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B-2016-1766 Application0 CUPERT NO ❑ NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION - COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildino(la cuoertino.org {Z t 0 ADDITION 0'.1TERATION / 7T ❑ REVISION / DEFERRED OORRIGLI IAL PIER-1,9TI# LY lY PROJECTADDRESS I APvrt c/ / S—L1Z —GS t OWTERNAME PHONE E-R441L IL4,1"Ze 4oS167c(0Z7 kWJAre� i�se{+.!<lrfszp.ro STREET.ADDRESS STATE, FAX /Ao pl,.e,( S14r CONTACT NAME /y _ v / re / „ `G i SSTRREETPDDRESS CITY. STATE, ZIP FAX , OWNER ❑ OWNER -BUILDER ❑ OW-N AGE77 ❑ cow. R&cToR ❑ cox TRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME !/ I LICENSENDMBER LICENSETYPE I BUS. LICE 5, COMPANY NAME E-MAIL FAX STREETADDRESS I CITY, STATE, ZIP PHONE .ARCHITECT,TNGD%TM LAME - - _ I L10E\SEWUMBER I BUS. Lie COMPANY NAIKE I E-4LAIL FAX STREET ADDRESS CITY, STATE,ZIP I PHONE DESCRIPTION OF WORK G�li 7%L S r - Z7� 51� K�tueaP m EXISTING USE {"63rdeka PROPOSEDUSE CO35TR T1PE STORIES USE I TYPE OCC. I $Q.FT. I V.9LL*.ATION (S E)LIST NEW FLOOR DARE40 TOTAL AREAO AREA �i �1 C� I 1:TET.^L4 BATHROOM KITCP.E\ OIFF R REMODELAREA REMODEL AREA REMODEL AREA i PORCHAREA DECKAREA TOT.ALDECKPOP.CHAMA GARAGE.AREA: ACH ❑Dr-- I DWELLWG LTITS: IS A SECOND UKTT Y S SECOND STORY ❑ ` HELNG ADDED? ADDITION". PREAP?UCATID\ ❑1S IF Y•S.PROVmt COPY OF PlAhTING.4PPL.' ❑k0 PLANNING APPROVAL LETTER ISTRERLDGAS ❑1ES EICHLER HOME? NO RECEI4EDB - '�. 3i---'�_�P:��-- — OT.AL VALUATION: 5 0 0 oo By my signature below, I certify to each of the following: I am the property pW;ner or authorized went to Wt on the property owner's behalf I have read this application and the raft tion I have p vided is correct I have read the Description of Work and verify it is accurate. I Lace to comply with all applicable local ordinances and state IaWs re'.ztina to bm o on truction. I authorize representatives of Cupertino to enter the above-identi`;ed property for inspection purposes. SiEnature of Applicant/Agent SUPPLEMENTAL FNFORh4ATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of buildi - -- I f permitfornewbuilding. _ Co=iercial Bldgs: Provide a completed Hazardous Materials Disclosu form if any Hazardous Materials are being used as part of this project. — I — _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal ofBuildin_g Permit application. —.- -_ --===CT Bldg.4pp_2011.doc revised 06121/11