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B-2016-1639 APP, FEE ESTIMATOR110 fsTans;:: CONSTRUCTION PERMIT APPLICATION 06A160q COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777.3333 • building(EDcupertino.org (=UPERTIN0 ❑ NEW CONSTRUCTION ADDITION 9ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT R PROTECTADDRESS , f ®Ir}(/�� �,�/%�- �� I� U _ /I �AP/N1_}:�(/t-�i(.I/' /7 �ry) OWNER NAME \I� (�fa _ V 1. t✓Y Vim" l.4 �7' PHONE 11 }� IJ(�t(/ E-MAIL1V `�I/ji.Vva-r`k'_ VV`t/-t �. CCt1H t� I \Z/[PO STREETADDRESSj r;2 p CITY, STATE, FAX � ll-I/y{'C� I 'E-MAIL ///]]]��^ CONTACTNAMF�/�p(,r�j rtp ,n nli.pj PHONE. - qqd C° U L� I I"I� Yt� r/�I �m� r --- STREET ADDRESS — CITY, STATE, ZIPn�' n . — Ate( ^ (I IV❑ IAACnitMe{r V❑ ❑ OWNER ❑ (YVNER-BUILDER CI OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTTOR AGENT ENGINEER ❑ DEVELOPER ❑ TENANT NA� LICENSE NUh4BER LICENSE TYPE BUS. L]C� —CONTRACTOR — COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGA'EER NAMEq„p Y� LICENSE NUMBER , „� _ BUS. LIC ' - -- -- COMPANY NAME EMAIL FAX STREET ADDRESS'�I\J C _-- /1-1/l'I'Y, STATE, ZIPI r PHONE -en Owl �j 1U1�4' �f �(/4D DESCRIP'T1DN OF }\'ORK�� EXISTING USE PROPOSED USE CONSTR. TYPE SSTORMS USE TYPE OCC. SQ.FT. VALUATION(S) EXISTO NEW FLOOR ➢ TOTAL AREA AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL.4REA REMODEL AREA REMODEL AREA POACH AREA DECK AREA TOTALDECI' CH .AREA GARAGE AREh-[T➢ET.4CH E.4TT.4CH 4DR'ELLMG LTIiS: 1SA SECOND "SIT ❑}'ES SECOND STORY []YES — BEINGADDED? ❑NO .4DDITIONY ❑NO PREAPPLICATION ❑YES IFYES, PROVIDE COPY OF IST13EBLDGAN jNaFS VALUATIONA/C, PLANW WC 4PPL;: ❑NO PLANNING APPROVAL LETTER EICHLER HOME? By ❑,y signature below, I certify to each of the following: I am the property owner or authorized agent t ct o property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and rif s accurate. I agree to comply with all applicable local ordinances and state lams relating to uildi➢g constrructti�oan. I authorize representatives of Cupertino to enter the abovvc-identified property for inspection ptuposcs. Signature —� ofApplicant/Aeent Date: SUPPLEMENTAL,INFORA4ATIONREQUIRED�s)iOUTI\GSLIP New SFD or N\ ultifanaily dwellings: Apply for demolition pernnit for ❑YO\ERTRECOUNTER BUILDI\G PL4\RE\]E\1" ' existing buildine(s). Demolition pertnit is required prior to issuance of building permit for new building. ❑r EXmREss �.PL�vvL\ > s PL _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sr�m4xn z -._ { �N xDvI } ;❑rPusLlethoRR, form if any Hazardous 1\4aterials are being used as partof this project. a© LucE �` z -- z '� i❑ FIRE nEPr ` - _ Copy of Planning Approval Letter or Meetins with, Planning prior to ❑ TLi]OR s4_\Ir4IFi sE\\Ex msrRlcT submittal of Building Permit application. ,. ` :-'❑F E\\TKOs\1En T.4L HEALTH Bldg9pp2011, doe reused 06121111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION VAFDjjSS: 642 MILLER AVE DATE: 03/28/2016 APN: 375 42 014 7 REVIEWED BY: PAUL 'VALUATION: 1$1,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1R3SFDREM PERMIT TYPE: WORIC CONVERSION OF AN UNCONDITIONED INTERIOR COVERED COURTYARD INTO CONDITIONED SCOPE SPACE (342 S.F.) :Wech_ 1116n1 Check Phvnb. Pion (;7rc nB- Eiet-. Plar. Chad Mech. Fe;-anil Fee.' f"trtnn..11ennit Fe'rc Ftec. Perron 011her.t1cch. Asp, (J;}dPt l hiprd)1 up, OfixP Fh';c. /lisp, Mech. rasp. Fee: 11honb, h,.sp. 1'ce: Biec. bisp. Fee, NOTE: This esti nate does riot include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are onlv an estinrate. Contact the Dept for adds l into. FEE ITEMS (Fee Resolution 11-053 EfT ZjUQ FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? ()Yes � No $0.00 503 s.£ $503.00 Remodel, Other IREMRESOTII Suppl. PC Fee: (F) Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes (D No $0.00 Suppl. Insp. Fee:) Reg. Q OT 0.0 lis $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C;ortctme ion .7 r .Ffi;/ndn itYGrf€ve Fee: 0 G Work Without Permit? C) Yes (F) No $0.00 Advanced Planning Fee: $0.00 0 hours $286.00 Plan Check, Hourly ISTPLNCK ®A .1'PrrVFl.1.7P)Ctifi9C?r[fCfF70M-PAYS; Strong Motion Fee: IBSEISMICR $0.50 = li s $286.00 Inspections 1STINSP Inspection, Hourly Bldg Stds Commission Fee: 1BCBSC $1.00 "SUBTOTALS:= $1.50 $1,075.00 TOTALr+EE;, $1,076.50 Revised: 01101 /2016