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B-2017-0707CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0707 10802 WILKINSON AVE CUPERTINO, CA 95014-4732 (356 13 039) CHUEN YANG YANG SAN LEANDRO, CA 94579 OWNER'S NAME: VIJAY CHAUDNARY I I DATE ISSUED: 05/03/2017 I OWNER'S PHONE: 650-576-5660 1 I PHONE NO: (510) 213-9981 I License Class 11 Lic. #397965 Contractor CHUEN YANG YANG Date 06/30/2017 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. G,,3 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. 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. BUILDING PERMIT INFO: BLDG X ELECT X PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: TO CLEAR CODE CASE- KITCHEN REMODEL - (100 SF); BATHROOM REMODEL (3) (120 SF) REV#1 REPLACE WINDOW (15) LIKE FOR LIKE TO MEET EGRESS; (N) CAN LIGHTS (42) ISSUED 5/4/2017 REV#2 - ADD NEW 3/4" BLACK IRON GAS LINE - KITCHEN - ISSUED 5/9/2017 Sq. Ft Floor Area: I Valuation: $25000.00 APN Number: Occupancy Type: 356 13 039 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 5/9/2017 Issued by: ABBY AYENDE Date: 05/03/2017 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 compensation, will do the work, and the structure is not intended or offered for RF. -ROOFS: 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. sale (Sec.7044, Business & Professions Code) z. 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: 5/9/2017 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. 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 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 9.18. Signature Date 5/9/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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, lections 25505, 25533, and 25534. GOwner or authorized agent: Date: 5/9/2017 CONSTRUCTION LE A " ENCY I hereby affirm that there is a construction lendin gency for the performance of work's for which this permit is issued (Se . 3 7, Civ C.) Lender's Name Lender's Address ARCHITECT'S DFCL RATION I understand my plans shall be used as public records. Licensed Professional 70 F4 OTO -1 CONSTRUCTION PERMIT APPLICATION 12 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildin(g(a�cupertino.org ED NEW NEW CONSTRUCTION ADDITION ❑ ALTERATION / TI }� (REVISION)DEFERRED ORIGINAL PERMIT # PROJECTED Z >��^� V ON ��� APN J`!-�j� OWNER NAME CP1lr V � PHO �� -, `Vb b � EMAIL ST �S� C 'A- VC. CITY, STATE, _, �� f_-7GA-"^ /O / FAX CONTACT NAME `/ n ` d 1�1 PHONE E-MAIL _ o, N J W STREET ADDRESS CITY, STATE, ZIP FAX OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAM LICENSE NUMBER ' /� LICENSE TYPE BUS. LIC # v 1 C G f_S COMPANY NAME E-MAIL FAX (t� L STREET ADDRESS CITY, STATE, ZIP. ^ PHO rei. ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK AS X7► 7 L' J kj: c G1 l- N EXISTING USE PROPOSED USE CONSTR TYPE It STORIES I USE TYPE OCC. SQ.FT. VALUATION ($) 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: Ll DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOi•D STORY []YES BEING ADDED? ❑NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES REC D Y: TOTAL VALU�3BN: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? E]NO ✓/ By my signature below, I certify to each of the following: I am the property owner or authorized agent to kct on tAe property owner's behalf. I have read this application and the information I have provided is correct. I have re d the Description of Work d verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to builditygOn ction. I autho ze represe ti es of roto enter the above-identifi d prope for inspection purposes. Signature of Applicant/Agent: vv Date: SUPPLEMENTAL INFORM4TIONIQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ 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 El MAJOR SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10802 WILKINSON AVE CUPERTINO, CA 95014-4732 (356 13 039) OWNER'S NAME: 650-576-5660 OWNER'S PHONE: 650-576-5660 License Class 5 Lic. #897965 Contractor CHUEN YANG YANG Date 06/30/2017 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. 