' %/1 /12) Mech. Flan Check Plumb. Plan Check Elee. Plan Check 0.0 1 hrs $0.00 ,,L1ec1,. Porn Elec. Permit Fee: IEPERMIT ollwr ;Uech. Insp.Ofher Plumb Inst, Ll I Other Elec. Insp. 0.0 hrs $45.00 I'/umb. hush. fez: Elec. Insp. Fcc. NOTE: This estimate does not include fees due to other Departments (Ge. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc ). These feet are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff.' %/1 /12) FEE QTY/FEE MISC ITEMS Plan Check Fey 5'up1�l. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. Irrsp Fee PME Unit Fee: $112.00 PME Permit Fee: $45.00 Construction Tax: Administrative Fee: IADMIN $42.00 Work Without Permit? 0 Yes 0 No $0.00 1 dtiuuceil P/arnfing Fees: Travel Documentation Fee: ITRA VDOC $45.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg* Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $245.50 $0.00 TOTAL FEE: $245.50 Revised: 10/01/2012 A. A ORVM AT RANC , ANTONIO January 2, 2013 Megan George 23500 Cristo Rey Drive #519G Cupertino, CA 95014 Dear Mrs. George, This is to inform you that Management has reviewed and approved your request for making the following renovations to your unit #519G as outlined in your Agreement for Unit Alteration. > Remove chandelier in dining area., Replace with recessed ceiling light- three 4" lighting cans over dining room table. Put three 4" lighting cans on side of living room near windows. You have stated licensed contractor Storm Electric will be doing the construction work. Please note that proof of general liability insurance, which includes The Forum as additionally insured, needs to be submitted to The Forum prior to any work being done. Please be aware that your contractor needs an electrical permit before any work may begin. Please be advised that in making the above improvements, you accept responsibility for the maintenance, repair, damages and liability as a result of these changes. In addition, the Board reserves the right to remove and/or restore any architectural changes added by you or your predecessor in order to maintain the general attractive appearance of The Forum and to safeguard the integrity of the original design, Approved by, Nancy Kao Executive Director NK/al cc: Richard Mohler, Architectural Review Committee Peter Dine, Director of Plant Operations Relocation Dept. Library www,ExperienceTheForum.com i 2350C Cristc Rey Drive, Cupertino, CA 95014 1 650 944 07 00 Callfornla RCFE# 435200344 1 t] Equal Hcusirg Cppertunity I CCA# 1'4 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS:'3L5' j0 Rey w- PERMIT # OWNER'S NAME: I (h 01-7 PHONE # 7/U 9 q�Z- 5z�' 7 -7 G£ , CONTRACT-hy,,h, -ic C BUSINESS LICENSE # SZ% 9 ADDRESS: -/--?p rim !iX_sUh Ge G &. CITY/ZIPCODE: Z.O %.S G! .SD 34 -- *Our municipal code requiKs all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS E OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. Q' I am not using any subcontractors: 1 Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date