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15070229CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR UNIT 401F CONTRACTOR: CITY BUILDING PERMIT NO: 15070229 INCORPORATED OWNER'S NAME: HOLMES DONALD K AND CAROL H TRUST 212 N SAN MATEO DR DATE ISSUED: 07/31/2015 O ER'S PHONE: 6509440100 SAN MATEO, CA 94401 PHONE NO: (415) 495-6000 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL UNIT 401F - REMODEL (E) KITCHEN (65 S.F.), REMODEL License Class IS Lic. # IZ. 335 (E) BATHROOMS (108 S.F.) & ADD 6 M RECESSED Contractor C.1TL1 !3 U llbl �J 6 VJ C Date .?al LIGHT FIXTURES IN BEDROOM AND LIVING ROOM 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: $11000 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: 34253168.00 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 FROM LAST CALLED 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 comply Issued by: Date: with all non -point source r lations er the Cupertino Municipal Code, Section 9.18. �115 RE -ROOFS: 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) 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 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 255 , 255 nd 25534. 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.org / FJ r pw rc)NRTRT W-FION I—I AT)nITtON R ALTERATION/T1 F-1 REVISION / DEFERRED 0 7-O Z2�) ORIGINAL PERMIT # PROJECT ADDRESS 23500 Cristo Rey Drive #401F APN# 1 OWNER NAME / %%Oil/An-D Cif'/L,pL /,-iv LM C --,V S'r E-MAIL FredHernlandez@theforumrsa.co PHONE 650.944.0100 STREET ADDRESS G Qn G/ CITY, STATE, ZIP JSP FAX 2 % COY I howes 1HONE415.850.2021 Tbwes@citybuilding.com STREET ADDRESS CITY, STATE, ZIP FAX 212 N San Mateo Drive San Mateo Ca 94401 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT 13[ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER 324335 LICENSE TYPE I BUS. LIC # Patrick Fellowes B,C20,C36 36043 COMPANY NAME Ci Building Inc E-MAIL Pfellowes@citybuilding.com FAX STREET ADDRESS 212 N San Mateo Drive CITY, STATE, ZIP San Mateo Ca 94401 PHONE 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 WOScope: New Kitchen and vanity cabinets with counter tops including new lumbing fixtures. new can Ii hting ba o �d-J r�c� ss�d i t 5 ih. c roork ( J f'U 0 EXISTING USE PROPOSED USE CONSTR. TYPE I # STORIES USE TYPE OCG SQ FT- VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA 1020 AREA 1020 AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA 108 REMODEL AREA I REMODEL AREA 65 PORCH AREA DECK AREA TOTAL DECKIPORCH ARE GARAGE AREA: DETACH []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 ❑ YES _ --.. TOTAL VALUATION: PLANNING APPL # ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ N It / coo By my signature below, I certify to each of the following: I am the property owner or authorized a on the property owner'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 agree 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. ma ft 8aam.:ti Signature of Applicant/Agent: Date: 7/31/15 SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE 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 Hazardous Materials Disclosure 1:1STANDARD ElPUBLIC 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 ❑ ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. MAJOR ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO P1, Vim �� FEE ESTIMATOR — BUILDING DIVISION ia, ADDRESS: 23500 CRISTO REY DR #401F DATE: 07/31/2015 REVIEWED BY: MELISSA APN: 342 53 168 BP#: EVALUATION: $11,00 ^PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi -Family Dwelling USE: 1 Buildina is >3 Stories 0 Yes (F) No PENTAMATION 1 R2REM PERMIT TYPE: WORK REMODEL E KITCHEN 65 S.F. , REMODEL E BATHROOMS 108 S.F. & ADD 6 N RECESSED SCOPE LIGHT FIXTURES IN BEDROOM AND LIVING ROOM NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School nictrirt. otr )_ Thoco fere aro hacod nn tho nroliminary infnrmatinn availahle and are nnly an estimate_ Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 108 s.f. $645.00 Remodel, Bath (<=300 sf) IREMRESBAT Suppl. PC Fee: (F) Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 65 s.f. $645.00 Remodel, Kitchen (<=300 sf) IREMRESKIT Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 © Electrical $72.00 IBREMFIAT Fixtures, Lighting PME Unit Fee: $0.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00 0 0 Work Without Pen -nit? 0 Yes (j) 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 $1.43 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $143.431$1,362.001 TOTAL FEE: $1, 505.43 Revised: 07/02/2015 Name: All CA 2013 Building Codes apply Address -".123500 Cristo Rey Drive Unit #401 F Model C Two Bedrooms • Two Baths THE--'fiORUM AT RANCHO tOFFICE COPY Interior Living Space J0ti� r�Space et =LOP"re;1IN0 1 ntEtvT 1,020 Square Feet r Feet 'IS10 _ APPROVED Scope: g4WLPr;OS 1 This set of pla-is a". specifications MUST be kept at the c �po� (�d1nS ((og job site dur ny 73rstruction. It is unlawful to make any r & ("N� �e�-e-s�_d. 1�� 5 ��`� changes or alterations on same, r tate UO ;r► _ �-vvv" therefrom, withcut approval from the al. be hAld to ninvii,t. ` 6 vikl inn C , place , Top Flobr — _-- _i 1 ; Living Rb6in 140"x.11'Q" 1_86dlltoolln ; ..L. : (Jfa I i 1:1'" x 1 2'5 i".... i.... '1 j p � i ; T • ' Cb dg Alt 8..3....x. i I : t i : '7"x 3161' i 'HIP C6111rig a op Floor .� IF i I i 0 A"A",U Entry 3 i f '! 1 1 i1'9" x 5'6. B ...... � _. ; :. :_.. ,. �'' ...;...; .. , � ° �� ani: ,, , . ..; _ 6 X54 11MNL. 1. .._.i...._,... i on • J a �--Exhaust Fan r gY www.experiencetheforum.com 1 23500 Cristo Rey Drive, Cupertino, CA 95014 1 650 944 0100 California RCFE# 435200344 1 (21 Equal Housing Opportunity 1 COA #204 c, Floor plans are representative, Actual measurements and layout may vary. Revised 09/2014. i ..t . ' ' i ..I • .. _._ ... ..� .....!_.._}..... j.. ...1...........Or . t i 1--�OI � i i q i t x112.9.......... ... i �... _._ -._.l. C , place , Top Flobr — _-- _i 1 ; Living Rb6in 140"x.11'Q" 1_86dlltoolln ; ..L. : (Jfa I i 1:1'" x 1 2'5 i".... i.... '1 j p � i ; T • ' Cb dg Alt 8..3....x. i I : t i : '7"x 3161' i 'HIP C6111rig a op Floor .� IF i I i 0 A"A",U Entry 3 i f '! 1 1 i1'9" x 5'6. B ...... � _. ; :. :_.. ,. �'' ...;...; .. , � ° �� ani: ,, , . ..; _ 6 X54 11MNL. 1. .._.i...._,... i on • J a �--Exhaust Fan r gY www.experiencetheforum.com 1 23500 Cristo Rey Drive, Cupertino, CA 95014 1 650 944 0100 California RCFE# 435200344 1 (21 Equal Housing Opportunity 1 COA #204 c, Floor plans are representative, Actual measurements and layout may vary. Revised 09/2014.