B-2016-2165 Building Department
City Of Cupertino
10300 Tone Avenue
9, Cupertino,CA 95014-3255
Telephone: 408-777-3228
CUPERTINO
Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: 1 0 5i 1 DBODU-A M., PERMIT# aoi6 - 2165'
OWNER'S NAME: NON t_cpc PHONE# (:)50 2O1 21S
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
Jo' io/o/fie
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
6/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork aterterfup Jowl COQ iler Sluith '4344eC 9 14124(4
Cement Finishing CPU Rbki cat4N)
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass/Glazing vt Gtacs 4 11 =A-ToAeDgoet F
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
/Contractor Signature Date
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(dtIcuoertino.org 1P
n NF.WCONSTRNCTToN 1-1 ADDITION F1 ALTERATION/TI 1-1 REVISION/DEFERRED ORIGINALPERMIT#
PROJECT ADDRESS I V J I I DCODOO V �
V
APN # { ` _ 3 j _ C) 4 ]-
1�"' "r
OWNERNAME WON L'oy
PHONE
E-MAIL'C
STREET ADDRESS IbS(( bmor-A D)L
CITY TATErZIP
cueenTE ZIP �l gsro14
FAX
CONTACT NAME
ANNY TAN6ef1.iSAN
PRONE
(Sb • S�6 •433`1
E-MAIL nn tnn@ann dKi
0. y � 9 0f. com
STREET ADDRESS 5.3,i' �$PeeY V
CITY, STATE, ZIP
R�DwooA Urf, CA (qO
FAX
❑ OWNER ❑ OWNER -BUILDER E5`OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑'TENANT
CONTRACTORNAME At4rr4L,4w
LICENSEENrUMMHBERR
LICENSETYPE
BUS. LTC
COMPANYNAME SAf`�rl L(,A%I
IT1`�
EMAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME
LICENSENUMBER
BUS. LTC #
COMPANYNAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK /1 A,r EMA
— 7Vh(;* rsiU�Ui u M
EXISTING USE,
PROPOSED USE
CONSTR. TYPE
# STORIES
I
USE
TYPF.
OCC.
SQ.F'T.
VALUATION (.$)
EXISTS
AREA
NEWFLOOR
AREA 0
—
DEMO
AREA /%�/ _TT �'
—
TOTAL
NETAEEA C� Sf
BAT14ROOM KITCHEN OTHER
REMODELAREA Dvrn �F REMODELAREA REMODELAREA
PORCI{AREA DECK AREA
TOTAL DECK/PORCH AREA
GARAGE ARE: ❑DETACH
[]ATTACH
#DWL•LLINGUNITS:
IS A SRCOND UNIT I]YES
SECONDSTORY ❑YES
BRING ADDED? LINO
ADDITION? ENO
PRE. -APPLICATION ❑YES 0 YES, PROVIDE COPY OF
ISTHEDLDGAN El YES
RECEIVED BY -
TALVA�L�Ur/A^T�ION:
PLANNINGAPPL# FIND PLANNING APPROVAL LETTER
EICHLER HOME? ❑NO
AAT
ItV �V
By any signature below, I certify to each of the following: I am the property owner or authorized agent o act on the property owner's behalf. I have read this
application and the information I have provided is con cut. I have read the Description of Work and verify it is acemate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives oPCuperlino to enter the above -identified property for inspection purposes.
Signature of Applicant/Ageut: J Date:
SUPPLEMENTAL INFORMATION REQUIRED
- PL,ary cltscR Tree:-
RouirNc SLIP
❑ OVERT HE-CODNTERI
❑ BUILDING PLAN RIEVIEW
_ New SFD or Multifamily dwellings: Apply for.denlolition permit for
existing building(s).. Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PI.ANNIP?G PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC woRKS
form if any Hazardous Materials are being used as part of this project.
❑ Lnacls�
❑ rrnE DEFT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEVER DISTRICT'
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
B1dgApp_2011.doc revised 06121111