15030177CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10201 HILLCREST RD CONTRACTOR: SCHILLER PERMIT NO: 15030177
CONSTRUCTION
OWNER'S NAME: LORRAINE THOMPSON & TRENT POLTRONET 2249 OLD MIDDLEFIELD WAY DATE ISSUED: 0610312015
OWNER'S PHONE: 6507995009 MOUNTAIN VIEW, CA 94043 PHONE NO: (650)940-1982
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
INTERIOR REMODEL (793 SQ FT); KITCHEN REMODEL
License Class Lic. # l (250 SQ FT); REPLACE 9 (E) WINDOWS/DOORS (2
II_ %� 6 I STRUCTURAL).
Contractor 31_ i l e? 1/� �� Date l• DEF # 1- DETAILS FOR GLASS WALL SYSTEM - ISSUED 6/23/15
I hereby affirm that I am licensed under the provisions of C apter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
rformance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $100000
I have and will maintain Worker's Compensation Insurance, as provided for by
`Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 32616086.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter INSPECTION.
upon the above mentioned property for inspection purposes. (We) agree to save 18 LA
indemnify and keep harmless the City of Cupertino against liabilities, judgments, (
costs, and expenses which may accrue against said City in consequence of the Issu Da e.
granting of this permit. Additionally, the applicant understands and will comply
with all non-point source regulati er the Cupertino Municipal Code, Section
9 18.
RE-ROOFS:
Signature Date ® S All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 255505, 25 3, and 25534. `
Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent 3
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10201 HILLCREST RD
CONTRACTOR: SCHILLER
PERMIT NO: 15030177
CONSTRUCTION
OWNER'S NAME: LORRAINE THOMPSON & TRENT POLTRONET
2249 OLD MIDDLEFIELD WAY
DATE ISSUED: 06/03/2015
OWN S PHONE: 6507995009
MOUNTAIN VIEW, CA 94043
PHONE NO: (650)940-1982
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
kr LICENSED CONTRACTOR'S DECLARATION
INTERIOR REMODEL (793 SQ FT); KITCHEN REMODEL
License Class_ Lie. # !2irE %
(250
n 4 ,y t f
��
SQ FT); REPLACE 9 (E) WINDOWS/DOORS (2
`� Date
Contraeto� (a?+
STRUCTURAL).
1 hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
Valuation: $100000
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
APN Number: 32616086.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
180 DAYS FROM LAST CALLED INSPECTION.
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Issued by: Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Section
9 18. —
RE-ROOFS:
Signature or/� Date ; t J
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I, as owner of the property, or my employees with wages as their sole compensation,
do the work, and the structure is not intended or offered for sale (Sec.7044,
will
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
1 hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Code, Section 25532(a) should I store or handle hazardous
declarations:
1 have and will maintain a Certificate of Consent to self-insure for Worker's
Health & Safety
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
compliance with the Cupertino Municipal Code, Chapter 9.12 and
performance of the work for which this permit is issued.
will maintain
the Health & Safety Code, Sections 25505, 25533, and 25534.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent� Date: 7
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
costs,
granting of this permit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9 18.
Signature Date
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 77773228 • FAX (408) 777-3333 • buildina(d)cuoertino.ora
CUPERTINO
❑ NEW CONSTRUCTION ADDITION C�l ALTERATION / TI n REVISION / DEFERRED
PROJECT ADDRESS APN O_ 9 6
OWNER NAMETp /In Jl I O / n� I PHONE O '2�
(C
STREET ADDRESS( J/,nr l I I CITY, STA E, ZIPpX
t
�J
J 0
r
CONTACT NA'4E j V 1�1 ' DLL
STREET ADDRESS/
CITY, STATE, ZIP
FAX
' OUTTER ❑ OWNER -BUILDER' ' ❑ 011R.TERAGENT ❑ CONTRACTOR - ❑ CONTRACTORAG"ENT ❑ ARCHITECT ❑ ENGINEER, ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER
1
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-NLAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
HI-ZECT/E GINEE 1' nQ2 f- „ _ LICENSE NUMBER �(l� n/�
-( CY(J
BUS. LIC
COMPANY NAME t I
E-MAIL
FAX
L=S O!
