15070232 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23100 VIA ESPLENDOR UNIT VD47 CONTRACTOR:CITY BUILDING PERMIT NO: 15070232
INCORPORATED
OWNER'S NAME: HICKS ANNA G TRUSTEE 212 N SAN MATEO DR DATE ISSUED:07/31/2015
OWNER'S PHONE: 6509440100 SAN MATEO,CA 94401 PHONE NO:(415)495-6000
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
UNIT VD47-REMODEL(E)KITCHEN(157 S.F.),
License Class Li..# IVSy S REMODEL(E)BATHROOMS(77 S.F.)&ADD 9(N)
Contractor C[TI [W(L9IW 6 1 AJC Date ) S RECESSED LIGHT FIXTURES IN OTHER LIVING AREAS
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:$30000
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:34255032.00 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 Mations r the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date "I 3? 1 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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
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 2550 55 and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:_� Y-7,
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 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
CONSTRUCTION PERMIT APPLICATION
ELI COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingna.cupertino.org D �JCUPERTINO 1150 C�
❑ NEW CONSTRUCTION ❑ ADDITION
.n M j�ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
i'KOJECTADDRF°Q Z3 I UU V 1,(L, Y uLn i 0 � APN# 3 14 2 5 5 - v 3 2
OWNERNAME PHONE 650.944.0100 E-MAIL FredHernandez@theforumrsa.co
STREET ADDRESS 23500 Cristo Re DriveCITY, STATE,ZIP FAX
Rey , Cupertino,Ca,95014
cO'ffkAcVVAlowes 1HONE415.850.2021 owes@citybuilding.com
STREET ADDRESS CITY,STATE, ZIP FAX
212 N San Mateo Drive tO San Mateo Ca 94401
❑OWNER ❑ OWNER-BUILDER 13 OWNER AGENT M CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER 324335 LICENSE TYPE BUS.LIC#
Patrick Fellowes I B,C20,C36 36043
COMPANY NAME EMAIL FAX
City Building Inc Ptellowes@citybuilding.com
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 Scope:New Kitchen and vanity cabinets with counter tops
incf ading Hew plumbing fixtur es.Ne w can fighting shown.New elect,ical de v ices it,
bathroom and kitchen only.New exhaust fans in bathrooms.
EXISTING USE PROPOSED USE CONSTR.TYPE I #STORIES
USE Il'PI[ OCC SQ Fl VALI IAIION 1$)
EXISTG NEW FLOOR DEMO TOTAL
AREA 1404 AREA 1404 AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA 77 REMODEL AREA 157 REMODEL AREA
PORCH AREA I DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: H DETACH
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 ❑YESOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? [3 NO
to
1040
By my signature below,I certify to each of the following: I am the property owner or au riz act 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 construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: MA f-uam v Date: 7/31/15
SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
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 1-1STANDARD ❑ 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 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 23100 VIA ESPLENDOR VD47 DATE: 07/31/2015 REVIEWED BY: MELISSA
APN: 342 55 032 BP#: *VALUATION: $30,000
,jj^PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1 R2REM
USE: 3 Stories 0 Yes (D No PERMIT TYPE:
WORK REMODEL E KITCHEN 157 S.F. , REMODEL E BATHROOMS 77 S.F. &ADD 9 N RECESSED
SCOPE LIGHT FIXTURES IN OTHER LIVING AREAS
Elec.Plan Check 1 0.0hrs $0.00
Elec.Permit Fee: IEPERMIT
LlOther Elec.Insp. 0.0 hrs $48.00
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on the prelitninar information available and are only an estimate. Contact the De t or•addn7 info.
FEE ITEMS(Fee Resolution 11-053 E('. 711113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 77 s.f. Remodel,Bath(<=300 sf)
Suppl. PC Fee: (F) Reg. 0 OT 0.0 1 hrs $0.00 $645.00 IREMRESBAT
PME Plan Check: $0.00 = s.f. Remodel,Kitchen(<=300 sf)
Permit Fee: $0.00 $645.00 1 IREMRESKIT
Suppl. Insp. Fee:(D Reg. Q OT 0.0 hrs $0.00 0 Electrical
PME Unit Fee: $0.00 $72.00 IBREMFIXT Fixtures,Lighting
PME Permit Fee: $48.00
Administrative Fee: ]ADMIN $45.00 Q
Work Without Permit? 0 Yes (F) No $0.00
Advanced Planning Fee. $0.00 Select a Non-Residential G
Travel Documentation Fee: ITRA VDOC $48.00 Building or Structure 0
Strong Motion Fee. IBSEISMICR $3.90 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $2.00
SUBTOTALS: $146.90 $1,362.00 TOTAL FEE: r $1,508,901
Revised: 07/02/2015
Scope d,eve
Name: �tt6tVW�1 s�g
All CA Building Codes apply0 G /
=
Address: 7-3 100 V IGS 65PItddr THo Rulv� I F-00WLS }
Unit #: Villa 47 AT RANCHN.ANTONIO J �j s �,t� Ct
(f l F/xwr '
l cu V I/ 2ooNt
Deluxe Villa Interior living Space Balcony Space poYCa-a a�
Two Bedrooms • Two Baths 1,404 Square Feet 210 Square Feet
Deck ,
15`0"x 616"
a Deck mG
i61611 x 171311
Living Room Master Bedroom P G
15'3"x 17'8" 15,0°X12'6" �. 00 ,.r o.
RECEIVED
o
l; A 20
JUL 3 1 ?0$ }� oloset1011 51 11
By
:Dinigg
Bath
21'11„ $,6„
>=
Foypr
Kitch n Clo 916" Exhaust Fan
+6" 9111,3,r xCloset
U — Oh
o 4'6"x 7, ,
t)till� Ltnen - _
Uj1'9"X 1'9' 'UNITY DE\irL0P%1ENT DEPARTMENT
UILDfNG DIVISION - CUPERTINO
VBath '
4,6., ,0 APPROVED
of plans and soeaficaticns MUST be kept at the
during cor-:r.:ction. It is unlav:fo to make any
LL I If tis or alterations on same. or to deviate
LL Garage m, ttiitrtout approval from !I-:0- Building Official.
13'6"x 20'0" iping O this pian and speci`icat ons SHALL NOT
0 to perm t cf the violation
Bedroom = a' or State Law.
12'6"x1 -
www.experiencetheforum.com I 23500 Cristo Rey Drive, Cupertino, CA 95014 I 650 944 0100.
California RCFE# 435200344 1 D Equal Housing Opportunity I COA #204 6.
Floor plans are representative. Actual measurements and layout may vary. Revised 09/2014,