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 perntit 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 regulation per the Cupertino Municipal Code, Section 9.18. i Signature Date OWNER BUILDER D CLi���_) I hereby affirm that I am exempt fro the Contractor's License Law for one of the following two reasons: 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) z. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Sec.7044, Business & Professions Code). 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. z. 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 9.18. Signature Date CONTRACTOR: I PERMIT NO: B-2017-0707 CHUEN YANG YANG SAN LEANDRO, CA 94579 DATE ISSUED: 05/04/2017 PHONE NO: (510) 213-9981 BUILDING PERMIT INFO: X BLDG X ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: TO CLEAR CODE CASE- KITCHEN REMODEL - (100 SF); BATHROOM REMODEL (3) (120 SF) REV#1 REPLACE WINDOW (15) LIKE FOR LIKE TO MEET EGRESS; (N) CAN LIGHTS (42) ISSUED 5/4/2017 Sq. Ft Floor Area: I Valuation: $25000.00 APN Number: Occupancy Type: 356 13 039 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar Date: 05/04/2017 RE -ROOFS: 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. Signature of Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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, tions 25505, 25533, and 25534. Owner or authorized agent: Date: CONSTRUC EN E I hereby affirm that there is a construction lending agency for the erformance of work's for which this permit is issued (Sec. 3097, Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CCUPERTINO I I XMI17 rnXTQTA1 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDWIIV4.&ON 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinaCcT�cupertino.orcl F-1 ATVITTT(1N F- AT.TFR ATTnW / TT '54 REVISION /DEFERRED ORIGINAL PERMIT # PR07ECTDRES (,J--� APN # PHO O STREET O W L� .l SQ • �Y, STA vV C 1Fi FAX CO TACT NAME , 1 r V BONE Q r E-MAIL TREET DRESS ' ^ p'�! ��} ,/� � � � 0 e� W 5- cc- S O N �V �.. CITY TATE, "_ Z F OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CO TOR NE A `^ LICENSE NUMBER LICENSFeE BUS. LIC # K C MP V e, EMA�pr AX FCA STREET ADDRESS CITY, STATE, ZIP P ONE - 2 - 1 ARCHITECT/ENGTNEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE 1 # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA�IECOND ECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: NIT ❑ YES SECOND STORY ❑YES BEING ADDED? [:]NO ADDITION? []NO PRE -APPLICATION ❑ IF YES, PROVIDE COPY OF IS THE BLDG AN YES [:]7rD*,(��YES L(J�)1%) pV 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 property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description' of ' it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b it g construction. I a orize re crRa ' es of Cupe oto enter the above -id for inspection purposes. /p/rope O S V 4 Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORNMTITN REQUIRED PLAN CHECK TYPE R6Uz'INGS1JP' ❑ 'OVER-THE-COUNTER ❑ 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 toEl MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ 'ENVIRONMENTALBEALTH B1dgApp_2011.doc revised 06/21111 CITY OF Cif PERTINO BUILDING PERMIT BUILDINGADDRESS: 10802 WILKINSON AVE CUPERTINO, CA 95014-4732 (356 13 039) CONTRACTOR: CHUEN YANG YANG PERMIT NO: B-2017-0707 SAN LEANDRO, CA 94579 OWNER'S NAME: VUAY CHAUDHARY I DATE ISSUED: 05/03/2017 OWNER'S PHONE: 650-576-5660 I I PHONE NO: (5 10) 213-9981 LICENSED CONTRACTOR'S DECLARATION ATION BUILDING PERMIT INFO: License Class.Q Lic. #897965 Contractor CHUEN YANG YANG Date 06/30/2017 X BLDG _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: TO CLEAR CODE CASE- KITCHEN REMODEL - (100 SF); t. I have and will maintain a certificate of consent to self -insure IFor Worker's BATHROOM REMODEL (3) (120 SF) 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 fz. 