15050081CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 331D
CONTRACTOR: CITY BUILDING
PERMIT NO: 15050081
INCORPORATED
OWNER'S NAME: REILLY VINCENT E TRUSTEE & ET AL
212 N SAN MATEO DR
DATE ISSUED: 05/14/2015
OWNER'S PHONE: 6509440100
SAN MATEO, CA 94401
PHONE NO: (415) 495-6000
LICENSED CONTRACTOR'S DECLARATION
W,
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
UNIT 331D- REMODEL (E) MASTER & GUEST
License Class C Lie. # �L �3�
BATHROOMS
q
C.Tf � WCDate �
(80SQ FT); UPGRADE ELECTRICAL LIGHT FIXTURES,
Contractor . + 1 :
—T�
SWITCHES &RECEPTACLES THROUGHOUT UNIT.
I hereby affirm that I am licensed under the provisions of Chapter 9
REPLACE
(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
ormance of the work for which this permit is issued.
Sq. Ft Floor Area: Valuation: $10000
" 've 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: 34253106.00 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 P153MT 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
J80 M LAWALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of
I
granting of this permit. Additionally, the applicant understands and wi mply
y'
with all non -point source regulations per the Cupertino Municipal Code, Section
918.
Signature �Frw : Date %�`o,M�-
RE-ROOFS:
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
1, 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, Sectio 3, 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 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
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 - buildinga�cuDertino.orp
CUPERTINO I
❑ NEW CONSTRUCTION ❑ ADDITION ®AI; fERA'HON / TI LJ REVISION / DEHRRED ORIGINAL PERMIT #
PROJECT ADDRESS 23500 Cristo Rey Drive 331 D PN" `I 2- r 3 — I0v
O
OWNERNAMey ixon V IA 1A ,(� P"oNF 650,944.0100 E'"Inu. FredHernandez@theforum
STREl3T ADDRESS CITY, STA IT ZIP TAN
23500 Cristo Rey Drive, Cupertino, Ca,95014
CONTACT NANIF Patrick Fellowes PHONL 415.850.2021 LF -MAIL Pfellowes@citybuilding.com
STREET ADDRESS CTY. STATE:, ZIP San Mateo Ca 94401 FAX
212 N San Mateo Drive
❑ OWNER 13 OWNER-aL11l..DGR ❑ OWNER AGENT' IR CON'I'RAC:'IOR ❑ CONTRACTOR A61tNT ❑ ARCHITECT ❑ ENGINEFR 11 DEVFLOPFR ❑ TENAN"I'
CONTRACTOR NANIB P t k F IIOWOS LIC'LNSE: Nt!)dnfR 324335 LICENSE -TYPE BUS. LI(' OI 36043
DESOUPTION 017 WORE;
New electrical devices throughout (plugs and switches) New Light fixtures, New bathroom ceiling fans to replace existing fans.
USI: I rypl: I occ. I SQ.F'r. I VALUATION (S)
EAISTG NEIV FLOOR DEMO TOTAL,
AREA 1090 1090 ARr;A NETARL•A
IIA 'IHROONi KIT(aIENO'rHER
REMOD U. AREA 80 RENIODIA ARTA 5 7 Rt N10DEL AitEA
POW -FI AREA DECK ARIIA TO'rAI. DECKfPORC111 ARla1 GARAGE; AREA n I)EFACH
Dw FL.LING UNITS
a rlc e
'
ADDITION? ONO
COMPANY NANIIi
City Building Inc
IS T111; BLDG AN ❑ Yt.�
E-MAII,
Pfcllowesr<krcitybuilding.com
FAX
STREETADDRESS
212 N San Mateo Drive
EICHLI:R HOME'. l o
CITY, S'rATF. ZIP San Maleo Ca 94401
PHONF. 650.375,6603
ARC MITCT/ENGINEER NAME N%�
7
1.1C'F.iNSL'; Nt1NIUER
BUS. LIC 0
COMPANY NANIE
�'�'�
Signature of Applicant/AVIlt
Date:
C -MAIL
FAX
STREET ADDRESS
ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
CITY, STA IT, ZIP
PHONE
DESOUPTION 017 WORE;
New electrical devices throughout (plugs and switches) New Light fixtures, New bathroom ceiling fans to replace existing fans.
