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14030009CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 4 INFINITE LOOP CONTRACTOR: XL CONSTRUCTION PERMIT NO: 14030009 OWNER'S NAME: APPLE COMPUTER INC 851 BUCKEYE CT DATE ISSUED: 03/04/2014 OWNER'S PHONE: 4088768131 MILPITAS, CA 95035 PHONE NO: (408) 240-6000 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ Ci 6� �"� APPLE T.I. - MODIFICATION OF WOMENS RESTROOM License Class Lic. # b�' FOR ADA ACCESSIBLITY d& CREATE CLOSET Contractor xt. GjN6ky%,At' Date r! 'Wf!l! DEFERRED # I - ADD MECHANICAL & ELECTRICAL TO PROJECT I hereby affirm that I am licensed under the provisions of Chapter 9 (EXHAUST & I LIGHT FIXTURE) - 5/14/14 (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 Sq. Ft Floor Area: Valuation: $10000 performance of the work for which this permit is issued. 1 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: 31602108.00 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 upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FR® ST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the " Date: 0 of granting of this permit. Additionally, the applicant understands and will comply �- with all so ce gulations per the Cupertino Municipal Code, Secti 9.18. RE -ROOFS: 5..��y Signature Dale 77 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. ❑ OW R -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 1, 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) 1, 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 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 1 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 Cup lino unicipaI Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 255 , 2 534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: 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 Compensation laws of California. If, after making this certificate of exemption, l CONSTRUCTION ].ENDING AGENCY 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 W-11TINIM 7 cr hTr7q A`ITr TIM-rr7lfT Rf,7rT, TAT 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 nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (lee Resolution 11 -053 Eff.' 7111/32 %L..JL JL ll \1411' 'k— IL1 ll 1Lj1L�11L 111 N SLY FEE lESTMATOR - HUID[..1NNG IDRVffSffCN ADDRESS: 4 INFINITE LOOP ]DATE: 03104/2014 REVIEWED BY: MELISSA Plocirh. Pius( heck APN: 316 02 108 BP#: 1560091*VALUATION: 1$10,000 *PERMIT TYPE: Building Permit PIAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building Ofl! ' /J.', . lnsp PENTAMATION PERMIT TYPE: 1GENCOM WORK APPLE T.I. - MODIFICATION OF WOMENS RESTROOM FOR ADA ACCESSIBLITY & CREATE SCOPE CLOSET Suppl. Insp. Fee:Q Reg. Q OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Con.itrvcllon l cIX. el (J!ntrlL�'1(1114' Fec., 0 E) Work Without Permit? C) Yes r) No $0.00 Advanced PlanninL Fee: $0.00 Select a Non -Residential 0 Building or Structure d, lr,n'c'1 1)i�c u;nc•rl/r?litllt hc�e's': Strong; Motion Fee: 1BSEISMICO $2.10 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: 1 $3.10 $278.00 TOTAL ]FEE: F $281.10 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 nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (lee Resolution 11 -053 Eff.' 7111/32 We,.h. Plun C'S;trk F Plocirh. Pius( heck MISC ITEMS V711C T, R,ru)0 Fev, I PIW77i) PO -Mit FCC- FI-/, I P, ;-,;li7 i"'t f?Ihc-r .lir,;'a. h7,rLj l)Ihc'r P/urnb /rv, Ofl! ' /J.', . lnsp .ncch. hop. N.1". Ph4wh hty. h"., J,wl ];/,I; 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 nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (lee Resolution 11 -053 Eff.' 7111/32 FEE QTY/]FIEF MISC ITEMS Plan Check Fee: Hourly Only? Yes E) No $0.00 hours Plan Check, Hourly $278.00 1STPLNCK Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Con.itrvcllon l cIX. el (J!ntrlL�'1(1114' Fec., 0 E) Work Without Permit? C) Yes r) No $0.00 Advanced PlanninL Fee: $0.00 Select a Non -Residential 0 Building or Structure d, lr,n'c'1 1)i�c u;nc•rl/r?litllt hc�e's': Strong; Motion Fee: 1BSEISMICO $2.10 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: 1 $3.10 $278.00 TOTAL ]FEE: F $281.10 Revised: 01/15/2014 ?"A1T1rrN\7 rKTr ir4Tr T1MTr Tn1'1r1T1\T/rh 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 preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Fff. 7,1/13) �L %L111 A R \U/ UL ILI 0.J ILL JL'V IlJL JLJ. V.Y FEE]ESTMATOS - BUR LMNG Il MSRON nia:r?I). ADDRESS: 4 INFINITE LOOP DATE: 04/07/2094 REVIEWED BY: MELISSA APN: 316 02 108 UUP#: 'VALUATION: $0 *PERMIT TYPE: PU,AN CHECK TYPE: Tenant Improvement PRIMARYmercial Building KlAn I PENTAMATION 1GENCOM USE: PEIaMIT TYPE: WORK 4/ /14 - DEFERRED # 1 - A MECHANICAL & ELECTRICAL TO PROJECT EXHAUST & 1 LIGHT SCOPE I FI TURE) 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 preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Fff. 7,1/13) FEE nia:r?I). M1ISC ITEMS Plan Check Fee: i�Tii('i ;'i-•it`c'1;. j7;,�'f�.Ll 0jhei111wi,6Ir.