11010090 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10302 PARLETT PL CONTRACTOR:YANYAN QIANG PERMIT NO:11010090
10302 PARLETT PL DATE ISSUED:01/14/2011
OWNER'S NAME: YANYAN QIANG
OWNER'S PHONE: 4086887691 '
CUPERTINO,CA 95014 PHONE NO:
C
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# MECH r RESIDENTIAL r— COMMERCIAL r
Contractor Date
JOB DESCRIPTION:CODE ENFORCEMENT CASE-2 BATHROOM
I hereby affirm that I am licensed under the provisions of Chapter 9 REMODELS(85SQFT)
(commencing with Section 7000)of Division 3 of the Business&Professions NON-STRUCTURAL&INCLUDE LIGHTING,ELECTRICAL,
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 Valuation:$3300
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area:
permit is issued.
APPLICANT CERTIFICATION APN Number:31646042.00 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 constriction,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,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section ��/
9.18. Issued bylDate:/ l '—v'
Signature
Date
r 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 roofing 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, Signature of Applicant: Date:
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed_cQtors to
construct the project(Sec.7044,Business&Professions Code). �(G� ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm 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
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
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I Owner or thorized a ent:
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 revo�
CONSTRUCTION L NDING 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 work's
correct.I agree to comply with all city and 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 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
-anting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
,pith all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Signature Date C / l/ Licensed Professional
LANDSCAPE WATER-EFFICIENCY CHECKLIST
Connnuiiity Development Department 408.777.3308/Fax 408.777.3333
10300 Torre Avenue
Cupertino, CA 95014 planningQcupertino.or0
http://cupertino.org/planninE
CUPERTINO
A licant Name: `\ ��� i Email:
pp
t.
Phone: '�Project Site Address: Q c� fLit),
•
e Landscape area: All the planting areas, turf areas, and water
Total Landscape features in a landscape installation. The landscape area does
Area (square feet): not include footprints of buildings or structures, sidewalks,
driveivays, parking lots, decks,patios, gravel or stone walks,
other pervious or non-pervious hardscapes, and other non-
Turf Area: irrigated areas designated for non-development (e.g., open
spaces and existing�Alildland vegetation).
Non-Turf Plant Area: Turf: A ground cover surface consisting of non-native grass
species that is customarily mowed. Annual bluegrass,
Kentucky bluegrass, perennial ryegzass, red fescue, and tall
Special Landscape Area: fescue are examples of cool-season turf grasses. Bermuda
grass, kiku}-u crass, seashore paspalism,St. Augustine grass,
Water Feature Wet Surface Area: zoysia grass,and buffalo grass are ivarm-season turf grasses.
If>10% of landscaped area,water budget calcu-
lation required with landscape project submittal.
NOTE: If landscape area exceeds 2,500 sq.ft.,a landscape project submittal shall be required. If no landscaping is proposed,enter
"0"above and proceed directly to the signature block at the bottom of this form.
Landscape Parameter Requirements Project Compliance
Turf
Total turf area shall not exceed 25% of the landscape ❑ Yes ❑ l
area,or 1,250 square feet,whichever is lesser in area. ate L:C cL u'c'a'Gi'-"'
All portions of turf areas shall be wider than eight(8)feet. ❑ Yes
Turf(if utilized)is limited to slopes not exceeding 15%. ❑ Yes
Non-Turf \o
At least 80% of non-turf area shall consist of native or ❑ Yes ❑
� .
low water use plants.
[if;1 "3teT'L'^::u_Ct Cal a;Oil 1 —1:::7"
„-;th iandscap e ra-oiect=-�:b:nttcl
Hydrozones Plants with similar water needs shall be grouped within ❑ Yes Q N-c,
hydrozones. Each hydrozone shall be controlled by a f=lar`_s ca: 1-,e gro_iped t e
separate valve. T Gl'ie 1=4 1
Irrigation System Systems shall be designed and maintained to minimize ❑ Yes ❑ ' 'c'
water waste(e.g.,runoff,low head drainage,overspray).
