13070086 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1154 KENTWOOD AVE CONTRACTOR:WEST MAX CO INC PERMIT NO: 13070086
OWNER'S NAME: SACHIN CHAUDHARI 15105 CENTER AVE DATE ISSUED:08/27/2013
OWNER'S PHONE: 4082029571 SAN MARTIN,CA 95046 PHONE NO:(408)623-6549
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
License Class_ Lic.# 2ND STORY ADDITION OF 849 S.F.TO INCLUDE 2(N)
T.� BEDROOMS&2 (N)BATHROOMS. ENCLOSE
Contractor'/✓ )nn Date I ( DOWNSTAIRS
I hereby affirm that I am licensed under the provisions of Chapter 9 PORCH TO LIVING AREA(50 S.F.).REMODEL KITCHEN
(commencing with Section 7000)of Division 3 of the Business&Professions REVISION 41-REMODEL(E)FAMILY,LIVING AND BEDROOMS
Code and that my license is in full force and effect. ISSD OTC 11/25/2013
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'
Compensation,as provided for by Section 3700 of the Labor Code
performance of the work for which this permit is issued. \ Sq.Ft Floor Area: Valuation:$160000
I have and will maintain Worker's Compensation InsurancF,kas rde
Section 3700 of the Labor Code,for the performance of the vD> for which this APN Number:35931026.00 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. 1 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 DAY F M LAST 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 Y✓
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: I/r,-/i75'
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature DateA l — AI I 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.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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. I will
I 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(x)should I 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 Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
r
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized age Date: q233
1 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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,1 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 T 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
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
CONSTRUCTION PERMIT APPLICATION
is COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333• building(aD-cupertino.org`
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI REVISION/DEF RED ORIGINAL PERMIT#
PROJECT ADDRESS APN#
Ow�OIRNAME �� PHONE E-NLAIL
" Z4 O
STREET ADDRESS CITY, STATE,ZIP FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑ OWNER ❑ OWNTER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBERqiio LICENSE TYPE BUS.LIC#
COMPANY NAME E-MAIL FAX
t
STREET ADDRESS CITY,STATE,ZIP PHONE
.ARCHITECT/ENGINEER 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 #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA wo �Z
BATHROOM KITCHEN OTHER /' J
REMODEL AREA REMODEL AREA REMODEL AREA Jr��
PORCH AREA DECK AREATOTAL DECK/PORCH AREA GARAGE AREA: UDETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY E]YES
BEING ADDED? ❑NO ADDITION? ❑NO
PRE-APPLICATION ❑YES IF YES.PROVIDE COPY OF IS THE BLDG AN ❑YES RECE ED Y: TOTAL VALUATION:
PLANNING APPL# ❑No PLANNING APPROVAL LETTER EICHLER HONIE? ❑NO I . t_
By my signature below,I certify to each of the following: 1 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 construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: ( -r Date: (i Z
SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit forOVER-THE-COUNTER El BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. y ❑.EXPRESS - ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials D1SC10Sllre ❑ STANDARD ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project. ❑ URGE f ❑ FIRE DEPT
Copy of Planning Approval Letter or Meeting With Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application. y
❑ ENVIRONMENTAL HEALTH
Bld,aApp 2011.doc revised 06/21/11
.r
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 1154 kentwood DATE: 11/25/2013 REVIEWED BY: mendez
APN: BP#: 13070086 *VALUATION: 1$1,745
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1R3SFDREM
USE: PERMIT TYPE:
WORK revision #1 remodel family, living and bedrooms
SCOPE
„.r
El Li
NOTE. This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). Thesefees are based on the prelimiina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff.' 7i1/Q FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 822 s.f. Remodel,Other
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $558.00 IREMRESOTH
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-0 Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? Yes No $0.00
Advanced PlanninL Fee: $0.00 Select a Non-Residential
Building or Structure 0
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg,Stds Commission Fee: 1BCBSC 1 $1.001 1
SUBTOTALS: 1 $1.501 $558.001 TOTAL FEE: 1 $559.50
Revised: 10/01/2013
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1154 KENTWOOD AVE CONTRACTOR.—TW!��E PERMIT NO: 13070086
.DLZ9AM*+O
OWNER'S NAME: SACHIN CHAUDHARI WkJ+�f �a DATE ISSUED:08/27/2013
