12080139CI-I'Y O`F CUPGRTIINO BUILDIt\'C. Pr11MIT
BOIIAING ADDRESS: 10917 FESTIVAL DR
C0 ,"TRACTOR: ROOF ROOFING
PERMI 1' N'O: 12080139
O\\'NBRS NAME': KIRAN KRAVOORI .@ MI:IiIiNDRAKER DEEPA
5.,77 VASSAR DR
DA'I V ISSU6A:08/13/3012
O\\'NER'S PI IONI.: 40850.16301
SAN JOSE, CA 95118
PUOSt NO: (408) :65-9270
' LICENSED CON'lIL\CI'ORIS DECLARATION
r r r
3 i I:ic..N Gs� �r6
BUILDING 1117101 IT INFO: BLDG ELECT PLUMB
.License Classy_ ,�
r -r r
_,
`�,r- 3N l_( t p
Contractor/' OJ
I\I F;CII I2LSIUF. N'1'1.\L COI\II\l EliC 1.\L
1 be,eby atrrnl that I and licensed colder the prarcisions nl'Chapter 9
.1013 DESCRIPTION: RHIMOVE I CI.S ING SHAKE ANIa l\'S'p,%I,1. COAII'OSI'1'ION
(Commencing wish section 7000) of Division 3 of the ltusiness \ I'rirfresinus
ROOFING 20 SQRS
Code and that np• license is in full force and effect.
,
I hereby affirm under penally a1perjury nnc of tire following hyo decla t anions:
I have and will maintain a certilicatc of wrier. to self-insure for Worker's
Compensation, as provided for by Section 3700 of dhc Labor Code, for the
perlonnance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided lar by
Sit. Ft Floor Arca:
Valualiun: 58500
Section 3700 of the Labor Code, for the perlbrmuce of the work 1'or which this
permit is issued. .�.(o ,
AI'N Number: 36217012.00
Occu pa ncr'I)pr.
\I'.I'LIC,\S'1' CEIt'1'I RI C.\1111 C)N
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 slate Iawsrclating
In building construction, and hereby authorize representatives or this city to enter
PLRNIII L\PIIi ISS►{' NVv I2K IS NOTSTARTED
upon the above mentioned properly for inspection purposes. (We) agree to $svc
indenulyan(] keep harmless the City of Cgtcrtiho againSt liabilities, judgntems,
WITHIN 180 DAYS OF PLRIIMIT ISSUANC► OR
costs. ,aid espensesotichmay lecture againstsaid City inconsequence ofthc
ISO DAYS FROM LA$-I Ct\L.LI�I) I1�1SP►:CI-IUB'.
granting oflhispermil.. Additionally, the applicant undClSlands .old' will conlpl%
w'Ith alLinal-point source regul'al S per Ihe Clpertllla bintllclpa COIIC, $l•CfIOn
G g 3 - ! Z
9.18.
�/�)
Issued by: v` '�-`�' Dane:
.Signalao, w Dalc 3 -I�� I(�
❑ O\\'NER-B1 ILDEIt DICC L,\It,\'I'IUN
RE ROOFS:
All tools shall he inspected prior to any rooting material being installed If a roof is
I hereby allirm that 1 :un rsengd from the Cuulractor's License Lal, for one of
[lie following Io'o reasons:
installed without first obtaining an inspection. I ' cc nu remove all new materials lily
I. as owner of the propery, or my employees with wages as their sole compensation.
will do the work, and the structureis not intended or offered for sale (Sec.7044.
inspection.
SiguniFe of Applican . 'Due:
Business S Professions Code)
h as owner of lir property. tut exclusively contracting with licensed contractors In
construct the project (Sec.7014, Business R Professions Code).
ALL ROOF COVEItINGS'10 BE Cl.,\SS "A" OR 131•`1"rpR
I hereby affinn.nndcr penalty of perjury one offlue tattooing three.
declarations.
HAZARDOUS MATERIALS DISCLOSURE
I bare and ill maintain a Certificate of Consenl Ioself-insure for Worker's
Pharr rad Ihe hazardous materials requirements under Chapter 605 of the
Compensation. as provided Ibr by Section 3700 of the Labor Code, lar Elie
California Health & sal 'et, Cade, Sections 2.,505, 255334 and 25531. 1 will maintain
performance oflhe work for which this permit is issued
cam pl is nee wills Ihe Cupertino Municipal Code. Chapter 9.12 and the Ilcallh &
I have and will maintain Worker's Compensation Insurance, as provided t'nfby
Safety' Code. Section 2.,.,32(a)>hntdd I stare or handle Int ardone material.
