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27697 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. BUILDING DIVISION APPLICATION/PERMIT I PLUMBING-MECHANICAL 7 9 7 BUILDING PROJ ECL'IDENTIFICATION 2 6 BUILDING ADDRESS: /////�����aa^�a SANITARY NO. APPLICATION SUBMITTAL DATE 504 LOT4 Lt \ / `er OWNERSNAME: �I�I I -1k 4 el^�_SHONE: CONTRATA C'1� NAME: % �I�L/IC�NO: /t� N/C 111��-CONTROL S • ARCHITECT/ENGINEER: PAU(wU W ASocnq -s LIC NO: gpORE$TS: IRLg✓•,1- Awe.) a 4- G«1i? ❑ CONTACT: ' PHONE: '471 al�/f44 BUILDING PERMIT INFO QTY. ELECTRIC PERMIT FEE kogm$ p14 1/3 5^ 6 no PERMIT ISSUANCE ��sil,' BT P.I.-I# MECH LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL 'TETT JOB DFSCRIPI'ION 0Cz I hereby affirm hatl am licensed under provisions of Chapter 9(commencing withLOB 00 Section T(gp)of Division 3 of the Business and Professions Code,and my license is in PANELS 4 full force and effect. ,Zed License Class Lic.4 UP TO 200 AMPS I- to<a; Date Contractor 201-1000 AMPS „Z ARCHITECTS DECLARATIONSQ.Fr.FLOOR AREA 5/SQ.FT. 0 Z- o I understand my plans shall be used as public records. OVER 1000 AMPS P uI L W SIGNS ELECTRICAL g.; Licensed Professional oma OWNER-BUILDER DECLARATION SPECIAL CIRCUIT/MISC. • ox,tpitl.o I hereby affirm that I am exempt from the Contractor's License Law for the W 3 94171 following reason.(Section 7031.5,Business and Professions Code:Any city or county TEMP.METER OR POLE INST. /512n which requires a pemtit to construct,alter,improve,demolish,or repair any structure C;!I)- prior to its issuance,also requires the applicant for such permit tonic a signed statement POWER DEVICES that he is pursuant to the ns of he s License w(Chapter 000 9(commelncing with Section7000)of Division 3 of the Business and Professsion Code) VALUATION d zSWIMMING POOL ELECTRIC _LLy or that he is exempt herefrom and the basis for the alleged exemption.Any violation of OUTLETS-SWITCHES-FIXTIIRPS F z>' Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 77 clnre tmothan five hundred dollars(E300). NEW RESIDENTIAL ELECTR SQ.FT. STORIES TYPE CONSTRUCTION 41 o 0 I.asowner of the propeny,ormy employees with wagesestheir sole compensation. L _ will do thework,and the structuress not intended or ffered for sale(Sec.9O44.Business and Professions Code:The Contractor's License Law does not apply to an owner of properly who builds or improves thereon,and whodoes such work himself orthrough his own employees,provided that such improvements are not intendedoroffered formic.If, OCC.GROUP RES.UNITS however,the building or improvement is sold within one year of completion,the owner- TOTAL: builder will have the burden of proving that he did not build or improve for purpose of 981`')' PLUMBING PERMIT FEE FLOOD ZONE APN ❑ I,as owner of he properly,am exclusively contracting with licensed licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's LicenseLawdoesnot apply to an owner of property who builds or improves thereon,and PERMIT ISSUANCE who contracts for such projects with acontracmr(s)licensed pursuant to the Contractor's gLTF.R-DRAIN&VENT-WATER(PA) FEE SUMMARY License Law, ❑ I am exempt under Sec. ,B&P C for this reasonOUTSIDE FEES BACK FLOW PROTECT.DEVICE • SANITARY Y N Owner Date 40 DRAINS.