OWNER'S PHONE: 4082029571 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License ClassL
_ Lic.# o� � 2ND STORY ADDITION OF 849 S.F. TO INCLUDE 2(N)
BEDROOMS&2 (N)BATHROOMS. ENCLOSE
Contractor\_,�,IJ4,'�' .til—m A Date9i—'7 DOWNSTAIRS
I hereby affirm that I am licensed under the provisions of Chapter 9 PORCH TO LIVING AREA(50 S.F.). REMODEL KITCHEN
(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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$160000
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:35931026.00 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 1 0 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 DAY LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, �Fv/
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: 7
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date _2 — AI I roofs shall be inspected prior to any roofing material being installed.If a roof is
�T installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I 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(x)should I 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 Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this D
Owner or authorized agent:' Date:
permit is issued. 1 13
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 CONSTRUCTION LENDING 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
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1154 KENTWOOD AVE CONTRACTOR:WEST MAX CO INC PERMIT NO: 13070086
OWNER'S NAME: SACHIN CHAUDHARI 15105 CENTER AVE DATE ISSUED:08/27/2013
OWNER'S PHONE: 4082029571 SAN MARTIN,CA 95046 PHONE NO:(408)623-6549
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class_ FS Lic.# j 2ND STORY ADDITION OF 849 S.F.TO INCLUDE 2(N)
1BEDROOMS&2 (N)BATHROOMS. ENCLOSE
Contractor\N C6 4 — 4 O_Date V DOWNSTAIRS
I hereby affirm that I am licensed under the provisions of Chapter 9 PORCH TO LIVING AREA(50 S.F.).REMODEL KITCHEN
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect. DEFERRED#1-TRUSS CALCS-ISSD OTC 10/8/2013
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 C�cje
performance of the work for which this permit is is �l � Sq.Ft Floor Area: Valuation:$160000
I have and will maintain Worker's Compensation In urance,as provided for by
Section 3700 of the Labor Code,for the performance of tAhk for wh' APN Number:35931026.00 Occupancy Type:
permit is issued. 1)
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. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 80 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 VOM LAST CALLED INS ION.
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 Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
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.
❑ OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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. I will
I 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 I 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 Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Seed ns 25505,25533,ano 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: A 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,I CONSTRUCTION LENDING 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
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
12 CONSTRUCTION PERMIT APPLICATION
CDERREHENTAPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE• CUPERTIN , CA 95014-3255 b�
CUPERTINO (408) 777-3228•FAX (408) 777-3333•buildinoacii ertl aor 1
❑NEW CONSTRUCTION [_ ADDITION ❑ ALTERATION/TI /a/
REVISI /DEFERRED ORIGINAL PERMIT# J d U
PROJECT ADDRESS `5 . O APN -3 _ /5 / O 7
OWNER NAME + PHON� + E-MAIL
Ink
STREET ADDRESSC- CITY, STATE,ZIP FAX
CONTACT NAME Z E-MAIL
(fA
cc
STREET ADDRESS CITY,STATE,ZIP L TFAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC At
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORKTT
EXISTING USE PROPOSED USE CONSTR TYPE k 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 ASECOND UNIT ❑YES SECOND STORY YES
BEING ADDED? NO ADDITION? ❑NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF Is THE BLDG AN E]YES RECEI B " AL VA
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 a e o 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 rify it is accurate. I agree to comply with all applicable local
ordinances and state laws rel
t* const . n_I authorize representatives of Cupertino to enter the above-identifie roperty for inspection purposes.
Signature ofApplicanvAgen Date: O I J
SUPPLEMENTAL INFORMATION QUIRED rLAricilEcic"""TYPE
ROUTING SLIP,,
New SFD or Multifamily dwellings: Apply for demolition permit for 01 '0_VER TI[E CouNTER ,' ❑ BUILDING Pi Ax REvtEw
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. "❑ EXPRESS"� ❑ PLANNINGPLANREViEW
_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
submittal Of Building Permit application. El MAJOR,�I ElSANITARYSEWERDISTRICT
❑f ENVIRONMENTALHEALTH
BldgApp_2011.doc revised 06/21/11
Q�
CONSTRUCTION PERMIT APPLICATION D
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M0
CUPet'�TtNO
(408)777-3228 • FAX (408)777-3333•building(a cupertino.orq !
