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13050094
4 CONSTRUCTION PERMIT APPLICATION J - COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE.AVENUE•CUPERTINO,CA 950143255 (4Q8).777-3228•FAX(408)777-3333•buildingOcuoertino.org Ct1P tttw,0 NEW CONSTRUCTION . LJADDMON - ❑ALTERATION!TI ❑ REVISION/DEFERRED ORIGINAL PER,(MIT# ' PR07ECT ADDRESS p G g. f APN# t OWNERNAMEt EMAIL STREET ADDRESS mow* C..o/?a CITY, STATE,ZIP py Ls,-X4L� cdlTAcr NAME � Re C( STREET ADDRESS '" f L' CITX,STATE,ZIPJ $�19 t.r4 pd C R�✓�f' FA--7-S-7- ?16,7 CGV ❑OWNER .0 OWNER-BUILDER ❑ OWNER AGENT} CONTRACTOR ❑CONTRACITOOR'AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER y ° LICENSE TYPE A BUS,LICA# COMPANY NAME /� �1� 4 S' J I t' 7 , FAX dA STREET ADDRESS CITY.STATE,ZIP ) 4,n B° f PHONE,?'Oe ARCHITECTIENGINEER NAME //� LICENSE NUMBER Cif /4sV BUS.LIC# ! Gt COMPANY NAME E-MAIL FAX STREET ADDRESS. CITY,STATE,ZIP PHONE DESCRIPTION OF WORK f EXISTIIGUSB PROPOSED USE CONSTR TYPE #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 #DWELLINGUNITS:, ISASECONDUNIT ®Y£S SECOND STORY []YES BEING ADDED? [l NO ADDITION? nNO .PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF. IS THE BLDC:AN ❑YE t ,CEI f.: TOTAL VALUATION: PLANNING APDL#, ®'NO PLANNING APPROVAL LETTER ETCHLER HOME? ®NO ;. By my signature below,I certify to each f the fo thorize representatives of Cupertino to enter the above-`denti d property for inspection purposes. Signature of ApplieanilAgem: Date: SUPPLEMENT TION RE UIRED New SFD orMuitifamilY dwellings: Apply for demolition permit for � „ x rs�co � �� existing building(s):.Demolition permit is required prior to issuance of building , i permit for new building. U� Commercial Bldgs: Provide a completed Hazardous Materials Disclosure fa_rm if any Hazardous Materials are being used as part of this project. _Copy of Planning Approval Letter or Meeting with Planning prior to � vti4 " s s � submittal of Building Permit application. BldgApp_201 Ldoe revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 21928 OAKDELL PL DATE: 05113/2013 REVIEWED BY: MELISSA APN: E32618 048 BP#: VALUATION: $18PERMIT TYPE: uilding Permit PLAN CHECK.TYPE: Alteration 1 Repair PRIMARY SFD or Duplex PENTAMATION 1R3SFDREM USE: PERMIT TYPE: WORK REMODEL E MASTER BATH NO STRUCTURAL CHANGES SCOPE L9c<c:lr, ?":.'rCheckt'r�ph, �`h Check f l c.1 1 a (,h(,,c k ,W ch. Permil Fee: t rUM&,tee e mit Fe""": �"kc Perfnit Fee: other,Wec=h.In'?, +tI: r AiribIrs"), Olh..rElec.ins . Al ^h. Inv)._Fee: Plumb, Ftnp� Fere: Ekec.InSP, Fe"': NOTE.This estimate does not include fees due to other Departments(L a Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). These ees are based on the prelimina, in ormation available and are onjE an estimate. Contact the De t or addn'l in o. FEE ITEMS Fee Resolution 11-053 E , 7111123 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 72 s.£ Remodel.,Bath(<=300 sf) Suppl.PC Fee: • Reg. 0 OT (},0 I hrs $0.00 $600.00 IREMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp:Feer Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (.,onso-action 1 a .° Admi ds•trative.Fee: 0 Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Tr�mwl Do ��mentulion Fess: Building or Structure Strong Motion Fee: IBSEISMICR $1.80 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 6VOTOTALS., $2.801 $600.00 602.80 Revised: 04/29/2, L Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone:408-777-3228 C U P E RT I N C3 Fax:408-777-3333 CONTRACTOR 1 SUBCONTRACTOR LIST 30B ADDRESS: l ` PERMIT# c9 OWNER'S NAME: 0 aPHONE# -10` - GENERAL CONTRACTOR: ® W720Z BUSINESS LICENSE# ADDRESS: &(Ov 1 CITY/ZIPCODE: . *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: ti/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE# Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/GlazingP Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile wner/Contractor Signature Date . - 11 -,.-,-- ,,��, g I m X 1 "I ,� glul I r FE I AR-It "I ",, �� k � I- - I , W4 ,� 11 _rW 1, 11 I , - , ,,, - -"",j , - , 11�, C t, I �o, ,,,, . . WE; Low I 1-1 11 ,� I . 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