15050084L"
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 218C
CONTRACTOR: CITY BUILDING
PERMIT NO: 15050084
INCORPORATED
OWNER'S NAME: ALLISON GLADYS H TRUSTEE
212 N SAN MATEO DR
DATE ISSUED: 05/14/2015
OWNER'S PHONE: 6509440100
SAN MATEO, CA 94401
PHONE NO: (415) 495-6000
rl' LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
'
�L 3 3
UNIT 218C - CHANGE COUNTER TOP & SINK IN MASTER
License Class �jic. #
BATH/POWDER RM, (N) CABINETS, COUNTERS &
., r a„�
Contractor C•TIr �! �' Date
REPLACE
(E) SINK IN KITCHEN & INSTALL 4 (N) RECESSED
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
Sq. Ft Floor Area:
Valuation: $10000
performance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance, as provided for by
rection 3700 of the Labor Code, for the performance of the work for which this
APN Number: 34253048.00
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 FR LED 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 comp
e'
with all non -point sour regulations per the Cupertino Municipal Code, Section
RE -ROOFS:
918. ,.
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)
1, 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 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
918.
Signature Date
CUPERTINO
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buiiding65�Cupertino.org
M NPW CONst'RI IC ION ❑ ADDITION 5� ALTERATION/Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT 11
PROJECT ADDRESS 23500 Cristo Rey Drive 218C
\PN `I 3 _ I 3 — 043
OWNER NAME / C\ I N \ /k_ / J _, (� d � 1 p/,U'IONE 650.944.0100
1 l� , v ✓ f T (w V ��' VVV r—
E-MAIL Fredl-ternand6ez@theforumrsa.com
STREET ADDRESS
23500 Cristo Rey Drive,
CiTY. STATE, -LIP
Cupertino, Ca,95014
FAX
CONTACT NAME Patrick Fellowes
PIIONI: 415.850.2021
E-MAIL Pfellowes@citybuilding.com
STREET ADDRESS
CITY. STATF. 711' San Mateo Ca 94401
E AX
212 N San Mateo Drive
❑ OWNER ❑ OWNER -BUILDER ❑ O4lNER AGE?NT CON-1-AACTOIt ❑ CONrRAC"1'OR AGENT ❑ ARCHI-1`' ❑ ENGINEER ❑ UEVG.OPER ❑ TENAN'r
CONTR ACTOR NAME Patrick FCllowes
LICi:NSI? NUMBER 324335
LICENSE'1'YPL
BIDS. LIC 4 36043
("i
COMPANY NAME City Building Inc
E-14AI1, )
I f(.11owes@citybuilding.com
FAX
STREET ADDRESS 212 N San Mateo Drive
CTI'Y, S'I'A1'E, ZIP San Mated Ca 94401
PRONE 650.375.6603
AKCHIT'EC"171:NCiINIiER NAME N/A
LICENSE NUMBER
BITS. LICII
COMPANY NAME E-NiAIL.
FAX
STREET ADDRESS (,I'I Y. STATE. Zi l'
PHONii
DESCRIPTION OF WORK
,. Nely vanity sink 1
New can bighting at living roots Only (4'1'otal),
FAIST1NG USE
PROPOSED USE
CONS'rR 'TYPE
I II S'roRIES
IJSii '1'5'1'1' OCC.
S(1.1;1'.
VALIJA'I'll)N (S1
fx"
NEW FI'Oota
DEMO
TOTAI.
AREA 10207
AREA 1020
AREA
NEI MWA
BATHROOMKI9'CI1EN
OTHER
REMODEI. AREA 5�
REMODEL. AREA
5�
REMODEL AREA
PORCII AREA DECK AREA 'TOTAL UECKMOM31 AREA
GARAOF; AREA DETACH
❑ ATTACH
__ _ _. _.._ _.._.. _–..... _._._.._ _.___..T_�.– __.._...,....—_..__.....____
WELLINti I1NI'rti ISA SECOND UNIT ❑)LES
__.___ __.._ .. _.....,..
SECONDS"TORY ❑YES
BEINGADDED? ONO
ADDITION? ONO
L2TOPAL VALUATION:
PRGAPPLICA'I'ION ❑ YES IF YES, PROVIDE COPY OP
t5'rllE BLDG AN ❑ Y e
PLANNING APPI. U [:]NO PLANNING APPROVAL L.ETTEIL
EICHLER HOME?
By my signature below, 1 certify to each ot'the following: I ani the property owner or . ct nn the property owner's beha C I have read this
_ I have read the Descri ii f Work and verify it is accurate. I agree to comply witli all applicable local
application and the information I have provided is correct.n o
ordinances and state laws relating to buildin ut rep esentatives of Cupertino to enter the above -identified property liar inspection purposes.
%�' Date:
Signature of ApplicanUAgcnt: - _-:
SUPPLEMENTAL INFORMATION REQUIRED
.ANCIBECKTYPE
ROUTING SLIP
r57T,,IE-COUNTER
❑ 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
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
Commercial 13ldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
_
forts 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
CITY OF CUPERTINO
FOR9. FEE ESTIMATOR - BUILDING DIVISION
imlADDRESS:
23500 CRISTO REY DR #218C
DATE: 05/14/2015
REVIEWED BY: MELISSA
APN: 342 53 048
BP#: 15050082
"VALUATION:
1$10,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi -Family Dwelling
USE:
Buildina is
>3 Stories 0 Yes Q No
PENTAMATION 1 R2REM
PERMIT TYPE:
WORK
UNIT 218C -CHANGE COUNTER TOP & SINK IN MASTER BATH/POWDER RM N CABINETS,
SCOPE I
COUNTERS & REPLACE (E) SINK IN KITCHEN & INSTALL 4 (N) RECESSED LIGHTS IN LIVING p
vfecra, I'ica�r t ;aecr11 Plumb. Plan Check 1 0.0 1 hrs $0.00 Elec. Plan Check 10.0 1 hrs $0.00
9lech. I'r, anit Fee., Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: 1EPERMIT
()then '.peen. Insp, Other Plumb Insp. 0.0 hrs $48.00 Other Elea Insp. 0.0 hrs $48.00
"/leen. Insp, f`ee: f'/rrmb. Jngl_ ee:
NOTE: This estimate does not include fees due to otter Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept,jor addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
40 s.f.
$645.00
Remodel, Bath (<=300 sf)
IREMRESBAT
Suppl. PC Fee: F) Reg. 0 OT0.0
hrs
$0.00
PME Plan Check:
$0.00
0 #
$10.00
Plumbing
IBPFIXTURE I Fixture set on One Trap
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. Q OT
0,0
hrs
$0.00
® Electrical
$72.00 1BREMFIXT Fixtures, Lighting
PME Unit Fee:
$0.00
PME Pen -nit Fee:
$96.00
C;r� scrtr<°fic�rt .L Et X:
Administrative Fee: 1ADMIN
$45.00
0
G)
Work Without Permit? 0 Yes Q) No
$0.00
Advanced Planning Fee.
$0.00
Select a Non -Residential
Building or Structure
0
i
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$1.30
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS':
$191.30
$727.001TOTAL FEE:'°
$918.30
Revised: 05/07/2015
Name: % ALL CA2O13BLDG CODES APPLY
Address: 235U0Cristo Rey Drive I18[
Scope: New vanity sink and countertop at two bathrooms. New Kitchen cabinets countertops and sink.
New can Lighting atkitchen and hallways (4Total)
Fireplace
.
@ Entry
�
Kitchen �
Balcony
Bnmoow
Closet
^~
Bath \