C i'Cell P
�
�(�`r/ V
�Y/ l (
`'-' U �• lir-"C�i
DESCRIPTION OF WORK //I r 'P n^ /
&2k99V-'d&i
S
Ae o.n/� n M /I2c� p
, i t S/14
� .Al .
<;It 1,r_
E STING USE PROPOSED USE CONSTR. T1T STORIES
USE TYPE OCC.
SQ.FT.
VALUATION (S)
EXISTG
heW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
REMODEL AREA
KITCHEN -OTHER
REMODEL AREA Z1
REMODEL AREA
�-T
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: EIDETACH
❑ ATTACH
DWELLING UI.TrS:
IS A SECOND UNIT ❑ YES
BEING ADDED?
SECOND STORY ❑ YES '
ADD CCION? 10
1
P50
PRE -APPLICATION [:]YES IF YES, PROVIDE COPY OF
PLAN.7NGAPPL9 [-]NO PLANNING APPROVAL LETR
IS THE BLDG AN ❑YES .,E�.:�F'✓,ry`��^€.-�,A
EICHLER HONSE?Psi-
T � VALUATI�
By my signature below, I certify to each of the following: I am the perry owner or authorized to act o e prope owner's behalf. I have read this
application and the information I have prov'� correct. h ead the Description of, and verify ' s accu agree to comply with all applicable local
ordinances and state laws relating construction authori presentatives of Cupertino to a ove-i ntified operty for inspection purposes.
14
Signature of Appl icanUAgent: Date:
SUPPLEMENTAL INFORMATION REQUIREDrrspLat?.cicic���pE'„4'Roi3xnGSlr3,r1t
4 'c
New SFD or Multifamily dwellings: Apply for demolition permit for
"t�S. �#zyrr;
g,.� .TONER T$F.OUI TER"- c�
BUILDT,,IV[G_PLlAN"RE\'�1Y a
existing building(s). Demolition permit is required prior to issuance of buildingzs�ws�zz
_ r�4>
sir
permit for new building.
H lid i t
iX` EXPRESSO � L°? $ � =S
ak � ?`�-
se g Yin JIVG PLAI11FtE� tj 7
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part ofthis project.
TJ+I�'DARI)�+ �,4 X
�.� i J 12 t til
w k srx {s a
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
-u"1a95' �n`�.#3erla`+%
ti L1r70R r�,�`h'k'�§ `� �+,y�',SA1�;TARYSER'ER.IS
0_
�✓L"' �" M= r'Fda-�}'4 �a, 't
STRIC a� 2.
r.alyS�u;-.4"'�-I;w? �ac��..`F`,•��`',d.'„�,�'!'?+
, � �EI�Y..IRONI"1Ei�:TA);H�°.4'L'i'C$�r�cct�r`
B1dgAPP_2011.doc revised 06/21/11
1- —
M
�� CITY OF CUPERTINO
IM1�P'(/�I FEE ESTIMATOR — BUILDING DIVISION
laADDRESS:
10201 HILLCREST RD
fk'e:l). Plar1 ( heck
DATE: 03/27/2015
REVIEWED BY: MELISSA
$0.00
APN: 326 16 086
BP#:
Ofllcr 'i tech. Inv?.
`VALUATION: 1 $100,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
Lk..'n Ins].). Fee:
Permit Fee:
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
USE:
0,0
1 hrs
$0.00
i
WORK
RECONFIGURE & REMODEL E 250 S.F. KITCHEN & RECONFIGURE E OFFICE DINING RM &
SCOPE
FAMILY RM TO CREATE OPEN AREA. REPLACE 9 (E) WINDOWS/DOORS (2 STRUCTURAL)
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
n:....:,.. �#' 1 Th— f oc aro haaod nn Iho nraliminan/ infarmalinn availahle and are only an estimate. Contact the Dent for addn7 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711/13)
+5i.' k,�.ti
Yi �.,r' {,' 7� C{ YV11 I.Y• .,s .,yyT 3,7 yS.
F(', io'`,'.
fk'e:l). Plar1 ( heck
111111;!14. Plot] (/levli
Elec. Plan (.hecl(
$0.00
Nlfalb. Pia'I]N( 1'i'c.
1-,le.c' Pearn Pea'
Ofllcr 'i tech. Inv?.