❑NEW CONSTRUCTION -Z ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS r ^' ^-+ AVEC V (N APN# 3�� 1 fi
OWNERNAME 1^I�I Vv V PHONE E-MAIL (/
s Ll, H 4 09-11CIZIS I s� ; G-) y L'
STREET ADDRESS CITY, STATE,ZIP FAX
11 -94 ll-k-r-41 W O O V;- C Q Pi� T i N 0 (A C1 X01 41
CONTACT NAME PHONE E-MAIL
56k h'k1 C k ot'A k Ifog- `L-t 5'e;�k Y1._t O
STREET ADDRESS CITY,STATE,ZIP FAX
OV,TIER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME (� E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC#
QN2�1 8�Ar+rrE-+'�
COMPANY NAME S f, E-MAILC ,a U a% t v i" FAX Lf
STREET ADDRESS I V y �a79A Dk. CITY,STA ,ZIPS✓nom �^ G�. PHONE
DESCRIPTION OF WORK CO11 r•'
✓)r� Svv c
V eA%,4 5 bnck' -f-D i i NA A5 c ti
EXISTING USE PROPOSED USE CONSTR TYPE 'STORIES
, USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMCJ TOTAL
`.I
AREA I S ARE+g Cl AREA NET AREA
BATHROOM T KITCHEN OTHER
REMODEL AREA REMODEL AREA 1 0 REMODEL AREA
PORCH7 DECKAREA TOTAL DECIVPORCH AREA GARAGE AREA: LJDETACH
�]ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY L2TES
BEING ADDED? ❑NO ADDITION? NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES REC { k �t ' TOTAL VALUATION:
PLA.NNINGAPPL# F1 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 ro 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 build' construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Appl icant/Agent: Date: 01
SUPPLEMENTAL INTFORMATION REQUIRED p>Al' cl ci TYPE ,, ;_
,. ROUTIhG,SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for ovER TaE counTER ❑ ;LIIIDT;\GPLANREVTEw
existing building(s). Demolition permit is required prior to issuance of building z
permit for new bullding. Z!J❑_ EXPRESS '' # 'x ❑
PLANTLNGPLAIIREVIE�P
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure «oRxs +
form if any Hazardous Materials are being used as part of this project.
LARGE " ❑ ERE DEPT' 3
_Copy of Planning Approval Letter or Meeting with Planning prior to
11TASOR s{ " " � ❑'SAISITARY SERTER3>ISTS2IC��a�
submittal of Building Permit application. ; ,T r,;,
x = yea ❑ EIVVIIiC+NTDTENTAI'�HEALTA:"
BldgA,pp_201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 1154 KENTWOOD AVE DATE: 07/12/2013 REVIEWED BY: MELISSA
APN: 359 31 026 BP#: / �� VALUATION: 1$160,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex 2nd Unit? 0 Yes No PENTAMATION 1 R3SFDADD
USE: OTC. 0 Yes ONOPERMIT TYPE:
WORK 2ND STORY ADDITION OF 849 S.F. TO INCLUDE 2 N BEDROOMS &2 N BATHROOMS.
SCOPE ENCLOSE DOWNSTAIRS PORCH TO LIVING AREA (50 S.F.). REMODEL KITCHEN (90 S.F.)
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
R-3 (Custom) II-B,111-B,IV,V-B 899 $2,577.00 1R3PLNCK $1,617.00 1R3INSP
TOTALS: 899 $2,577.00 $1,617.00
'MECH,HOURLY Q Yes 0 No PLUMB,HOURLY C) Yes Q No ELEC;HOURLY Q"Yes o No
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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'l info,
FEE ITEMS (Fee Resolution 11-053 E[' 711,112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,577.00 F0771 s.f. Remodel,Kitchen(<=300 sf)
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $626.00 IREMRESKIT
PME Plan Check: $0.00
Permit Fee: $1,617.00
Suppl. Insp. Fee-.0 Reg. Q OT 0.07 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? Q Yes Q No $0.00 0
Advanced Planning_ ee: 1PLLONGR $125.86 Select a Non-Residential Q
Building or Structure 0
I
Strong Motion Fee: 1BSEISMICR $16.00 Select an Administrative Item
Blde Stds Commission Fee: IBCBSC $7.00
SUBTOTALS: $4,342.861 $626.00 TOTAL FEE: $4,968.86
Revised: 07/01/2013