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: $25000.00 APP I ANT CERTIFICATION I certify that I have read this application and state that the above "N 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 35613 039 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 consequence the granting this permit. Additionally, the applicant understands and willl comply with all ll non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.181 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 05 03-2017 Issued by: Kim Dunbar f OWNER -BUILDER DECLARATION Date: 05/03/2017 I hereby affirm -that I am exempt from the Contractor's License Law for one of the REQ following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is r. 1, 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) f 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: 05-03-2017 I hereby affirm under penalty of perjury one of the following three d Iclarations: s. 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. I maintain compliance with the Cupertino Municipal 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(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 California. 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 prLoL ,visions of the Labor Code, I must forthwith comply with such provisions or llus permit shall will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety C d Sections 25505, 255 , and 25534. r be deemed revoked. Owner or authorized agent v APPLICANT CERTIFICATION Date: 05-03-2017 1 certify that I have read this application and state that the above information is CONSTRUCTION END GAGENCY correct. I agree to comply with all city and county ordinances and sate laws I hereby affirm that there is a construction len - ing 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 againstliabilities, judgments, costs, and expenses which may accrue against said it 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 05-03-2017 Licensed Professional CUPERTINO ❑ NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENIT DEPARTMENT •BUILDING DIVISION 10300 TORRE AVENUE • CU PERTINO, CA 95014-3255 (40188))1777-3228 • FAX ((408) 777-3333 • buiidin cuoerkino.op 2� �' � �? 9r F1 AT)T)TTTON 1 1 AITF;RATTOM/TT AFit7TQTnXT/TRTMDDUT% nI T-AT T, PJO� CS W,►,,,t,��TIs�N CA)PC, rWa -�)5 & _ i--; - C) ?::;, OWNER � .� �a.''� � � �� � � #c► P GNE � L CITY, STA f y m ® CIT -0 FAX - CONTACT J � t J CT t I 13_ ldlt��6 �� AIL V I/� l A• S ®T SL w c, to ! °u� ® CITYLJL! FAX OWNER 11 OWNER-BuL DER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CQNTRA6OR NAME �� A ®� `�, I,F 4T"T� � LICENSE BUS. LIC # CO �CU G 14 PTN � ms,( i,U 3 a C-. V c -IR Frxri bCc STREET l DRESS S a 1 J ` s'A ° V c 11 CITY v 6Tk O (2 i 4 ig O® 2_'J J ( O ARCHITECTIENGINEER NAME LICrSE NUMBER BUS, LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK ^X �A P l K ® ® NIS AIb T T :? k e" k C -e -M o b ('E -L w 0 0 SV) + EXISTINGUSE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (a) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETT AREA BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA I PORCHAREA DECKAREA TOTALDECK/PORCH AREA GAP AGE AREA: Lj DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑YES BEINGADDED? 6r�QNO SECONDSTORY YES ADDITION NO PRE•APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES . RECEIVED BY. • - VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO - it 0 0 0 By my signature below, I certify to each of the following: I am thep o1 rized agent to act on the property owner's behalf. I have read this application and the information I hav provided is correct. have re e D tion of rk and verify it is accurate. I agree to comply with all applicable local '. ordinances and state laws relating t�ld" g Qomtructio . I uthonze representatives o C ertino to enter the above-iden ed property for inspection purposes. Signature of ApplicandAgent: Date:101 7 SUPPLEMENTAL INF005 ION REQUIRED PLAN CHECK TYPE "ROUTING SLIP j] OVER- THE -CO vNTER ❑ BUILDr"dPLAN REVIEW , _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to iss� ance of building permit for new building. C7xPREss ❑ ' Px Atvly>rlc gLArr REviw " _-Commercial Bldgs: Provide a completed Hazardous Mate�ials Disclosure ❑ STANDARD 01.1PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. 0 LARGE FDREDEPT. Copy of Planning Approval Letter or Meeting with Planning prior to _ _ Iv1AroR sANiTA72YSEwERDISTRICT , submittal of Building.Permit application. ENVIRONMENTALHEALTH ".--• . BldgApp 2011.doc revised 06121111 aN'1P�1 WN