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B-2016-2566CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2566 20111 JOHN DR CUPERTINO, CA 95014-4414 (369 33 036) DE ANZA BUILDERS CAMPBELL, CA 95008 OWNER'S NAME: BREWSTER RICKY G AND YANG DULCE DAOMIN TRUS DATE ISSUED: 6.7.17 OWNER'S PHONE: 408-857-7814 PHONE NO: (408) 865-0222 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 13 Lic. #943227 Contractor DE ANZA BUILDERS Date 02/28/2018 X BLDG _ELECT _PLUMB X MECH X RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: I st FLOOR ADDITION (551 S.F.); REMODEL FAMILY RM (235 S.F.) I hereby affirm under penalty of perjury one of the following two declarations: AND BATHROOM (30 S.F.); 2ND FLOOR ADDITION (185 S.F.) I have and will maintain a certificate of consent to self -insure for Worker's REMODEL MASTER BEDROOM (193 S.F.) AND BATHROOM (78 Compensation, as provided for by Section 3700 of the Labor Code, for the S.F.); (N) A/C. (/J performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by REVISION #2: ADD KITCHEN REMODEL (192 SQ FT); REPLACE Section 3700 of the Labor Code, for the performance of the work for which this BEAM AT FAMILY ROOM; REVISE TRUSS TO SUPPORT CEILING permit is issued. JOISTS. ISSUED 6.7.17 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 ciWV enter upon the above mentioned property for Sq. Ft Floor Area: 736 Valuation: $150000.00 inspection purposes0e) gree to save indemnify and keep harmless the City of Cupertino again t Iia ilities, judgments, costs, and expenses which may accrue against saik Ci inconsequence of the granting of this permit. APN Number: Occupancy Type: Additionally, the appli ' nt derstands and will comply with all non -point source regulation per he upertino Municipal Code, Section 9.18. 369 33 036 Deferred Submittal (R -3),R-3 (Custom) Signature Date PERMIT EXPIRES IF WORK IS NOT STARTED OWNER -BUILDER DE LARATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as owner of the property, or my employees with wages as their sole Issued by SEAN HATCH compensation, will do the work, and the structure is not intended or offered for Date' 6.7.17 sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is I hereby affirm under penalty of perjury one of the following three declarations: installed without first obtaining an inspection, I agree to remove all new materials for 1. I have and will maintain a Certificate of Consent to self -insure for Worker's inspection. Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Signature of Applicant: 2. I have and will maintain Worker's Compensation Insurance, as provided for by Date: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER s. 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 HAZARDOUS MATERIALS DISCLOSURE exemption, I become subject to the Worker's Compensation provisions of the I have read the hazardous materials requirements under Chapter 6.95 of the Labor Code, I must forthwith comply with such provisions or this permit shall California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the be deemed revoked. Health & Safety Code, Section 25532(a) should I store or handle hazardous APPLICANT CERTIFICATION material. Additionally, should I use equ' me t or devices which emit hazardous I certify that I have read this application and state that the above information is air contaminants as defined by the Bay rea Quality Management District I 'rtino correct. I agree to comply with all city and county ordinances and state laws will maintain compliance with the Cup unicipal Code, Chapter 9.12 and relating to building construction, and hereby authorize representatives of this city the Health & Safety Code, Se tions 5505, 25533, and 25534. to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Owner or authorized agent: judgments, costs, and expenses which may accrue against said City in Date: consequence of the granting of this permit. Additionally, the applicant understands CONSTRU TION LADING AGENCY and will comply with all non -point source regulations per the Cupertino Municipal I hereby affirm that there is a construction llending agency for the performance Code, Section 9.18. of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Signature Date Lender's Address ARCHITECT'S DECLARATION CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95MISI®N (408) 777-3228 • FAX (408) 777-3333 • buildingacupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION / DEFERRED ORIGINAL PERMIT # 13'aol6' L�56� PROTECT ADDRESS _ ZoAPN # t,LI v,� �r OWNERNAME PHOos �/ J E-MAIL t STREET ADDRESS Zo \ \` CITY STATE, FAX E : �o Cl S O l CONTACT NAME ( t j�,/l PHO17R,E-MAIL IS VIS t 61,.rt �t".