11060203 CITY OF CUPERTINO BUILDING PERMIT
[it H,DING ADDRESS:7902 FESTIVAL CT CON'7"RACfOR:KALLURI ESWAR PERMIT NO:11060203
OWNBR'S NASIE:KALLURI ESWAR DATE ISSUED:06/24/2011
OafNLICS PHO.NE::4089961517 CUPERTINO CA, 95014-4115 PHONE NO:
❑ LICENSED CON'FR$CI'OR'S DECLARATION'
BUILDING PERMIT INFO: BLDG r ELECT r PLCMB r
License Class Lie.u r r r
iRFSIDEN'1'IAL COMMERCIAL
(tnnraemr Date
hereby affirm that l am licensed under the provisions of Chapter 9 30BDESCRIPTION. REMODLL(2)EA I HROOMS 160 SQ FT WITH ALL NEW
(commencing with Section 7000)of Division 3 of the Business&Professions FIXTURES(REPLACL 7"UD W/SIIOWER ENCLOSURE IN HALT.
Code and That in,license is in full force and effect. RA NI RM)NON-S IRUCI'URAL
I hereby affirm under penalty of perjury one of the following two declarations:
I hill-and will maintain a ecnificme of consent to self-insure for Worker',
C'ompensu0on.es provided for by Section 3700 ufthe labor Code,for the
Nitro mute of work for which this permit is issued. Sq.Ft Floor Area: Valuation:$50000
I have and wdl r-ounin Workcr s Compensation Insurance,ns provided for by
s.cno,i 3-110 of the Labor Code Will performance oflhe work tier which this
I+inn,t s,.sued Al Number:36213018.00 Occupancy Type:
APPLICANT CER'ri FICA LION
I ccrwj that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correcbuil 1 g o,ccon to comply and
h all city and county ordinances and state Taws 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+ROM LAST CALLED INSPEC ION
l li d keep harmless the City of Cupemno against liabilities,judgments, ,//
t ,it ,p l nay accrue againsl said City in consequence of the
t t this permit Additional ly,the applicant understands and will comply Issued by: Date:
s d,If non poi t ,ur-e regulations per the Cupertino Municipal Code,Section "'F7
918
Suuoaure DateRE-ROOFS:
All roofs shall be inspected prior to any muting material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materals fur
PK OWNER-BL7LDER DECLARATION inspection
I lv-chy affirm that 1 am eserni from the Contractor's luceose Law furone of Signature of Applicant_ Date
the lulinwi 01 two
woftile
reaconc: ALL ROOF'COVERINGS IT),BE CLASS"A"OR BETI"ER
I.as oner thm
e ppertr.or my employees with wages as their sole compensation.
will du the work,and the structure is not intended or offered for sale(Sem 7044,
13usinese&Professions Code)
I.as o r of the propeny.am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
nnstruaclhe pruiect(51147044.Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
I hrreM affirm under penalty of California Heallh&Safety Code,Sections 25505,25533,end 25534.1 will
p perjure one of the following three ai'Win compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarali�ns: Health&Safety Code,Section 15532(a)should 1 store or handle hazardous
•have and will maintain a Certi icate of Consent to self-insure for Worker's material.Additionally,should 1 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 1
perlimnanee 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 the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
pernm is issued Owner or authorized agent: KFIf4 YZLX — Date:_662 00h,
I aroh that to the performance of the work for which this permit is issued,I shall
not empluvany pars m m ane manner so as to become subject,,the Worker's
Compenu0un laws of Cal,
I mia. II:alter making this certificate ofexempoon.I CONSTRICTION LIE AGENCY
hecaru•fubdect In the Worker's Compensation provisions of the Labor Code,I must hereby affirm that there is a construction lending agency for the perfornanee of
ford,villi comply with such provisions or this permit shall be deemed revokedwork's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICAN-I-CURT I PICA1'ION Lender's Address _
I antis that I have read do,applo.enum and state that the above information is
' to comply wuh all cay and county odu unce,and state laws relating
t,huddmga-rueu s uclion,and hereby authorize repos.entanve,of this ate w enter
upon the ubuvc uncultured property for luspecnon purposes.(We)agree to save
indenuulj and keep harmless dte City of Cupertino against liabilities,judgments, :ARCHITECT'S DECLARATION
osts.and expenses which mal accrue against said City in consequence of the I understand my plans shall be used as public records.
nmOng of this permit.Additionally,the applicant understands and will comply
.iib sll non-point source regulations per the Cupertino Municipal Code,.Section Licensed professional
9 Ix
Signature_/�($;� Date -I
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Elk: Lot:
APN ... .....: 36213018.00
DATE ISSUED... ... .: 06/24/2011
RECEIPT #. .... .. . .: BS000013884
REFERENCE ID # . . .: 11060203
SITE ADDRESS ... . .: 7902 FESTIVAL CT
SUBDIVISION . . .. . ..