Diller 141111)71) 11.1sp.Li I
(oilier Llec. Imp. El
A -loch. hap, Fee:
1,17110). his11. Fee:
Lk..'n Ins].). Fee:
Permit Fee:
$0.00
Suppl. Insp. Fee -(F) Reg. Q OT
0,0
1 hrs
$0.00
= # Window / Sliding Glass Door
$1 ,718.00 1WINMEWSTR New (Shearwall/Masonry)
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
F-7 I # Window / Sliding Glass Door
$431.00 IWINREP Replacement
1.rctioll 'Tax.77
:1.e lllinis•trarNe P"C :
Work Without Permit? Yes (j) No
$0.00
Advanced Plannipg Fee:
$0.00
Select a Non -Residential E)
Building or Structure O
I 'A
.�YSL„�k'hyleMe�
StrongMotion. Fee: IBSEISMICR
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
n:....:,.. �#' 1 Th— f oc aro haaod nn Iho nraliminan/ infarmalinn availahle and are only an estimate. Contact the Dent for addn7 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711/13)
+5i.' k,�.ti
Yi �.,r' {,' 7� C{ YV11 I.Y• .,s .,yyT 3,7 yS.
F(', io'`,'.
fk'e:l). Plar1 ( heck
111111;!14. Plot] (/levli
Elec. Plan (.hecl(
$0.00
Nlfalb. Pia'I]N( 1'i'c.
1-,le.c' Pearn Pea'
Ofllcr 'i tech. Inv?.
Diller 141111)71) 11.1sp.Li I
(oilier Llec. Imp. El
A -loch. hap, Fee:
1,17110). his11. Fee:
Lk..'n Ins].). Fee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
n:....:,.. �#' 1 Th— f oc aro haaod nn Iho nraliminan/ infarmalinn availahle and are only an estimate. Contact the Dent for addn7 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
250 s.f. Remodel, Kitchen (<=300 sf)
$645.00 1 REMRESKIT
Suppl. PC Fee: Q Reg. Q OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
F 674 s.f. Remodel, Other
$575.00 1 IREMRESOTH
Permit Fee:
$0.00
Suppl. Insp. Fee -(F) Reg. Q OT
0,0
1 hrs
$0.00
= # Window / Sliding Glass Door
$1 ,718.00 1WINMEWSTR New (Shearwall/Masonry)
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
F-7 I # Window / Sliding Glass Door
$431.00 IWINREP Replacement
1.rctioll 'Tax.77
:1.e lllinis•trarNe P"C :
Work Without Permit? Yes (j) No
$0.00
Advanced Plannipg Fee:
$0.00
Select a Non -Residential E)
Building or Structure O
I 'A
Truvel Doe uineiitaligrl
StrongMotion. Fee: IBSEISMICR
$13.00
Select an Administrative Item
Bldg Std.s Commission Fee: JBCBSC
$4.00
A1 Ll -SBTk
1 31Ei l4 t�� iq ofd i ! n' r L4 Id�C l -� Yh
,terYJM�
OT
111x1..�x
$3369.00 �,..�3 ,
3, 00
386.$17.00
Revised: 02/14/2015
CONSTRUCTION PERMiT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228• FAX (408) 777-3333 • building (cDcuDertino.orq
CUPERTINO,
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI EO'REVISIONEFERRED ORIGINAL PERMIT # O�
PROJECT ADDRESS l o s^ ( i4L' - -' c v
AP�N R
OWNER NAME ( t ^ V�� l , P/� abCk7 c ��1lYt
( (J
l/
ST , MOT �/(
�
- -) A-1
CITY, STATE, ZIP j n �`✓l O' yl FAX
l �l(
/! I C�
CONTACT NAME PHONE
E-MAIL
STREET ADDRESS 6t It -�
CITY, STATE, ZIP
FAX
13 OWNER •❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTORAGENr ❑ ARCHITECT ❑ ENGD,9MR ❑ DEVELOPER ❑ TENANT
CONTRACIORNAME /
LICENSE NUMBER
LICENSE TYPE
BUS. LIC k
I I
COMPANY NAME J; f I f j
E-MAIL
FAX
S
V "
STATE.
216
1/\
ARCHITECT/ENGINEER NAME LICENSE NUMBER
BUS. LIC ff
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
EMSTING USE 'PROPOSED USE CONSTR. TYPE w STORIES
,
USE TYPE OCC. SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR.