Section 3700 of the Labor Code. Ibr the performance oflhe work lar which this
Additiuually, should I use eyuipmew ordevices which emil hazardous air
Permit is issued.
contaminants as defined by tire Italy Arca Air Quality \I:ulagenwnl District I will,
I certify that ill the performance of the work for which this permit is issued 1 shall
rnaintain court)] ill oil[] Ihe Caller IiII0 \hrliCip:d ('Title. Chapter 9,12 and [tie
Ilcallh & Safety' Cudc. Sec in, 1_-511;. 2.,533.:nu1 25531.
our employany person in any manner so arm become subject to the Worker's
Compensation kovs of Catlfmr iia. lf, after making this cetlticate of exemption. I
Owner in, .e I:
-Dare P-1
become subject to the Woiker's Compensation provisions of the labor Code. I must
—
forthwith comply with such provisions or this permit shall be deemed revoked.
CONS'l RUCTION LENDING A(;FNCV
APPLIC\N'R CERTIFICATION
Thereby affirm that there is a consin ction lending agency I'or the performance orwork's
I ecrtily that I have read this, application and state that the above inlbnnmion is
Ibr which this permit is issued (Sec. 3097. Cie C.)
correct. I agree to comply with all city and county ordinances and state Imes relating
Lender's Name
m building construction, and hereby, authoriv.c representatives ofthis city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Address
indemnify and keep harnles5 the City of Clpcnino against liubilitics.jud.:mems,
crisis. and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, tilenppliaurt understands and will conhply
ARCIII'1'ECI" S DECLAR,%T1ON
with all 11011-point Source regulations per the Cupertino (municipal Code, Section
I understand lay plans shall be used as public records.
9.18.
Licensed Professional
Signature Dale
CUPERTINO
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildino(d),cupertino.ong
PROJECTADDRFSSt (% 11 F� V`v-I, %I
`, Y`
l`'
APNa
PHONE
OWNERNAME V' rL- �` q n9 �I
` v V V b� Yoe-• so . 6,�0
EMAIL
STREET ADDRESS
CITY. STATE.ZIP
FAX
CONTRACTOR NAM i-
LICgSr,�Y MIER
(' `EE --MAUL
L(IICF\�{SE7j{
'0
BUS, LIC.#
COMPANYNAMEGJ .,,�• n
�n
OC) b'r
I-
F �•t c(`�Ol, 6 C
STREET ADDRESSQt)ati
CITY.SzATE.`�ZI-P .^
PHOS
I UNDERSTAND AND AGREE TO THE FOLLOWING:
The re -roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled up to the day before the inspection date. Please call (408)777-
3228 from 7:30 - 3:30pm (Mon-Thurs) or 7:30 - 2:30pm (Friday) to schedule the next day inspection.
For Tear -Off and Nailing Inspections, you must also call on the day of the inspection only after that
phase of the work is completed. The building inspector will be available within one hour. Progress
and Final Inspections will be given a two hour window.
3. Tear -Off Inspection is required. Any and all dry -rotted wood shall be replaced prior to this inspection.
Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either
completely knocked -down or removed prior to this inspection.
4. If plywood is installed, a plywood Nailing Inspection is required.
Roofing shall not be applied without first obtaining all prior inspection and written approvals from the
building inspector. Any roofing which is applied without first obtaining an approved inspection will
require the removal of all new material down to the sheathing so a proper inspection can be performed.
6. Progress Inspection is required when approximately 50% of roof covering is installed.
7. A Final Inspection and approval shall be obtained from the building inspector when the re -roofing is
completed. To receive a final sign -off, the following items will be verified:
a. Flat roofs shall have a minimum of I/<" per foot of slope and demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre -manufactured products used shall be
available on-site to review at the time of the inspection.
c. Proper spark arrestor installation, vents painted, gutter/downspouts installed, debris removed.
8. NOTE: .If you call for a tear -off or plywood nailing inspection and the work is not complete, you will be
charged a re -inspection fee of $126.00. The re -inspection fee shall be paid before another inspection
can be scheduled.
