10120048 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10271 WESTACRES DR CONTRACTOR:FENMEI YAO&JIWU SUN PERMIT NO: 10120048
OWNER'S NAME: FENMEI YAO&JIWU SUN 10271 WESTACRES DR DATE ISSUED: 12/08/2010
O"''NER'S PHONE: 6509652298 CUPERTINO,CA 95014 PHONE NO:
L LICENSED CONTRACTOR'S DECLARATIONF I
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
MECH F RESIDENTIAL F COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:KITCHEN(182SQ)&BATHROOM(284SQ)REMODEL,THREE
(commencing with Section 7000)of Division 3 of the Business&Professions BATHROOMS&KITCHEN ARE TO BE
Code and that my license is in full force and effect. REMODELED;NON-STRUCTURAL&RE-PIPE THE HOUSE
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 performance of the work for which this Sq.Ft Floor Area: Valuation:$2300
permit is issued.
APPLICANT CERTIFICATION APN Number:35911034.00 Occupancy Type:
1 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 E YtPIRES 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 WITH DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DA ROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. � _, /�
Issued by: ` Date:
Signature Date
OWNER-BUILDER DECLARATION
RE-ROOFS:
I bcreby 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
I,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:
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
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
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
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 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&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
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
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or authorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. ,»i_•, J,- Date:
T
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
and expenses which may accrue against said City in consequence of the
ng of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
all non-point source regulations per the Cupertino Municipal Code,Section
I understand my plans shall be used as public records.
Signature -21<f' C .� Date [2 C5 n Licensed Professional
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35911034 . 00
DATE ISSUED. . . . . . . : 12/08/2010
RECEIPT #. . . . . . . . . BS000012178
REFERENCE ID # . . . : 10120048
SITE ADDRESS . . . . . : 10271 WESTACRES DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : FENMEI YAO & JIWU SUN
ADDRESS . . . . . . . . . . : 10271 WESTACRES DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : FENMEI YAO
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : FENMEI YAO & JIWU SUN
ADDRESS . . . . . . . . . . : 10271 WESTACRES DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 2300 . 00 2 .00 0. 00 2 . 00 0 .00
1BSEISMICR VALUATION 2,, 300. 00 1 .00 0. 00 1. 00 0 .00
1PRREPIPE NO OF FIXTURE 10 . 00 220 .00 0. 00 220. 00 0 .00
1REMRESBAT SQ FEET 284 . 00 1140 . 00 0 .00 1140 . 00 0 .00
1REMRESKIT SQ FEET 182 . 00 1140 . 00 0 .00 1140 . 00 0 .00
1TRAVDOC FLAT RATE 1. 00 84 . 00 0 .00 84 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 2587 .00 0. 00 2587. 00 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 2, 587 .00 MC
---------------
TOTAL RECEIPT 2, 587 . 00
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: DATE: 12/08/2010 REVIEWED BY: gs
APN: BP#: *VALUATION: 1$23,000
q*PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
Y '07 PENTAMATION 1 R3SFDREM
USE: SFD or Duplex � r� . r>� PERMIT TYPE:
WORK
SCOPE
.'C/1'( ; F Plumb.Plan CheckTO.01 hrs $0.00
T r„rr I�t Plumb.Permit Fee: IPPERMIT I1<c_ 1' rrtr,':rf
F-1 IOther Plumb Insp. 0.0 hrs L $42.00 (. , r Y�i<( �",p
NOTE. Thesefees are based on the preliminaty information available and are only an estimate. Contact the De t or addn7 info,
FEE ITEMS(Fee Resolution 09-051 Elf '7,1/1Oj FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 182 s.f. Remodel,Kitchen(<=300 sf)
Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 $570.00 1REMRESKIT
PME Plan Check: $0.00 = s.f. Remodel,Bath(<=300 sf)
