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15040178 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23800 AMAPOLO CT UNIT V7 CONTRACTOR:CITY BUILDING PERMIT NO:15040178 INCORPORATED OWNER'S NAME: FITZGERALD G GERALD TRUSTEE&ET AL 212 N SAN MATEO DR DATE ISSUED:04/23/2015 OWNER'S PHONE: 6509440100 SAN MATEO,CA 94401 PHONE NO:(415)495-6000 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL 0 UNIT V7-REMODEL 2(E)BATHROOMS(100 SQ FT);NEW License Class 3Z19_Lic.# - (o SINK IN KITCHEN;REMOVE AND REPLACE PLUGS AND OUTLETS(10);INSTALL(10)NEW LIGHTS. Contractor j, .= P i Date I 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 erformance 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:34254007.00 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 LED INSPECT N. upon the above mentioned property for inspection purposes. (We)agree to save 180 indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued by: Date: granting of this permit. Additionally,the applicant understands and will comply with all non-point sourc tions per the Cupertino Municipal Code,Section 918. J RE-ROOFS: Signature Dat �g 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 Cu rtino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec' ns 5505 25533,and 25534. !/ Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age Date- I -z� 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.) Lenders 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 CONSTRUCTION PERMIT APPLICATION t COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 1-914 CUPER (408)777-3228• FAX(408)777-3333•buildingacupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS 4%00Villa 7 APN# L/ 2 O b 2 o AN42910 cT V W4l OwNERNAME G.Gerald FitzGerald,Mildred FitzGerald PHONE 650.944.0100 E#f&Hernandez@theforumrsa.com STREET ADDRESS Y, STATE,ZIP FAX 23 QY�rl�}r .�10.�'1� CITCupertino,Ca,95014 `T&R&Arglowes PHONE415.850.2021 Efe owes@citybuilding.com STREET ADDRESS CITY,STATE,ZIP FAX 212 N San Mateo Drive San Mateo Ca-94401 ❑OWNER ❑ OWNER-B=ER ❑ OWNER AGENT [RCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBERLICENSE TYPE BUS.LIC# Patrick Fellowes 324335 B,C20,C36 36043 COMPANY Ci Buildin Inc E-MAIL lFAX lowes@citybuilding.com STREET ADDRESS CITY,STATE,ZIP PHONE 212 N San Mateo Drive San Mateo Ca 94401 650.375,6603 ARCHITECT/ENGINEERNAME NIA LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK 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 EXISTING USE PROPOSED USE CONSTR.TYPE I #STORIES USE TYPE OCC. SQ-FT. VALUATION($) EXISTGNEW FLOOR DEMO TOTAL AREA 1404 AREA 1404 AREA NET AREA BATHROOM KTTCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: B DETACH ATTACH #DWELLING UNITS: IS A SECOND UNPr ❑YES SECOND STORY ❑YES - TBEINGADDED? []NO ADDMON? ❑NO 2 PRE-APPLICATION [:]YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RE ,- S TAL VALUATION: PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑N17 /d By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have pr a - orrect. 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 it ' co ction. I authorize representatives of Cupertino to enter the abov�j-identified property f r inspection purposes. Signature of Applicant/Agent: Date: J ` SUPPLE AL INFORMATION REQUMD PLA I N CHECK TYPE ROUTING SLW New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUHAING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNINGPLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure '❑ STANDARD ElPUBmcwoRm form if any Hazardous Materials are being used as part of this project. ❑. LARGE ❑ FIItE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR; ❑ SANITARY SEWER DISTRICT, submittal of Building Permit application. ❑ ENVIRONM ENTAL HEALTH ` BldgApp 2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS 2 3 SUQ_A-rvlc_.joot0'Ct V '3­ DATE: 04/23/2015 REVIEWED BY: MELISSA APN: : BP#: "VALUATION: 1$10,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1 R2REM USE: 1 >3 Stories 0 Yes (E) No PERMIT TYPE: I I A WORK UNIT' tEMODEL 2 E BATHROOMS 120 SQ FT); NEW SINK IN KITCHEN; REMOVE AND SCOPE REPLACE PLUGS AND OUTLETS (10); INSTALL (6) NEW LIGHTS. Afech. Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check 0.0 hrs $0.00: iblech. Permit Fee: Plumb.Permit Fee: 1PPERMIT Elec.Permit Fee: IEPERMIT Ot)aer A(ech. Insp. Other Plumb Insp. 0.0 �rs $48.00 Other Elec.Insp. ELI hrs $48.00 tlech.Insp. Fee: Phaaiib. hul)..Fee: 1.;tec.Insp. Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 E. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 100 s.f. Remodel,Bath(<=300 sf) Suppl.PC Fee: (j) Reg. Q OT 0.0 hrs $0.00 $645.00 IPEMRESBAT PME Plan Check: $0.00 = Electrical Permit Fee: $0.00 $48.00 1 IBREMRECEP Recep/Switch/Outlets Suppl. Insp.Fee:Q Reg. Q OT 0.0 1 hrs $0.00 © Electrical PME Unit Fee: $0.00 $72.00 IBREMFIXT Fixtures,Lighting PME Permit Fee: $96.00 0 # Plumbing Construction Tax: J7 $10.00 IBPFIXTURE Fixture or Trap Administrative Fee: ]ADMIN $45.00 0 Work Without Permit? 0 Yes (j) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential G Travel Documentation Fee: ITRAVDOC $48.00 Building or Structure A Strong Motion Fee: IBSEISMICR $1.30 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 ,SUBTOTALS:g $191.30 $775.00 $9 =,TOTAL FEE;° 66 30 Revised: 04/01/2015 Name: G. Gerald FitzGerald &Mildred FitzGerald Trust ALL CA 2013 BLDG-CODES APPLY - Address: e ?,gQp SMA?G I Q CT V D I 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 Ifans to replace existing fans. New can Lighting at kitchen and hallways(10 Total) Evr.�wgf LIE 10 a _ W w � Oo =� _ Cjj 65 +n I N =O = N CQ _ _® 02 . OCD =0 � Z C. p CJn X O W O c X N 00 X� 1CD C�) s � dE27 6 —20 � o co r 7, _ x� 6- X Cl) cc 41 C205 O _ M CD � tv _ CA _y Q I C_ O co C7 X CD XCD C) �j W X C07 N? X � � 6; 0 F�,'Cd'A.E' G7"" )s' CUPERTINO { 06i'19 Depa stent APR U 2015 CO' "-'! —7":' nEVELOPMENT DEPARTMENT R. - ��iON - CUP. RTINO `-V'�ED F=OR CODE COMPLIANCE t . Reviewed By: ST be kept at the make any deviate The .c.r r LL M:,T ` be held to pen,.��: .�� !ir .,�.�.:���;� � of an sions 01 anv �ice or State Lay.. ddb s; PERMIT# S-LI) Y�i