Low-volume irrigation shall be utilized in non-turf areas.
Irrigation shall only occur between the hours of 8:00 pm [ii:-o,prc.v, 'e�'.T_'n�tian c;
and 10:00 am.
Soil A minimum of eight(8)inches of non-compacted topsoil ❑ Yes ❑
f:no, ;=o�::_:
shall be available in planted areas. 'eplarzto; e.;. backl
Soil amendments,such as compost or fertilizer,shall be ❑ Yes ❑ l�o
appropriately added according to the soil conditions at
the project site and based on what is appropriate for the [lf no,
selected plants.
A minimum two(2)-inch layer of mulch shall be applied C] Yes
Mulch ❑ '�' '
on all exposed soil surfaces of planting areas,except in
-- =� :- .
areas of direct seeding application(e.g.hydro-seed). �':' '''''� ""c'''
I am aware of available informational resources regarding native and low water use plants,irrigation efficiency,and other aspects of
water-efficient landscaping. I certify that the information provided on this checklist is correct,and the installed landscape complies
with the requirem s of Chapter 14.15.1 also understand that any changes to the project will necessitate a new checkli
Signature f ro er Avner or autho ed re resentative
Date
Page 1 of 2
This checklist implements the requirements of Chapter 14.15,Landscape Ordinance,of the Cupertino Municipal Code.
The responses provided will be evaluated to determine whether the proposed landscape is generally consistent with the
ordinance's water-efficiency goals.
Applicant Comments
=-_ -
Staff Evaluation Staff Comments
EJApproved
Not Approved
Signature Date
Select Definitions
Hydrozone: A portion of the landscaped area having plants with similar water needs. A hydroz.one may be
irrigated or non-irrigated.
Low-volume irrigaticn: The application of irrigation water through a system of tubing or lateral lines and
low-volume emitters such as drip and bubblers. Certain rotaiy emitters desimned for highly efficient water
distribution,and situated to irrigate low water use plants,may also be included in this definition at the
discretion of the Planning Office.
Low water use plant: A plant species whose demonstrated water needs are compatible with local climate and
soil conditions such that regular supplemental irrigation is not required to sustain the plant after it has be-
come established. Any species classified as"very low water use' and"low water use" by WUCOLS,having
a regionally adjusted plant factor of 0.0 through 0.3, shall be categorically deemed a low water use plant.
Native plant: A plant indigenous to a specific area of consideration. For the purpose of this division,the term
will refer to plants indigenous to the coastal ranges of Central and Northern California,and more specifical-
Iv to such plants that are suited to the ecology of the present or historic natural community of the project's
Vlcrnity.
Special landscape area: An area of the landscape dedicated solely to edible plants, areas irrigated with re-
cycled water,water features using recycled water and areas dedicated to active play such as parks,sports
fields,golf courses, and where turf protides a playing surface.
Tm-,: A --round co,.7er surface consisting of non-native glass species that is customarily mowed. Annual blue-
grass, Kentucky bluegrass,perennial ryegrass,red fescue, and tall fescue are examples of cool-season turf
grasses. Bermuda grass,kikuyu grass, seashore paspalum,St. Augustine grass,zoysia grass, and buffalo
grass are swarm-season turf grasses.
/Tater feature: A landscape design element where open water performs an aesthetic or recreational function.
Nater features include ponds,fountains,waterfalls and artificial streams. Also includes spas and swi-m-
m4ng pools that are ancillary to single-family, two-family and multi-family residential uses.
;Feet surface area: The surface area of that portion of a water feature that functions to contain water, such as the
water surface of a swimming pool,spa,or garden pond. For a fountain or other feature with flowing water,
iw'et surface area sizall be measured as a taw o dimensional plane bounded by the perimeter of the area where
water has been designed to flow.