.DEMO
TOTAL
AREA
AREA
AREA
NETAREA
-
BATHROOM.
KITCHEN. OTHER.
REMODEL AREA
REMODEL AREA REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
-9 D AW LAGUNTIS:
ISA SECOND UNrr ❑ YES
SECOND STORY []YES
BEING ADDED? El NO
ADDITION? ❑NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑
fi`g$ K- -' ``_"'` -:. TOTAL VALUATION:
PLAIINING ADPL -, ❑ NO ' PLANNING APPROVAL LETTER
EICHLER HOTIE? ❑ 0
_ '
+r f �� ,
't
By my signature below, I certify to each of the following: I am the property owner or niak
enzeda,Int t e property.oum 's behalf I have read this
application and the information I have pro�d'orrect have read the Description of -Work and verify it is a rate. i;" o c mply with all applicable local
ordinances and state laws relating o b •u 'o I authorize represents ' , £Cupertino to enter the above -i ertti"ed pr erty f inspection purposes.
6
Signature of Applicant/Agent:
Date: O)—
SUPPLEMENTAL INFORMATION REQUIRED
[t� OVERTH><COUhTER
-❑ BTIII,DII\GPLt�TREVIEF '�
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
s
`£
permit for new building.
; i]E Explts�sr
wrt
i�� J')Ji1NIQIIV� PL4rv�R&v�E v" �
�}.
_ Commercial Bldas: Provide a completed Hazardous Materials Disclosure
5
STAiQDRD
®PuglewoRxs
form if any Hazardous Materials are being used as part of this project.�r�
Approval Letter Meeting Planning
r�
_ Copy of Planning or with prior to
Permit
MO�13Y'^tT'y°suDrs�Rtc
submittal of Building application.
.EI�'YO.Lk'MEI�Tr+LTS-E.ATiT$ .3.t
BId.-App_2011.doc revised 06/21/11
CITY OF CUPERTINO
FM'_1 FEE ESTIMATOR - BUILDING DIVISION
. p v G. n.e
ADDRESS: 10201 HILLCREST RD
DATE: 06/23/2016
REVIEWED BY: MELISSA
alt,& Permit Fee;
APN: 32616 086
BP#: 15030177
*VALUATION: Iso
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Plumb. hap. Pee:
PENTAMATION 1GENRES
PERMIT TYPE: A
WORK
DEF # 1 - DETAILS FOR GLASS WALL SYSTEM - ISSUED 6/23/15
SCOPE
. p v G. n.e
Llech. Plan Check
Plumb. Plan Check
Elec..Plan Check
alt,& Permit Fee;
Plumb. Permit 1,ee:
Elec. Permit Fee:
Other Aleck. Insp.
Other Plumb Insp.
Other Elec. Insp.
Ltech. Insp. Fee:
Plumb. hap. Pee:
Elec. Insp. 1%ee:
NOTE: This estimate does not include fees due to other Departments (i. a Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept}or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/131
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$286.00
Deferred Submittal
/DEFSUBM
Suppl. PC Fee: r!) Reg. 0 OT
FO.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -0 Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Administrative Fee:
Q
0
Work Without Permit? 0 Yes (j) No
$0.00
Advanced PlanniDg Fee:
$0.00
Select a Non -Residential
Building or Structure
i
Trcn,el Doewn.entation Fees:
Strong Motion Fee:
$0.00
Select an Administrative Item
Bld Stds Commission Fee:
$0.00
-: SUBT,OTAIS:
$0.00
$286.00
TOTAL FEE:.,
$286.00
Revised: 05/07/2015
DEC -18-2015 12:43 SCHILLER CONSTRUCTION
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
16509401984 P.01/01
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS:.{w
PERMIT #
BUSINESS NAME
OWNER'S NAMt.- /- 10 /- 7'� e0 A, 2
PHONE #
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GE,NERA.L CONTRACTOR:
BUSINESS LICENSE #
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ADDRESS: ullt 7 Qu
Cl'fY/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 OBTAINFD .A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information:
Date
Owner / Contractor Signature
Date
TOTAL P.01
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
67®® Oyl
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
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Glass/ Glazing
Heating
Insulation
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Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
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Roofing
Septic Tank
Sheet Metal
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Sheet Rock-�-
Tile
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3 3 -
Owner / Contractor Signature
Date
TOTAL P.01