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14090039-F CONSTRUCTION PERMIT APPLICATION la COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•buildinga-cupertino.oiq ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT i# PROJECT ADDRESS r 614 Q APN# OWNERNAME `� PHONEiC, – �(1 E-MAIL OA(� CK �((N lVf1 STREET ADDRESSp `�f S {�I(�_� CITY,STATE,ZIP �(�f F CONTACT NAME l l � PHONE (, E-MAIL) STREET ADDRESS. CITY,STATE,ZIP FAX OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT. ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION { / L � d �►lnda�l on fel1id. AdQ G�'UtI — n fw�— face 6 lea VQ4tn/ � r/✓��� . k EXISTING USE PROr,C USE CONSTR.TYPE I #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KrrCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNTr ❑YES SECOND STORY ❑YES BEING ADDED? ONO ADDITION? []NO PRE-APPLICATION ❑lB5 IF YES,PROVIDE COPY OF IS T- HE AN ❑YES ,RECEIVED$Y y"r ,' ' ,% ` '� 'I""rLA`7`I=J"ICTIO PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO , _ n By my signature below,I certify to each of the fo win 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 correc I have r .tlleI5—escription of Work and verify,it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building consorize representatives of Cupertino to enter the above-iden fied ropertyfor inspection purposes. Signature of Applicant/Agent: I Date: ��I SUPPLEMENTAL INFOWhOREQUIREDsNew SFD or Multifamily dwellings: demolition permit for OVER THE COUNTER i BUII DING PLAN REVIEW z existing building(s). Demolition permit is required prior to issuance of building permit for new building. EXPxEss, , OPLANNING Pf AN RE yv f M ' _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure D sxaNDAxD w ❑ PUBLTC WORKS tom' form if any Hazardous Materials are being used as part of this project. a 3s= "� LARGES & FIRE DEPT, t , _Co of Planning Approval Letter or Meeting with Planning prior to ` , n PY g PP g g p � ®�1kIAJO�tfi ��:�hw�� �� �C���§SANITARY SEWE�RDISTRICT.� 5 submittal of Building Permit application. F x BldgApp_2011.doc revised 06/21/11 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 C U P S RT l hI O (408) 777-3228 - FAX(408)777-3333-buildinwa)cuoerdno.org /.rte G� ,r; G� XNEWCONDDITI CONSTRUCTION ❑ AON ❑ ALTERAnoN/TEl REVISION/DEFERRED ORIGn�?AL PERI`41T f/ (� / G6— ( PROTECT ADDRESS APN R �0 o S 7 AJC 3`-7 - OWNERNA.ME PHOT E E-N.AL STREET ADDRESS CrTY, STATE,ZIP FAX at �¢o Tl Som ✓� C-U -I:-: 6.7'T-(kJ0 Cr- _ csof4 CONTACT NAME PHONE E-A4A.IL f STREET ADDRESS CITY,STATE,ZIP FAX #�02 cv a M - ❑ OWNER ❑ OIAWM-BUILDER ❑ OWK.-RAGE.NT ❑ CONTRACTOR ❑CONTRACTORAGTi xARC==CT ❑ENGWEER ❑ DEV-ELOPER ❑ TEN,AI.'T COA'TRACfORNAASE I LICENSENUA.3ER I LICENSE TYPE I BUS.LIC COMPAI.Y NAME E-INtAIL I FAX STREET ADDRESS CITY,STATE,ZIP PHONTE ARCIIITECTrr.NGiNEER NA 1,4E Co to`�a I10ENISE NUMBER I BUS.LIC R w� Pr S C`�. COMPAI Y NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP I (�PHONE Qa u DESCRIPTION OF WORK CJ j wo S-r0R- Ai-E:c4 T H O USS w ) 'Twp EXISTING USE PROPOSED USE CONSUL TYPE STORIES EXISTAREA USE TYPE OCC. SQ.FTI. VALUATION(S)S �_� Is t , �-:f DEMO 15tr! AREA ARE AREA 9.7 AREA3J e /Z�2I^4-z a3a/ BATHROOM ! KITCHEN _ / OTF3ER Yd D REMODEL AREA ,+(/J%f REMODEL AREA �/''�j REN,ODEL AREA .