Loading...
12010082 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21311 COLUMBUS AVE CONTRACTOR: PERMIT NO: 12010082 OWNER'S NAME: ROBERT PRANTIS -P& AID GC t< DATE ISSUED:01/11/2012 OWNER'S PHONE: 4084462129 5'� j G� PHONE NO: LICENSED CONTRACTOR'S DECLARATION License Class Lic.# �I lD2y BUILDING PERMIT INFO: BLDG ELECT PLUMB MECH F RESIDENTIAL� COMMERCIAL Contractor s M0 N �ML CA)NS7-• Date -P— I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMODEL KITCHEN(300SQFT);NON-STRUCTURAL (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 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$80000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36205033.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by: _ Date: 1-­�—//� Signature QX Date I It-/2 ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material berg installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner oized agent: - Z become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of wrk's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36205033 . 00 DATE ISSUED. . . . . . . : 01/11/2012 RECEIPT #. . . . . . . . . : BS000015733 REFERENCE ID # . . . : 12010082 SITE ADDRESS . . . . . : 21311 COLUMBUS AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ROBERT PRANTIS ADDRESS . . . . . . . . . . : 21311 COLUMBUS AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JONATHAN F HERRERA CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 80, 000. 00 4 . 00 0. 00 4 .00 0.00 1BSEISMICR VALUATION 80, 000 .00 8.00 0. 00 8.00 0.00 1REMRESKIT SQ FEET 300 .00 588 . 00 0. 00 588.00 0. 00 ---------- ---------- ---------- --------- TOTAL PERMIT 600. 00 0. 00 600.00 0. 00 o Y'.2, CONSTRUCTION PERMIT APPLICATION 19 COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 (408)777-3228- FAX(408)777-3333- buildinaC(Dcuper4no.org CUPERTINO \/ El NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROIECI'ADDRESS DRESS APN I n, p 035 /K ^ � # n Q � O E-MA II. 00 STREET ADDRESS CITY. STATE,ZIP `t TW FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CO CTOR NAME LICENSELICENSE TYPE �J BUS.I1C# NUMEJER CONTANYNANEFAX O ! (%Cff,5141- ,%"PPos7ATIdL ifJ7TZ.A/6-7T STREET ADDRESS CITY,STA PHONE n n �� X�"►' P ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK l-rtC ',1 Na�<_ j7'/1� � � � k1 Cir1�1 G�YcnIC, / CoItAJi'17° NC In 1p°PL_i�1 '� U��� Clef (4zr7ZC�TS RT- CA,f WAIN fMJr- tAV 41f6A ,1 7-D s VIM &(1SVtiIC IS /c0 IWP EXISTING USE PROPOSED USE CONSTR TYPE I #STORIES USE TYPE OCC. SQ.FI'. VALUATION(S) EXISTG NEW FLOOR —7DEMO TOTAL ` AREA AREA AREA NErAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA (kj >f REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA H DETACH ATTACH #DWELLING UNITS: 1S A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ONO ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOTAL VALUN:� PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO `iS/Jti J (J1 By my signature below,I certify to each of the following: I am the property owner or authorized agent to act 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 construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant(Agent: Date: SUPPLEMENTAL ORMATION REQUIRED PLAN CHECIC TYPE GROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for C 'ovx-THE-COUNTER u..B�ff 6ING AN xEvvrEw existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ McRESS ❑ PLAMUNG PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORM form if any Hazardous Materials are being used as part of this projectLARGE❑ ❑ FIRE DTT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1do App 2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 21311 columbus ave. DATE: 01/11/2012 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$80,000 y°PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: PERMIT TYPE: WORK remodel kitchen non structural SCOPE Li NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the relinina information available and are only an estimate. Contact the De t or addn 7 info, FEE ITEMS (I�ee Resolution 11-053 Eff.' 711-11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 300 1 s.f. Remodel,Kitchen(<=300 sf) Suppl.PC Fee: (F) Reg. () OT 0.0 1 hrs $0.00 $588.00 1REMRESKIT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp.Fee-C) Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? 