Permit Fee: $0.00 $570.00 IREMRESBAT
Suppl. Insp. Fee-0 Reg. 0 OT 0.0 hrs $0.00 = # Plumbing
PME Unit Fee: $0.00 $110.00 IPRREPIPE Re-Pipe Interior
PME Permit Fee: $42.00
Acoustical Fee: 0 Yes (E) No $0.00 0
Work Without Permit? 0 Yes E) No $0.00 0
Planning I ee: $0.00 Select a Non-Residential E)
Travel Documentation Fee: ITRA VDOC $42.00 Building or Structure
i
Strong?Motion Fee: IBSEISMICR $2.30 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $87.30 $1,250.00 TOTAL FEE $1,337.30
Revised: 12/07/2010
OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
is I (408)777-3228•FAX(408)777-3333
CUPERTINO
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the properly
improvements specified at:
SITE ADDRESS 91 11 n BP#
p.2 I IdeS C(rYO i P -,+qri A 3 5 9 - t 1 - 0 3 4-
OW ERN E I OWNER ADDRESS
WtJtJP 'C 2tr 11
DESCRIPTION OF WORK: 7A 4t M ' m ✓ > ' !, <,K
We are providing you with an Owner-Builder Acd�8m t and Information Verification Form to make you aware of
your responsibilities and possible risk you may W*ql�av Ih`i sued in your name as the Owner-Builder. We
will not issue a building permit until you have reaiinitial-d Zr understanding of each provision,signed,and
returned this form to us at our official address ind' nt 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.)
`151. 1 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.
. 1 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.
I understand as an"Owner-Builder"I am the responsible party of record on the permit. I understand that I may
rotect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
name instead of my own.
ll1/�4. I understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
J4hJ5. 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.
I understand if I am considered an"employer"under state and federal law,I must register with the state and
f deral 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.
- I 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.
4avy
I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for
financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction
I
defects in the workmanship or materials.
OwnerBudderForrn 2010.doc revised 04114110
&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.cslb.ca.gov for more information about licensed
contractors.
J� 'I"�'t0. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I
a the party legally and financially responsible for proposed construction activity at the site address listed above.
11.JA
I 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. I agree to notify the issuer of this form immediately of any additions,deletions,or changes to any of the
mation 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 property 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 qhV be required to be presented when the permit is issued
to verify the property owner's signature.
Property Owner's Signature: c�l Date: Z
(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 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 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:
OwnerBuilderForm 2010.doc revised 04114110
EXISTING 2'8"X6'8"
SLIDING DOOR TO REMAIN
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REMODEL OF EXISTING KITCHEN AND 3 BATH ROOMS.TOTAL REMODELED AREA IS 456 SO.FT. NO ADDITIONAL S0.FT.IS W N n
PROPOSED. °p O O V
GENERAL NOTES: DEMOLITION NOTES:
1. PROVIDE TEMPERED GLASS AT ALL GLAZED DOORS AND GLAZING WITHIN 24" 1. VERIFY WITH THE OWNERS WHETHER OR NOT OLD, REMOVED OR UNUSED DOORS, WINDOWS, CASINGS AND W
OF A DOOR OR WITHIN 18"OF FINISHED FLOOR. PROVIDE TEMPERED GLAZING AT MISCELLANEOUS MATERIALS SHOULD BE SAVED FOR FUTURE REUSE OR DISCARDED. cr
WINDOWS AT SHOWERS AND ABOVE BATHTUBS. a
2.SEE CEILINGIELECTRICAL PLAN AS&A6 FOR LIGHTS,SWITCHES,OUTLETS,TV, 22. GRENERAL CONTRACTOR IS RESPONSIBLE FOR REPLACING OF ITEMS DAMAGED BY DEMOLITION OR REMOVED IN U
PHONE LOCATIONS,ETC. VERIFY W/ELECTRICIAN&OWNOR.COORDINATE H
ALIGNMENT W/TILE FINISHES,HEIGHTS,WALL DEPTHS&FINISH,BLOCKING,ETC. 3. NO ASBESTOS REMOVAL IS TO BE UNDERTAKEN BY ANY PARTY EXCEPT BY LAW.