-FLOOR,ROOF,AREA,COND. RECEIPT p WORKMAN COMPENSATION DECLARATION SCHOOL TAX Y N ❑ I hereby affirm that I have a certificate of consent o self-insure,or a certificate of FIXTURES-PER TRAP RECEIPT Worked Compensation Insurance or a certified copy thereof(See.3800.Lab C.)which PARK FEE Y N covers all employee's under this permit. GAS-EA.SYSTEM-I INC.4 OUTLETS RECEIPT M Policy - BUILDING DIVISION FEES Company GAS-IA.SYSTEM-OVER 4(PA) PLANCHECK FEE 1.2.1:(4.....44 ❑ Certified copy is hereby furnished. 0 Cenified copy is filed with the city inspection division. GREASE/INDUSTRL WASTE INTERCEPTOR GRADING FEE CERTIFICATE OF EXEMPTION FROM WORKERS' GREASE TRAP SOILS FEE COMPENSATION INSURANCE - (Ths section need not be completed if the permit is for one hundred dollars($100) SEWER-SANITARY-STORM EA.200F1. ENERGY FEE or less.) I certify that in the performance of he work for which this permit is issued,I shall WATER HEATER W/VENT/ELECR not employ any person in any manner so as to become subject to the Workers' PAID O z CompensationClaws of California. Date WATER SYSTEM/TREATING Date Receipt 4 z � NOTICF.TO APPLICANT:If,after making this Certificate of Exemption,you should NEW RESIDENTIAL PLMB. SQ.PT. TOTAL: t-. (/I become subject to the Worker's Compensation provisions of the Labor Code,you must tr' + forthwith comply with such provisions or this permit shall he deemed revoked. BUILDING FEE Fq Da Q CONSTRUCTION LENDING AGENCY SEISMIC FEE pL, I hereby affirm that them is a construction lending agency for the performance of R • O TOTAL: EI.ECIC FEE o the work for which this permit is issued(Sec.3097,Civ.C.) ti D-i f.r Lender's Name PLUMBING FEE [” Lender's Address QTY. MECHANICAL PERMIT FEE o UI certify that I have read this application and state that the above information is MECHANICAL FEE >" a correct.I agree n comply with all city and county ordinances and state laws relating to PERMIT ISSUANCE building construction.and hereby authorize rtpresentatives of this city toenterupon the CONSTRUCTION TAX V above-mentioned property for inspection purposes. ALTER OR ADD TO MECH. (We)agree to save,indemnify and keep harmless the City of Cupenino against liabilities.judgments,costs and expenses which may in any way accrue against said City AIR HANDLING UNIT(TO 10.000 CFM) in caeske eof the granting of this permit. Co 'T�I I (14- AIR HANDLING UNIT(OVER I0,000 CFM) ' Signature of Applicant untracto Date EXHAUST HOOD(W/DUCT) PAID ' HAZARDOUSMATERIALSupDISCLOSURE HEATING HEATING UNIT(TO 100.000 BTU) Date Receipt 4 Will the applicant or future building occupant store or handle hazardous material 'TOTAL: Code,as defined by the Cupertino Municipal Chapter 9.12,and the Health and Safety IIEATINC UNIT(OVER 100,000 BTU) Code.Section 25532(a)? VENTILATION FAN(SINGLE RESID) ❑Yes 0 N BOILER-COMP(3HP OR 100,000 BTU) IS6UAp�CI D®TE Will the applicant or future building occupant useequipmenl or devices which emit CC A hazardous air contaminants as defined by the Bay Area Air Quality ManagementII BOILER-COMP(OVER 10(1.000 BTU) District? ❑Yes 0 No NEW RESIDENTIAL MECH. SQ.FT. DEC 2 1994 I have read the hazardous materials