CITY CUPERTINO
IMPACT AREA . . .. . ..
OWNER . ...... ... . .: KALLURI ESWAR
ADDRESS ..... ... . .:
CITY/STATE/ZiP . . .: CUPERTINO CA, 95014-4115
RECEIVED FROM .. . .: KALLURI ESWAR
CONTRACTOR .. ... . .: LIC # *OWNER*
COMPANY ..... ... ..: KALLURI ESWAR
ADDRESS ..... ... . .:
CITY/STATE/ZIP . . .: CUPERTINO CA, 95014-4115
TELEPHONE ... ... . .:
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
----- ------------- ---------- ---------- -- - - ----------
1BCBSC VALUATION 50,000.00 2.00 0.00 2.00 0.00
1BSEISMICR VALUATION 50,000.00 5.00 0.00 5.00 0.00
1REMRESBAT SQ FEET 1.00 570.00 0.00 570.00 0.00
1S'TPLNCK HOURS 1.00 126.00 0.00 126.00 0.00
TOTAL PERMIT 703.00 0.00 703.00 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
------------ ----- --------------- ------ ------
CHECK 703.00 1581
---------------
TOTAL RECEIPT 703.00
OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT"BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228"FAX(408)777-3333"building5cuoertinoora
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
Sn'E ADDRESS
7902 FrsTtJAu cT APN36.2-13_018-00 BP#
OWNER NAME KALLuRL IESWA OWNER ADDRESS 7902 FESTIVAL C?-
DESCRIPTION
rDESCRIPTION OF WORK: T W U g A-(j-{ kC)tj MS R EM obtL
We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We
will not issue a building permit until you have read,Initialed your understanding of each provision,signed,and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you,the property owner,obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.)
A-1.I understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner-
Builder"building permit that erroneously implies that the property owner is providing his or her own labor and material
personally.I,as an Owner-Builder,may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowners insurance may not
provide coverage for those injuries.I am willfully acting as an Owner-Builder and am aware of the limits of my
insurance coverage for injuries to workers on my property.
2.I understand building permits are not required to be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contractor to assume this responsibility.
_�_3.1 understand as an"Owner-Builder"I am the responsible party of record on the permit.I understand that I may
protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
name instead of my own.
__� 4.1 understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
5.1 understand if I employ or otherwise engage any persons,other than California licensed Contractors,and the
total value of my construction is at least five hundred dollars($500),including labor and materials,I may be
considered an"employer"under state and federal law.
6.1 understand if I am considered an"employer"under state and federal law,I must register with the state and
federal government,withhold payroll taxes,provide workers'compensation disability insurance,and contribute to
unemployment compensation for each"employee."I also understand my failure to abide by these laws may subject
me to serious financial risk.
Ik 7.1 understand under California Contractors'State License Law,an Owner-Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale,unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year,or all of the work
is performed under contract with a licensed general building Contractor.
_8.1 understand as an Owner-Builder if I sell the property for which this permit is issued,I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction
defects in the workmanship or materials.
0wnerBuilderForm_2010.doc revised 04/14/10
r 9.1 understand I may obtain more information regarding my obligations as an"employer'from the Internal
Revenue Service,the United States Small Business Administration,the California Department of Benefit Payments,
and the California Division of Industrial Accidents.I also understand I may contact the California Contractors'State
License Board(CSLB)at 1-800-321-CSLB(2752)or www.csib.ca.gov for more information about licensed
contractors.
10.1 am aware of and consent to an Owner-Builder building permit applied for in my name,and understand that I
am the party legally and financially responsible for proposed construction activity at the site address listed above.
_L11.1 agree that,as the party legally and financially responsible for this proposed construction activity,I will abide
by all applicable laws and requirements that govem Owner-Builders as well as employers.
�12.1 agree to notify the issuer of this form immediately of any additions,deletions,or changes to any of the
information I have provided on this form.Licensed contractors are regulated by laws designed to protect the public.If
you contract with someone who does not have a license,the Contractors'Stale License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint.Your only remedy against unlicensed
Contractors may be in civil court.It is also important for you to understand that if an unlicensed Contractor or
employee of that individual or fine is injured while working on your property,you may be held liable for damages.If
you obtain a permit as Owner-Builder and wish to hire Contractors,you will be responsible for verifying whether or not
those Contractors are properly licensed and the status of their workers'compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECT/ONS:Please complete the following construction lending agency information.)
