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B-2017-0204CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10341 N BLANEYAVE CUPERTINO, CA 95014-2331 (316 33 006) CONTRACTOR: SOUTHERN PERMIT NO: B-2017-0204 CALIFORNIA ROOMS INC ANAHEIM, CA 92806 OWNER'S NAME: KHOO MAUREEN O TRUSTEE DATE ISSUED: 02/02/2017 OWNER'S PHONE: 408-203-8616 PHONE NO: (562) 802-1100 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #827937 Contractor SOUTHERN CALIFORNIA ROOMS INC Date 12/31/2017 XBLDG _ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH X RESIDENTIAL — COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: CONSTRUCT PATIO ENCLOSURE (364 S.F.) WITH 2 SWITCHES; 5 s. I have and will maintain a certificate of consent to self-insure for Worker's PLUGS REV # 1 - PROVIDE CALIFORNIA FRAMING DETAIL - ISSUED 4/6/17 Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. \ Lvhave 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 permit is issued. Sq. Ft Floor Area: Valuation: $45000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 316 33 006 representatives of this city to enter 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understa� and wil e6mj3Jy with all non-point source regulations qe WITHIN 180 DAYS OF PERMIT ISSUANCE OR per 6u a Munic' al C e, Section 9.18. 180 DAYS FROM LAST CALLED- SPECTION. , Signature 9 % Date 04/06/2017 Issued by: MELISSA N Date•'02'IOi/E017 OWNER-BUILDER DEC ARATT I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property; am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 04/06/2017 I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of Califomia.`If, after making this certificate of "' air contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal CoWChaDtcf1JJ>2 and the Health & Safety Code, Sections 255 255 Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 04/06/2017 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 I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 04/06/2017 Licensed Professional CLQPERTINO I R NEW CONSTRIJCTiI:N CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408)777-3228 • FAX (408) 777-3333 Q building(a?cupartino.org A I Q ADDITION ❑ ALTERATION / TI VISION / DEFERRED ORIGINAL PERMIT## PROJECT ADDRESS FAIN# OWNERNAME { i PHONE ��i�'j > -' 200— 9#`MAIL�� STREET ADDRESS j p CITY, STATE, ZIPAV FAX CONTACT INAME /!\(/ HCl Y�L� Gt PHO V , �y�� !6 I E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT 19 cONTRAC'rOR ❑ CONTRACTORAGENT ❑ ARCHITECT El ENGINEER ❑ DEVELOPER ❑ TENANT CONTRA TOR NA �/ LICENSE NUMBER LICENSE TYPE �J BUS. LIC # m� Ci �a✓ f✓L r y„ 9 in �— COMPANY NAME g E-MAIL Y STREETT ADDRESS CITY, STATE, ZIP PHONE s'oz—moi ARCHI,. F. TIENe�O G EER E r LICENSE NUMBER BUS. LIC # 2GrJd1 f — COMPA E-MAIL I FAX STREET ADDRESS CITY, STATE, Z1P PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE --7 CONSTR TYPE # STORIES USE TYPE acc. SQ.FT. VALUATION (�) EXISTG NEW FLOOR D 10TOTAL AREA .AREA AREA NET AREA BATHROOM YITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: 0 DETACH ❑ ATTACH` # D`NELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY []YES BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN CI YES RECEIVED BY: TOTAL VALUATION: PLANNING APPL # []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the properly owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin 'o oriz representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicanVAgent: _ Date: ®����� SUPPLEMENTAL INFOYMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ovER THE -COUNTER [71BUILDING PLAN REVIEW _ New SFU or Multifamily dwellings: Apply for demolition permit for❑ existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING 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. Lei LARGE - - ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior toj MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BIdgApp_2011.doc revised 06121/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0204 10341 N BLANEYAVE CUPERTINO, CA 95014-2331(316 33 006) SOUTHERN CALIFORNIA ROOMS INC m ANAHEIM, CA 92806 ` OWNER'S NAME: KHOO MAUREEN O TRUSTEE OWNER'S PHONE: 408-203-8611 1111 Lei _51011_DI 1X91INK I MA I) 14.111 License Class 5 Lic. #827937 Contractor SOUTHERN CALIFORNIA ROOMS INC Date 12/31/2017 I 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. I hereby affirm under penalty of perjury one of the following two declarations: 1. 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 performance of the work for which this permit is issued. z ]have and will maintain Worker's Compensation Insurance, as provided for by ection 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations pder, the Cupertino Municipal Code, Section 9.18. Date 2/2/2417 ISSUED: 02/02/2017 NO: (562) 802-1100 BUILDING PERMIT INFO: BLDG ELECT _PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: CONSTRUCT PATIO ENCLOSURE (364 S.F.) WITH 2 SWITCHES; 5 Sq. Ft Floor Area: ' l Valuation: $45000.00 APN Number: Occupancy Type: 316 33 006 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: AbbyAyende Date: 02/02/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) i. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 2/2/2017 I hereby affirm under penalty of perjury one of the following three declarations: 1. 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 performance of the work for which this permit is issued. i. 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 permit is issued. 3. 