11120108CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingC&cupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED
:1
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ORIGINAL PERMIT #
PROJECT ADDRESSAPN
9 i /=6snVr,,- c rLT.
#
36 r a of 6
OWNER NAME
`OulS AM Uie
PHONE
O 9vz-
E-M2IL
Op/grn,4i1.
STREET ADDRESS � ' T `, r ��cn u C Rte,
J
CITY, STATE, IP%M1Nv C - 17�/q FAX
CONTACT NAME
PHONE
E-MAIL
S
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME n
LICENSE NUMBER
LICENSE TYP8
BUS. LIC # .J qJ T
1
T
FAX /
35iF � &s5—
COMPANY NAME 5�.�, `D� �`ONST. /NC •
E-MAIL
STREET ADDRESS
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CITY, STATE, ZIP
C
PHONE
_; 1 �S3
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
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AIV r>WtsR L) nrr.a L_ PA- VA
W/mbowS / $q WI)VOWry /
EXISTING USE
PROPOSED USE
CONSTR. TYPE
# TORIES
S F rL
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
AREA
NEW FLOOR I DEMO
AREA .AREA
TOTAL
NET AREA
yo
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREP.AS.ECOND
TOTAL DECKiPORCH AREA GARAGE AREA: DETACH
❑ ATTACH
# DWELLING UNITS:
UNIT ❑ YES
SECONDSTORY ❑ YES
ADDED? XNO
ADDITION? ❑NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPL # []NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLER HOME? Ii NO
RECEIVED BY:
TOTAL VALUATION:
/
By my signature below, I certify to each of the following: 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 ?s coir . 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 building cons 1orI an rfftatives of Cupertino to enter the above -identified prope for inspection purposes.
�.fi� /
Signature of Applicant/Agent: _ Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
SLIP
SHE-couNTER
�---� GROUTING
LI BUILDING PLAN REVIEW
_ 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.
❑ 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.
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
IM -1 FEE ESTIMATOR - BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.. These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addh7 info.
FEE ITEMS (F ce Resolution 11-053 R/j, '1.711
ADDRESS: 7914 festival crt.
DATE: 12/20/2011
REVIEWED BY: bobs.
.44
APN:
BP#:
*VALUATION: 1$16,500
hPERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex
Suppl. PC Fee: 0 Reg. Q OT0.0
PENTAMATION
PERMIT TYPE: 1GENRE i
WORK
6 windows replace, i bay window, 1 patio door, non structural.
SCOPE
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.. These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addh7 info.
FEE ITEMS (F ce Resolution 11-053 R/j, '1.711
Llech. Plan Check
QTY/FEE
CC. Plan Check
Mech. Perniit Fee,,
Plan Check Fee:
r1ec. Pep -Mir Fee:
Other Mech. Iner,.E1__L_
= #
$392.00
?er r1ec. Insj,.
Stet„ hr
Suppl. PC Fee: 0 Reg. Q OT0.0
hm V.
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.. These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addh7 info.
FEE ITEMS (F ce Resolution 11-053 R/j, '1.711
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= #
$392.00
Window / Sliding Glass Door
1 WINREP Replacement
Suppl. PC Fee: 0 Reg. Q OT0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -0 Reg. Q OT
00
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction TCzv:
Administrative .Fee:
Work Without Permit? Yes O No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
i
l i-avel Docztrneiltatrori Fees:
Strom Motion Fee: IBSEISMICR
$1.65
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.65
$392.00
TOTAL FEE:
1 $394.68
Revise 12/ 011
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS:
�577V#L- C4? -r--
PERMIT #
OWNER'S NAME: V/ S
PHONE # '
GENERAL CONTRACTOR: jZ
BUSINESS LICENSE #
ADDRESS: I
,q-
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 SUBCONT CTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
Date