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15070018Ar CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 306E CONTRACTOR: CITY BUILDING PERMIT NO: 15070018 INCORPORATED OWNER'S NAME: SMITH SUSAN B TRUSTEE 212 N SAN MATEO DR DATE ISSUED: 07/02/2015 O ER'S PHONE: 6509440100 SAN MATEO, CA 94401 PHONE NO: (415) 495-6000 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL UNIT 306E - REMODEL (E) 66 S.F BATHROOM License Class 16 Lic. # 3Z<%'�S.S Contractor _C 17y l LJC+ 1--JG Date_V6 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. 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: $ 10000 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: 34253112.00 Occupancy "I ype: 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 P 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 LLED INSPECTI N. indemnify and keep harmless the City of Cupertino against liabilities, jud - costs, and expenses which may accrue against said City in consequence of granting of this permit. Additionally, the applicant understands and will comply Y: Date: with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. �- RE-ROOFS: Signature Date G % 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. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: 1 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) I, 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(x) 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 1 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 25505, ?�5 3, r 534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: 6 permit is issued. 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(ftwertino.ong M NRW CONSTRI ICTION n ADDITION M ALTERATION / TI n REVISION/ DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 23500 Cristo Rey Drive 306E APN # OWNER NAME S,.stt C,. ,I'' usr�(�� � / PHONE 650.944.0100 E-MAIL FredHernandez@theforumrsa.com STREET ADDRESS 23500 Cristo Re Drive, 7P YCupertino, CITY, STATE, ZIP Ca,95014 FAX "IW&Vhowes M rs)8 - T6 PHONE415.850.2021 elobwes@citybuilding.com STREET ADDRESS CITY, STATE, ZIP FAX 212 N San Mateo Drive San Mateo Ca 94401 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT Q CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER 324335 LICENSE TYPE I BUS. LIC # Patrick Fellowes B,C20,C36 36043 COMPANY NAMEZE-MAIL Ci BuildingInc Pfellowes@citybuilding.com FAX STREET ADDRESS CITY, STATE, ZIP PHONE 212 N San Mateo Drive San Mateo Ca 94401 650,375,6603 ARCHITECT/ENGINEER NAME NIA LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAQ. FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK Scope, New tops at bathrooms- New light fixtures, new fixture,-;- new electrical vanity sink and counter guest plumbing devices (plugs and switches) in bathroom only. New fan to replace existing. EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMOTOTAL AREA 1100 AREA 1100 AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA 66 REMODEL AREA REMODEL AREA 0 PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH I ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ EI TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? d/ QO U By my signature below, I certify to each of the following: I am the property o r authori act on the property owner's behqlO have read this application and the information I have provided is correct 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 building construction.. representatives of Cupertino to enter the above -identified property for inspection purposes. /I authorize Signature of Applicant/Agent: �� mawiy Date: ___f2/15 SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP El New SFD Or Multifamily dwellings: Apply for demolition permit for _ existing building(s). Demolition permit is required prior to issuance of building ER-THE-COUNTER POEXPRESS BUILDING PLAN REVIEW permit for new building. ❑ 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. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 1. doc revised 06/21/11 CITY OF CUPERTINO 1►1'�_.-�/JI FEE ESTIMATOR —BUILDING DIVISION lal ADDRESS: 23500 CRISTO REY DR # 306E DATE: 07/02/2015 REVIEWED BY: MELISSA APN: 342 53 112 BP#: l 'VALUATION: $10,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi -Family Dwelling USE: Buildino is 3 Stories 0 Yes © No PENTAMATION 1 R2REM PERMIT TYPE: WORK REMODEL E 66 ST BATHROOM SCOPE NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution 11-053 E . 7111131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Other Afach' In.s/3 �.)ftt:'1 Plw-"d) Ift.),si,Li I P­'A*', 10.0 hrs NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution 11-053 E . 7111131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. $645.00 Remodel, Bath (<=300 sf) IREMRESBAT Suppl. PC Fee: (F) Reg. 0 OT 10.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -.0 Reg. Q OT 0,0 lirs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 /11.x: 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Plannin Fee: $0.00 Select a Non -Residential Building or Structure 0 0 i '? Documentafi€>n .l -est, Strong Motion Fee: IBSEISMICR $1.30 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SGBT0'FAl,S: $2.30 $645.00 TOTALFEE-T $647.30 Revised: 07/01/2015 Name: Helen Saunder SV %Sr& H E FORUM colo All CA 2013 Building Codes apply AT RANCHO SAN ANTONIO �,'IZ„VGZ) C-LopMFN� Address:-.. 23500 Cristo Rey Drive s oar_ cup FpARrMF Unit #: 306E ob c to Of'plans anAApA,C)Vico � ERr,,vo Nr Model E Interior Living Space �Iccmy Jo��conS Spe�rfiC '� Two Bedrooms • Two Baths 1,100 Square Feet f 67 S eg, aiterF.atiort°n• Itisn� "USrbe k P Y P 9 $' l4ew F t ix rne, or V10 o , at the Scope: New vanity sink and counter tops guest bathroo �Q m�;;e �o!niEro s tovia,o "ny plumbing fixtures, new electrical devices (plugs and switcl %Y replace existing. p' Balcony 22'9" x 7'2" CUPERTINO JUL 6 2015 REVIEWED FOR C Bedromwed By. 1011 " x 13'10" E COMPLIANCE 0'11" x 11'10" NO. 'ision or to be Wil Specific atio Official. ~ r'r ns cv _don co W. Living Room 15'0" x 15'0" Fireplace at Top Floor High Ceiling at Top Floor Dining 12'6" x 8'9" JW/D Closet '0" x 6'10. Closet TO" x 6'0" Entry 5 3 x 6'9" Kitchen o O - Bath Bath-- 7'0" x 11'0' 00 1011 6" x 6'0 `V Exhaust Fan Can light CE�VE� AW eriencetheforum.com i 23500 Cristo Rey Drive, Cupertino, CA 9 4 944 0100 CaliforniaR FE# 435200 44 i Q Equal Housing Opportunity � YA #204 door dans are representative A.ct�,a' measur-ements and layout may vary. Rev+sed 09'2.