�J—V� O V :l (y"�✓�ia �' STREET ADDRESS CITY, STATE, ZIP ` FAX Cv �{ s i✓t L�� v L vL n� b�L\ C�� 0 C) El OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT Ef-CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAI LIcAA-5NUMBER LICENS TYPE BUS. LIC #t �\\ COMPANY NAML /� ` E-MAII FAX U'l_ T U� L G._ V \ ` `Qv 'S 14/�-)L-`z� °L�� ` Lc�� v \\ Q ✓S . Le . STRE TADDRESS (A DRESS r �t / ` OO PHONE LAA ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZiP PHONE DESCRIPTION OF WORK ` q vV 'S S Cana, EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDETACH ❑ ATTACH # DWELLING UNITS.` IS A SECOND UNTT ❑ YES SECOND STORY []YES BEING ADDED? ❑NO ADDITION? []NO PRE -APPLICATION []YES IF YES, PROVIDE COfX OF IS THE BLDG AN ❑ YES RECEIVE TOTAL VALUATION: PLANNING APPL # []NO PLANNING APPROV ITER EICHLER HOME? ❑ NO "C9 �n o 0 By my signature below, I certify to each of the fo owing: 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 provide 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 b i ing c ction. I authorize representatives of Cupertino to enter the above-ide tided property for inspection purposes. Signature of Applicant/Agent: Date: l SUPPLEMENTAL INFO TION REQUIRED PLAN CHECK RouT>res%tr „ New SFD or Multifamily dwellings: Apply for demolition permit for OVER TI6-coUN~rEx uILnuNc3PLANREVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. q ExPREss rLANTmcPLAN REv>Ew t" t _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC woRxs form if any Hazardous Materials are being used as part of this project. AGE' ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to MAJOR❑ S AN'IT,'My s' L ER DISTRICT submittal of Building Permit application. ,a u .= .. .., �r '�.,..� „ .,;; . „❑.;$N�'II20NMENTALHEALTH ::;'... "". BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO BUILDING PERMIT BUH,DINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-2566 20111 JOHN DR CUPERTINO, CA 950144414 (369 33 036) DE ANZA BUILDERS CAMPBELL, CA 95008 OWNER'S NAME: BREWSTER RICKY G AND YANG DULCE DAOMIN TRUS DATE ISSUED: 03/02/2017 OWNER'S PHONE: 408-857-7814 PHONE NO: (408) 865-0222 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class $ Lic. #943227 Contractor DE ANZA BUILDERS Date 02/28/2018 X BLDG —ELECT —PLUMB X MECH X RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: a 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 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. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. a ree to comply with all city and county ordinances and state laws relatin to building construction, and hereby authorize representatives of thij ci to enter upon the above mentioned property for inspectionpurposes. (We agree to save indemnify and keep harmless the City of Cupertino aga nst I abilities, judgments, costs, and expenses which may accrue against s id ity in consequence of the granting of this permit. Additionally, the apple an understands and will comply with all non -point source regulate ns r t e Cupertino Municipal Code, Section 9.18. rj Signature Date 3/31/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the 1 st FLOOR ADDITION (551 S.F.); REMODEL FAMILY RM (235 S.F.) AND BATHROOM (30 ST.); 2ND FLOORADDITION (185 S.F.) REMODEL MASTER BEDROOM (193 S.F.) AND BATHROOM (78 S.F.); (N) A/C. #1 - ADJUSTMENT TO BUILDING SIZE - ISSUED 3/31/2017 Sq. Ft Floor Area: 736 1 Valuation: $150000.00 APN Number: Occupancy Type: 369 33 036 Deferred Submittal (R -3),R-3 (Custom) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by: Abby Ayende following two reasons: 1. I, as owner of the property, or my employees with wages as their sole RE -ROOFS: compensation, will do the work, and the structure is not intended or offered for All roofs shall be inspected prior to any roofing material being installed. If a roof is sale (Sec.7044, Business &Professions Code) installed without first obtaining an inspection, I agree to remove all new materials for inspection. 