14020031 CONSTRUCTION PERMIT APPLICATION
19 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255v
CUPERTINO (408) 777-3228•FAX(408)777-3333•building(Wcupertino.org U
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS lo 21S L120
/ � APN#
K IC��h PHONE �b Din 'y�j. E-MAIL
STREET D,BES G., �,.,_ ,-Ty STATE I U J-
�3 FAX
CONT E may- PHONE E-MAIL
STREET ADDRESS . � �STATE,- \ C.G- // FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACT NA uL J,4QY LICENSE NUMBER LICENSE TYPE BUS.LIC#
I
COM N 1 E-MAIL FAX
STREE S / j" y jZ� CITY,STATE,ZIP PHONE
ARC fNAM1 ` LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL
S REET D CITY,ST I PHONE /OS-1
EXISTING USE PROPOSED USE CONSTR TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXLSTG 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: D DETACH
❑ATTACH
#DWELLING UMTS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? NO ADDITION? ❑NO
PRE-APPLICATION DYES IF YES,PROVIDE COPY OF 1S THE BLDG AN ❑YES RECEIVED 8Y; - `°II TOT V UATIOhI;_�»
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO ' '� '�„ (jam/ /
�. Y ,.
By my signature below,I certify to ch o the following: I am the property r or authorized agent to act on the property owner's behalf. I ha read this
application and the information I ve pr vided is t. I have read the es iption f rk and verify it is accurate. I agree to comply with applicable local
ordinances and state laws relatin to bu' in on ion. I authorize rep es es,
of pertino to enter the aj� -Identifijed�propertyfo)rin/s�ection purposes.
Signature of Applicant/Agent: / Date: T �� K �0 4
SUPPLEME ALtORMATION RE UIRE xis s a s 4� i
.
_New SFD or Multifamily dwellings: Apply for demolition permit for
'OVER THE-CQUNTER � Si�iLDINGPLANRF�VIEW
existing building(s). Demolition permit is required prior to issuance of buildi � r �a
permit for new building. Rm
1� �xrRss � a LAr�� �9
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure1 STANDARD * �xCvORKs� s�
fo_rm if any Hazardous Materials are being used as part of this project. :'
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permits application. MAJotQi � ArTtTA� VDI RICTp ��;
g PP
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10298 cold harbor ave DATE: 02/04/2014 REVIEWED BY: Mendez
APN: BP#: / 0,,;;Z000) :VALUATION: 1$15,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION
USE: PERMIT TYPE: 1 R3SFDRE;
WORK master bathroom remodel 55 sq ft
SCOPE
Lj
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc . Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolulion 11-053 Ef. 7-"1 '13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.f. Remodel,Bath(<=300 sf)
Suppl. PC Fee: Q Reg. Q OT 0,0 hrs $0.00 $626.00 1REMRESBAT
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-.E) Reg. Q OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
0
Work Without Permit? ® Yes E) No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential G
Building or Structure 0
i
Strom Motion Fee: IBSEISMICR $1.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: 1 $2.50 $626.00 TOTAL FEE: $628.50
Revised: 01/15/2014