B-2016-1399CITY OF CUPERTINO BUILDING PERMIT
BUM DING ADDRESS:
CONTRACTOR:
EE
TIN10:10-2016-1399
23500 CRISTO REST DR UNIT 5270 CUPBRT1NO, CA 95014-6537 (342 54 999)
( CITY BUILDING INC )
I
SAN MATEO, CA 9440I
OWNER'S NAME: WILLCOX RILEY R TRUSTEE & ET AL
IRATE
ISSUED, 02/22/2016
OWNER'S PHONE: 650-944-0100
PHONE
NO 415-495-6000
LICENSE, CONTRACTOR'S fill Ck ARA' ION
BUILDING PEI+rART INFO:
License Class B.C-20.0-38 Lic. #324M
Contractor ( CITY BUILDING INC ) Date 02/2212016
X BLDG X ELECT _ P1LU
I hereby affdrm that I am licensed under the provisions of Chapter 9,(commencing
MECH X RESIDENTIAL _
COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
REMODEL (2)13ATHROOMS
84 S.E); KITCHEN (84 S.F.); INSTALL (N)
I hereby affirm under penalty of perjury one of the fallowing two declarations:
RECESSED LIGHTS (QTY 59)
AND ELECTRICAL OUTLETS (QTY 11)
1. 1 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 ofthe work for which this permit is issued,
z. I have and will maintain Worker's Compensation Insurance, as provided for
Mby Section 3700 of the Labor Code, for the performance of the work for which
Sq. Rt Floor Area,
Valuate
n: $50000.00
this permit is issued.
APPLICANT CERTIMCATION
certify that 1 have read this application and state that the above
APN Number:
Occupy
cy'fpe:
information Is correct. I agree to comply with all city and county
ordinances and state lavas relating to building construction, and hereby
342 54999
authorize representatives of this city to enter upon the above mentioned
property for Inspection purposes, (We) agree to save indemnify and keep
harmless the City of Cupertino agalnsc liabilities, judgments, casts, and
PERMIT EXPIRES IF
WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will
WITHIN 180 DAYS+
PE ITANCE OR
comply with all non -point source regulatto per the Cupertino Municipal
180 DAYS FROM L
A D INSPECTION.
Code, Section 9.18.
"
Issued b
Signature Date 02/22/2016
Date: 02/22(2016
OWNER B iii D R D r ARATIdDr
-ROp S
I hereby affirm that I am exempt from the Contractor's License Law for one of the
All roofs shall be, inspected prior to
any roofing material being installed. If a roof is
following two reasons:
installed without first obtaining an ii
ispeotion, I agree to remove all new materials for
t. 1, as owner of the properly, or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered
far sale (See.7044, Business & Professions Code)
Signature of Applicant:
2. I, as owner of the properly, am exclusively contracting with licensed
Date: 02/22/20I6
contractors to construct the project (Scc.7044,:Business & Professions Code).
I hereby affirm ander penalty of perjury one of the following three declarations:
ALL ROOD` COVERINGS
TO BE CLASS "A" OR BETTER
a. 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
HAZARDOUS
ATERIALS DOSCLOSURE
performance of the work for which this permit is issued.
I have read the hazardous mateia1_s
requirements under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety Co
le, Sections 25515, 25533, and 25534. I will
by Section 3700 of tho Labor Code, for the performance of the work for which
maintain compliance with the Cupertino
Municipal Code, Chapter 9.12 and the
this permit is issued.
Health & Safety Code, Section
5532(x) should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued, I
material, Additionally, should I u
ie equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air' contaminants as defined by th
Bay Area Aar Quality Management District I
will maintain eompliance with the
Cupertino Municipal Code, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health 8s Safety Code,
Sections 25 0 g, 5533, and 25534.
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permitshall
-
owner or authorized agent:
be deemed revoked,
Date: 02/2212016T
AlbPLICANT CER—TIFICATION
CONSTRUCI
YON LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction
leading agency for the performance
correct.1 agree to comply with all city and county ordinances and state laws
of work's for which this permit is hnsued
(Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant
understands and wi11 comply with all non -point source regulations per the
RC T
I understand my plans shall be used
9 O
as public records.
Cupertino Municipal Code, Section 9.13.