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). Signature of Applicant: I hereby affirm under penalty of perjury one of the following three declarations: Date: 3/31/2017 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. 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. 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 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 9.18. Signature Date 3/31/2017 1/ A 11 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 equip t or devices which emit hazardous air contaminants as defined by the Bay ea ' Quality Management District I will maintain compliance with the Cuper ' o Municipal Code, Chapter 9.12 and the Health & Safety Code, Sectlonq 25505, 25533, and 25534. r or authorized agent: 3/31/2017 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 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTIN0 (408) 777-3228 • FAX (408) 777-3333 • building(?�cupeegino.M 0 NEW CONSTRUCTION _❑ ADDITION El ALTERATION/ TI [9REVISION'/ DFFFRRFII ' nulrn.IAI UFTR AAT P 44 PROJECT ADDF.ESS,----pi_ -�_ APN# --- Jlt" 1 - U OwNERNAME c7 iP tt1�9O l_ jF � MAIL} r� STREET ADDRESS `�, ✓ a 4, 16 CITY STATE, C �� C 1 S�l� 4 FAX w (> T CONTACT NAME PHONE E-MAIL STREET ADDRESS �� i�L ✓ CITY, STATE, ZIP FAX ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONrRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAIvIE� nfi`�^ c LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME . rr11 �7 1 G S'nx� 'J �3 \ i� �✓ E411AI i M\ 1)_ '(� �( V��yS(7U FAX STREET D S CITY, STATE, ZIP C. t 1 �.� �� CA ei<0 0 Pq 4a' 3q 1 ARCHITECUENGINEER NAME LICENSE NUMBER BUS. LIC # CON[PANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE # STORIES - USE TYPE (JCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM REMODEL AREA I KITCHEN OTHER REMODEL AREA REMODEL AREA. - PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH - ❑ ATTACH I # DWELLING UNTI•S: IS A SECOND UNIT ❑ YES SECOND STORY 0 -YES BEING ADDED? []NO ADDITION? []NO ' PRE -APPLICATION []YES IF YES, PROVIDE COPY OF PLANNING APPL # .f,] NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO RECEIVED BY: -TOTAL VALUATIQQQQ� By my"signature below, I certify to each of the f' 1 wing: I am the property owner or authorized agent to act on the prop e owner's behalf. I have read this application and the information I have provided s orre.t. I have read the Description of Work and verify it is accurate. I agree to comply witkall applicable local ordinances and state laws relating u' ding o ction. I authorize representatives of Cupertino to enter the above-'dentified property for inspection purposes. Signature Applicant/Agent: o �7 of Date: •� SUPPLEMENTAL INFO -TION REQUIRED PLAN CHECK TYPE ROUTINGSLIP rn Q OVER_THE-00VNTER C] BUH,DING 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 II FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAIOR- ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑. ENVIRONMENTAL HEALTH, BldgApp_2011.doc revised 06121111 C CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2566 20111 JOHN DR CUPERTINO, CA 95014-4414 (369 33 036) DE ANZA BUILDERS CAMPBELL, CA 95008 OWNER'S NAME: BREWSTER RICKY G AND YANG DULCE DAOMIN TRUS DATE ISSUED: 03/02/2017 OWNER'S PHONE: 408-857-7814 PHONE NO: (408) 865-0222 LICENSED CONIRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class ]a Lic. #943227 Contractor DE ANZA BUILDERS Date 02/28/2018 X BLDG —ELECT _ PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing X 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: 1st FLOOR ADDITION (551 S.F.); REMODEL FAMILY RM (235 S.F.) I hereby affirm under penalty of perjury one of the following two declarations: AND BATHROOM (30 S.F.); 2ND FLOOR ADDITION (185 S.F.) 1. I have and will maintain a certificate of consent to self-insure for Worker's REMODEL MASTER BEDROOM (193 S.F.) AND BATHROOM (78 Compensation, as provided for by Section 3700 of the Labor Code, for the S.F.); (N) A/C. performance of the work for which this permit is issued. 