13050195 CONSTRUCTION PERMIT APPLICATION
�a w-' COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 19
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10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 �`
408)777-3228•FAX(408)777-3333-building(ftupertino.org � �
NEW CONSTRUCTION . ❑ ADDITION ❑ALTERATION/TI ❑ REVISION/DEFE
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RED ORIGINAL PERMIT#
PRO 7E D SS APN#
O R EMAIL
S E"Z"AD RESS , STATE,ZIP FAX "
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CONTACT NAME PHONE EMAIL
STREET ADDRESS.' CITY,STATE,ZIP FAX
13OSS'm ❑ OWNER-BUILDER ❑OWNER AGENT 11 CONTRACTOR ❑CONTRACTORAGENS ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER 1:1 TENANT
CO CTOR NAME LI S E LICEN TYPE BUS.LIC#
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COMP NAME ✓ �� FAX p
S REST ADD S CITY TATE,ZIPL fj PHONE
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ARC ETGFNEE NAME LICENSE NUMBER BUS.LIC#
Q ANY NAMEEMAIL P J�� FAX,.
STREET ADDRE§ CITY,STATE,ZIP Cd
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EXTSTiNG IJSB ADM 20-7 &AM41 hip,
PROPOSED USE CONSTR.TYPE #STORIES USE TYPE QCC. 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: FIDETACH
❑ATTACH .
#DWELLINGUATTS:' ISASECariDUNIT [AYES SECOND STORY [DYES
BEING ADDED? ONO ADDITION? ❑NO
PRE-APPLICAT€ON OYES IF YES,PROVIDE COPY OF. IS THE BLDG AN ❑YES ? GENE I# *� ,Oil Wim , "TOTA�I TION:
PLANNING APPL#, ONO PLANNING APPROVAL LETTER EICHLERHOME? LINO �, - ^" WWI f`lJJ (y
By my signature below,I certify to each of the following. I am the property owner or authorized ageht 1W 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 Iocal
ordinances and state laws rel ati to ild''g ns au r represen 'ves of Cupertino to enter the abov idenntttifie/property for inspection purposes.
Signature o£Applicant/Agant: Date 4 LJ d
SU'PPFE7ALDTFORMATION REQUIRED W .>$Ax caI•,rz __. . „ . ..
New SFD or Multifamily dwell s: Apply for demolition permit for �
_ y g pp Y F Qv {pp Coup BtaTL.' a L ��.
3 �
existing buildings):,Demolition permit is required prior to issuance of building 100g- �
permit for new building. ' r I
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure s DARDS` IBI? Q �
farm if any Hazardous Materials are being used as part of this project. � a �; fl t
_Copy of Planning Approval Letter or Meeting with Planning prior too ATr
submittal of Building Permit application. H x�
BldgApp_20II.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
W! ADDRESS: 4 INFINITE LOOP DATE: 05128/2013 REVIEWED BY: MENDEZ
PN: BP#: *VALUATION: $70,000
PERMI7[ TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: p PERMIT TYPE:
WORK APPLE- 1ST FLOOR& GARAGE-ADD TEMPORARY POT WASHERS DEMO WALL CONVERT E
SCOPE JANITOR CLOSET TO (N) MAT WASH ROOM
7777777
9,<:h, Plan("heck Iplrrrrrl. F'lcrt C'hc.c°, Ellec;.Pl an<..,hecl
ls,><;lt. f'e ttaie Fee: I'hvnh.Permit Fee: fuer Permit Fec::
0Ix er,ialrech.In,Vr. 0 Other I'I""nh lrasts. OtherElec' In P.
,k h.his'p. t�',tz; Plumb Insp,Fee: Elec.Inca Fee:
L2--d
NOTE. This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta . These ees are based on the prelimin information available and are onLy an estimate. Contact the Deptor addn 11 in o.
FEE ITEMS(Fee Resolution 11-053 Eff. 71112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes No $0.00 2 hours Plan Check,Hourly
Suppl. PC Fee: (F) Reg. Cl OT 0.0 1 hrs $0.00 $266.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes No $0.00
Suppl. Insp.Fee: Reg. 0 OT {1.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
("Onsmuc tion Tax:
dininistrative fi'eet
Work Without Permit? 0 Yes (j) No $0,00
Advanced Planning Fee: $0.00 4 hours Inspections
7-I'(Wel Documentationcce,r: $532.00 1STINSP Inspection,Hourly 0
Strong Motion Fee: IBSEISMICR $7.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $3.00
SBI'pLs $10.00 $798.00 $808.00 777'77
Revised: 04/29/2013
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR SUBCONTRACTOR LIST
JOB ADDRESS: I- hVFrr--1 17e PERMIT# / i 0-50/
OWNER'S NAME: lqrn'e- PHONE# ,tQ6— l -Q --a,2 0/9
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: &17 CITY/ZIPCODE: M1z-PyjA-,1Q
*Our municipal code requires all businesses working in the city to have a City of Cupertino busineis license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) 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:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
D-&
Owner Contractor Signature ate