B-2016-1468 APP, FEE ESTC�Pl1��IliiiL�]
❑ NEW CONSTRUCTION
CONSTRUCTION PERMIT APPLICATION EX16—IL6
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION I
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a cupertino.org
ICJ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 7 (y P— 0 L L 1 H 1i D leLL D
APN k 3,523 i C61
OwNERNAME C VIA-Ti A.N KI I_I-f}t'\/
PFIONE
E-MAIL
STREET ADDRESS QD L.G-1" Q r) Z7L L P ?-
CITY, STATE, ZIP C v P L` 12 i 1 " O C A
gro I
FAY.
CONTACT NAME
ec �7�1l
PHONE
�/v�G�sos>%
E-MAIL
sc
STREET ADDRESS
ZG 6U CWT��
CITY, STATE, ZIP
L6f 716v6 �.a 9��1//
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LICA
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME. � �
LICENSE NUMBER �1zf
BUS.LIC-
COMPANYNAME 527 41-5//'I,1 /�
((�' �j�j,J L�{�' Y
E-MAIL
—
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
EXISTING USE
PROPOSEDUSE
CO;T .TYPE
#STORIES
i
USE
TYPE
OCO
SQ,FT.
VALUATION ($)
Ex1STG
5,/-
W FLOOR
AREA .^J P/i
DEMO
AREA G
TOTAL
NET ARE/O. /
fI
BATHROOM
KITCHEN OTHER
REMODELAREA �.
REMODELAREA REMODELAREA d
PORCH AREA DECKAREA
TOTAL DECKTORCH AREA
GARAGE AREA: DETACH
G
0
❑ ATTACH
HDWELLBJGUNFIS:
1SASECOND UNIT ❑YES
SECOND STORY ❑YES
HEiNG ADDED? O
ADDITION? Ire0
PRE -APPLICATION []YES IFYES, PROVIDE COPY OF
ISTHEBLDCAN ❑1'ES
, IVEDBY `'
TOTALVALUATION:b
PLANNING APPLF 11.'NO PLANNING APPROVAL LETTER
i
FIEDLER HOMm �r�.O
/
_
!(ll
!�ocw
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. I have read this
application and the information I have provided is em�ect. have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building consnn ❑. I authorize representatives of Cupertino to eater the above -identified property for inspection pwposes.
Signatiu e of Applicant/Agent: Dater C
SUPPLEti4ENT ATION REQUIRED
Pr ANCHECKTYP
;- RO64MN SLIP '�
-
❑
r
New SFD or Multif ily dwellings: Apply for demolition permit for
—
existing building(s). Demolition permit is required prior to issuance of building
Oi ER THE CO JNTER
1
BUILDI\GTLAN REV IEii'
;_
penult for nevv building.
❑�
PL4\\L\G PLAN AEi IER
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
}E\PRESS
y� 3T4Vn4RD r
❑ Puslle n oRRs
fmni if any Hazardous Materials are being used as pall of this project.
-
AIR
FIRE nzPr -
_ Copy of Planning Approval Letter or Meeting with Planning prior to
Copy
❑ t+LAJOR -
` ❑ svlTnR>;-sse ER msTliicT
submittal of Building Permit application.
-❑ ENVIRONMENTAL HEALTH
Bld App_2011.doc revised 06121111
CITY OF CUPERTINO M16 -) .
FEE ESTIMATOR - BUILDING DIVISION
61
ADDRESS: 7480 ROLLINGDELL DR
DATE: 03/04/2016
REVIEWED BY: PAUL
APN: 359 31 061
BP#:
*VALUATION:
1$40,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
USE: SFD Or DUp12X
2nd Unit? Yes No
OTC? Yes O No
Pp
PERMIT TYPE: 1 R3SFDADD
WORK
CONSTRUCT N SIDE YARD ADDITION 245 S.F.
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
p FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,III-B,IV,V-B
245
$1,091.00
1
DDPLCK
$1,057.00
IADDINSP
TOTALS:
245
$1,091.00
$1,057.00
MECH, . HOURLY
0 Yes G No
PLUMBS HOURLY Q Yes (j) Np
FLECS HOURLY Q Yes (E) No
Vech. Ye . ` Fee :
Ptunic_ P<q mrt ?'ee.
fnsp�
b:ap.
<? ,,,
Irm, 1'ee,
t U� lh In"'k. L:.
f;. Invx i ec:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preltnduarv, infornmtion available and are only an estimate. Contact the Dept for akin'! info.
FEE ITEMS (Fee Resolution 11-053 Ej. 7/UQ
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,091.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: (j) Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,057.00
Suppl. Insp. Fee:Q Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
"ouq ZSUIWP, 1[Zx:
0
Work Without Permit? Yes Q) No
$0.00
Advanced Planning Fee: IPLLONGR
$34.30
Select a Non -Residential 0
Building or Structure
i
y 7� )< i ynrru,7 r < r,y,1
Strong Motion Fee: IBSEISMICR
$5.20
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$2.00
SUBTOTALS:
$2,189.50
$0.001
TOTAL FEE: '',
$2,189.50
Revised: 01/0112016