2
4. GENERAL CONTRACTOR TO PROVIDE VISOUEEN SCREENING DURING DEMOLITION TO PROTECT EXISTING L) ¢ U j
3. ALL WORK SHALL COMPLY WITH 2007 CBC.2007 CPC,2007CMC,2007CEC AND RESIDENCE, AND FURNISHINGS.
2007 CEC. Q p vi N y
S. GENERAL CONTRACTOR TO BE RESPONSIBLE FOR REMOVAL OF ALL CONSTRUCTION DEBRIS AND OTHER ZZ O W
4. THESE CONTRACT DOCUMENTS ARE PROPERTY OF ARCHITECT AND SHALL ASSOCIATED MATERIALS FROM THE STRUCTURE AND THE SITE. FRAMED AREA TO BE FREE OF DEBRIS PRIOR TO m w J '�
SHEETROCKING. Q ..I
NOT BE USED WITHOUT HIS OR HER WRITTEN CONSENT.THE CONTRACT 0 O
DOCUMENTS SHALL NOT BE USED FOR ISSUE OF A BUILDING PERMIT UNLESS 6. ALL UNUSED AND DEMOLISHED ELECTRICAL IS TO BE REMOVED BACK TO THE NEAREST UTILIZED JUNCTION. ¢ u 0 W
SIGNED AND SEALED BY THE ARCHITECT. NO DEAD HOTS TO REMAIN AFTER CONSTRUCTION.
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GENERAL NOTES: F-
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1. PROVIDE TEMPERED GLASS AT ALL GLAZED DOORS AND GLAZING WITHIN 24" OF A DOOR OR WITHIN 18" OF 6. AT ALL SHOWERS AND TUBS WITH SHOWERS, WALL cr LL
FINISHED FLOOR. PROVIDE TEMPERED GLAZING AT WINDOWS AT SHOWERS AND ABOVE BATHTUBS. COVERINGS SHALL BE PORTLAND CEMENT CONCRETE,
CERAMIC OR STONE TILE, OR APPROVED EQUAL TO 80"
2. VERIFY ALL PLUMBING FIXTURES, APPLIANCE, LIGHTING SELECTIONS, DIMENSIONS & REQUIREMENTS ETC. WITH ABOVE DRAIN. MATERIALS OTHER THAN STRUCTURAL
OWNER PRIOR TO ROUGH FRAMING. COORDINATE WITH FRAMING CONTRACTOR. ELEMENTS SHALL BE MOISTURE RESISTANT. VERIFY Lu
FINISH MATERIALS W/ OWNER. INSTALL HOT—MOP x
3. SEE CEILING/ELECTRICAL PLANS A.5 &A.6 FOR LIGHTS, SWITCHES, OUTLETS, TV, PHONE LOCATIONS, ETC. SHOWER PAN*ALL SHOWERS(TYPICAL). BASE MATERIAL <
VERIFY W/ELECTRICIAN & OWNOR DURING FRAMING. COORDINATE ALIGNMENT W/ TILE FINISHES, HEIGHTS, WALL NENEATH SHOWER PAN TO SLOPE TO DRAIN PER UPC
DEPTHS & FINISH, BLOCKING, ETC. 410.5 VERIFY DRAIN LOCATION W/ OWNER. TEMPERED Lu L=u)
GLASS 0 WINDOW AND SHOWER ENCLOSURE. SHOWER z
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4. PROVIDE CLEARANCE AT TOILETS: 24" CLEAR FROM FRONT OF BOWL, 15" CLEAR WIDTH EACH SIDE MEASURED DOORS & ENCLOSURE SHALL BE FRAMELESS, TEMPERED, > z
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FROM TOILET CENTERLINE. 3/8- GLASS. SHOWERS AND TUB/SHOWER COMBINATIONS cc cc v co
SHALL BE PROVIDED WITH INDIVIDUAL CONTROL VALVES < <1 0 m
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5. WOOD KITCHEN CABINETS, GRANITE COUNTERTOPS, VERIFY ALL PLUMBING, APPLIANCES, FINISHES, SELECTIONS, TYPE ADJUSTED TO 120 DEGREES MAXIMUM. 00 Lu
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1. VERIFY LOCATIONS OF ALL NEW SWITCHES, OUTLETS, 5. ALL CAN LIGHTS TO BE UL LISTED AND 0 O=)
LIGHTING FIXTURES, ETC. IN FIELD WITH OWNER PRIOR TO APPROVED, IC AND AT RATED. 20v 220V OUTLET LL U
INSTALLATION.