requirements under Chapter 6.95 of the Ca I I California Health&Safety Code,Sections 25505,25533 and 25534.I understand that Lir VVf-C if the building does not currently have a tenant,that it is my responsibility to notify the occupant of he requirements which must be met prior to issuance of a Cenifmate of Occupancy. Owner or authorized agent Dam TOTAL: ISSUED BY: OFFICE tre Donald E. Banta & Associates, Inc. Consulting Geotechnical Engineers v 415 Meridian Avenue • San Jose, California 95126 • 408/287-7800 • Fax 408/275-9019 October 10, 1994 440-2, C6I44 Citation Homes Central 404 Saratoga Avenue, Suite 100 Santa Clara, California 95050 Attention: Mr. Martin Petersen RE: NOTIFICATION OF RELEASE FROM GEOTECHNICAL ENGINEERING RESPONSIBILITY-TRACT 8325 PORTOFINO UNIT NO.2 AND LATER DE ANZA BOULEVARD AND HOMESTEAD ROAD CUPERTINO,CALIFORNIA Gentlemen: •, We understand that the above property has been purchased through foreclosure by Citation Homes. Since that time, we understand Citation has contracted with MacKay & Somps to provide new civil drawings and Terrasearch to provide geotechnical services on this property. We would like to make it perfectly clear that any use of our previous foundation related reports by Citation or others will be done without our knowledge or permission. Since we have not been retained by Citation or others to provide supplemental recommendations for the changed construction, it should be clearly understood by all parties that our firm no longer has any geo- tecnical involvement or responsibility for the subject development. The new geotechnical engi- neer should make any additional investigations necessary to provide an independent opinion as to the geotechnical requirements for this project. Such responsibility must be borne entirely by the new geotechnical engineer of record for the subject project. Very truly yours, • DON I E.B• 4, AA&ASSOCIATES,INC. j�j/ '' r•onald Ba a Geotechnical Engineer 113 DEB:ml • Copies: Addressee (1) MacKay& Somps, Inc. (1) Attention: Mr. Bill Ferrari City of Cupertino (2) Attention: Mr. Hermie Bocus and Mr. Bruce Donahue • • FREMONT UNION HIGH SCHOOL DISTRICT 589 WEST • SUNNYVALE, CALIFORNIAFREMONTAVENUE 94087 SUNNY 408-735-6060 Developer Impact Fee Compliance Building permits will not be issued without a completed Certificate of Compliance Building Application A lication • The City of rap P2 -ANO has received a request for a Building Permit described as follows: 2 New Residential Development Project ___ Residential Addition (501 sq. ft. or more) Name of Developer f i 4A it/ N° P .r (. e Pe A /- 3 5 350 4.2, 76l g6 BS ) 9 G/' 9937 Project Address: ie /aefo{,.o Lot/Parcel 0, lv, hll,?-7) ),'25 1 a6 Square Footage: /9j A' 79 Description: . Permit/Plan Check # X7,223, y_7a2 7JO6, 7.78. 4 .a78a7j .278a1 ,76 tag 2.7130 2793/. • Date: .-2?-2-G"GS By: `-C,Ir-4'1 • • City Building Inspector Square footage verified by the city prior to issuance of a building permit; fees may be adjusted accordingly. SCHOOL DISTRICT DEVELOPER IMPACT FEE • CERTIFICATE OF COMPLIANCE The authorized representative of the Fremont Union High School District has reviewed the City of (�I.I0-4 Building Permit Request described above and hereby certifies that the developer or authorized representative has met the requirements of the District's Developer Impact Fee requirements. Dated:7L4Ai o2 9 /795 By.