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10302 parlett pl. DATE: 01/14/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: $3,300
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION 1 R3SFDREM
USE: SFD or Duplex PERMIT TYPE:
WORK To Clear Code Enforcement Case: 2 bath remodel non structural include li htin electrical Iu
mbing
.
SCOPE
e(li, Plan t'hc c k
ar?>. t'Inn C't.�t' L/,-c:. f'i,�tr C'hec'k
Liech. Pc>rnt t f",>c Phat7b, Pcvtni1 I``'ts: f;lr�c 1'e "al!""V:
Ocher:�lec'i. Irts;> Olher Pltonh InsP, I iec Insli.
.............................
11rIr. Itzt�. 1 ,t,- P!rrath_ li.�j;. l:t t ties. Iny, I'ae
NOTE: Thesefees are based on the preliminatrTy in ormation available and are only an estimate. Contact the De t or addn'1 info,
FEE ITEMS (Fee Resolution 09-OSI E . 7,14( FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 85 s.£ Remodel,Bath(<=300 sf)
Suppl.PC Fee: (OD Re ® OTF-761 hrs $0.00 $570.00 IREMRESBAT
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Feer Reg. 0 OT F0---0-] hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
(:,on,slrliction lav
Acoustical Fee: 0 Yes (E) No $0.00 0
Work Without Permit? (D Yes 0 No $570.00
Planning Fee: $0.00 0
0
77<r�c'l 1)(�c trrrr(�rricrtir,rr l��rc>s:
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
BldgStds Commission Fee: IBCBSC $1.00
SUBTOTALS: $571.50 $570.00 TOfiAL°JFEE: $1,141.50
Revised: 01/03/2011
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31646042 .00
DATE ISSUED. . . . . . . : 01/14/2011
RECEIPT #. . . . . . . . • : BS000012496
REFERENCE ID # . . . : 11010090
SITE ADDRESS . . . . . : 10302 PARLETT PL
SUBDIVISION
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : YANYAN QIANG
ADDRESS : 10302 PARLETT PL
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : WEI LI
CONTRACTOR LIC # *OWNER*
COMPANY YANYAN QIANG
ADDRESS . 10302 PARLETT PL
CITY/STATE/ZIP . . . : CUPERTINO', CA 95014
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ----------
------ ---
---------- -
1BCBSC VALUATION 3, 300. 00 1 . 00 0 . 00 1. 00 0 . 00
1BSEISMICR VALUATION 3, 300 . 00 0 .50 0 .00 0 . 50 0 . 00
1REMRESBAT SQ FEET 85 . 00 1140 .00 0.00 1140 . 00 ------0_00
TOTAL PERMIT
1141 .50 0 . 00 1141. 50 0 . 00
METHOD OF PAYMENT AMOUNT -- -
REFERENCE NUMBER
----------------- ---------------
CHECK 1, 141 .50 #1684
---------------
TOTAL RECEIPT 1, 141 .50
RESIDENTIAL PROJECT COVER SHEET-
Assessor's Parcel Number: f
Name of owner. Cit
Project address.
Contactr erson. C,-Lj Phone. �1��—7
Fax.
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor:
Garage: LLM
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces inside the garage? ,,Y><�,,N
.1�
-ivacy protection planting required for the project? Y---- N
Build it Green Total Points
On what floor(s) is work being done? /
Brief description of work. �2 \(\Q^rv,_o6-ftX c\ctq
b czt- vn L iYt c f_�v,.�Te P c ori,
Code editions: 2007 CBC N)2007 (Wt RSI' 07 CMC (Y-N)
IT i NF CITY O'
2007 CPC �N)2007 CF+T wo �,�; ,i - CIT N<._
UA I Ez
o
SIGNi_t)
Effective 1/1/08 This set of plansns MUST
b*'keC)'On the land it is
jnlawf�.;;to rdalterations
un�3mc wrthou' tintten pPrfnriAon from
the E3wlding C)e{,.ar , nt r r f Cupertino � 1r
The stamping of the ,, l
f sn, _fcifrcatrons .
