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15040179CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 225C CONTRACTOR: CITY BUILDING PERMIT NO: 15040179 INCORPORATED OWNER'S NAME: KNOFLOCH HELEN TRUSTEE 212 N SAN MATEO DR DATE ISSUED: 04/23/2015 OWNER'S PHONE: 6509440100 SAN MATEO, CA 94401 PHONE NO: (415) 495-6000 R LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIALE] UNIT 225C - REMODEL 2 (E) BATHROOMS (120 SQ FT); License Class ' `. y Lic. # NEW SINK IN KITCHEN; REMOVE AND REPLACE PLUGS AND Contractor C IT 1/ et, t I&l+G' Date ��.t t OUTLETS (10); INSTALL (6) NEW LIGHTS. I hereby affirm that I am licensed under the proVrsi'oirs f 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: $10000 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: 34253053.00 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 WITITIN 180 D IT 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 1801 A OM ALLED INSPECTI N. indemnify and keep harmless the City of Cupertino against liabilities, judgments, 2 3 City in consequence of the �� costs, and expenses which may accrue against said Date: ss by: granting of this permit. Additionally, the applicant understands and will c y with all non -point source regul r the Cupertino Municipal Code, Section 9 18. 1100- e _ RE -ROOFS: being installed. If roof is Signature Date All roofs shall be inspected prior to any roofing material a 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 M 'icipal,Code, Chapter 9.12 and Code, Sections 2553 a d 25534.8g I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety , , 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 California. 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 918. Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION 0 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 0 408 777-3228 • FAX 408 777-3333 • buildin cu ertino.or ( ) ( ) 9Cai p Q ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 23500 Cristo Rey Drive 225C 7APN# 3 U Z 7 OWNERNAME Bob & SUe Shaffer PHONE 650.944.0100 E -"A -u" FredHernandez@theforumrsa.com STREET ADDRESS 23500 Cristo Re Drive, Villa 7 Y CITY, STATE, ZIP Cupertino, Ca,95014 FAX CONTACT NAME Patrick Fellowes PHONE415.850.2021 E-MAU, Pfellowes@citybuilding.com STREET ADDRESS 212 N San Mateo Drive CITY, STATE, ZIP San Mateo Ca 94401 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT 13t CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER 324335 LICENSE TYPE BUS. LIC # Patrick Fellowes B,C20,C36 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 ARCI-=CT/ENGINEER NAME N/A LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK Scope- New bathrooms- yanity cabinet, sink and rountertop at master and p5iest New Kitchen cabinets countertops and sink- New dk,e�dlroughout (pI gs and switches) New 'ght fixtures. New bathroom ceiling fans to replace existing fans. EXISTING USE PROPOSED USE CONSTR- TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXLSTG NEW FLOOR DEMO TOTAL AREA 1260 AREA 1260 AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA z REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH LJ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES / BEING ADDED? ❑NO ADDITION? ❑NO l PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YESCEIVED B �= TOTAL VALUATION: PLANNING APPL # []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO -- \ C9 / 0G C3 By my signature below, I certify to each of the following: I am the property owner or authori�d agen6to ac/on theproperty owner's behalf. I have read this application and the information I have is correct. I have read the Description of Work and verify it Is ac rate. I agree to comply %vth,all applicable local ordinances and state laws relating ilding onstruction. I authorize representatives of Cupertino to der above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLE AL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ New SED 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 El STANDARD El 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_2011.doc revised 06/21/11 Name: Bob & Sue Shaffer ALL CA 2013 BLDG CODES APPLY Address: 23500 Cristo Rey Drive 225C Scope: New vanity sink and countertop at master and guest bathrooms. New Kitchen cabinets countertops and sink.New electrical devices throughout (plugs and switches) New Light fixtures. New bathroom ceiling fans to replace existing fans. �urt_Dtrvr Qf'�tENT iVIS1oty _ Ct��ERAR-rMENT ''PPR To l 'his set V N Job site d!;r;nJ .i specifications h1L' chan9�s r)r struction. It is unla�.fu! tST kept at the :herefron� .tirr, rations to make any r4 o ut on SarT7G, or to 5:m�,rn.; :. PProval from h deviate he;d r., This plan and �. e buirdin9 Official _ seri rations SHALL N 7 v s rr — Prcval Of the OT ina violation _1 TF - - = nce or State Law, !"TTV n1 1"TTP1 i2TTATn N A.It- b zz 1+' 14r� .in f I� kk 1. ' � ....� .a 5�;. FEE ESTIMATOR - BUILDING DIVISION ;M 7"' ADDRESS: 23500 CRISTO REY DR 225C DATE: 04/23/2015 REVIEWED BY: MELISSA Plumb. Plan Check 0.0 hrs $0.00 APN: 342 53 053 BP#: "'VALUATION: 1$10,000 Elec. Permit Fee: IEPERMIT *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi -Family Dwelling Buildina is >3 Stories 0 Yes E) No PENTAMATION 1 R2REM PERMIT TYPE: i USE: 1lecit. Irish. Fee: Plttntb. ht p. T'ee: WORK UNIT 225C -REMODEL 2 E BATHROOMS 120 SQ FT); NEW SINK IN KITCHEN; REMOVE AND SCOPE I REPLACE PLUGS AND OUTLETS (10); INSTALL (6) NEW LIGHTS. N A.It- b zz 1+' 14r� .in f I� kk 1. ' � ....� .a 5�;. Sa.ktiMl�.h1'.a 7 y�h+6.h'VX K I' F 3[ v fi x"` ;M 7"' ;Tisch. Plan Check Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check 0.0 hrs $0.d0 Permit Fee: Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: IEPERMIT ech. Plan Check Fee: $0.00 ;ilech. Irtsp. Other Plumb Insp. 0.0 hrs $48.00 Other Elec. Insp. 0.0 hrs $48.00 1lecit. Irish. Fee: Plttntb. ht p. T'ee: Elec, Insp. Fee: $0.00 PME Plan Check: $0.00 10 $48.00 Electrical 1 IBREMRECEP Recep/Switch/Outlets Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 © Electrical $72.00 1BREMFIXT Fixtures, Lighting PME Unit Fee: $0.00 PME Permit Fee: $96.00 = # Plumbing $10.00 IBPFIXTURE Fixture or Trap C.:onstruction Tax: i r nN.n 6 N A.It- b zz 1+' 14r� .in f I� kk 1. ' � ....� .a 5�;. Sa.ktiMl�.h1'.a 7 y�h+6.h'VX K I' F 3[ v fi x"` ;M 7"' ;Tisch. Plan Check Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check 0.0 hrs $0.d0 Permit Fee: Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: IEPERMIT ech. Plan Check Fee: $0.00 ;ilech. Irtsp. Other Plumb Insp. 0.0 hrs $48.00 Other Elec. Insp. 0.0 hrs $48.00 1lecit. Irish. Fee: Plttntb. ht p. T'ee: Elec, Insp. Fee: NOTE: This estimate does not include fees due to other Departments (t.e. Ytammng, .rubuc works, rtre, aantrary,3ewer utstruz, ,3cnoot _ mr. ___ r--- , - L---,4-- sG . , 1:...:., ..., :.,f . aAnti anailahlo and aro nnhf on ov imate Contact the Dent for addn'l info. a, c...... �•aw� ..w »... .,�..,.».... .....-....�.__. _.. ____________ __. _________ _ FEE ITEMS (Fee Resolution 11-0531✓ . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 100 s.f. $645.00 Remodel, Bath (<=300 sf) IREMRESBAT Suppl. PC Fee: (F) Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 10 $48.00 Electrical 1 IBREMRECEP Recep/Switch/Outlets Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 © Electrical $72.00 1BREMFIXT Fixtures, Lighting PME Unit Fee: $0.00 PME Permit Fee: $96.00 = # Plumbing $10.00 IBPFIXTURE Fixture or Trap C.:onstruction Tax: Administrative Fee: ]ADMIN $45.00 0 E) Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G Travel Documentation Fee: ITRA VDOC $48.00 A Strong Motion Fee: IBSEISMICR $1.30 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 �'SUBTOTALS $191.30 $775.00 t TOTAL FSE 966.30 ` $ Revised: 04/01/2015