� 4.tc,r_21-e--/ Fremont Union High School District '- 5, � •. Authorized Representative yy�`t rid W I •, Certificate notvalid without District Seal,Initial,and Hati- -r1 Fee$ / 7. Facilities Planning--White ' City-- Yellow Requester--Pink Accounting--Gold wA,-i !)tt . Cupertino Union School District • 3889_ 10301 Vista Drive (408) 252-3000 Cupertino, CA 95014 Developer .1 •trona ct Fee Compliance . The Cupertino Union School District has adopted Resolution Nos. 1403 and 1404, imposing developer impact fees pursuant to Government Code 53080. - Building Permit Request The City of ('-ute(11/ N o has received a request for a Building Permit described as . follows: -Residential Development Project Commercial/Industrial Development Project Name of Developer: C;1Attorll 11 oene3 1CQAil 2AL �o 350 62, 76, 86, gs 73, 6t Y9 37, /� Project Address: I 14; / O410 t,tie) • Lot/Parcel #:9,10,t/. (2. ,2 3,a a5,..26 Square Footage: / 9, 87 9 Description: Permit #:427&2 -)7d2,/, 27.206, -278a6,.278a7, a lfid?j 271St'? 27830, 2 713/ Date: c,—)-q—CkS By: �e-"` • • City Authorized Representative Square footage will be verified by the city prior to issuance of a buidling permit;fees may be adjusted accordingly. • SCHOOL DISTRICT DEVELOPER IMPACT FEE CERTIFICATE OE COMPLIANCE The authorized representative of the Cupertino Union School District has reviewed the City of 1�/t�.t�4 ( / Y) 'Building':Feltinkt Request described above_and/hereby certifies that the developer or authorized representative has -. , ' 2.1met the requirements of the District's Developer Impact Fee requirements. Dated: =� =I (J I ' �. . . } Authorized Representative Cupertino Union School District ` .,. c • Certificate not valid,without 7 , 41' 41 District Seal, Initial, and Date Fee X18�i/ _ Facilities Planning— White City— Yellow Re uesfor— Pink Accounting — Gold .p VIA PORTOFINO 42.29- • . o v_ °° $�.2 . . — i .0• 1i• 5r. PLAN 3 LA 1 • 9 I I I I 5T.F 107.7 3.0 ,., It Zo4.9 4 tOcc; - �N 1 1 J ,#-� a �"•32� A* � x MMR 2 9 1995 i_. BLDG. INSPECTION o�r�°� � ENT.. 1 OFFICE ]IY 11 1 1 1 1 _ TRACT No. 8686 LOT C� 00�3011C of by • 9 0 0aatI01100 CITATION HOMES CUPERTINO CALIF. ACME 1'.20' DAIS: JAN 1995 pcw.NO: 15236-1 TNS pbl r plan.br tM pwo..or.towing 1b gp neral txatoo of llr row low cor.trua.e on lbs a ane tM dr.ction or.urlaa wal.r erawpa oe 1M la all%minimum pro assumed S.ib.d.at.r Orn mivmwn oreinanc rpuir.mara an app.oaimata Dory and must not W aswm.e conga TM-as•but ball condition ril vary from this plan. VIA PORTOFINO t04., 10, pU • • • •• 0 r-- '--- rJr . i • 5 PLAN -•-Q- • 2L0 o o `- 1 10 1o;io 51 7.f zoai t>< t za7O 5' 5 win �_ * 1fz 42.32' l'\ LOT COO 1°30IICA at TRACT No. 8686 by • 10 1 O�°ff0at0 CITATION HOMES CUPERTINO • CALIF, SCALE: 1'.20' t DATE: JAN 1995 P20.1.NO: 15236-1 This plot l ratan la br dr purpose of shortly the general beaten of the house to he constipated,on the hot and the direction of suc. ta wales drainage oil the tat at 1%minimum gradient per any standards Setbacks other than minimum ordnance r.rpnm.nl are approximate only and MAI not b.assumed correct TM'as-burr field condlian will vary from flit plan • VIA PORTOFINO • . E _zon /0' p1 co rr ,7J� 1 � �. �.Q'J - - ` TLWb r-- 1 `---- 5' 11 5 r i—. I PLAN - . I ul2LB • 1 N CO • LI") 3.O' , I 1_ i co 5 r ZaB.5 —•••• o, 8 5' ..