�: 1A Deferred Submittal IDEFSUBM } Suppl. PC Fee: E) Reg. C) 01 0.0 hrs Ve, . 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 preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Fff. 7,1/13) FEE QTY/FEE M1ISC ITEMS Plan Check Fee: $0.00 =# $278.00 Deferred Submittal IDEFSUBM } Suppl. PC Fee: E) Reg. C) 01 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feed Reg. Q OT p.p hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? C) Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 Z l as I /sr?1:ulne nt(11'ion FS: Strong_Motion Fee: $0.00 Select an Administrative Item B1dQStds Commission Fee: $0.00 gUBTOTALS: $0.00 $278.00 TOTAL FEIE: $278.00 Revised: 04/01/2014 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 4 INFINITE LOOP CONTRACTOR: XL CONSTRUCTION PERMIT NO: 14030009 OWNER'S NAME: APPLE COMPUTER INC 851 BUCKEYE CT DATE ISSUED: 03/04/2014 OWNER'S PHONE: 4088768131 MILPITAS, CA 95035 PHONE NO: (408) 240-6000 ®.. LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ (ate C APPLE T.I. - MODIFICATION OF WOMENS RESTROOM FOR License Class Lie. # V 1 IUB "j�ivlC 11G'� ADA ACCESSIBLITY c& CREATE CLOSET Contractor N Date �j hereby affirm that 1 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: 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 Sq. Ft Floor Area: Valuation: $10000 performance of the work for which this permit is issued. ] 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: 31602108.00 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 PE T ISSUANCE OR building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FRO T ED INSPECTION. indemnify and keep harmless the ity of Cupertino against liabilities, judgments, costs, and expenses whic ay a c e against said City in consequence of the 3/4 /N granting of this -mit. ditio all , the applicant understands and will comply Date: with all non-po t sourc r gula o pe the Cupertino Municipal Code, Secti 9.18. RE-ROOFS: Signature Date 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. ❑ 04, lER-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, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, 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 declarations: Health & Safety Code, Section 25532 s ould 1 store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use q i ent or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the B y a Air Quality Management District I performance of the work for which this permit is issued. no will maintain compliance wit the Cu r no micipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Se ions 2 05 255 and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized ager Date.*i+ 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 Compensation laws of California. If, after making this certificate of exemption, I CONS'fRUC' ION AGENCY 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 CUPERTINO n NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building0kupertino.orq 7 ADDITION R ALTERATION / TI 7 REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS l� l �/ { L06? l i V APN N / o CG OWNER NAME `, PHONE �.,�y E MAIL STREET ADDRESS { CTI Y, STATE, ZIP ped FAX CONTACT NAME/Cg�A( PHONE\. STREET ADDRESS (r� (Z'A' y {�f / , CITY, STATE, ZIP /`/� �(�� I e�❑ FAX p ❑ OWNER ❑OWNE&-BUILDER 1:1OWNER AGENT CTO& ❑ CONTRACTOR AGENT ARCHITECT ECCJJY� ❑_! ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSENUMBER 7CENSE TYPE BUS. LIC N COMPANY NAME ` t �,�' ^� E-MAIL?- FAX STREET ADDRESSCITY, STATE, ZIP PHONE ARCHITECT/ENGINEERNAME 1 LICENSE NUMBER BUS. LIC N COMPANY NAME (l��S E-MAIL Q } . FAX STREET ADDRESS (� 1 �.IZ CITY, STATE, ZIP G a S 6 ®'CN � ( PHONE N DESCRIPTION OF WORK int s5w-A- L d Ab'Lj EXISTING USE PROPOSED USE CONST& TYPE 11 STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NEr AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: EIDETACH ❑ ATTACH 4 DWELLING UNITS: IS A SECOND UNrr E] YES SECOND STORY ❑YES BEING ADDED? NO ADDITION? []NO PRE -APPLICATION [:]YES IF YES, PROVIDE COPY OF IS THE BLDG AN [3 YES - OTAL VALUATION: PLANNING APPL # []NO PLANNING APP AL LETTE EICHLER HOME? !O 00 U I am the property owner or authorized a to roperty owner's behalf. I have read this By my signature below, I certify o each t e foAct application and the information I have pr i ed iI have read the Description of Work and Is accurate. I agree to comply with all applicable local ordinances and state laws relatin to build g conI authorize representatives of Cupertino to enter the aboveidified property for inspection purposes. Signature ofApplicant/Ag, Date: / SUPPLEMENT INF