14110053 REV#1 APP FEE ESTCUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY0300 TORRE AVENUOE MCUPERTINO, CA 95014 312D5NG DIYI§tW� `'�IO 1 #Atb
(408) 777-3228 - FAX (408) 777-3333 • building a(),cupertino.org
M NEW CONSTRUCTION M ADDITION ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT t
PROJECT ADDRESS
APN N
o4-0
OWNERNAME \
l l'1
PHONE
O
E-MAIL
STREET ADDRESS
�. hsW �Y.�7'�d�
CITY, STATE, ZIP
FAX
CONTACT NAME
�vt�
PHONE
E-MAIL
STREET ADDRESS -I
l a 2 6 cE 1 t e 4. tav - r
CITY, STATE, ZIP
GUeil
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME
LICENSE NUMBER
LICENSE TYPE
BUS, LIC#
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECTAINGINEER NAME
TO SENUMBER
BUS. LIC#
COMPANY NAME -t`
�VC1 rei'S to ln4\ �Sp
E-MAIL
FAX
STREET ADDRESS
DESCRIPTION OF WORK>kK �
�
g� eA, IL r 6
Vr®trsLY
ice,.
EXISTING USE
PROPOSED USE
CONSTR. TYPE
RSTORIES
S c:) I
S"V, p
6 /
USE
TYPE
OCO.
SQ,FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM KITCHEN OTHER
REMODELAREA RFMODELAREA REMODELAREA
PORCH AREA DECK AREA
TOTAL DECK,TORCH AREA
DE GARAGE AREA: TACH
ACH
#DVJELLINGUNITs:
IS.A SECOND UNIT ❑YES
SECOND STORY
FIYES
BEING ADDED? O
ADDITION?
PRE -APPLICATION YES IF YES. PROVIDE COPY OOFF'..
PLATTING APPL# NO PLANNING APPROVAL LETTER
IS THE BLDG AN ES
EICHLER HOME. '0
IVED BY
/xs
TO VALUATION:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. T have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply With all applicable local
ordinances and state laws rQlathjkjobuilding constr a I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
r2 "-'� C"
Signature of Applicant/Agent Data:
SUPPLEM' RNIFORhQA N REQULUD
�PLAN-CHECK TYPE
:. ROUTING SLIP -'
1NIew SFD or Multifamily dwellings: Apply for demolition permit for
' ov E$ xxE coUNrER
❑ sUILmNe PLAN REv Ieli ,,
existing building(s). Demolition pennit is required prior to issuance of building
permit for new building.
❑ Ex'PUEss
❑ PLANNPnG PLAN REv ]EtryT
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑. srA�•nARD
�O PUBLIC WORKS
_
four2 if any Hazardous Materials are being used as part of this project.
❑ LAxcE - _
❑ FIRE nErr
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ nLalox
❑ sANIrARY"sE}sERmsxlucT
submittal of Building Permit application.
= - ,
.•❑ ENVIRONMENTAL HEALTH
BldgAyy_2011.doe revised 06121111
CITY OF CUPERTINO REVISION #
FEE ESTIMATOR - BUILDING DIVISION
7955 Rainbow Dr DATE: 02/19/2016
REVIEWED BY: PAUL
WADDR7SS:
APN: 362 11 040 BP#:
-VALUATION: $900
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
SFD Or DUp12X
PENTAMATION
1 REAP
USE:
PERMIT TYPE:
WORK
REVISION #1 ADD BACK INTO ORIGINAL SCOPE OF WORK MASTER BATHROOM REMODEL -
SCOPE
INSTALL (N) 40 AMP SUB PANEL IN GARAGE - ISSUED 2/19/2016
rt, Phur l rxk
1'i1•#h. Pi'm hcc,',
Flee. Plan Check 0.0 hrs $0.00
Piu rzn_ F'¢-:: it f'en
Elec. Permit Fee: IGPLRMIT
oM", p;r;,,<i;;,nF
Other Elec, Insp. 0.0 hrs $48.00
NOTE: Thisesilmate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Server District, School
District, etc.. These fees are based on the preffininar information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-0531i . 711113�
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
40 amps Electrical
$48.00 IBELEC200 Services
Suppl. PC Fee: Q Reg, 0 OT
0.0 1
hrs
$0.00
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:
$48.00
(. t+,)g;t7ii'Yi Uri lov
Administrative Fee: IADMIN
$45.00
Q
Work Without Permit? Yes (j) No
$0.00
Advanced Planning Pee_
$0.00
Select a Non -Residential
Building or Shucture
i
Travel Documentation Fee: 1TRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
Select an Administrative Item AA��
(m.,
Bldg Stds Commission Fee_ IBCBSC
1.
SUBT,OTALSi',
$142.50
$48.00
TOTAL FEE:'
$ Q,
J
Revised: 01/01/2016