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MX-M1100_20160421_112524
CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMIENT' BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CiJPERTIH0 (408)777-3228• FAX (408)777-3333'building(cilcupeFtino.org 51/1yr IM� NEW CON'STRliCTION 9 ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERK IT I_ PROJECT.4DDRESS 'Act (-+L AP-l' .? 4'Z"v Z0 `/�V l.i /1 VJPHO?\B/tt/(J � Vb6 ,I,E-biAlL ONERNAME STREET .ADDRESS I£AS6 aYC1 v,0CC0It CONTACT NAME PHONE oq E-h14IL a P, d .�1 1 /I� � g312Y3CqWin re51 I vC — r STREET ADDRESS 2193vM ANZ46A D�- CITY, STATE, ZP(n^j-,0)e FAX ❑ OVWER OwN-.-BULDERC] DAWER AGERT ❑ CONTRACTOR ❑ CONTR4CTTOR,AGENT ARCHITECT ❑ ENGNEER ❑ DEVELOPER ❑ TEMII.T CONTRACTOR NAME --- LICEHSENUTIBER LICENSETYPE BUS. LICE COWANYNAMIS f-- E-MAIL —.— FAX STREET.4DDRESS CITY, STATE, ZIP PHONE ARCHITECT'ENl7AtER NAME LICENSE UUNBER BLS.LIC. �.. COMPAN7 HALE E-R44IL FAX STREETADDRE$$—_----_ --- CITY, STATE, ZIP -- - PHONE— ___ _ DESCRIPT101i0F1i'ORK 3 _ -becA repo _ L�Lf�_� G{ r C Zf�4Art o cv%t —(� 1 _ --- A"dlcAk�on ©T AA,Q 5�,�f-- I(eL10t14 JvAb(1 CC-) 64r(A EXISTING USE P-Lq') ( ..l PROPOSED USE CONSTR, TYPE. jp„�l�n „ �C'LL `wVt- 'STORES A jJ- USE I TYPE I OCC. SQ.FT. VALUATION (S) EXISTG)J AREA D NEW FLLTR AREA II 14 DE610 /,RE.4 +, (tom. /v JiOTHER 'I OTAb- NtT AP.EA I — BATHROOM KIT`CHEN REMODF.L.4RE.4 REMODEL AREA REMODELAPEA PORCHARE.4 DECKAHEA TOTAL DECKTORCH AREA GAR.4 AGEREA: ❑DETACH — ❑ ATTACH 4 DWELLM-C "TTS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEtNGADDED" ENO .ADDITION". ENO PF-4P?L)CATI0\ ❑1'ES IF 1TS, PROVIDE COPY OF - PLANING :APPLR []NO PLANNIT"GAPPROVA.LLETTER ISTHEBLDGAN ❑YES RICH=HOME^ ❑\'O RECER ED = T T4L }+.4LUATIGN; By my signature below, I certify [o each of the fallowing: i zm the properh� owner or authorized agent to act o the pr perty owner's behalf, I have read this application and the information I hate provided is correct. I have read the Description of \Alork and verify it is accurate. I agree to comply with all applicable local ordinances and state lai',s relating to building construction. I uthorize repi cseniatives of Cupertino to enter the above-identi5ed property for inspection pnnoses. Signatureef ApplicantlAgenC_ �--�, CA I-r ( Date: �' Zo �� Ib SU-PPLEMEN7TAL. INFORMATION REEDQUIR r,S.,�ROUTING`SLSP ❑ OA ER TY-E. COU\TrR '� ib I\Tew SFD Or Multifamily dv, elliPgS Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of builder L LDI\G PL4\ "F, a-'.2--,, perm it;or new building. s❑ FlPREss �r`" ❑ FL`4.\�L\e FLa\,.Ei IEw Commercial Bides Provide a completed Hazarcons MateriLls Disclosut ❑ s mARD�` s ❑ Pt,BLlciioxR� - _ form if any Hazardous B42telialS are be ,Ig used ES Dart of th;S project. " ' ' °• .. fARGE ° �''*�, � ti as :_ �FiRE.DEPI" £ Coat of Plarmmg Approval Letter or Mecnne is -,h Planning prior to- U AiAdGR ❑,iS4\IT Ail] SEq ER DIc7ptC7 subnaitial of Bulldina Permit arIplicati OIL 20 '. :. ❑t ENi7R0A E\TAI. idE4LTH Bldg 4,op_? 011. doc revised 0612 1/11