#so7.� 5' co of a.. 0 tifil_° to76 42 , 1D�• - 96 ,1ca ir N LOT i©02,t11©& aA TRACT No. 8686 by • 11 P 0 21' 00 0 CITATION HOMES CUPERTINO CALIF scnI: 1•-20' DAM JAN 1995 plOJ.NO: 15236-1 This plot/plan S br the paryose of showing the general locuon of the house to be constructed on the M and the Bracton of solace water drainage of to Id a11%minimum gradient per city standards Setbacks other than minimum ordinance requirement are • ' approximate only arid must not be assumed cont The•a,•but 1410 condition will vary horn this plan. • VIA PORTOFINO x'207,3 • 0 . 6 • , . r`_ wap -. + /O a ? ___ 0- 1.0r — ?D/1 03 _ -----^ • ' +sowo 1.0' 5 PLAN - �-. 3 LC �' 4 • 30r1• 1 ' 23Jcv cl 5 .01 0 ..: ,.,,,,. •-1- ► - t 43 73, ri N LOT ©© 3mCA nA TRACT No. 8686 by • 12 D 0 MIC0ME0 CITATION HOMES CUPERTINO CALIF. unto: t'.20' DAT[: JAN 1995 PROJ.NO: 15236.1 This plot l plan w br rha propos,M sb.wiq tM g0arsral location of tha Pious,ro b.carstruns0 on lM lot and tha dirac lot,of sutac. walar dranagotfrha lot al 5% mum no posnt par citystandae-assabaas olhr thannwilvn Iromda plan' ata as approximate only and must riot b.assumed oorract mi .but field caMri+n wit vary from Ova plan. • • • \ .4944461 in 'o)*. . ,,,,,,•-• ` in 6' Y zoa.8 3 P • 1 22R . 3 P LAN j . 3B COill ._ OCO • *2070 1 ?\.±:i... 2c1',y I /O e P 1N ''c .y E • 44•/81 . .48.77 T G • VIA POROFINO LOT co {3m al TRACT No. 8686 0 22 c 0RI 0 CITATION HOMES CUPERTINO CALIF. SCALE: 1 20' l DATE: JAN. 1995 PROJ.NO: 15236-1 TN,plot/plan is br the purpose of showing Vowel location of thi Neuss to be constructed on the lot and the direction of*Waco water drainage off the lot at 1 14 minimum g,adsnt per city standards.Setbacks ether Men minimum ordinance requirement use approximate only and must rot lows assumed correct The'as-but ltd condtin will vary horn ins plan. • 10),61€ r +ld' + x 7_, s.f6. *CD 2.0 4 3' � 'rev ��_ in _. I * A N ' , I L. 2o7.c. 5 :� 1 I Tf sag,3 3. =rn 6' x _x r 23x 6 ick to 4.4. PLAN I ' 2A N -- co • 1},691 L--- 5' 6 • 0a 10. P •ao • sal" tivE � N 7. f8.71• .. EIrE _ - ' 25.37•. : • VIA POROFINO LOT Co 00L°3t8c& as TRACT No. 8686 by 0 23 POO ° l0psan0 CITATION HOMES CUPERTINO CALIF sine 1'-2O' DAM JAN. 1995 .ROJ.NO: 15236-1 . TNs plot I plan'slortt.purposed.lowing II.aaemral location al the house to be corstr d.ontha b and de diramlonof s rtace waur dra'papp oil tM bl al t%mirimum prad.nl per city staMarb.5eroads L tr than miimum€Gonanes rran'aam.m are - approaimat.only and must r.l b usumed carrot me ss•but IL condaon wit vary born this plan. •i • •I-- 2fj$435gi �. .rnf �� 0 :"� C; 1. c Y zoc.7 3 6' T.fen7 1 24 ci PLAN ! 2 B M • 6. 4- • tots ---- 5'.