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B-2016-2095 C�qN�'fIf�UCYIClN P�RMIT /a,PpL.ICpe`fION � � -COMMUNITY DEVELOPMENT DEPARTMENI'•BUILDING DIVISION . 10300 TORRE AVENUE•CUPERTINO, CA 950143255 (40P,)777-3218^ FAX(408)777 3333• buildin _cu ep rtino_org ���,� ,��� �;�.7��R"d'INf? � I_�NEWCONS'I7tUCfION � L.� A])DI'PION UALTERATION/7'I �J REVISIOM/UEFE2RRD ORIGINALPERMI'T# ' ren.n:cr ai�naess (0�0 U uU.�j�1A�A}Q `.i� a��N n 3� _O � —O Cl3 OWNERNAMB C,ay� a CTIF'lnS ����-^ ' PHONE ��s LIIC J/��/��� E�MAIL . - '� ���.___ ' "-'-'""—"' ��J "�`� _ 5fRIi5'I'AWRP.SS F{� K��1^ � . �� /� CITY.STATC.ZI /�„� �M�__�e r��� FAX `'� l�1 IC 1'1 !?���Y7\Lax µ coMrncr�n�nMF � PI�IONE�„�,�'('{�P, E.MA1L --.. ._._.__�Ctvll�e L12�1 --------- V`� � SfREG'CAD�RFS3 � CI'fY,5TAT8,Z[C /�[ �`� PAX --------- --20 11�inS �,tl2e,9�.�'J1y�.___�----��1viU i. t.r� .-----�-- ❑ONNER ❑ OWNER-llO➢,DFR ❑ OP✓NERAGiN1' ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITCCT ❑ENGINLER ❑ DGVL+UJPGR ❑ TNNANT � (;ONTRA("fORP1AM13 �C� ,Sr... A.. Q �_.( ,� I,ICBNSENUMHEIt LICENSETYP6 UUS.LICq �_s�-�- ✓ l��L�F'Ci J(�/? �ll�� CObiPANYNAA4L "_`_--__'_'�._-'--__.�,___ - C-MNL ."---__...____ . ---_ PAX --__---_ S1'RF.ST ADDRF.55 CITY,STA'PC,Z[P PAONY. ARCHI7'F,'C'C/P�l'OMtiERNAh1L' �p����� LICENSENUMI3ER //-��.��� �US.LICN � l --.._.---------�Ill �}eNev�sC,Ye.c.k Bl� z o ---- ��.a—�l��---- ----� � R-��ve_�tVr,l.,,,��u�v-� — „�...___e ------- — COMPANY RMAC l-MAII, h'AX ��'�Fs�u . tiCl(PETADURliSS ._.._. GPI'Y,STA7'H.7IP PHONtiv `{v� �� DHSCRIP"CIONOPNORK— 'T"�0�.._._� X�Z� _S��_ SI'��V'�'`�I`S _� ���5^ IL�� � LXISPllJGUSC�^6� PRUPOSFAUSI" CONSTILTYPL HHTO[tILS " `�OFI'ICEUSEONLY �' d� _,_. ,_,_.__ _ ,_. , -` OL'C PYPE DESCRIP"CION " SQ,4T � VAI.UATIOAj51;�' PXIbTC NEW FLOOIi DGMO TOTAL AItEA ARNA AREA - -- NF.TARF.A "_--"- ➢ATIiROOM KITCIIEN OTH6R _ ItCMODCLARLA ILbMOUELARHA t2EMOpLLARLA " : __ ." _ " -_'--__ _ . POHIIiNtEA IILCKMLA YUl'AI.UIX;IC/f'ORCHNtGA OARAGEAReA�.� DLTACH I . � ......� . .. _ _.._� _-.__._ _.-�nrrncx .� . '. . nnwr.uwcurvits rsnseconuun�r Qv-es se.carvosranv �res oeixc,wucu! ��Nn nomr�orvx �rvo --_-___"_' -_ _ �- '-___—_ � !'ftF.APPLICRTION '� YIS IFYFSPRQVIOfiC01'YOi PLANNEA'SNAh1E T��rypDBY�� ���J� 'fOTALVALUAl10N PLWNINOqPPLY � NU PWJNINGMYAOVALL6Y1'tiR �VWK Zp�Qp�} By my signaliue below,I certify lu each of Ilie Following: I nm the propeiTy avner or aulho�ized agent lo ac[on lhc pmperty owner's be]ialC ]have read flus � �_�� . applica[ion and ffie inForma[ion I liave,provided is couect, I have�end the Description of Work aud verify it is acourate. I agrce[o cmn�ly with nll applicable local oa�d'uiaooes•and stato]aws rela[ing to b�il u�g co e tion. I anYhoriza represertaflves of Qapectino lo enfcr[lie above-irlentiSed property for inspection purposes. SignalmcoPApplicanUAgenC_ �___ ______ __ _ Date:_��� � �___ SUPYLEMEN'TAL 1NFORMATION REQUIRED � rj,�ii,cxecx rreE�: xourirvc scrr New SFU or Multifaanily dwellings: Apply for demolifion permit fm� ❑ pyER-THE-COUN7ER. ❑ Buv.mrve rLn�xisv�c�v __-' R S existingbuilding(s). DemoLidon pe.miit is required prior to issuance of building permit for new huilding. O sxr�ss ❑ il,n�m�ucrLnivn�view�,���' Commarcial Bldgs: Provide a completed ffazardous Materials Disclosure ❑ srarvuAan ❑ PUNLIC 1YORKS f'orm if any Haz2rdous Mat�erials are being u&ed as pnrt of thie project. ❑ �,,�cE��: ❑ aias nEeT a Copy�ofPlaniungApprovalLct[crorMeetingwitliPlnmiivgpriorfo � n,WSOR� ❑ sarvirnavsan�cxn�s'rwcz ' submittal of Building Permit application. ❑ I:NVIkO�MEN7'AI,HF.ALTH �'� .87dg,ApFr_20]].doc r�evised�J3/tG/71