(/��/J PORCI�AREA DECK;�nR�FA TOTALDE 'ORC/H AREA GARAGE AREA: ❑DETACH fj ❑.AITACrI m DWELLING UNITS; IS A SECOND"UNIT ❑YES SECOND STORY ❑YES BEING ADDED? 0 ADDITION? NO -P2L�-A-FPL3CA- ON 'ES- l=rS,3�R0]MELOP OFA JS IE BLDG AN 1rs T07.AL\?tLU.47ION:_- PLAN1gNGAPPL- NO PLANIFNINGAPPROVAL LETTER EICHLERHONIE? .1 0 �Y-� oil= — By my signature belo-\v,I certii,to each of the following: I am the property o'\vner or authorized agent to act on the property m xrier's behalf. I have read this application and the informztio have provided is correct. I have read the Description of\�rork and verify it is accurate. I armee to comply�a�th all applicable local ordinances and state]a�vs relating ildina construction. 1 zuth0rize representatives of Cupertino to enter the above-identified property for inspection purposes. SienatureofApplicant/Agent: � Date: SU-PPLE?`IEIvTAL :rFOR24ATI0NREQUIRE ; L �CHECKTSTE s .... ti. .ROIITIIiG L]F.j= u;`:' New SFD or Multifamily ciN'ellings: Apply for demoli ' n peimit fr © OVER THE-COUItTER ' �BL�.b]ItGPLA'�'REF��r s t existing building(s). Demolition permit is required prior to issw wilding $ 3 IR g: permit for neer building. © lss �I A1.mIi cPLs Ri isr« _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ��TA.DA�tn �usilc t�'oRxs 4 form if any Hazardous Materidls are being used as part of this project. _�- _Copy of Planning Approval Letter or Meeting with Planning prior to } Submittal ofBuildin.Permit application. 2 `IIsRDzsTr.Icxi <.-�,--"=- s.ra _..r .. z -=� :E:�T�'IROn'➢4ETT.A);HE.a3;TA�.� ���. Bldo4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO OFEE ESTIMATOR—BUILDING DIVISION TAPN: DDRESS: 19240 Tilson Ave DATE: 09/09/2014 REVIEWED BY: Sean BP#: C��� VALUATION: 1$400,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex 2nd Unit? Yes G No PENTAMATION 1 R3SFDW USE: PERMIT TYPE: WORKConstruct two story residence 2321 s ft Covered Porch 57 s ft Attached arae 420 s ft . SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. R-3 (Custom) II-B,111-B,IV,V-B 2,798 $3,025.83 IR3PLNCK $2,916.89 IR3INSP TOTALS: 2,798 $3,025.834 $2,916.89 e Vech. NO Check 1''honi). Plein C-eek !.Jec% Pian C"neck t�eelr. °'?nliil k'ce Plumb. 1'e,m111''c<e: I=.1ea. Perini Fee: Other AUcch, Insp. E1__L_ Odle;-1'1wrib l sp. OtherI lec.Ins1�. F-1 ,81ech. hap, kee: pfarnab. 1 isp. Fee: � Jsiec.PI-VP,Fee: NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the prelimina information available and are only an estimate. Contact the Dept-for addn'l info. FEE ITEMS Jee Resolution 11-053 Eff.' 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,025.83 Select a Misc.Bldg/Structure Suppl.PC Fee: (j) Reg. 0 OT 0.0 hrs $0..00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $2,916.89 Suppl. Insp.Feer Reg. ® OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1 units#new $667.63 Z1.G�l711{1l.1tT"i Work Without Permit? 0 Yes (2) No $0.00 f" Advanced Planning Fee: IPLLONGR $391.72 Select a Non-Residential 0 Fees: Building or Structure 0 .r�rrc. 1:)orrtrnc.ntut..ur: � Strong Motion Fee: IBSEISMICR $52.00 Select an Administrative Item Bld,g Stds Commission Fee: IBCBSC $16.00 SUBTOTALS $7,070.07 $0.00 TOTAL'FEE $7,070.07 Revised: 08/20/2014