15050080E
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 110C
CONTRACTOR: CITY BUILDING
PERMIT NO: 15050080
INCORPORATED
OWNER'S NAME: HARTINGER MARKS ELIZABETH 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 DECLAP-14N
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
UNIT 110C- REMODEL (E) MASTER & GUEST
y�
License Class iii Lie. # l C:OC-rG.
BATHROOMS
2 �`•1 �,:"
(80
Contractor Date is%"
�f
SQ FT); UPGRADE ELECTRICAL LIGHT FIXTURES,
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.
�lbave 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: 34253019.00
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 O IT 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 DAY 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
Date:
granting of this permit. Additionally, the applicant understands and will com
ss
with all non-point sourcqj=tlations per the Cupertino Municipal Code, S ion
9.18.
Signature r"= Date
RE-ROOFS:
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 C rtino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
Labor Code, for the for this
the Health & Safety Code, Se 550 25533, and 25534. _
Section 3700 of the the performance of work which
Owner or authorized ag 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
r
CONSTRUCTION PERMIT APPLICATION O�
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 %^
CUPEFCTIi`9O (408) 777-3228 • FAX (408) 777-3333 - buildingWcupertino.org \
n NPP CY)NIq'rnl WTTnNI n AnnrrioN n7C ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT d __,
PROJECTADDRESS 23500 Cristo Rey Drive I i0C
APN1 •3 � � S 7 — 8�,�
rnvNElt NnM' .C_,�'�" ,_ Ir ..
A��4
-MA t. FredHernandez theforumrsa.com
STREET ADDRESS
23500 Cristo Rey Drive,
CITY, STATE, zip
Cu ertino, Ca,95014
FAX
COUR&Wlowes PIION1415.850.2021
li'talowes@citybuilding.com
STREET ADDRESS
CITY, STA'T'E, ZIP
FAX
212 N San Mateo Drive
San Mateo Ca 94401
1�
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT yl CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT'
CON'TItA("I'OR NAME
LICENSE NUMBER
324335
LICENSE TYPE
B,C20,C36
BIDS, LIC P
36043
Patrick Fellowes
COMPANY NAME
Citv Buildina Inc
E-MAIL
Pfellowes@citybuilding.com
FAX
STREGI' ADDRESS
212 N San Mateo Drive
CITY, STA'T'E, ZIP
San Mateo Ca 94401650.375-6603
PHONE
ARCHITECT/ENCIINFER NAME NIA
LICENSE NUMBER
BUS LIC U
COMPANY NAME
E-MAII.
FAX
STREFT ADDRESS
CITY, S'TA'TE. ZIP
PHONE
DESCRIPTION OF WORK
). r
New electrical devices throughout (plugs and switches) New Light fixtures. New bathroom ceiling fans to replace existing fans.
EXISTING USE
PROPOSED USE
CONSTR.'I'YPE
tl STORIES
uar;
TVFr 0( V.
sQ.F'r, VALUATION rs1
cxmrcl -
NEW FLOOR
DEMO
TOTAL
AREA 1020
AREA I0,)0
AREA
NL"r AREA
BATHROOM Kn'CICEN
OTHER
REMODEL AREA REMODEL, AREA
REMODEL .AREA
�� SS
PORCH AREA DECK AREA TOTAL. DECK/PORCII AREA
GARAGE: AREA: DETACH
ATTACH
U D14CiL1.1NG I:NITS IS A SECONll UNIT ❑ Y[sS
SEf.UND STORY ❑1'ES
TIRING ADDED? NO
ADDITION" NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN [] YES
TOTAL VALUATION:
PLANNING APP[, 11 ❑ NO PLANNING APPROVAL LrI'rER EICIILEII HOME?
By my signature below, I certify to each of the following: I am the property owner or aut agent to 1ny 16+"c te) s
application and the information 1 have provided is coned. I have read the Description of Work a u IS accurate. I agree to comply with all applicable local
ordinances and slate laws relating to bulld'ng c. t/al `-e re ntatives Of Cupertino to enter the above-idtntitied property for inspection purposes.
_o-- Date:
Signature ol'Applicant/Agent: .`�/= `i/
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CIIECdTYPE
ROUTING SLIP
❑ OVER-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.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
Bldgs: Provide a completed I'fa7ardOLIS Materials Disclosure
ElSTANDARD
❑ PUBLIC WORKS
—Commercial
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
1:1SANITARY SEWER DISTRICT
subn)ittal of Building PelTnit application.
❑ ENVIRONMENTAL HEALTH
B1dg,4pp_201 Woe revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 23500 CRISTO REY DR #110C
DATE: 05/14/2015
REVIEWED BY: MELISSA
I MISC ITEMS
APN: 342 53 019
BP#: 15050080
*VALUATION: $10,000
*PERMIT TYPE: Building Permit
40 s.f.
$645.00
PLAN CHECK TYPE:
Alteration / Repair
PRIMARY Multi -Family Dwelling
USE:
0.0
Buildina is
3 Stories Cl Yes E) No
PENTAMATION 1 R2REM
PERMIT TYPE: A
WORK
REMODEL E MASTER& GUEST BATHROOMS 80SQ FT ; UPGRADE ELECTRICAL
SCOPE
HUNIHT110C-
T FIXTURES, SWITCHES & RECEPTACLES THROUGHOUT UNIT. REPLACE KITCHENS
'Vit ch. Plan
Other 'U ch. Insp.
Plumb. Plan Check 10.0 1 hrs $0.00 Elec. Plan Check 10.0 1 hrs $0.00
Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: IEPERMIT
Other Plumb Insp. 0.0 hrs $48.00 Other Elec. Insp. 0.0 hrs $48.00
Ele£:. j; j•. 1*ee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanita►y Sewer District, School
District, etc.). 1 %nese. fees are based on the preliminary information available and are only an estimate. contact tie Dept.for aaan'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113)
FEE
QTY/FEE
I MISC ITEMS
Plan Check Fee:
$0.00
40 s.f.
$645.00
Remodel, Bath (<=300 sf)
1REMRESBAT
Suppl. PC Fee: (E) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
=
$48.00
Electrical
1 1BREMRECEP Recep/Switch/Outlets
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q
OT
0.0
hrs
$0.00
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
(,V,istrm:,f on .Tctx:
Administrative Fee:
1ADMIN
$45.00
0
E)
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
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:
. a, �....
$191.30
$775.00
TOTAL FEE
$966.30
Revised: 05/07/2015
Name: 2 ALL CA2O13BLDG CODES APPLY
Address; 235OOCristo Rey Drive 118C
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)
X