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name: Lender Address:
Before a building permit can be issued,this form must be completed and signed by the property owner and
returned to the agency responsible for Issuing the permit. Note:A copy of the property owner's drivers license,
form notarization,or other verification acceptable to the city maybe required to be presented when the permit is issued
to verify the property owners si nat r.
Property Owner's Signature: rMl Rat- 6 2� 20 /
----------- ---- - ----- -------- ---- ------------------------------------------- ---i----- ----- ---- -- -- ---------------
(NOTE: The following Authorization Form is required to be comp/eted by the propertyowner only when designating an
agent of the property owner to apply for a construction permit for the Owner-Budder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner,the execution of which I understand is my personal responsibility,I hereby
authorize the following person(s)to act as my agent(s)to apply for,sign,and file the documents necessary to obtain an
Owner-Builder Permit for my project.
Scope of Construction Project(or Description of Work):
Project Location or Address:
Name of Authorized Agent: Tel No
Address of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy.Note:A copy of the property owners driver's license,form notarization,or other
verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's
signature.
Property Owner's Signature: Date:
0w .,B.h'd,Form 2010.doc revised0494/10
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS:7902 festival ct. DATE: 06/24/2011 REVIEWED BY: bobs.
APN: BP#: 'VALUATION: 1$50,000
"PERMIT TYPE: Building Permit PLAN I.ECK TYPE: Alteration/Repair
PRIMARY SFD or Duplex PENTAMATION
USE: PERMIT'I'YPE:
WORK remodel 2 bathrooms non structural.
SCOPE
r ED
NOTE:These ees are based on the preliminary ire(ornmtion available and are oniv,an estimate. Contact the De t or addn'l info,
FEE ITEMS Le Resolution 09-051 Fff?l 10) FEE QTY/FEE I MISC ITEMS
Plan Check Fee: Hourly Only? O Yes (E)No $0.001�hours Plan Check,Hourly
Suppl.PC Fee: O Reg. OOT"00 $0.00 $126.00 ISTPLNCK
PME Plan Check: $0.00 F160 s.f Remodel,Bath(r--300 sf)
Permit Fee: $0.00 $570.00IT, IsBAT
Suppl.Insp.Feer Reg. OOT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Acoustical Fee: O Yes (E)No $0.00 O
Work Without Permit? ()Yes 0 No $0.00
Planning-Fee: $0.00 Select a Non-Residential Q
Building or Structure O
Strone Motion Pee: IBSEISMICR $5.00 Select an Administrative Item
Bide Stds Commission Fee: IBCBSC $2.00
SUBTOTALS: $7.00 $696.001 TOTAL FEE: $703.00
Revised:04/2912011
PROJECT DATA-RESIDENTIAL
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
tUPEftT1N0 (408)777-3228-FAX(408)777-3333•buildina(dcunertino oro
PROJECT ADDRESS 7'10,)
90,) F E S T I V-A L C r APN q
OWNER NAME PHONE
KALLURI C'—WAR 4t7g-qq6-151 col-eash.��o Ynn �.m
STREET ADDRESS CITY,STATE,Zn' FAX
Gut ESTI✓hL Cf cvPeP-- Irvc> cA R50(4
APPLICANT NAMEPHONE E-tn��
KA,LLOR I .^y,b
F S�+AQ D 5-996 -1517 cnl.eav�•2t7Co J
STREET ADDRESS CITY,STATE,ZIP FAX
902 s7 L Cr c✓?cR7LA(a cA 9501
❑ON'�It 1�r OW!(hA-RDLLDER ❑OwNERwGEM ❑CONTRACroR ❑CONiRACIOR AGEM ❑ ARQRTEt.T [3, ❑DEVELOPER ❑JENAW
pPscrrtex[creJSHittFe.
u'.
EXISTING USE(S): PROPOSED USE(S):
Resi�tn,—r1�7, _Sf=� RE51i)tivrL/kL
OCCUPANCY(S): TYPE OF �rtt PARCEL
CONSTRUCTIOAREA 17 J S
FIRE
SPRINKLERS. Y N RTII AREA: Y N FLOOD AREA Y N SIESNEC AREA: Y N
Existine Proposed
Floor Area: First Floor: s.f. SX..
Second Floor: s.f s.f. —_
Garage � ---51.. / _._s.f '
TOTAL: 81. s.f.
