10030106 Application CITY OF
CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # Date:
Building Address: If
n ;1
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes ❑ No
HOA: (Exterior work only) Yes ❑ No If yes, provide letter from HOA
Owner's Name- Phone#:
% V; �� 1�1�s4-
Contractor: y0�
:Fax:
one: !.! Cl a _CSR!O
Pn
k"A0Qle 14 r— 0 3a-09 a0
Contractor License#: G S 13 71
Cupertino Business License#: L'
Contact: Phone: C.� a(U-
JQ,SCl u \ Fax: 0 -C�
Residential ❑ Commercial
Job Description: E1,evoJor (y%o8Qr-ni zoO-on 4,o i r1c ludo r,
tiydu l PvWer nI -1- d0Vr- Opp�Or�, ele0a wi i ri�J
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CA ON its=fix► i � ^ __�, /
Building Permit Info:
Bldg �'-- Elect Er-� Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
I-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-13 [1 1
Valuation: I m l 000 Square Footage:
Project Size: Express EJ----Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
to the application or if applicable, include in plan set& the sheet index.
Points Achieved:
For help, contact Build it Green at www.buildit reen.or
Revised 07/14/09
SfltCITY OF CUPERTINO
OF GENERAL BUILDING APPLICATION
CUPS TINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows)
1 WINMEWSTR New Window-structural shear B
wall/masonry (includes plan ck fee)
l EPERMITFEE Electrical Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit Fee P
1 ELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1 PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
When not over counter) hourly-stand alone
1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
1 TRAVDOC Travel &Documentation B
1 BUSLIC Business License B
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