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15070102CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 118C CONTRACTOR: CITY BUILDING PERMIT NO: 15070102 INCORPORATED OWNER'S NAME: BATES ELINORE B TRUSTEE 212 N SAN MATEO DR DATE ISSUED: 07/15/2015 OWNER'S PHONE: 6509940100 SAN MATEO, CA 94401 PHONE NO: (415) 495-6000 Ji LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL UNIT 118C - CHANGE COUNTER TOP & SINK IN License Class . Ze 6 Lic. # 3 2¢3SS� BATHROOM & (N) CABINETS, COUNTERS & REPLACE (E) SINK IN Contractor `t7y $..ttac.l (r / It«.Date �/� KITCHEN 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 performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $8000 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: 34253025.00 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 O + ERMIT 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 D CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, - costs, and expenses which may accrue against said City in consequence of the — S bY: Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section RE-ROOFS: 9.18. 171VrPZ'J Signature Date !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: _ 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) 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(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 2,55 533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: 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 CONSTRUCTION LENDING AGENCY Compensation laws of Califomia If, after making this certificate of exemption, I 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinq(o1cupertino.org / O /a Z ❑ NEW CONSTRUCTION ❑ ADDITION ® ALTERATION/ Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT # I=] PROJECT ADDRESS 23500 Cristo Rey Drive 118C APN# _ OZ S OWNERNAME � 1/ ,/ /;/1')n PHONE 650.944.0100 EIA' FredHernandez@theforumrsa.com STREET ADDRESS 23500 Cristo Rey Df rive, Y CITY, STATE, ZIP Cupertino, Ca,95014 FAX cor §9&VAlowes 1 PHONE415.850.2021FP owes@citybuilding.com STREET ADDRESS CITY, STATE, ZIP FAX 212 N San Mateo Drive San Mateo Ca 94401 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENA,, I CONTRACTOR NAME LICENSE NUMBER 324335 E TYPE F77V'C20,06 BUS. LIC # Patrick Fellowes 36043 COMPANY NAME City Building Inc E-MAIL 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 N/A LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK Scope7 New kitchen and vanity cahinets and counter tops including plumbing fixtures, EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. I SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA 800 AREA 800 AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA 54 REMODEL AREA REMODEL AREA 77 PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH I ❑ ATTACH I # DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY []YES YES BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION [] YES IF YES, PROVIDE COPY OF IS THE BLDG AN TOTAL VALUATION: PLANNINGAPPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? NO O. By my signature below, I certify to each of the following: I am the property owner or authorized age on the property owner's behalf. I 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 const ti orize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: 7/15/15 SUPPLEMENTAL INFORMATION 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. ❑ 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 B1dgApp_2011.doc revised 06/21/11 � CITY OF CUPERTINO 1/JI FEE ESTIMATOR — BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Metriet etc-)- Thece fees are haced an the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eg. 7/1113) ADDRESS: 23500 CRISTO REY DR # 118CDATE: 07/15/2015 REVIEWED BY: MELISSA Alech. Permit Fee: APN: 34253025.00 BP#: ` Q "VALUATION: 1$8,000-� *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi -Family Dwelling USE: Building is 1 >3 Stories Q Yes Q No PENTAMATION 1 RPFIX PERMIT TYPE: WORK UNIT 118C - CHANGE COUNTER TOP & SINK IN BATHROOM & N CABINETS COUNTERS & SCOPE REPLACE (E) SINK IN KITCHEN NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Metriet etc-)- Thece fees are haced an the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eg. 7/1113) FEE Plumb. Plan Check 0.0 hrs $0.00 MISC ITEMS Alech. Permit Fee: Plumb. Permit Fee: 1PPERMIT ec. Permii r Oiher Mech. Insp. Other Plumb Insp. Lodhrs $48.00 Oilier Ele e, Insp. Xkc•h. hrslr. Fee: Plumb. [rasp. Fee: Elea. fnsp. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Metriet etc-)- Thece fees are haced an the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eg. 7/1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 # $20.00 Plumbing 1BPFI URE Fixture set on One Trap Suppl. PC Fee: 0 Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? ()Yes (D No $0.00 Suppl. Insp. Fee -0 Reg. © OT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 Construction T .. Administrative Fee: IADMIN $45.00 Work Without Permit? O Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) i Travel Documentation Fee: ITPA VDOC $48.00 Strong Motion Fee: 1BSEISMICR $1.04 2.0 hrs $286.00 Inspections ISTINSP 7Inspection, Hourly Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $143.04 $306.00 TOTAL FEE: 1 $449.04 Revised: 07/02/2015 Name:THE FORU CVS' Codes aply Ada ss: 22 ll CA 20135 00 Cristo Rey Drive AT RANCH.0 SAN ANTO 'fel `ry�Jj v/�drn9 ��a �N� Unit #: 118C Model AD �e URC j)1,�d°°� Interior Living Space Balc61* e oo� ace One Bedroom • One Bath Deluxe br^ 800 Square Feet 60 Square Feetuar� Scope: New kitchen and vanity cabinets and - counter tops including plumbing fixtures. >M a O U LLJ U LL LL 0 Storage 3'0" x 513" Not Available on Corner Units. Balcony 7'5" x 7'2" Bedroom 10'11"x 137" Closet E'8" x 47" I Bath 5'11"x8'11" EMEN-A-m [WI/D clpSet 2' Ik 2'7 COMMUNITY DEVELOPMENT DEPAR' BUILDING DIVISION - CUPERTIN Liv 15'0 ROVED This set of plans and specifications MUST ab site curing construction. It is unlawfu'. changes or alterat ons on same, or tc therefrom, without approval from the Buil The �±arnping of this 'Ic»tion of Dining �Q• 12'6" x 8'9" Ih Ceiling at TopFioor Eli D Entry 5'0" x 9'5" Kitchen 7'0" x 11'0" a 0 • e kept at the o make any ieviate ing Official. SHALL NOT i,� vbo atk;n S' -"' . L aw. rrs . T2� �a Z RECEIVED JUL 15 2015 V No electrical changes. BY www.experiencetheforum.com 1 23500 Cristo Rey Drive, Cupertino, CA 95014 l 650 944 0100 California RCFE# 435200344 1 Q Equal Housing Opportunity I COA #204 & Floor plans are representative. Actual measurements and layout may vary. Revised 09/2014.