USI: I rypl: I occ. I SQ.F'r. I VALUATION (S)
EAISTG NEIV FLOOR DEMO TOTAL,
AREA 1090 1090 ARr;A NETARL•A
IIA 'IHROONi KIT(aIENO'rHER
REMOD U. AREA 80 RENIODIA ARTA 5 7 Rt N10DEL AitEA
POW -FI AREA DECK ARIIA TO'rAI. DECKfPORC111 ARla1 GARAGE; AREA n I)EFACH
Dw FL.LING UNITS
IS A SECOND UNIT
DP:ING ADDED' 0 N
'
ADDITION? ONO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OI:
IS T111; BLDG AN ❑ Yt.�
JIYAL VALUA'MANNWGAPPI.
A ❑NO PLANNING APPROVAI. 1,F'rr1:R
EICHLI:R HOME'. l o
By u1y signature below. 1 certify to each Of the fiJllowing: I am the property owner t
zed agent to act
'
t operty owner's behalf. I have read this
I to comply with all applicable local
application and the inlbmation I have provided is correct I have read the Description of Work and verifil ccurate. agree
ordinances and state laws relating to buildin ks I, uthor' (prcsent.,3tives of'Cupertino to enter the above -identified pr perty for inspection purposes.
�'�'�
Signature of Applicant/AVIlt
Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
❑ OVER -TILE -COUNTER
❑ BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PIANNING PLAN REVIEW
Commercial Bldgs: Provide it completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
_
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
1:1SANITARY SEWER DISTRICT
__Copy
submittal or Building Permit application.
n FNVIRONMF.NTALHEe1LTH
BfdgApp,_2011.doc revised 0612//11
CITY OF CUPERTINO
F"__74 FEE ESTIMATOR — BUILDING DIVISION
imADDRESS:
23500 CRISTO REY DR #331D
DATE: 05/14/2015
REVIEWED BY: MELISSA
APN: 342 53 106
BP#: 15050081
*VALUATION:
1$10,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi -Family Dwelling
USE:
Buildina is
>3 Stories 0 Yes 0 No
PENTAMATION 1R2REM
PERMIT TYPE: A
WORK
UNIT 331 D- REMODEL E MASTER & GUEST BATHROOMS 80SQ FT); UPGRADE ELECTRICAL
SCOPE
LIGHT FIXTURES, SWITCHES & RECEPTACLES THROUGHOUT UNIT. REPLACE KITCHENS p
kfec h/ Alan C;;uac:k Plumb. Plan Check 1 0.0 1 hrs $0.00 Elec. Plan Check 10.0 1 hrs $0.00
&I£,,h. f'<:r> �„tt Fee: Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: 1EPERMIT
C'3t?:c:r fs:£rr't, irss7;.E17- Other Plumb Insp. 0.0 1 hrs $48.00 Other Elea Insp. 0.0 hrsL$48.00
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, Sc/tool
Utstrtct, etc.). inese.jees are based on me pretinunary tntormatton avauame ana are onty an estunate. contact the uept_Tor aaan't info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
® s.f.
$645.00
Remodel, Bath (<=300 sf)
1REMRESBAT
Suppl. PC Fee:, 0 Reg. 0 OT
Mhrs
$0.00
PME Plan Check:
$0.00
=
$48.00
Electrical
1 1BREMRECEP Recep/Switch/Outlets
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. 0
OT
0,0
1 hrs
$0.00
0 Electrical
$72.00 IBREMFIXT Fixtures, Lighting
PME Unit Fee:
$0.00
PME Permit Fee:
$96.00
= # Plumbing
$10.00 IBPFIXTURE Fixture set on One Trap
COnrrai°izora :Ic€x:
Administrative Fee:
IADMIN
$45.00
0
G
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
i
Travel Documentation Fee: ITPA VD0C
$48.00
Strong Motion Fee:
IBSEISMICR
$1.30
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS.”
$191.30
$775.00
TOTAL FEE
$ 966 30
Revised: 05/07/2015
Name: 4 ALL CA 2013 BLDG CODES APPLY
Address: 23500 Cristo Rey Drive 331D
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. New can Lighting at kitchen and hallways (13 Total)
Living Room,
N g�
Bedtorjw
Olt,mg
,1O'S ei
miryK
,{,, t rtose�
L Whim d �
...._e. il Uloset Shill -- i
Bain
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