By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act on the
property owner's behalf. I understand and agree to corn I ,ith the re -roof policy stated above. I also understand that
smoke detectors and carbon monoxide detector ar r Kired to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Code p
Signature of Applicant/Agent: l' Date:
ReroofPolicv_2011.eioc reviser/ 02116/11
6,('—
CITY OF CUPERTINO
FEE ESTIMATOR -BUILDING DIVISION
FEE ID ROOFAREA
(s.L)
1REROOFFRES 2,000
ADDRESS: 10917 Festival Drive
DATE: 08/13/2012
REVIEWED Bl': Sean
Mech. Permit Fee:
APN:
BP#: �OgD 3
VALUATION:
1$8,500
*PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY SFD or Duplex
USE:
Flee. hup. Fee:
PENTANIATION 1SFDWLRO0F
PERMIT TYPE:
WORK
Remove existing shake and install composition roofing 2000 sq ft).
SCOPE
FEE ID ROOFAREA
(s.L)
1REROOFFRES 2,000
A'OTP.-: This estimate does norrhnclude jeer Blue to other Departments (i.e. Planing. Public Works. Fire, Sanihnq• Sewer District, School
District, etc.). These fees are based on the mreliminan• information available and are onh• an estinuae. Contact the Dent for adda'I into.
FEE ITEMS (Fce Resolution 1I-053 E2' 7/1/11)
Mech. Flan Check
Phooh_ Phar Check
Flee. Plan Check
Mech. Permit Fee:
Plumb. Permit Fee:
L•lec. Permit Fee:
Other Mech. Insp.
Other Plumb Insp.Ll I
Other Fier. Insp.
Alech. hup. Fee:
Plumb. hasp. Fee:
Flee. hup. Fee:
A'OTP.-: This estimate does norrhnclude jeer Blue to other Departments (i.e. Planing. Public Works. Fire, Sanihnq• Sewer District, School
District, etc.). These fees are based on the mreliminan• information available and are onh• an estinuae. Contact the Dent for adda'I into.
FEE ITEMS (Fce Resolution 1I-053 E2' 7/1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
SuppL PC Fee
Plumb./d1ech./E1ec
Permit Fee:
$300.00
Suppl, /its/) Fee
P1amb.lHech./Elec
Phrmh./Mech./Elec Permit Fee:
Consowetion Ttt\':
Administrative Fee:
Work Without Permit? O Yes (j) No
$0.00
Advanced Planning Fees:
�
Travel Documentation Fees:
Strone Motion Fee: IBSF-ISA11CR
$0.85
Select an Administrative Item
Blda Stds Commission Fee: IBCBSC
$1.00
sui TOTALS:
1 $301.851
$0.001
TOTAL FEE:
1 $301.85
Revised: 07/01/2012
CUPERTINO
Q,t�,3-4?1771L
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 • buildino(a)cuoertino.o[g /�p7
PROJECT ADDRESS r I \ I (�
APNtl �Z /n / C/
i D
OWNER NAI—
A,�
PHONO& �O �`�fOt(!v�/
E -MAD.
STREET ADDRESS
S IYML
CITY, STATE, ZIP FAX
L1 SD
CONTACT NAAIE
PHONE
E-AL11L
STREET ADDRESS
CITY, STATE. ZIP
FAA
❑ OWNER ❑ OWNER.BURLER ❑ O%RNERAGENT 1V(CONDUCrOR ❑CONTRACIORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TIDE
BUS. LIC.0
COMPANY NAME
E-AIAIL
FAX
STREET ADDRESS
CITY, STATE. ZIP
PHONE
ARCHITECTIENGINEER NAME
LICENSEENUNMERI S�
(%
BUS. LIE.4
(��J
COMPANYNAME T[ 00 rT
IT'/—t/
\�IL •1 `(a 0`'' _/ iCJ
`_
al/I,fN• (l�M
T�Jp� yy�
FAX
-9 2 r (�
^
STREET ADDRESS �77\ �g55n� 9 •tom
CITj�ST. J ZIP ���L
PjI.Qt¢ S` C �•�O
✓( (/6 l
USE OF FD or Duplex ❑ Multi -Family
ROOF.AREA:
VALUATION:
/-)O ()
STRUCTURE: ❑ Contmerclal
O
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES 'OOD SHAI:F-S ❑WOOD SHINGLES ❑ 0714ER(SPECIFY)
PLACE I ES
IF NO.
