15070017CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 306D
CONTRACTOR: CITY BUILDING
PERMIT NO: 15070017
INCORPORATED
OWNER'S NAME: RAMOS LOUIS E TRUSTEE & ET AL
212 N SAN MATEO DR
DATE ISSUED: 07/02/2015
O ER'S PHONE: 6509440100
SAN MATEO, CA 94401
PHONE NO: (415) 495-6000
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
UNIT 306D - REMODEL (E) 66 SY BATHROOM
License Class Lic. #
� 3 2y 355
/� �
Contractor C ITh AV I LQ W (, 1rIC- Date -1Aab(;
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.
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: 34253090.00
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
building hereby this to
DA P 'ISSUANCE OR
wITIiIN 180 PAYS -OF
to construction, and authorize representatives of city enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 D ALLED INSPECT ON.
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
sue Date:
with all non -point source regulation per the Cupertino Municipal Code, Section
RE -ROOFS:
9.18.
' �7 /
Signature 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
Section 3700 of the Labor Code, for the performance of the work for which this
the Health & Safety Code, Sections 2550553��a25534.
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
Compensation laws of California. If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a-)cupertino.or4
[:]NEW CONSTRUCTION ❑ ADDITION ® ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
B
PROJECT ADDRESS 23500 Cristo Rey Drive 306D
APN # 5 —010
_T_
OWNERNAME Lo v (S 710�0S1�
PHONE 650.944.0100
E"tea' FredHernandez@theforumrsa.com
STREET ADDRESS 23500 Cristo Re Drive
Y ,
CITY, STATE, ZIP
Cupertino, Ca,95014
FAX
C'Y§9&T&lowesL1�#__Ljll g�S0 q,O ,
I PHONE415.850.2021
Wefbwes@citybuilding.com
STREET ADDRESS
CITY, STATE, ZIP
FAX
212 N San Mateo Drive
San Mateo Ca 94401
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT 131 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER 324335
LICENSE TYPE
BUS. LIC #
Patrick Fellowes
1R,C20,C36
36043
COMPANY NAME
CiIX Building Inc
E-MAIL
Pfellowes@citybuilding.com
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
212 N San Mateo Drive
San Mateo Ca 94401
650.375.6603
ARCHITECT/ENGINEER NAME N/A
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
Scope, New tops at bathroom-,- New ligbt fixtures. new fixtures, new electrical
vanitysink and counter guest plumbing
devices (plugs and switches) in bathroom only. New fan to replace existing.
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE TYPE OCC. SQ.FT.
VALUATION (S)
EXISTGNEW
FLOOR
DEMO
TOTAL
AREA
1100 1 ��
AREA 1100
AREA
NET AREA
BATHROOMKITCHEN
OTHER
REMODEL AREA 66
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
I
❑ ATTACH
I
# DWELLING UNITS:
IS A SECOND UNIT ❑YES
SECOND STORY YES
BEING ADDED? ❑ NO
ADDITION? ❑ NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN
RE Y TAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HO NO
0 coo
By my signature below, I certify to each of the following: I am the property owner or authorized agent t ct on th riy owner's behalf. I have rea
application and the information I have provided is correct. I have read the Description of Work and v ' ccurate. I agree to comply with all applicable local
ordinances and state laws relating to building II representatives of Cupertino to enter the above -identified property for inspection purposes.
lco�nsstruruction-. authorize
(Y t.
Signature of Applicant/Agent: 4tti t 8A� d w(fy Date: /2/15
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
tqVER-THE-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.
11EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
11 STANDARD
El PUBLIC WORKS
form 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
B1dgApp_2011.doc revised 06/21/11
PIP"MA
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
r
9
ADDRESS: 23500 CRISTO REY DR # 306D
DATE: 07/02/2015
REVIEWED BY: MELISSA
Z'£ ?£:;
APN: 342 53 090
BP#: 1,5o gooig*VALUATION:
$10,000
*PERMIT TYPE: Building Permit
PLAN CHECK E: Alteration / Repair
PRIMARY Multi -Family Dwelling
USE:
Buildina is
3 Stories 0 Yes (j) No
PENTAMATION 1 R2REM
PERMIT TYPE:
WORK
REMODEL E 66 S.F BATHROOM
SCOPE
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Dictriet etc-). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dept for addn 'l info.
FEE ITEMS (Fee Resolution I1-053 E . 711113)
C3.
iaw cif£?C:h
L.i ...
Z'£ ?£:;
Plan Check Fee:
Et£?£'.�£.'?'Tdf7Y
hav".
(,)f1i:. 1 /1!7 l> llii)7.ILI
Remodel, Bath (<=300 sf)
IREMRESBAT
Suppl. PC Fee: Q Reg. Q OT
Elec. hisv. ]'ee:
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Dictriet etc-). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dept for addn 'l info.
FEE ITEMS (Fee Resolution I1-053 E . 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.0066
s.f.
$645.00
Remodel, Bath (<=300 sf)
IREMRESBAT
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee,0 Reg.
Q OT0
0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C omtr•uctii n Tax:
0
Work Without Permit? ® Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
Strong Motion Fee:
1BSEISMICR
$1.30
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$2.30
$645.00
TOTAL FEE:
$647.30
Revised: 07/01/2015
Name: Louis Ramos THE F O RUM
All CA 2013 Building Codes apply
Address: '423500 Cristo Rey Drive AT RANCHO SAN ANTONIO COMMUNITYDEVELOPMENT DEPARTMENT
BUILDING DIVISION - CUPERTINO
Unit #: 306D
APPROVED
Model E Interior Living Space 8�11¢olity Spae� necifications MUST be kept at the
Two Bedrooms • Two Baths 1,100 Square Feet 167 Square Feetrction. It isunlawful to make any
Scope: New vanity sink and counter tops at guest bathrglgms. New light fixtures, new L yip,
plumbing fixtures, new electrical devices (plugs and switches) in bathroom only. New fan to
replace existing. T` uifrcationa i. LL NOT
11 ., of ti tion
Balcoy
22,9\, 7,2„
A(
Q� CP
{� �A-
O
Befoom
10'11" x 13'10"
Closet
'0" x 6'10
Bath
' 10' 11" x 6' "
Bedroom
10'11" x 1110"
Closet
2'0" x 6'0"
Bath
x60
i_aw.
CID
w�V
��..
Living Room
15'0" x 15'0"
Fireplace
at Top Floor
High Ceiling at Top Floor
Dining
12'6" x 8'9"
Entry
5'3" x 6'9" Kitchen0 0
17'0„x11'0' QO
`
�"r Exhaust Fan Can light UCEIVED
www.ex ncetheforum.com i 23500 Cristo Rey Drive, Cupertino, CA 95014 JUL6RPM9 100
alifornia RCFE# 435200344 f' Equal Housing Opportunity I COA #204 6,
Floor plans are raorese^tat,ve. A,tuz measurements and layout may vary. Revised XV2oi4”
/50 �00/7