0 Yes (E) No $0.00 Advanced Planninu Fee: $0.00 Select a Non-Residential Building or Structure Strom.-?Motion Fee: IBSEISMICR $8.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $4.00 SUBTOTALS $12.00 $588.00 TOTAL FEE: $600.00 Revised: 1/01/2012 l CITY OF CUPERTINO BUILDING PERMI ._ _ -2-.1..) ( �� 3UILDING ADDRESS: 213 t I COLUMBUS AVE CONTRACTOR:POST AND LINTEL PERMIT NO: 12010082 CONSTRUCTION OWNER'S NAME: ROBERT PRANTIS 34305 XANADU TER DATE ISSUED:01/11/2012 DR'NER'S PHONE: 4084462129 FREMONT,CA 94555 PHONE NO:(RU)396-3933 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB" L:icenseClass Lia# MECH ` RESIDENTIAL COMMERCIAL, �'onCrictor Ja?4 t�lLfu','t Date � -'('-� I hereby affirm that l am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMODEL K[TCHEN(300SQFT);NON-STRUCTURAL 1/31/12-REV#i REVISE CEILING AT KITCHEN,ADD NEW (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 1/31/12-REV#I REVISE CEILING AT KITCHEN,ADD NEW GAS LINE AT FIRE ROOM FIREPLACE,SERVICE UPGRADE-1/31/12 REV#I tSS'D 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 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 performarice of the work for v 'ch this Sq.Ft Floor Area: Valuation:$80500 permit is issued. APPLICANT CERTIFICATION APN Number:36205033.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply 180 DAY0 FROM LAST CALLED INSPECTION. with all non-point s ce egtilatit-is per the Cupertino Municipal Code,Section 9.18. 1,/L, Issae Date: Signature Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any rooting material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,ani exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby atErin under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the perforinance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for(tie performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bav Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall tuaintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to becorne subject to the Worker's Heal _� Safety Code,Sections 25505,25533,and 25534. 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 tnust Own 14 inthorized agent: 31 t�irtliwith comply with such provisions or this permit shall tie deemed revoked. UV Date: I(- L CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of Vkirk's correct.I agree to comply with all city awl county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in codsequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 4.18. I understand my plans shall be used as public records. Sipriature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36205033 .00 DATE ISSUED. . . . . . . : 01/31/2012 RECEIPT #. . . . . . . . . BS000015886 REFERENCE ID # . . . : 12010082 SITE ADDRESS 21311 COLUMBUS AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER ROBERT PRANTIS ADDRESS 21311 COLUMBUS AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JONATHAN F HERRERA CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 80, 500 .00 5 .00 4 .00 1 .00 0.00 1BSEISMICR VALUATION 80, 500 .00 8 .50 8.00 0 .50 0 . 00 1REMRESKIT SQ FEET 300 . 00 588 . 00 588. 00 0 .00 0 .00 1SUPPKFEE HOURS 4 .00 520 .00 0 .00 520 .00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 1121.50 600 .00 521 .50 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- -•-------------- -------------------- CREDIT CARD 521 . 50 MC --------------- TOTAL RECEIPT 521. 