PLYWOOD p.:5- ❑
PLYWD 058
PITCH: 11,,� �
ROOF
❑ N
aLAYER<
CR C • ❑ sn;'
TE' ❑ CDX
—
SS•
PROPOSED ROOF TYPE: ❑ BUI`IL�T-UP ROOF ❑ OTHER'
SSHHIINNGLESI ❑ WOOD SHAKES C1 WOOD SHINGLES
IC[ -FS REPORT 0
�l(I/AISPHALT
ES
DCRI OQ O✓y/\Jr D % 11 q SO
UY /TTV J NvaI`n)�C
� e• LG� �� [i CSC r � �n .
By my signature below, 1 certiry w each of the following: Ithe Propertyowner or authorized agent to act on the property owner's behalf. 1 have read this
application and the information I have ptovidzd is conect. ave read [he Description of Wort: and verify it is accurate. 1 agree w comply with all applicable local
ordinances and state laws relating to buil it .n I 't' I authorize re resenatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of ApplicanVAgent:Dale:
SUPPLEMENTAL INFORMATION REQUIRED
orrice
USEONLY. -
PLUM CHECK TYPE,..
ROUTING SLIP
If building is associated with a Home Owners Association, provide letter
� OVER -THE COUATER
�� BUILDING PLAN REVIEW
_
of approval front 1{0A.
_ Provide Planning approval to verify if there any restrictions.
❑ ECPRESSS
PLANNING PLAN REVIEW
_ Provide copy of Manufacturer's Installation Specifications.
❑ STANDARD
-❑ _FIRE DC",
Provide signed copy of Cupercinds Tear -Off Policy.
❑'-OTHER: - -
ReraajApp_2011.doc revised 03/16111
17
I CITY OF CUPLRTINO BUILDING 111?RNII.1'
BUILDING ADDRESS: 10086 LAf 1PLRill1Uf SQ
OWN'ER'S NAME: ILANGO R LATHA RAVI
OWNEWS 1'110NIC: 4088930661
❑-.- LICENSE•:D CO,\"I'12ACF0 It's DECLARATION
License Class I H'Lic. ff �7 2 / 3 7/9
Contractor IRS S YJvE ZN Date/ 13 /Z
I hereby affirm that I :nn licensed under Ill pr(visiuns of Cha pIV1.9
µ't,mumrncing with Sect inn 7000) of Division 3 ul't he Business \ Professions
Cute and that ntv license is in full force :nal eflecl.
1 here[), affirm under penally ul perjury one of the following tilt, declinations:
I have mid will maintain it certificate of consent to sclt'-insure Ru Worker's
Compensation, as provided Ibr by Section 3700 ol'the Labor Cock, for the
performance ol'the work for which this permit is issued.
I have laid will maintain Worker's Coupens:uion Insurance, as provided for by
Section 3700 of the Labor Code, f'nr the performance ol'the work for which this
permit is issued.
APP NT CERTIFICATION'
I ccnily that I have read this application and state than the above inlbnnation is
correct. I agree to comply with all city and county ordinances and state laws relining
to building construction, and hereby authorize representatives ollhis city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indcomily and keep harmless the City of Cupertino against liabilities,judgments,
costs. and expenses which may accrue against said City in consequence of lite
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. �y
Signature Date a//}/��
❑ OWN'EIl-I UILDER DECLARATION
I here[)' :cflirnt Ihat 1 ant rsempt (rain tine Cmnlrarlor's License Lia fur one ill'
Ihr• fullusvine two reasons:
L as owner ol'thc property, or my employccs With "•agcy as their sole compensation.
Will do the Work, and the structure is not intended or offered for sale (Sce.7044,
Business .l'' Professions Code)
L as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm nater penalty of perjury line of Ihr• follom'ine three
declarations:
I have and will maintain a Certificate of Consent m 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, lar the performance oflhc work for which this
permit is issued.
