12110067
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CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinclacupertino.org
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❑ NEW CONSTRUCTION ❑ ADDITION M ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS -z 4> 2 MARIAMI AVE
APN# 2QP Gj (P o Zo 2-.7'>
OWNERNAME heft C
PHONE
-°t96-loi0
E-MAIL
STREET, DDRE rte V STATE 71P ' FAX
Z2 Z
CONTACT NAME�C.WUA-cc cwc-
PHONY v � /�� r / 717
(J •� U
STREET ADDRESS rJ ��/y)
CITY, STATE, ZIP
FALX
❑ OWNER ❑ OWNER -BUILDER❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME CR - `C_.S„r b A D `
LIC E R
LICENSE TYPE
BUS. LIC #
COMPANY NAME Q/r, ��O .1 Q �(��
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EMAIL ^ QAQQ�. LV�1OEVS•
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FAX
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STREET ADDRESS /1lL+ �/I16
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/(� - JLICENSE
CRY,S� ;T ZIP
P O _
ARCHITECT/ENGINEER NAME,,&
NUMBER
BUS. LIC #
COMPANY NAME ^ D y_ I 0 �'�S}
E-MAIL
FAX
ST T ADDRESS
CITY, STAT ZIP �//J;IL/
PIJONFL�/7 L
DESCRIPTION OF WORK ,A � ^ �,'w� _ \ Dr - C � � ��A �,p �+ •
EXISTING USE
PROPOSED USE
CONSTR.E
# STORIES
�
USE
TYPE
OCC.
SQ.FT.
VALUATION (5)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
�r
V T`C--
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 ❑);FS
BEING ADDED? O
SECOND STORY s
ADDITION,
011ZO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
ISTHEBLDGAN YES
.. CEIVEDB'Y ='"�
�'' � `'= F.
TOTAL VALUATION:
PLANNING ADPL # Gl'iJ0 PLANNING APPROVAL LETTER
/ _
EICHLER HOhM? /( NO
••
- MAO
Coo
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 construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent:—tet Date:
SUPPLEMENTAL INFORMATION REQUIRED
l'I a.CHECKTYPE
N
HOUTI(V(a SLIP
Q o� R=Tri-coUnTER
' AUILDINGP> &N rary Ew
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.
CI- EVRT�SS
❑ PLA NINC,PLAN R.E77£w
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
STANDARD '
L] . PUBLIC WORKS "
form if any Hazardous Materials are being used as part of this project.
LARGE
fd I>IItE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑- OH
ALA"J
❑
SANITARY-SEN'ERi71STRICT
submittal of Building Permit application.
❑,.ENVIRONA4ENTAI; HEALTH
B1dgApp_201 /.doe revised 06/21/11
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