NATION REQ UIRED y PLAN CHECK •TYPE ROUTING SLIP © 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 OVER THE COUNTTER i permit for new building. EXPRESS ' PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sTANnARD 'PUBLIcwoRKS form if any Hazardous Materials are being used as part of this project. k ` ° LARGE u Wyk ❑ :FIRE DEPT _ of Planning Approval Letter or Meeting with:Planning Prior to M4, ED MAJOR s rI � f`CoPY ❑ - SEWER DISTRICT. submittal of BuildingPermit a lication. PP ¢k . waxy X*; 'xF ,,. u; ENVIILONIIIENTAI HEALTH.,; . BldgApp_2011.doc revised 06/21/11 CONSTRUCTION PERMIT APPLICATION Q Lis COMMUNITY DEVELOPMENT DEPARTMENT a BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 a FAX (408) 777-3333 o building D( upertino.orq CUPERTINO [:]NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION/ DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS % I p I 1 , r-q� t ' APN -9 _ O J OWNER NAME P � I N / PHONEd�b _� ( 1 [E -M AIL�jC re�Se �iC0nstfy-t&&If6 STREET ADDRESS INF -04 I -v-c---lJ� OP CITY, STATE, ZIPc• e&,,s •,� �1 cA l y y` FAXJb b CONTACT NAMEJP� ^� PHONE `� E MAII STREET ADDRESS CITY, STATE, ZIP lQ O%W) I c � � FAX ❑ OWNER ❑ OWNER-BUB.DER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAM LICENSE NUMBER �^� LICENSE TYPE C BUS. LIC # COMPANY NAME \ E-MAH.�L 1 FAX STREET ADDRESS CITY, STATE, ZIP _ ^ � PHONE-���i/�✓�� ARCHTTECT/ENGINEER NAMEl r�O C -ts`T LICENSE NUMBER BUS. LIC # COMPANY NAME, l ®S E -MAH. � c��z�'�-145 • ,G�— FAX STREET ADDRES —_ r CITY, STATE, ZIP a� ��, a p J � PHONE Aa6--';:t3 "3k-® DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE # 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 TOTAL D WPORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ONO ADDITION? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES D BY: TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LE EI ER HOME? ❑ NO By my signature below, I certify to ea h of the foll wing I e pro erty owner or authorized -a owner's behalf. I have read this application and the information I haverovided is one. I v read a Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and State laws relating to bull ding cons c ' n. I oriz r resentatives of Cupertino to enter the above-ide tified roperty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTALfm TI REQUIRED PLAN CHECK TYPE ROUTING SLIP _ New SFD or Multifamily dwellings: pply for demolition permit for ❑ OVER -THY -COUNTER ❑ BUILDING PLAN REVIEW 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_201 1. doc revised 06/21/11 REWMam D DEFERRED FL RREDD JfECT DESCRIPTION: � �� `%L�%%�1 � DATA: p - Re• 13 ENCY ILDING ARY IN RETURN MIT IIS] RETURW STATUS M7 IN R� STAMS IMT f k, c9 � /STATUS A �r 4TI®N: '0-1 SO. PT ACT. Let PHONEA? q& 5 (t s 5- D BY - DATE: COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION 10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255 (408) 777-3228 ^ FAX (408) 777-3333 ^ building(ftupertino.org n ADDITION n ALTERATION D RIGINAL PERMIT #' PROJECT ADDRESS j n ( P APN N C• ('{J OWNERNAME^ 1 I PHONE E•�� _I Ca/ Tu r- j ' eJ STREET ADDRESSi �� CITY, STATE, ZIP/�J Q / 1 _ FAX CONTACT NAME I PHONE 6 91� E STREET ADDRESS / ( D CITY STATE, ZI /1 FAX Q ( G J❑ ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑I CONTRACTOR AGENT ❑ ARCHITECT ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME r LICE SE l (BEER' (a / I LICENSnTYP BUS. LIC N [ 10 68 COMPANY NAME Yr. V t / L n -MAIL 1/ E � / eC FAX STREET ADDRESSQ, � ( � � � � n f` CITY, ST TE, 5 ARCHITECT/ENGINEER NAME 'PES - / LICENSE NUMBER BUS. LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS��1'�-!!!r CITY, STATE, ZIP PHONE DESCRIPTION OF WORK De e n r I 1 11 n r� 1 EXISTING USE PROPOSED USE CONSTR. TYPE N 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: DETACH ❑ ATTACH #DWELLING UNITS: IS A SECOND UNIT []YES SECONDSTORY ❑YES BEING ADDED' []NO ADDITION! []NO _ A PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING LETTER IS THE BLDG AN ❑ YES EICHLERHOME! RECEIV • o .1 TOTAL x'A)11 PION: PLANNING ADPL# E) NO APPROVAL _f❑NO , 1 / V By my signature below, I certify to each of the fol lowing: I am the property owner or authorized agerli to act on the property owner's behalf. I have read this application and the infdrmation I have 02vided is correct. I have red the Description of Work and verify it is accurate. I agree to comply with all applicable local' ordinances and state laws relating to d g construction. I aut rize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL IN ORMATION UIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-TII&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 IC4DISTANDARD ❑ 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 BIdgApp_2011.doe revised 06/21/11 IN