I certify that in the performance of the work for which this pennil is issued, I shall
not employ flny person in any manner so as to become subject In the Worker's
Compensation Encs of Cali lirrlda. Il; alter making this ecrtilicate 11'exeniption. I
become subject to the Worker's Compensation provisions ol'lhc Labor Code, I mist
forthwith comply with such provisions ur this pennil shall be deened revoked.
APPLIC\N"I' CER'I'l FIC TION
I certify that I have read this application and state thin the above inliunation is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, mid hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnity and keep harmless the City ofCupertinn against liabilitics,judgments.
costs, and expenses which may accrue against said City in consequence of the
graining of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per die Cupertino 1\Lmicipal Code. Section
9.18.
Date
COSTRAC'MR: SITARS HOME PERMITNO: 12080/10
IMPROVEMENT
1024 FLORIDA CENTRAL 1'EWY DATE ISSUI.D: 08/132012
LONGWOOD. FI, 32750 PDON, NO: (925)245-2000
BUILDING PERMIT INFO: BLDG r FLECT r PLUMB r
MECH r RESIDENTIAL r COMINIERCLu. r
JOB 1)ESCR I PTION: Rl:PLACI: SI IOWER PAN. INSTALL NEWTI1REE ACRYLIC
WALLS, NEW SHOWER VALVE & NEW SHOWER MOOR.
Sy. PI Fluor Arca: I Vahn:uiun: S-1526
APN Nunthcr: 34233003.00 1 Occup:mcy Typr:
PERA-IIT ES PI RES IF WORK IS NOT STARTED
WI.1'IiIN 180 DAYS OF PERN11T ISSUANCE OR
180 DAYS FRON1 LAST CALLED INSPECTION.
Issued b/.- Uate: 13�/
RE -HOOFS:
All tools shall be inspected prior In any rooting material being installed. II'a root is
installed without first obtaining :in inspectiun. I agree m remove ;dl nese 1111IM IN for
inspection.
Signature of
Date:
AI.I. ROOF COVERINGS TO Ili: CLASS "A" OH IIF I ] I'll
HAZARDOUS MAI ERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of Ihr
California I Icalth \ Safety Code. Sections 255115. 25533, and 25534. 1 will maintain
compliance will] the Cupertino Municipal Code. Chapter 9.12 and the Ilealth &
Safety Code, Section 2ss32(a) should I store or handle hazardous material.
Additionally, should I rise equipment or devices which emit hazardous ;ill-
contaminants
ircontaminants as defined by the Bay,%rea Air Quality Management District 1 will
maintain conn plies lice wish the Cupertino Municipal Code. Chapter 9.12 and the
I le nth & Safelc (:ode. Sections 25505. 25533. ;,ad 25534.
Uonu•r ithur''rtl aero /��/2
Uar:
CONS'1'I(1i CI'I ON I.EN1)ING AGFNCV
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Norm•
Lender's Add
ARCHITE.C'I" S DECLARATION
I understand rely plans shall be used as public records.
Licensed
r������� CITY OF CUPERTINO
I_yiM FEE ESTIMATOR -BUILDING DIVISION
M
.;)DRESS: 10086 Lamplighter Sq.
DATE: 08/13/2012
REVIEWED BY: RDW
A/ech. Permit Fee:
.\fN:
13P#: �pZQ�' �
'VALUATION:
$4,526
*PERMITTYPE: Building Permit
PLAN CIIECK TITE: Alteration / Repair
PRIMARISFDorDu
USE: Duplex
Elm bup. Fee:
PENTAI\IATION
PERMIT TYPE: 1RPFIA
\YORK
Redo shower.
SCOPE
$0.00
NOTE: This estimate roes not include fear due to other Departments (i.e. Planning, Public /Parks, Fire, Sanitary Sewer District, School
District. etc). Theve leer are haled on the nrethninan, information availahle and are only an eviinutte. Contact the Dent for arltdn 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/11/1)'
Aleeh. Plan Check
Plumb. Plan Check 0.0 1 hrs $0.00
Dec. Plan Check
A/ech. Permit Fee:
Plumb. Permit Fee: IPPERMIT
Elec. Permit Fre:
Other Alec•h, Insp.
