BUILDING APPLICATION B-2016-2231CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE.AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 •FAX (408) 777-3333 • buildinc0).cu ertinO_.or2
❑ NEW CONSTRUCTION ' pLLyADDIT']ON ❑ ALTFRA'PION / TI ❑ REVISION / DEFERRED
ORIGINAL PERMIT 9
APN O
PROJECT ADDRESS j %^
C�•'6
,[� /®/®/� /mow
OWNERNAME
��1'gAt-i l�f't�.l� PHONE(
y,�/L���(1'l
-rI,�Q
STREETADDRESS tG�jl rt�py.'<Q (�VTTv
----M('AIL
CITY, STATE, ZIP
-------
FAX
CONTACT NAME PHONE yS SLa E-MAIL 1 yn O p F
1
STREET ADDRESS CITY, STATE, ZIP FAX—
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
NUMBER�IY/VLI�i%
(�J v
LICENSETYPE
BIDSS.LICN
COMPANY NAME /'•rAipV 11LLIICENSE
11 1(
E-MAIL
FAX
STREET ADDRESS %' f �f [�(��, ( C2�-I lt
CITY, SLATE, ZIP Tt_? ct' �' ("(�Y
PHONE
c,
ARCHITECT/ENGINEER NAME s.ma.
LICHNSENUMBHR
BITS. LIC4
-------------
_--
_---
COMPANY PIAMB
E-NAIL
FAX
STREET ADDRESS ^'--.--_-----��___—.'
CITY, STATE, ZIPS®-- -----
PHONE
�V sue_
DESCRIPTION OF WORK
—_ �1LJ._(1-�_(_-6E�+L-'�{—_—.__�� (—�� __-�'✓_'�t1:t1��-fil� `=]�_IIC_ /�{.? "(`//.
EXISTING USE PROPOSED USE OONSTR. TYPE 4STORIES
USE
'TYPE
OCC.
SQ.FT.
VALUATION($)
EXISTONEW FLOOR DEMO
AREA 117 E AREA AREA NET AREA p
N
—
BATHROOM \ KIT 1 M14ER_—
REMODELARP.A f t REMODEL AREA -U� REMODEL AREA V
oq,<ATTACH
PORCH AREA DECK AREAPIS
TOTALDECIC/PORCH ARL�GARAGE
AREA: ❑DETACH
'[]YES
NDWGLLWG GNITS:
OND UNIT AYES
SECONDSTORY
—
GADDED? ❑NO
ADDITION? ❑NO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
ISTHEBLDGAN ❑YES
?. RE]Y
TOTAL VALUATION:
PLANN1NGAPPL# []NO PLANNING APPROVAL LETTER
EICHLERHOME? ❑ND
By my signature below, I certify to each of the following: I am the property owner or authorized agent tVact on the l W operty o f. I have 1 ad this
application and the information I have provided is correct. I h ve 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 can ruction. aµ rite representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Appticant/Agent; _ Dale:
SUPPLEMENTAL INFORAATION REQUIRED
PLAN CHECK T1TE'.
ROUTING SUIP
New SFD or Multifamily dwellings: Apply for demolition permit for
❑ TIIGCOIINTER
BUILDING
_
existing building(s). Demolition permit is required prior to issuance of building-
OYLx
-
PLAN REVIEW'
- -
permit for new building.
❑ EXPRESS
PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed.Flazardous Materials Disclosure
El STANDARD
❑ PUBLIC WORKS '
Term if any Hazardous Materials are being, used as part of this project..,
❑ LARGc.
❑ emE nePT
Copy of Planning Approval Letter or Meeting with Planning prior to
❑
snN[TAxY
submittal of Building Permit application.
nuaox'
SEVER msTTHCT
❑ GT9'IRONMENTAL HEALTH
P
'I I � to,
BldgAplm_201 Ldoe revised 06121/11