___ N N .Y"'� �- . t 2.0S6 r''••i•••...... . CC:- 1p% PUE. N . a • ••-41t ` 4 r • :4"3-69' 'E oma; �z 1aso VIA POROFINO LOT. C� u:oacca at TRACT No. 8686 by • 24 ° O2:`� oOTLS11V0 CITATION HOMES CUPERTINO CALIF. SCALE: 1'.20' DAZE: JAN. 1995 PROJ.NO: 15236.1 Tbia plotI pun abr the purees*al ahavigl.y{�anerah Mwion of the house lo be conic t.E on to lot and the direction of audaw water dabepa off the hal at 1X minimum padiem pe,dry atarWraa.Setbacks other than minimum ordnance rpuiemed are approximate only and must rot bbea aaaumed COMM The aa-bur Ietl condition mil vary from Ria plan. • • • rn r� •N4.f 41.25' 2 N 5 1 1 oto >` - 1 welt i. 1 r: 6' .4204.•5 1 I 77�20Z2 I 7, I 5' • 25 4 PLAN L . M co 3D co co _ 5' ..610 2,06, 5, 1 yp • 5' '�° O _ -CIO' PU.t tN O . 01 co • 47.4 ' S W.E. renews VIA PORTOFINOIli LOT © 00 31311CA ail TRACT No. 8686 by • 25 0 02°CI' 00Litan CITATION HOMES CUPERTINO CALIF SCALE 1'.20' OATS: JAN 1995 PROJ•NO: 15236-1 • THe plod pian's br the puw poss of sheicl the general bcation 011110 11011.0 to constnooM lotted on It and on Oranion of suttee* wale drarupe oft the lot at 1%minimum yadem per city standards.Setbacks other than minimum maniacs rpu smart ate approximate only and must root be assumed correct The Eur tsb concision will vary from this plan. • • 23.08 a _ n 27.15' +y I t) O to n 4- to zo57 `- ,a5.o5, Z7 5' 7W.2.06.6, 13' 2 w LI\ . We to m PL co 1 LC 4 0 • 5' D Can ^/� -a__ 5, 4111 13'13' V J + „ . j 0 0 r 04 tet, . . : :30.87' . ': • 1'9 rac.444, racy,..) N VIA POROFINO 1 LOT COO I UCA ak TRACT No. 8686 by • 26 POD:le©Mai© CITATION HOMES CUPERTINO CALIF. suit: 1'•20' 0A11: JAN. 1995 PROJ.NO: 15236-1 TEis plot?plan's lot the purpow of abwmg the yyenenl location of the touw to he corwtructatl on IM b and the OirMion of t:a"water drawpsollthe lot at 1%minimum amass par pity atardarsa.SnhediI other Ifun miNmumy Sam lit plan. atare approximate ooy and must not Ca assumed correct TM•as-Eur fltl eondton dl vary from lit plan. • 7, TRACT NUMBER PLEASE TYPE OR PRINT HEAVILY- YOU GET THE LAST COPY County of Santa Clara Current Planning Office 70 W.Hedding St.,San Jose,CA 95110 Phone:299-2454 See Instructions Below 1. Location of Tract 2. Proposed Tract Name • 5IF OcRa Fbrng-s rim /2z)..• • Da AA)217 aBuiD -r-- 3; Number of Lots & Units ' 4. Approximate Acreage 5'. Date'of Planning Commission' /// / /"i SS t Approval of Tenative Map 6. Owner's Name LISS* Owner's Address C i m no u 1-lam Es Ceu rtatiL lei SaarnccrA AU) 9E7E7, e $ tj TP C.Ati4 8. Engineer's Name : 9. Engineer's Address and Phone Number 995-696.0 1i)AGKA-L/ a .3?)rP5 1955 SIE Au.-Mit 40,¢ 3/Mi JOKE 9siz4v 10. Is the Proposed Tract in 11. Is the Tract Proposed 12. If the answer to 10 or 11 is an incorpora(ed City? for Annexation? yes, What City?�U� ��A '^ Yes �( No Yes No /,[ 13. Remarks: ' • • INSTRUCTIONS FOR COMPLETING TRACT NUMBER REQUEST FORM: 1. Existing frontage and intersecting adjacent streets or reference to existing tract limits. 2. If unknown, so state. Name must be provided prior to recordation if name is to be used. 3. Self explanatory. 5. The tract number will be issued only after the Tentative Map has been approved by the Planning Commission. 6. through 12. Self explanatory. 13. For additional comments by private engineer/surveyor. NOTES: l ' - 1. .Enclose copy of approved Tentative Map. 2. The form shall be filled out and the gold copy retained by the engineer. 