-HAL NOT t*' i)"'1
- PErmit or 10 be ai i
ar,Proti:_,I of tt l, �;,s 1,V Provisions
0
Plan Review Process Work Book Page-8- Revised 06-15-10
' 4
pr /V*�)
-
OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228- FAX(408)777-3333- building(a)cuDertino.org
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:
SITE ADDRESS[
O APN BP#
G1�
OWNER NAME ` OWNER ADDRESS l o O
DESCRIPTION OF WORK: c:► �(`eY1tiU
C see
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.)
I understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner-
ui der"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 homeowner's 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.
y . 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.
YQ-3. I 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.
numY4. I understand Contractors are required by law to be licensed and bonded in California and to list their license
ers on permits and contracts.
AW. I 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.
Ya6. 1 understand if I am considered an"employer" under state and federal law, I must register with the state and
ederal 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.
7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
re' srdential 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.
Y18. I 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.
OwnerBuilderForm 2010.doc revised 04/14/10
Q1 I 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. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I
a'm'The party legally and financially responsible for proposed construction activity at the site address listed above.
N&_1 1. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
by-N applicable laws and requirements that govern Owner-Builders as well as employers.
Yo12. I 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' State 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 firm 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
(DIRECTIONS: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 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 si na ur
Property Owner's Signature: Date:
(NOTE: The following Authorization Form is required to be completed by the property owner only when designating an
agent of the property owner to apply for a construction permit for the Owner-Builder).
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 Loration 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 owner's 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:
OwnerBuilderFormn 2010.doc revised 04/14/10
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: )G(, PERMIT#
OWNER'S NAME: cam. �` PHONE# `
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
ignature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum /Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Z/
Owner/ContraaDr Signature Dat
GiTY OF
CITY OF CUPERTINO
ADDITION/REMODEL
CUPERTINO FEE SCHEDULE
/ Date: Z ��
"
1 f ❑ please fill out the permit application for 2"
If yes, unit.
Is a 2 unit being added. Yes No
Is this a 2"d story Addition? Yes ❑ No
Is this house an Eichler? Yes ❑ No �f yes, needs Planning approval.
Building Address:
Mailing Address (if different from building address):
Phone# :
Owner's Name:
Contractor: Phone#:
Fax/e-mail:
Cupertino Business License: State Contractor License#:
Contact: Phone#:
Fax/e-mail:
Landscape Ordinance Compliance:
Landscape area in sq. ft. (includes all irrigated areas):
! If 2,500 sq.ft. or less, compliance with the Landscape Water-Efficiency Checklist is required.
If more than 2,500 sq. ft., a complete Landscape Project Submittal is required.
Com liance Method: ❑ Plant T e ❑ Water Bud et
Building Permit Info: Bldg. E ct. lambing echanical
Hillside
Project Size: Counter x ress ❑ Standard ❑ Large ❑ Major ❑
Job Description:
Addition-What is being added?(Be Specific):
What i being remodeled (not including addition)? CODO �2A
;Z Cy P 5
Remodel Includes Re-Roof: Yes ❑ No If yes list number of squares
Structural: Yes No C
Remodel Includes ❑
Do you have the pre-application planning approval? Yes ❑ No [�
If yes,p1lease provide a co of your planning ajpRK2yal letter. Planners name:
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
r�
Remodel: Kitchen Bath_ �.5� Other
Type of Construction(Usage Class): Occupancy Type:
1-A, 1-B ❑ IUIII/V-A ❑
IUIII B, IV-HT,V-B Valuation: D
Please complete relevant portion of the Green Building `
Checklist & attach it to the application or if applicable, Green Building Points Achieved:
include in lan set 8
the sheet index.