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15070230�1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 509G CONTRACTOR: CITY BUILDING PERMIT NO: 15070230 INCORPORATED OWNER'S NAME: BROWN ROBERT C III ASSIGNEE 212 N SAN MATEO DR DATE ISSUED: 07/31/2015 OWNER'S PHONE: 6509440100 SAN MATEO, CA 94401 PHONE NO: (415) 495-6000 I LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ UNIT 509G - REMODEL (E) KITCHEN (65 S.F.), REMODEL License Class Li,. # 324 335 (E) BATHROOMS (108 S.F.) & ADD 2 (N) RECESSED f LIGHT FIXTURES IN BEDROOM AND LIVING ROOM Contractor (4j� /3N (LD I)J1 , I1JC Date 1 I hereby affirm that I am licensed under the provisions of C apter 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: $18500 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: 34253228.00 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 FROM LAST 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 granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulation s per upertino Municipal Code, Section 9.18. 3/ RE -ROOFS: 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. 1 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 255 i53 d 25534. Section 3700 of the Labor Code, for the performance of the work for which this Date: permit is issued. Owner or authorized agent: r / 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building@cupertino.org 50�o 230 M NEW CONSTRUCTION M ADDITION F� ALTERATION /TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECTADDRESS 23500 Cristo Rey Drive #509G APN# 3 Y OWNER NAMEj4C,�jr 650.944.0100 E'L FredHernandez@theforumrsa.com STREET ADDRESS 23500 Cristo Re Drive5tJ9 Y , CITY, STATE, ZIP Cupertino, Ca,95014 FAX coY&Rc &lowes PHONE415.850.2021 We*bwes@citybuilding.com STREET ADDRESS CITY, STATE, ZIP FAX 212 N San Mateo Drive San Mateo Ca 94401 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT [)I CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER 324335 LICENSE TYPE 1 BUS. LIC # Patrick Fellowes B4O0,06 36043 COMPANY NAME Qy Building Inc E-MAIL Pfellowes@citybuilding.com FAX STREET ADDRESS CITY, STATE, ZIP PHONE 212 N San Mateo Drive San Mateo Ca 94401 ARCHITECT/ENGINEER NAME N/A LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WO Scope: New Kitchen and vanity cabinets with counter tops including new lu bing fixtures. nye li ting Lca shown. New eleetrieal deviees in bathroom and Idtehen only. new exhattst fans in bathl-0 1 o o d Z C e—e— S �eJ 1 1�f S EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES I USE TYPE OCC- SQ FT VALUATION ($) EXISTG NEW FLOORDEMO TOTAL AREA 1020 AREA 1020 AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA 108 REMODEL AREA REMODEL AREA 65 PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH H ATTACH # DWELLING UNITS: IS A SECOND UNIT [3 YES SECONDSTORY ❑YES BEING ADDED? []NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RE TOTAL VALUATION 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 authorize agent a 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 construction,.. II authorize representatives of Cupertino to enter the above -identified property for inspection purposes. M4if a4a /`G V Signature of Applicant/Agent: Date: 7/31/15 SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ ❑ 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 OVER-THE-COUNTER 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. ❑ ENVH2ONMENTAL HEALTH BldgApp_201 1. doc revised 06/21/11 CITY OF CUPERTINO R FFF. FgTIMATOR — RITILDING DIVISION 19 ADDRESS: 23500 CRISTO REY DR #509G DATE: 07/31/2015 REVIEWED BY: MELISSA APN: 342 53 228 BP#: *VALUATION: 1$18,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi -Family Dwelling Buildina is 3 Stories 0 Yes (F) No PENTAMATION 1 R2REM PERMIT TYPE: USE: $0.00 A WORK REMODEL E KITCHEN 65 S.F.),REMODEL E BATHROOMS 108 S.F. & ADD 2 N RECESSED SCOPE LIGHT FIXTURES IN BEDROOM AND LIVING ROOM NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School h:..�..:,.♦ — 1 rl -..n lr . n..n A—d __ thn n .:lahlo and aro nnh, na octimnto ('."tart tho vont inr add"'I inin_ FEE ITEMS (Fee Resolution 11-053Eff. 7/1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 108 s.f. $645.00 Remodel, Bath (<=300 sf) IREMRESBAT Suppl. PC Fee: ) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 65 s.f. $645.00 Remodel, Kitchen (<=300 sf) 1 IREMRESKIT Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hr $0.00 �2 Electrical $72.00 IBREMFIXT Fixtures, Lighting PME Unit Fee: $0.00 PME Permit Fee: $48.00 T-1 Administrative Fee: IADMIN $45.00 0 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure Travel Documentation Fee: 1TRAVDOC $48.00 Strong Motion Fee: 1BSEISMICR $2.41 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $144.41 $1,362.00 TOTAL FEE: $1,506.41 Revised: 07/02/2015 Name: All CA 2013 Building Codes apply THE-10-Rum Address: 23500 Cristo Rey Drive AT RANCHQ SAN ANTONIO Unit #509G sse o/ J-06 to ah, AT chap ✓ri ' �; �/Qn N - C �'FP Model C Interior Living Space h er�'i i�n'rD �,Spe 8t (&' �If"- /V; Twa Bedrooms •Two Baths 1,020 Square Feet Leh S� p' g:U �t� on7; ri- ee/t `vo Of toin N 9 �� �1 d per S pn ui�/�44G/10` be K S-one (22Uw-� �� �5 I 8 anyp�os °rn�/t Gr , �/6 a`�ds `off e P make ,�, of e) i U F e an '°ecr�;c ,.Buiei dei; ny nti ate A/c/ °on Garner Units (Exhaust Fan I www.experiencetheforum.com 1 23500 Cristo Rey Drive, Cupertino, CA 95014 1 650 944 0100 California RCFE# 435200344 ( Q Equal Housing Opportunity I COA #204 6' Floor plans are representative. Actual measurements and layout may vary. Revised 09/2014.