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, (judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section ,w Date 2/2/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Se ns 25505, 533, and 25534.1 Owner or authorized agent: Date: 2/2/2017 CO 1 LB4/IN(- AGENCY hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION ni COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DTVI ION �V q O -wq 90300 TORE AVENUE - CUPERTINO, CA 95014-3255 +� CtUIpekTINO (403) 777.3225 • FAX (405) 7773333 • bulldlll ctlnertltloora ❑ NEW CONSTRUCTION k ADDITION n AT'I'RRATION/TT MR PITT-Zir)TIT / T1VVPI?TXrn nArrrATAr W201 ATT PROJECT ADDRESS -? /- ,/e 4, /e 't' V ApN# OWNER NAME PHONE :::;:_0/ E-MAIL STREET ADDRESS CONTACT NAME J PHONE CE v Rj STREET ADDRESS 2 /V �° l CITY STATE, IP i Z4 �FAXep 2- az - /o ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT Ci�iV'TiuiCTCic "'tiE ��X"/ Q M"1 �' ` LICENSENI,�� 7 LICE?;E BUS. LIC# fd , d .F if COMPANY NAMED//yf y �D reo �n STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER N.9ME, LICENSE NUMBER BUS. LIC # COMPANY NAME E.MATL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK / 3 1"y 2 o, r s� /�y / fe/ e ,� �G y`�/ 7 �rCl Ci /✓G�l7�d I�/S� EXISTING USE oe`I PROPOSED USE CONSTR ✓/� ����� TYPE #STORIES ® USE TYPE OCC. SQ.FT. VALUATION($} EMTG W V.5. AREA NEW FLOOR AREA -5 DEMO AREA TOTAL ��L� NET AREA BATHROOM REMODELAREA KITCHEN REMODELAREA ./� OTHER REMODEL AREA PORCH DECK AREA - TOTALDECK/PO�Ti-AREA �/'/�ZATTACH Cn9RAGEAREA: DETACH #DWELLING UNITS: ISASECONDUNIT YES "" ���� SECOONND�STOORY _❑_3 / BEING-WDEU? �v0 AUDITION? �PfNO PR&APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑l YES R ETVED B.Y- - TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? �NO Q By my signature below, I certify to each of the following: I am the property owner or authrnized agent th act on6e 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 verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to build` construction. i uthorize representatives of Cupertino to enter the ab e= etifi d perty for inspection purposes. Signature of Applicant/Agent Date: SUPPLEMENTAL INFO .iATION REQ uMED PLAN CHECK TYPE ROUTING SLW 1] OVER-THE-COUNTER ❑ BUffiDING PLAN REVIEW _ New 5FD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building ❑ '❑ permit for new building. Ex PRES' . � - Py ANNwG PLANREVIES vtl _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTAN:omw) ❑ . PUBLIC WORKS Form if any Hazardous Materials are being used as part of this project. ©URGE DEPT _ Copy of Manning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp 2011.dac revised 06121111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2404 10341 N BLANEY AVE CUPERTINO, CA 95014-2331 (316 33 006) PAUL ARNOLD CONSTRUCTION INC SAN JOSE, CA 95123- 3412 OWNER'S NAME: KHOO MAUREEN O TRUSTEE DATE ISSUED: 07/28/2016 OWNER'S PHONE: 408-690-8785 PHONE NO: (408) 690-5013 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #394567 Contractor PAULARNOLDC)NSTRUQTIONINC Date 03/31/2018 XBLDG ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH X RESIDENTIAL _ COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: REMOVE WALL TO CREATE (l) OPENING BETWEEN KITCHEN I hereby affirm under penalty of perjury one of the following two declarations: AND FAMILY ROOM (22 LF) 1. 1 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 performance of the work for which this permit is issued. 1-2. 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 permit is issued. i Sq. Ft Floor Area: Valuation: $1000.00 APPLICANT CERTIFICATION 1 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 316 33 006 representatives of this city to enter 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations er the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. / Signature4"Qt- _ Date 7 7la Issued by: Phuong Devries OWNER- lUILDFR DECLARATION rs Date: 07/28/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be, inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property; or my employees with wages as their sole installed without frst obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 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 performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE z. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. 1 certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Cod tions 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent:;' r� APPLICANT CERTIFICATION Date: >>°%= j QJl I certify-that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal T'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date Professional CUP RTIN'O CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 FAX (408) 777-3333 • build ing(a)cupertino.org "NEW CONSTRUCTION . ❑ ADDITION ❑ ALTERATION / TI '9 REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 10 _. 3 / I IV - {J q AE APN # 6 I TOTAL OWNERNAME. PHONE AREA. E-MAIL AREA STREET ADDRESS CITY, STATE, ZIP FAX KITCHEN CONTACT NAME P REMODELAREA STREET ADDRESS CITY, E, ZIP _ FAX DECK AREA ❑ OWNER ❑ OWNER -BUILDER ❑////OWNER AGENT �NTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER.. ❑ -TENANT CONTRACTOR NAME f��� Y / & ^ , ^, ,�7 (l LICENS'NI7MBER J LICENSE TYPE []ATTACH BUS. LIC # COMPANY NAME E-MAIL # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES- STREET ADDRESS r" CITY STATE ZIP PHONE ADDITION? []NO .5 -S' &-v , S j -5--) Z �s ARCHITECT. N INEERNAME n �� LICENSE NUMBER` BUS. LIC # 9 f� .' COMPANYNAME E-MAIL FAX STREET ADDRESS j CITY, STATE, ZIP p PHONE DESCRIPTION OF WORK TYPE I # STORIES USE I TYPE I OCC. I SQ.FT. I VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA. AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODELAREA _ PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH. []ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES- BEINGADDED? ❑NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES TOTAL VALUATION: PLANNINGAPPL# NO PLANNINGAPPROVALLETTER EICHLER HOME? ❑NO a r .ice /v f nature below, I certify to each of the following: I am the property owner or autho It t act on operty owner's behalf. I have read this vided is correct. n and the information Iha4�' I have read the Description of Work and rift' I ' curate. I agree to comply with all applicable local F.Zp-!-..sand state laws relating ting c/�stwn./ri�zepresentatives of Cupertino toe eabove-identified ropert}+ for inspection purposes. of Applicant/Agent: Z �G'� Date: BldgApp 2011.doc revised 06121/11 LOW