Other Plumb Insp. 0.0 hrs $45.00
Other Elce. hup. El
,Rech. hu'p. Fec:
Phanh. hop. Fee:
Elm bup. Fee:
NOTE: This estimate roes not include fear due to other Departments (i.e. Planning, Public /Parks, Fire, Sanitary Sewer District, School
District. etc). Theve leer are haled on the nrethninan, information availahle and are only an eviinutte. Contact the Dent for arltdn 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/11/1)'
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= #
$10.00
Plumbing
IBPFLITURE I Fixture set on One Trap
Suppl. PC Fee: Q Reg. Q OT
FO 0-1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee D Reg. Q O'I'
Q,Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$45.00
Consb7tction Tits:
Adininistrative Fee: I,iD,idly
$42.00
0
Work Without Permit? 0 Yes Q No
$0.00
Advanced I'lannine Fee:$0.00
Select a Non -Residential
Building or. Structure
0
Travel Documentation Fee: ITRAhDOC
$45.00
Shone Motion Fee: IBSEISHICR
$0.50
Select an Administrative Item'
Blda Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$133.50
$10.001
TOTAL FEE:
$143.50
Revised: 07/01/2012
CUPERTINO I
1�
1 I AIC\U rnl IQTU1 =V11.1
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinala)cuoertino.oro
1 erINTVIIJ [5F1 AITFRATInM/TI 7 RFVICIr11J111FFFRRFII
/aog01�o
r1RIrmNA1 PFRMITft
PROJECT ADDRESS %Oo $G L A M P L I'6l-I T E Q S
APN 4 / a 3�3 003
OWNER NAMEPHONE
_ A 1✓G o kA v i v Lq Y� 893 0661
E-MAIL
STREET ADDRESSCITY,
loo 6 PIf 6 TE✓2 s
STATE, ZIP —Olt FAX
Cups 2T; a CA 9
CONTACT NAME
107✓
PHONEEMAILt�SSEnv:c
S/° 566-3885
s.Sf@GNa;[-c
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSETYPE
BUS.LICH
COMPANYNAME S,EA RS ktnmc 11,4.
E-MAIL
FAX
STREET ADDRESS n
2 E. ;R WA r /, L-
CITY, STATE, ZIP
L;VERMo2E CQ 955SI
PHON
925 2Ss -2000
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC 0
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK Sn f/Oliv-P PAN `.— 7 L •W -TfIPEF AC I.LiC UIfl LLS
ALVE 1 TAIL u r w .5kOW ego
EXISTING USE
PROPOSED USE
CONSTR. ME
0STORIES
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-3
J
2 > , ?
S (3
USE
TYPE
OCC:
SQ.Fr.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA _
AREA
AREA _
NETAREA
BATHROOM KITCHEN OTHER
REMODELAR[A -( 5 tom( REMODEL AREA REM1IODEL AREA
J ��
PORCH AREA DECK AREA
TOTALDECK/PORCHAREA
GARAGE AREA:U DETACH
❑ATTACH
k DWELLING UNITS:
IS A SECOND UNIT ❑}'ES
SECOND STORY ❑YES
!
nEINGADDED^ �jNO
ADDITIOM17 PNO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPYOF
ISTHEBLOGAN ❑YES
RECEDB}'+,='.>--- ----
�`
TOTAL VALUATION:
NO NO PLANNING APPROVAL LETTER
'P
EICULERHOME` 'El NO
,1 .-f'lµ' _
�1S26.Oo
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. 1 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 resentatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicrun/Agent: •`� Date: 3 Z
C UD
SUPPLEMENTAL BQFORi ]O' IRE
Q
_ 1'I.SN CIIF.CKTI'PE
- O - -'
'� rROUTi\CSI'IY�_ _ ..
❑ oJea-Tur -
❑ RtT'IEN•
New SFD or Multifamilv dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
counrru
BUILDING PLAN
permit for new building.
❑-. ' PRESS-_
El 1 IanslNc PLAN liF} feF+
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ s 'ANDIARD _
El PUBLIC Ic }YORKs` . ,.
_
Tom— if any Hazardous Materials are being used as part of this project.
- '
I - -'
❑
❑ 1_1R
. CE -
FIDF.PP
_ Copy of Planning Approval Letter or Meeting with Planning prior to
t + '' `
❑ eOR '
_RF
v . ?
°❑ SANITARY SEwea
submittal of Building Permit application
DISTRICT
-
�,'ENl IRO\l[1TAIf II E,\Ll'li[- _
B(dgApp_2011. doc revised 06/21/11
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