Are there at least two 10 feet by 20 feet clear spaces inside the garage? Y N
Is privacy protection planting required for the project? y N
Governing Codes: 2010 California Building Code(based on the 2009 International Building Code) C'y;
2010 California Residential Code(based on the 2009 International Residential Code)
2010 California Plumbing Code(based on the 2009 Uniform Plumbing Code) �-
2010 California Mechanical Code(based on the 2009 Uniform Mechanical Code)
2010 California Electrical Cod8Qg1d itiIRM Code)
2010 California Energy Code BUILDING DIVISION-C UPERTINO
2010 California Green Building StandardAOVED
Cupertino Municipal%Ie
s set of plans and specifications MUST be keit at the
Job site during construction. It is unlawful to make any
changes or alterations on same,or to deviate
therefrom,without approval from the Building Official.
The stamping of this plan and specificatlons SHALL NOT
be held to perrnH or to be an approval of the violation
Of any PrOVIa1011a Of arty City Ordinance oeMWq2Wes&endal-doc revised 03109111
DATE Z `+—
PFQRa'r Nfl O z-
r.OM106NITY DEVELOPMENT DFPARTMENT
BUILDING DIVISION-CUPERTINO
1 <s sP M APPROVED
This set of plans and specifications MUST be kept at the
job cite dcrkng construction. It is urlawful to ma:<e any
chanyes or alterations on same,or to dev,-'e
from the Building Of;!cial.
............................................................ therefrom without approval
i 8 2 Tho stamping of this plan and s"p*e*c ific ations SHALL NOT
„ , the viol tion
ce r State Lnw.
reverse wet wa I
New soffit 4A
/ ATE mail Q
7 PERM
5' _
N. me
11VQL5 Shower
relocate WC rated Fan Light
s"+- dimmer
se �\
FI
5• /
W.
Dimmer —�
relocate WC
6"+- Panasonic FV-
11 VQL5 Shower
rated Fan Light
Now soffit at7' Mst Bath
reverse wet wall
34" Min.22"Shower door Temp Glass
Kalluri Eswar
Do Not Scale
7902 Festival Ct Cpt 6/22/11 ;
996- 1517
COMMurf rr P; r-
BUILDING[)rd'.- -i]J..,I�I j
APrP. VT7j_)
This set of plans a[td sp rific.'; ,^iiI �T�: F
job site qtr.-inj construc i, it
cr:an
ya5 Or 8+P,ry O 'Un or[1
therefrom,w',houf app cv al frrrrn n Bu i i,
Soffit Framing Notes
The stemping of this p,an and spa,-'h^atione S";;.!
be held:o errni -11-4
-r�
of any pro .1
of an f tY,e
BY th
l L-
DA
f _.
1 X11" t PEPMI§6fri4 Cram
2 x 4 Ledger 3 sides 7'above
1 i tFloor
1
2 x 4 at face and on each side
5' AN t of fan 11"apart
0 (E)8'Ceiling to remain
4
1
5'1
1 Fan
1 soffit-Framing
2 x 4 Ledger 3 sides 7'above floo
or 12"below(E)8'ceiling
2 x 4 at face and on each side of
fan 11"apart
(E)8'ceiling to remain
P 1141
Master bath
M
Kalluri Eswar
7902 Festival Ct Cpt
996- 1517 6122/11
�7v2— I, s
rotif-
Sc��
9"deep
0'
22" �
S
J77
Aseat
30..
ZQ),CG p A
HALL BATH `ra '
This se1 CUPc PARoI�tNT
t q`�_
io.,;; lq� APPP,
r/,or,,h..:d� at'hue oh° ns S �a
er to, bo It T `
e�d.t of ih.sr
approval/,om yelBr to/ LkePt a�^she i
�f .,
a, 9 It orpabead specifioatiIc" Uilai�91, x:71.
SSI anY City0",�3nCe°rIS`N�,II,:v,' ,-
...dri I:0
9"Deep
30"
soap
22"
Ram
o
F-1 1 32"
L--j
IF ZZZZZZZZZZ�
ti�ss
371.7%;N- 30"
77s
MASTER BATH CMML�NITY DEVELOPMENT DEPARTMENT 6122/11
BU LDING DIVISION-CUPERTINO
APPROVED
T', 3 ao.d specifications MUST be kept at the e.
Or,--j:ie,or to deviate
q',t 3,,P,6',-If fle,i i the Building Official,
Thic'Pirati,esSHALL NOT
he ho! toPeTlt-' t(;J(,,r.apr!t',,Ya'ofthe v:o!,ition
of any provis;.ns of any City Ordinance or State Law.