50 CITY OF CUPERTINO 3 FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 21311 Columbus ave. 7 DATE: 01/31/2012 REVIEWED BY: bobs. LINNAPN: BP#: VALUATION: $5,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY SFD or Duplex PENTAMATION 1 GENRES USE: PERMIT TYPE: WORK revise ceiling at kitchen add new gas line at fire room fireplace, service upgrade. SCOPE El I NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Ii'orks,Fire,Sanitary Sewer District,School District,etc.). These ees are based on therelin ina information available,and are onl an estimate. Contact the 201- or addn I info. FEE ITEMS "°'�:� e, r,," �c�r ;' f' ,%11 FEE QTY/FEE MISC ITEMS Platt Check Fee: $0.00 Select a Misc Bldg/Structure Suppl.PC Fee: Q Reg. Q OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? 0 Yes () No $0.00 G r _ '£ W ° -W. $0.00 Selectallon-Residential Q Building or Structure ( St: IBSE1SMC-R $0.50 4.0 hrs Revision Bldg_ijd:s_corrmlisxion Fee: 1BCBSC $1.00 $520.00 1SUPPKFEE Over the Counter SUBTOTALS: 1 $1.501 $520.00 TOTAL FEE: 1 $521.54 Revised: 1/19/2012 C��._ 0 � ♦.. `, , O� � ��� U c'+{f� ��T +� Ct� � � �.� ;, -: � .i _ ` ,r I � .. ,, _. �_ ,' .., as ,, ;, �� �_� �� _ F ,.�. _� .� -_ __A a� e s` . . � n � �� � � ��� � ��- ��, � � �� �` I) � l �_ �� �- ���., (( „� d � '. y ... ,` � �r-y. � ,�\ _, K� .�. ,,, � � �_ 1/� �, `; �, A .T. f �jj i ,!_ 5Y� � � '� �� ; � ;- � � 6 i r 1 ! � � � � �� �., � ; , , � � s�� � ,e, ,��:. S „ q ! � V`� � ?W— 'r� �� ..._y Z J 0 ail fit oo qo oI� i I i i 1 1 I I I I aas «oc ------------------- =-------------- o i� _ - 21111 COLUMBUS AVL TEAM 3 DESIGN LOW'°RGAL"A" non ( 650301.16-1 ms`s LUDWIGRGALVANI,~C CUM N n PRANTIS CUPLRTINO.CA Residential Dk ign&Remodel � #� /\ � , , �J \ r / i � } \\ \ \(/ ) � { ) [ ( � r ® x � !> ~ = --------------- - (cg" 7 - / ` L9 } / © 21311 COLUMBUS AVE T£�/ D\S\\ 650 3033627 P��� a� . . _ra maw_\,x._ - 21311 Columbus Ave., Cupertino Job# 011-12 JOB 1ENGINEERINS-1 SHEET NO. OF , GI CALCULATED BY DATE 1-31-2012 626 Jefferson Ave., Ste. 5 Redwood City, CA 94063 CHECKED BY DATE Tel 650.575.5680 Fax 650.369.1528 it tl i4- F PAC J1 ------ d-- -Tc ------ II 71 s- 41 31 -4- BELOW INT. WALL BELOW INT. WALL fl---;PELOW INT. WALL NEW 12 SQ. - NEW 12" SQ. CONC. PAD - � CONC. PAD >1 E-'X: C Z 41' NOTE: 1. ALL EXIST'G't'OOR FRAM'G SHALL REMAIN.' 2. ALL EXIsr'G (TERIOR & INTERIOR WALLS TO REMAft 3. ALL EXIVG CONC. PADS TO REMAIN. PARTIAL FLOOR FRAMING & FOUNDATION PLAN SCALE, 1/4' = V-0 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIV f ffW 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 GUPERTINO (408)777-3228• FAX(408)777-3333• buildingCcDcupertino.org ❑NEW CONSTRUCTION ❑ ADDITION aALTERATIONV171 REVISION/DEFERRED ORIGINAL PERMIT# PROTECT ADDRESS ;?A311 CO1 1 1 M", APN# OWNER NAME �� PHOA, )z4q( E MAIL STREETADDRESS 2✓11 CDC IAn/lejlLs �. QTY• STATE,-ZIP ( U l�j F7AX CONTACT NAME PHONE E-MAIL. STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT U-6ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME jr LICENSE NUMBED 711��� LICENSE TYPE BUS.LIC# COMPANY NAME / U LvP�S -fA.('J1G1� E-MAIL Jbtlta'PL .►�L(►�1�L .Nl�i� FAX . STREET RESS JJCA CITY,STATE ZIP , j C� PHONF�qGI 4?A 2 ARCHPTECT/ENG INEERNAME LICENSE NUMBER �Jr BUS.LIC# / l> J COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP FDD" �/� DESCRIPTION OF WORK ' AiT V/{�} ,� � �� (,I to t_ IIT "'LU` FDD" 'i `kG'kA&e - EXISTING USE PRgAREA CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FI. VALUATION(S) EA ATG f—' FLODEMO TOTAL -p- AREA AREA NET AREA � + ' BATHROOM KOTHER REMODELAREA RREMODEL AREA PORCH AREA DECK AREACK/PORCH AREA GARAGE AREA DETACH ATTACH DWELLING UNITS: ISIT []YES SECOND STORY ❑YES B ❑NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOT VALUATION: PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO j 1 1 By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prrperty 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 buil ' struction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant(Agent: Date: 3 l SUPPLEMENTAL INV#AMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for El- �-T�-COUNTER ALAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PIAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD ❑ PUBLIC WORKS 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 ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ElENVIIZONMENTAL HEALTH B1dgApp 2011.doc revised 06/21111