Licensed
Signature Date 02/221201.8
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
OUPERT0140 (408) 777-3228 • FAX (408) 777-3333 - building cupertino.org
El NEW CONSTRUCTION 1 1 ADDITioN nX Al.-MRATInNITT n RRVTaTnxl1T)PP~T?Tarn T2T1'.7¢.TA1 13C1>hA7-r4
PROSECT ADDRESS 23500 Cristo Rey Drive #577C
7APN #
�4
�Pb 7t J
HONE
OWNFRNAME fd
E -MAI
Fredhlernandez@thefarumrsa.
rO F iLe . 650.944.i71ti0
om
STREET ADDRESS
2350(1 Crista Drive,
CITY, STATE, ZIP
FAX
-Rey
Cupertino, Ca,95014
CGI art's vi vid
PIIGNE415.850.1461
in
dwinbuildirlg,coirl
STREET ADDRESS
CITY, STATE, ZIP
FAX
212'N Sart Mateo Drive
San Mateo Ca: 94401
❑ OWNBR ❑ OWNER -BUILDER ❑ OWNEP.AGENT IRCONTRACTOR ®CONTRACTORAGEUT ❑ ARCHITECT
ENGINEER ❑ DEVELOPER CI TENANT
CONTRACTOR NAME
LICENSE NUMBER
324335
LICENSE TYPE.
BUS. LTC #
Matt Baldwin
B C20,C3
3043
COMPANY NAME
E
FAX
Ci Buildin Inc
mbaldwin@citybtlilding.corn
STREETADDRESS
CLTY, STATE, ZIP
PHONE
212 N San Mateo Drive
Sari Mateo Ca -94401
415-495-6
ARCHITECT/ENGINEER NAME N/A
LIC ENSF.NUMBER
BUS. LTC#
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION UP wORK Scope: New Kitchen and Vanity Cabinets (2 Vanities total) with counter tolls includ
hg new plumbing
total). New exhaust fans in bathroom (2 total), New flooring throughout. Paint throughout.
L
EXISTING USE
PROPOSED USE CONSTR
TYPE
#STORIES
USE
TYPE
C
CC.
SQYT.
VALUATION ($)
EXISTG
NEW FLOORDBwIO
TOTAL
AREA 1260.
AREA 1260
AREA
NET AREA
BATHROOMKITCIIEN
OTHER
REMODEL AREA 34
REMODEL AREA
REMODEL AREA
65
PORCHAREA DUCK AREA 'TO'T'AL DECKMORCH AREA
GARAGEAREA, []DETACH
I
® ATTACH
#DWELLINGUNITS:
IS A SECOND -UNIT ❑YES
SECONDSTORY []YES
BRING ADDED? -AND
ADDITION? NO
PRE -APPLICA'T'ION. ❑YES W YES, PROVIDE COPY OF
ISTHEDLDGAN [3 YES
-R] VED-BY:
T,TAIVA.LUA�TION:
PLANNING APPL # ®NO PLANNING APPROVAL LETTER
EICHLER HOME? I NO
I
- [ _
p+
AiA=
V
By my signature below, I certify to eaeb of the following: I am the property owner or authorized agent to act on the property3
wner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agr
e to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified
property for inspection purposes.
A4P f f"' 8aw4v
Signature of Applicant/Agent: Date: 2/19/16
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
�
M OVER-THE-COUNTER
13UILDING PLAN REVIEW
_New SI DOr Multifamily dwellings: Apply for demotition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building,
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial BIdgS: Provide a completed Hazardous Materials Disclosure
-in
❑ STANDARD
❑ PUBLIC WORKS
Tr if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
Copy of Planning Approval better or Meeting with Planning prior to
.❑ MAJOR
Cl SANITARY SEWER DISTRICT
submittal o£Balilding Permit application.
❑ ENVIRONMENTAL HEALTH
Bldg_.4pp 2011.doc revised 06121111
WILLCOX RESIDENCE
23500 CRISTO REY DRI
NO527E
CUPERTINO, CA 95014
2/19/16
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v �QYER (th
Building Department
Z9
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax,:, 408-777-3333
�Vu%; a V"Jull C5 kill "Usinesses woriung in the 041 to have 2 CltY Of Cnpertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BESCHEDULED UNTIL THE
GENERAL CONTRAC
TOR AND ALL SUBCONTRACTORS HAVE OBTAINED A, CITY OF CUPERTINO
BUSINESS LICENSE.
am not using any subcontractors:
Signature Date
Please check; applicable. subcontractors and complete the following information-.
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE
Cabinets & Millwork
Cernent.Finishing
x
Electrical
Conoley Electric
36286
Excavation
Fencing
Flooring, / Carpeting
Linoleum / Wood
x
Glass / Glazing
Bay Glass
29595
Heating
-
Insulation
.Landscaping
Lathing
Masonry
Painting I Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic, Tank
Sheet Metal
x
Sheet Rock
Allen Drywall
25705
Tile
I
V Ver / Contractor Signature