BY
DATE
PERMIT NO.
CONSTRUCTION PERMIT APPLICATION
2 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
C (408)777-3228-FAX(408)777-3333•buildinaCad7cuoertino ora
❑NEW CONSTRUCTION ❑AUDI"I'10N IC—XCTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERM T a I I vim P O C�7
�O
PROIEC ADDRESS 7"102 F O S7I VA` CTT APNp 3 62- 13 -019-00
OWNER NAME k A L l U R I E s W A
P"°'•`E409- 196-/517 Et� Zeoo@il.�.
STREET ADDRESS
1 9O 2 FE S T J.Vit L C 7 crrv,STATE,sz, FAX
C� ERTjNo Ch 45 0I1-1-
CGMACT
STREET ADDRESS CITY,STAT£,LtP FAX
awtmt lx owNER-altl.nEa ❑OwNERAmvr CONTRACTOR ❑(70r CroaA T ❑ ARanTBcr ❑ENGnlIDt ❑oEYE10PER ❑rENANr
CONTRACTOR NA LICENSE NUhIBER- SET
Q f BUS.LIC M
C(1IR1S C�4RvALNO 52� `11 g, ' IVT IVY-
CONn'.ANY NAME E-MAQ,
f'KC-Stl(tIE RE�OpELiNG llvC. Chr�SaP�.(Ores�'� eC--cypl.cor,.t FAX
STasu r nDoaess S I}�� M c K E E R 0.• CITY.STATE,ZIP SRN J-0-SE, CA 4 51 L7 PHONE
4-uS--272 -063S
ARCHITEC[BNGINEER LAAME LICENSE—ER BUS.LIC k
COh1PANY NAME E-MAB, FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK R t D t7 TiAlO T O L L 3 A'T H
R0oMS W11 AL-l. NL-yv FTXTU42t5, INCLVOES
9(-PLACU_MENT OF 7V0 1N HALL 6ATH W11H SHOWIrR L(V.LDsuRE NO ADD771M_5.
E)IS D,GuSE PROPOS®ISE co—TYPE aSTORffS
REsr DENT CRL RESSDIFNTLAL (2Efnox)D-i.
1 .
FXlsrc l NEw mnoR DEMO Tar_ 15 r 3 cf
AREA 1Sf� �T AREA 1513 i{ AREA "/a NEI AREA
BATHROOM KrTCHEN O'rF3E¢ l >. ya . �.
REMODEL AREA 160 s f xsto0¢AReA hone REMo'm AREA ^u n e
PORCH VIEA DECKAREA TOT_DECK/PORWAREw GARAGE AaEw:❑DErwCH ,.: ' ,{cz', 4x'a
- ❑ATTACH � 'E -h
aDN'ELLNn nNna:1 ®ABLCRI'O UNIT ❑T6 ❑yga ,'S'r�� � a:�'
PREnPN.u'wnoN ❑Y[a 1NNFaa xwea nx 'bk.*•s
PLAtaiWa APPLa n.MMWO APPRO�YLEfTEa •F ,�...
Whigg
By my m sig ure below,I ce fy m each of he following: I am he property owner or autho ed agent mat on the property owner's behalf I have read this
application and the mforristien I have provided is correct I have read the Description of Work and verify it s accu [e.I agme ro comply wrth all applicable local
ordinances and smote laws relating m,building ec-on�struc[Io`rL I au�thori�ze�reoresrn�nves Of Cutxrtino to enter the ahn /fie nfied oroDertv for--b-
Signal=
o�unoses.
Signature of appliranUAgenr._ Chrt.l.e't7 --- 6/2 L}/2 Fj r/
SUPPLEMENTAL INFORMATION REQUIRED t'n ��:" -�
_New SFD or Multifamily dwellings:Apply for demolition permit for a t+nv a C a p$1 '#'°�2+R 1 r fi.�.
existing buihlmg(s).Demolition permit is required prior to issuance of buildin w r �� �
permit for
CottimerGial Bldgs:Provide a completed Hazardous Materials Disclosure ♦ 9'LAl/DhRD Y pdg't:,9`µ.Djtgg,.
form if any Hazardous Materials are being used as part of this project. =`
CO ofPlannin A sNtcR t r s`,1'TM*r=te '�:
PY 8 Approval Letter or Meeting with Planing prior to aurum-' Lr'Sewgxn;
submittal of Building Permit application.
v. amsan`sAia6,[sxm"`
BldgApp_201 Ldac revised 03116111