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. Sq. Ft Floor Area: 736 Valuation: $150000.00 APPLICANT CER'T'IFICATION 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 369 33 036 Deferred Submittal (R-3),R-3 (Custom) representatives of this city to enter upon the above mentioned property for a gree to save indemnify and keep harmless the inspection purposes.ridtCi City of Cupertino agaIia ilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against s in consequence of the granting of this permit. Additionally, the appli nt u derstands and will comply with all non-point WITffiN 180 DAYS OF PERMIT ISSUANCE OR source regulations pe the upertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. _� 'Signature Date 3/2/2217 Issued by: Abby A e� nde Date: 03/02/2017 OWNER-BUIL DER DECLARATION 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 ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 312/2017 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 Munici al Code, Chapter 9.12 and the a. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(x) sh Id store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipme t o devices which emit hazardous Worker's Compensation laws California. If, this air contaminants as defined by the Bay Area Air uality Management District I of after making certificate of will maintain compliance with the Cuperi cipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sec i s 505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. C, _ Owner or authorized agent: APPLICANT CERTIFICATION Date: 3/2/2017 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 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 ARCH[TECT'S DECLARATION 1 understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 3/2/2017 Professional ,$'LOW"12,U PA-- CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 UPER ttECs' 0 (408.} 777-3228 - FAX (408) 777-3333 - buildingQcugertino.ora �� ,� — i—fJ I 6NFW(--1NCTRTIr'TTOW N AT7nimN �AT.TFRATTnwiTI n T?WA71CTnV tT)PPr:RAFn ()PT(-MTAT Tsr.T?nirTTY 11r, 011f OWN MAME CK !�-!i✓Y�/iR%'t✓CCJ� PHONE �=FCf Ej nComa; STREET ADj7RESa CITY, STATE, 7�PCA- FAXCO '[� I 407 IKk jN 'TACT E , �` P E-MAIL ST ADORES C Y, STATE, A— FAX OL ❑ 0,vXTR ❑ OV,Ra'ER.-BUIIA£R ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTI'RACTQRAGENT ' ARCHITECT 0 Eh*GA'EER ❑ DEVELOPER ❑ TEMTANT C07dTRACTOR NAMEE T- LICENSE NUMBER - ^ i s Z 2-16LICENSE BUS, LIC n � COMPANY AtAME1 f jTYPE� STREET ADDRESS %. pj [� CITY, STATE, IZ_IP P ONTE R HrfECT/FNGIM ER hTANLE + MCENSE NUMBER- BUS. LTC 0 TJIiP NAME Dire, MAIL FAX L DPA 1 h C, .. t.�+ Apt levet, STREPTADDRESS �I C STA ZIP �i �(-� p� PHONE A,ir�' a aA .- D S P ION OF R'ORY, i ! c 1 �_�_!!�lOYL' k�L 'I�CLr'YtM,94o'[. -- --_---tCWVt1rd b�ecCYtrrrms W/ a Cjs rW4 41 Annc mik%&–bxA"* lr Vew A EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES !, S � H � ) 8 A V Lr' 2 USE TYPE OCC. SQ.FT. VALUATION {S} E.XISTG V• AREA NEW FT.oOR�� ARL -A �f7 DEMO AREA NOTAL ATE'PAREA BATHROOM I:TTCBEN REMODELAREA REMODEL AREA OTHER REMODELAREA Soo PORCHAREA DECKAREA TOTALDECIUPORCHAREA OARAOEARE-A: DETACH RATTACH biGF 44 13M ELLWO UNITS: [5 A SECOND UNIT EYES SECQN'D TORY ❑ YES 1 BELNGADDED? E] NO I ADD3TION? ONO PRF -APPLICATION Q1'ES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES TOTAL VALUATION: PLA KINGAPPL'a, ❑NO PLANNING APPROVAL LETTER EICI3LER HOME? ❑ Nb�.�y�PzZ A-Z - -- t �b� G 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 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 building CopStruotion, I authorize representativcs of Cupertino to enter the above -identified property for inspection purposes. Signature ofApplicantfAggent- " - Date: 7Z T SUPPLEMENTAL lI�'FORMAT REQUIRED -_ _ �'PL41ti:CfiECK�TIPE:-,;:sem"•,i`_�-e'_ ='ROI71'INGSLIP.,ti-�=L� r� - - - --- -- - - t,--ft_t'EIt,TH1:r"CffCfiftk:!-== _ - -- - `- a:-BUIL.Dli4•/-±+.i']3A14'REl3ESiT= New 5FD orMultlfamli} dlaelllnbs, Apply for demolition permit for eXistin buildin s. Demolition enilitisr aired prior to issuance ofbuildm __- ---__.•�----.-_-.�:,,_�;=:=r,-�-�_Y.,;.,-:_..=..:.-_•-:�•-. ennit for new buildin . ullercial Bldgs: Provide a completed Hazardous Materials Disclosure Con• RON>oli fo�rn If an Hazardous Materials are being used as art ofthis project. - _ - -- 4_ — Co Yof Pall11Dg Approval al Letter or Meeting with Planning prior -_ --- -- _ - - - - -_- - - _ ._1 - ----- - - - -- - submittal of BuildinaPermit application. a__ _I1[.1JQR.'Y::•�.rr-�'w��-.,. -- ,_ -- _ t _ .S ,�E .13I5 _ - -- Bldg.4pp_2011.doc revised 06121111