15050082El I
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 41 OF
CONTRACTOR: CITY BUILDING
PERMIT NO: 15050082
INCORPORATED
OWNER'S NAME: CLARK RUTH L TRUSTEE
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
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
UNIT 41OF - REMODEL (E) MASTER & GUEST
License Class 9 + . Ip Lic. #
BATHROOMS
,����
Contractor C i r�', `_!+9 Date
(80SQ FT); UPGRADE ELECTRICAL LIGHT FIXTURES,
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
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $10000
and will maintain Worker's Compensation Insurance, as provided for by
AAve
, ion 3700 of the Labor Code, for the performance of the work for which this
APN Number: 34253174.00
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 T 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
S FROM LLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of
a l
granting of this permit. Additionally, the applicant understands and ' comply
Is e:
with all non -point source regulations per the Cupertino Municipal Code, Section
918.
RE -ROOFS:
Signatu 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 25505, 25533, and 25534.
Section 3700 of the Labor Code, for theerformance of the work for which this
p
-�*
Owner or authorized agent: Date: O-
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
CUPIERTINO
1%
CONSTRUCTION PERMIT APPLICATION
V
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 x o
� B
(408) 777-3228 • FAX (408) 777-3333 • building Q)cupeltino.orq
n NFW CONI ITRt1CTION 7 ADDffION 5d ALTERATION /TI ❑ REVISION / DEFERRED ORKIINAL PERMfI' N_�___._
PRO,�ECr.ADDRESS 23500 Cristo Rey Drive 41OF
Al
OWNr•,R NAMI•: u 1 pqt/+ L, •r'Y1 , t�-t�� PHONE 650.944,0100
C�r/GCITY,
r'"'IAIL FredHernandez@lheforumrsa.com
S'PRFI:
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). Ilzese.tees are based on the preluninary information available ana are only an estimate. c;omtact the Dept for aaan'l znJo.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13)
ADDRESS: 23500 CRISTO REY DR #410F
DATE: 05/14/2015
REVIEWED BY: MELISSA
APN: 342 53 174
BP#: 15050082
*VALUATION: 1$10,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi -Family Dwelling
USE:
1 hrs
Buildina is
3 Stories 0 Yes (j) No
PENT TION 1 R2REM
PERMIT TYPE: 'A
WORK
-REMODEL E MASTER& GUEST BATHROOMS 80SQ FT ; UPGRADE ELECTRICAL
SCOPE
HUNIHT.41OF
FIXTURES, SWITCHES & RECEPTACLES THROUGHOUT UNIT. REPLACE KITCHENS p
NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). Ilzese.tees are based on the preluninary information available ana are only an estimate. c;omtact the Dept for aaan'l znJo.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13)
FEE
QTY/FEE
I MISC ITEMS
Plan Check Fee:
$0.00
80 s.f. Remodel, Bath (<=300 sf)
$645.00 1REMRESBAT
Suppl. PC Fee: Q Reg. 0 OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
20 Electrical
$48.00 1 IBREMRECEP Recep/Switch/Outlets
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q
OT
r 0.0
1 hrs
$0.00
�7 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
;`r�rr cr�rrli��aa :1C!X:
Administrative Fee:
IADMIN
$45.00
0
O
Work Without Permit? O Yes G No
$0.00
Advanced -Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee:
IBSEISMICR
$1.30
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
; ; ..... '
SUBTOTAL
, .B,-
$191.30
$775.00 TOTAL FEE: .
$966.30
Revised: 05/07/2015
Name: & _ ALL CA 2013 BLDG CODES APPLY
Address: 23500 Cristo Rey Drive 410E
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 (7 Total)
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