3. All other copies must be forwarded to Current Planning Office, 70 W. Hedding St., San Jose 95110 4. Where development involves more than one unit, submit a separate Tract Number Request for each unit. 5.--Traet•Nv - • .- - ren ewaLbas.raoLbean.raceivedr 6. A request for renewal shall be in writing and shall include the date of the re-approval or extension and the length of time for such extension 7. The assign number is not transferable, except upon written re-application. 8. Enclose $ issuance fee. TRACT NUMB R ASSIGNED: This space for machine validation - oQt(/(J& REQUEST CO LETS BY DATE rC1/ /� -f/ 10/11/94 1:s4 ooin9772 Routing ' White - Land Development Coordinator 1RRCT 61 1SSURM1GE4U.UU Green - Owner's Engineer Canary - Planning Commission Pink - City Engineer Goldenrod - Owner's Engineer (Preliminary Copy) 56240 REV 8/88 ' , • TRACT NUMBER PLEASE TYPE OR PRINT HEAVILY - YOU GET THE LAST COPY County of Santa Clara Current Planning Office • 70 W.Hedding St.,San Jose,CA 95110 Phone:299-2454 See Instructions Below 1. Location of Tract2. Proposed Tract.Name - . - Sig. 00E002. f n re:Ab gib, $ Li p/Jz,9 &vb. , . 3. Number of Lots & Units 4. Approximate Acreage 5., Date of Planning Commission 10 S ZS ,f Approval of Tenative Map ' 6. Owner's Name /n� 7. Owner's Address C i?Pfl ) l-/OJYIr,�,'`<:-gAI7eRL /log S4earzs4 Av;;SUIT:/b SEA-7779 ant 8. Engineer's Name ' -- 9. Engineer's Address and Phone Number 9 09AD n(in 4klq 4 -.5mip3 055 77/E r1LArn5M SW Ms- 95/az 10. Is the Proposed Tract in 11. Is the Tract Proposed 12. If the answer to 10 or 11 is an incorporat d City? for Annexation? yes, What City? // - -Yes' .No-- • _.., ,.- . .- 'Yes-: :'. , No-y.-:, . . . .._ ;{;U vitiQ 13. Remarks: C . • - i INSTRUCTIONS FOR COMPLETING TRACT NUMBER REQUEST FORM: . , 1. -Existing frontage and intersecting adjacent streets or reference to wasting tract limits: • 2. If unknown, so state. Name must be provided prior to recordation if name is to be used. 3. Self explanatory. . 5. The tract number will be issued Only after the Tentative Map has been approved by the Planning Commission. 6. through 12. Self explanatory. 13. For additional comments by private engineer/surveyor. NOTES: 4. 1. Enclose copy of approved Tentative Map. 2. The form shall be filled out and the gold copy retained by the engineer. 3. All other copies must be forwarded to Current Planning Office, 70 W. Hedding St., San Jose 95110 4. Where development-involIves more than one-unit;submit a separate Tract Number Request for each unit. 5,-4re • . -. • o 'om e•a eo issuean• r-qv-- ' r, reraewa I-hes-not-been-ceeeiuede 6. A request for renewal shall be in writing and shall include the date of the re-approval or extension and the length of time for such extension 7. The assigne number is not transferable,except upon written re-application. 8. Enclose $ issuance fee.. • TRACT N M ER,ASSIGNED: This space for macthine validai�pndPP) 6-109772 A , / 'a6I� • TRACT +i rsst>mricEaa.f n ' REQUEST COw1PLET BY DATE , •J . , Routing White - • Land Development Coordinator . Green Owner's Engineer Canary - Planning Commission Pink - City Engineer Goldenrod - Owner's Engineer (Preliminary Copy) ®6240 REV 8/813