15050006-DPCUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT,- BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building Qcupertino.org
7 NEW CONSTRUCTION ❑ ADDITION FI ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT 4
PROJECT ADDRESS ��a 5 alle—Alf C.04
APN # J(P6
OWNER NAME
b :MATE -11
QiN I
STREET AD S
CITY, ST
CONTACT e r A GU�G
STREET ADDRESS CITY, STATE, ZIP
❑ OWNER ❑ OWNER- BUILDFRRi ❑ OWWNE ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
/RAAAGEENNr
CONTRACTOR NA� CZ
LICE
L10EN E
BUS. LIC #
ANY N Al
FAX
-n
STRBU
CI
JR16SSh
O V �
�5 La�64
ARCHITECTIENGINEER NAME LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
TE Z3
4
&x ) CsT
cY LL �P/�i'/ Piry �� iz2jl\17LLc 35 �L�J �,'bJZS
EXIS l�
PROPOS USE
CONSTR. yPE
#S S
USE
TYPE
OCC.
V �
SQ.FT. VALUATION
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
''...........
BATHROOM
REMODEL AREACP_35
KITCHEN OTHER
REMODEL AREA REMODEL AREA � �-I Q�
l
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
» DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY []YES
BEING ADDED? POO
ADDITION? 2NO
PRF- APPLICATION El YES IF YES, PROVIDE COPY OF
PLA.NNING.4PPL» �3Q0 PLANND.G APPROVAL LEI -I -ER
IS THE BLDG AN El YES
EiCHLER HOME? �y0_w,3
RFrC£IVED B ""'�
:+�tiY
h �EYstl"c
TOTAL VALUATION:
By my signature below, I certify to each of the follow' 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 is c ct. have Wd the Dascription of Work and verify it is accurate. I a ee tocomp!y with all applicable local
ordinances and state laws relating to bui!din ons t' gut orize,re esentatives'of Cupertino to enter the above -ide fled ro for inspection purposes.
Signature ofApplicant/Agent: Date: ?I J
SUPPLEMENTAL IN1 TION REQUIRED
P A cHECKZIPE
OVER THE COUNTER ",
UII.DJI�GPLANJ2EVII::W -:rat"
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
�`i E,cYLArzEVrEw
",
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
sTAnnAxD r F
PusLICRORKS.
form if any Hazardous Materials are being used as part of this project.
r
4 axes
_ Copy of Planning Approval Letter or Meeting with Planning prior to-a�m
"D.bIA7C1R 3''" 'r
` 'I.SANITARYSE�'ERDISTRICT
submittal of Building Permit application,
cr
-1`�w�
BIdgApp_2011.doc revised 06121/11
n�
��,--,�--���� CITY OF CUPERTINO
1 1 FRE ESTIMATOR — BUILDING DIVISION
imADDRESS:
21957 Oakleaf Court
DATE: 05/01/2015
REVIEWED BY: Sean
Plan Check Fee:
APN:
BP #: f C 00
i'VALUATION: 1$175,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PME Plan Check:
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
woRK
Kitchen remodel 216 sq ft • bathroom remodels 235 sq ft); other remodel 148 sq ft); remove and
SCOPE I
replace (19) windows and (2) doors.
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. e>e 1. These fees are haled nn the nrelindnary infarmation availahle and are anly an actimaty_ Cnntart tho Dent far addn'I info_
FEE ITEMS (Fee Resolution 11 -053 Ef. 7/1113)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
$0.00
= s.f. Remodel, Bath (< =300 sf)
$645.00 IREMRESBAT
Suppl. PC Fee: Reg. C) OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
216 s. f. Remodel, Kitchen (< =300 sf)
$645.00 1REMRESKIT
Permit Fee:
$0.00
Suppl. Insp. Fee: Reg. Q OT
0,0
hrs
$0.00
148 s.f. Remodel, Other
$431.00 1REMRESOTH
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
21 # Window / Sliding Glass Door
$717.00 1 WINREP Replacement
i. onsfruc.'tion, 7'cza":
�1r17r7iti�t7 °;ta•�� l'i:c=:
Work Without Permit? Yes O No
$0.00
Advanced Plannin Fee:
$0.00
Select a Non - Residential Q
Building or Structure
/i ".tlt'c:� a, 1! 1C:tJ7ili.7;t: %f7f1d'1.1'C'.Y�:
Strong Motion Fee: IBSEISMICR
$22.75
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$7.00
t = dSUBTOTALS
$29.75
$2,438.00 ' 'TOTALS FEE
r a
$2 467.75
,
Revised: 04/01/2015
4
09 pp
Z
0
6w E
3�
gm
I
9
IVWO
w
Z
1.51
q) .6 A 01 a 12 S 0 El 0 -X
ip F d
2�
sill L 01p;
iji, j, fix g 1, 1 9-A
1 IN 92 1. 19 If
i 1
H ICI ,I jig jIs
-H j,
H
'ilia 0"I 1H 'I g
fp
I
z SO
Ci
1096 V) Ilose V3,0NI.Luadfla
-Wedro Xvo -pvwv 2,tiol
1-m-DJra1)fKO 4961Z
�,g �S
"It
W
0
P
8
0
Z.
w
aaNaGisaulda(1-00 NVA
2z Z,
00
d LL
W
M
4
09 pp
Z
0
6w E
3�
gm
I
9
IVWO
w
Z
1.51
q) .6 A 01 a 12 S 0 El 0 -X
ip F d
2�
sill L 01p;
iji, j, fix g 1, 1 9-A
1 IN 92 1. 19 If
i 1
H ICI ,I jig jIs
-H j,
H
'ilia 0"I 1H 'I g
I
z SO
Ci
�,g �S
"It
W
0
P
8
0
Z.
w
2z Z,
00
d LL
W
M
CM
co 0
2 <
LU
ow
08 !R
0"
:E w Z
mm
4
09 pp
Z
0
6w E
3�
gm
I
9
IVWO
w
Z
1.51
q) .6 A 01 a 12 S 0 El 0 -X
ip F d
2�
sill L 01p;
iji, j, fix g 1, 1 9-A
1 IN 92 1. 19 If
i 1
H ICI ,I jig jIs
-H j,
H
'ilia 0"I 1H 'I g
4T656 V� `oaN.+a ^ Tapoayl sago ;a te pm ga oogeg E
JIM VD `ONTLLd'gdaD � 'd,� �a8 aoPd 2iT0T
� aD1eIaCIISaU 2IH(I'IH`J [titVA
a
9 AI
Ule
o�
LL
G
-
hT3 X' N
S
0
— o
r
m
f
1
r
p y
z
i
C)
71, w
IT
ji!
z
Ci
R TRI
0 a
i
uj m ZW
zz
NN
lo: W.
E.; w Z
LL
w < Z on
N.
C3
w L)
U- C: �g
<0
m , 1, 2 wo
Qo w
Ne
OC3❑ w LU C�
10 um, Z 6 K!;E 0
4-0
W4
0
El
0 wm L
ai
cir r "L L
00
- nq.
It
tu
0
2
T i
O
2
•
r,*
lei
#64i�& *�*Coj ej loom
Ig I P 0
lilt
H
L J
r,*
lei
#64i�& *�*Coj ej loom
Ig I P 0
lilt
H