6. PROVIDE (2) 20-AMP BRANCH CIRCUITS FOR 0 RECESSED CAN INCANDESCENT
2. VERIFY ALL LIGHT FIXTURE SELECTIONS WITH OWNER. KITCHEN COUNTERTOP RECEPTACLES. LIGHT FIXTURE
3. COORDINATE ELECTRICAL WITH FRAMING CONTRACTOR 7. PROVIDE DEDICATED 20-AMP CIRCUIT FORLu
TO ACCOMMODATE SWITCHES, OUTLETS, CAN LIGHTS, ETC. REQUIRED BATHROOM OUTLETS, SEPARATED FROM Q RECESSED CAN FLUORESCENT c
THIN ROUGH FRAMING PRIOR TO CONSTRUCTION. VERIFY OTHER RECEPTACLES, LIGHTS, OR FANS, PER CEC LIGHT FIXTURE
WIF
BLOCKING LOCATIONS IN FIELD AS NECESSARY. 210.11-C-3. U c�
4. LIGHTING FIXTURES IN BATHROOMS, TO BE EITHER 8. PROVIDE DEDICATED 20-AMP CIRCUIT TO KITCHEN CEILING HUNG FIXTURE Lu gg
APPLIANCE OUTLETS, PER CEC 210.11-C-2 AND 2 w dr Z
FLUORESCENT OR CONTROLLED BY A MANUAL-ON >
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9. GAS SHUT-OFF VALVES FOR APPLIANCE SHALL BE ¢ O y a _'
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Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
U P E RTI N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: l Q I wry ¢c Y�S Lu {��t t PERMIT#
OWNER'S NAME: �eo i'l 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:
Signature Date
Please check applicable subcontractors and complete the following information:
V 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
Owner/Contractor Signature Date
CITY OF CUPERTINO
ADDITION/REMODEL
CUPERTINO FEE SCHEDULE
APN# Date:
3-51- 1 1 z-
Is a 2" unit being added? Yes ❑ No 0 If yes, please fill out the permit application for 2" unit.
Building Address:
0211 �'56C rPS Or C,6L,OAr424112, v 1 U-
Mailing Address (if different from buil ing address):
Owner's Name: W , Phone #
LE 0 v el C L' v Fr 16t-22W
Contractor: d Phone #:
rQ� Fax#:
Cupertino Business License: State Contractor License#:
Contact: Phone#:
Fax#:
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.
Compliance Method: ❑ Plant Type ❑ Water Budget
Building Permit Info:
Bld Elect. Plumb.i2Mech. Hillside ❑
Job Description:
Addition-What is being added?(Be Specific): Yl L)r1 P_
What is being remodeled (not including addition)? k,'+c l-tko, ghrk kcf1 ,rwyl / 114r� bc-t4rxL
Y
etAme a cj wo rt ��(�6.(1f a'�-'�' x"11 A o,,t S Q Wy", 4-
Remodel Includes Re-Roof. Yes ❑ No ❑-c If yes list number of squares
Remodel Includes Structural: Yes ❑ No ]
Do you have the pre-application planning approval? Yes ❑ No ❑
If yes, please provide a copy of your planning approval letter. Planners name:
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen 191 sf I Bath f. Other
Type of Construction (Usage Class): Occupancy Type: Vac a
1-A, 1-B ❑ II/III/V-A El 11/111 B, IV-HT, V-B Valuation: 000
Please check this box if the project is a
Project Size: Expresso Standard Lar e ❑ Major ❑ second-story addition ❑
Please complete relevant portion of the Green Building
Checklist& attach it to the application or if applicable, Green Building Points Achieved:
include in plan set& the sheet index.
Revised 05/18/10