11120110CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 7T7-3228 - FAX (408) 777-3333 • building cDcupertino.org
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❑ NEW CONSTRUCT -ION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PR07ECT ADDRESS Z O F Q g O Drl Y CL( Ph o
APN #
o` NA'��tIJU I L l� • S HRIVA-srAvA
PH X 50 - 39/-8 � s
E-MAIL _s�1fii@ al,00 C4ti
STREET ADDRESS
'2_000 3ARC"a K/ur
CrNSTA ZIP
11W(5 LA 710 f
FAX
CONTACT NAME V r sVJ PAL ^
11 7 H
PEG 1400-3B6- 0 / 6
7
E-MAIL % AQO
STREET ADDRESS
CITY, STATE, ZIP F
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX .
STREET ADDRESS
CrrY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIPa�
PHONE
) J �
DES RIP17ONQW RC �'I Ma0,ye,_
�
rG�i�
Re�_'Yenl rOorA G
Kt: iwx: L- 2- FUR KIA GE -
EXISTING USE
PROPOSED USE CONSTRTYPE
# STORIES
v— IT
1
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTHA2 g2
Ate' FLOOR NEW �
DEMO 566
AREA • S
S "
_�'�
/Z sr a va
BATHROOM
REMODELAREA
KITCHEN
REMODEL AREA 2610
OTHER
REMODEL AREA /Y `
/U
PORCH AREA
DECK AREA
TOTAL DECKRORCH AREA
GARAGE AREA DETACH
I
[]ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑YES
Z
BEING ADDED? XWO
ADDITION? 1CYNO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OFT'
IS THE BLDG AN [I _YES
IES BY:
TOTAL VALUATION:
PLANNING APPL # O PLANNING APPROVAL LETTER
EICHLER HOME? 1I 4�I*O
IZ ,.S7vV-0
By my signature below, I certify to each of the following I am the property owner or authorized agent to act on the prr9perty owners behalf. I have read this
application and the information I have provided is correcL 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 buildi . I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent- Date: 2
SUPP rNFORMA N REQUIRED
PLAN CHECK TYPE
RouriNG SLIP
ovEx-TH><cooNTiR
u>z DnvG PLATT REVIEW
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.
❑_
M 9 0ZKING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
�EXPRESS
9 -STANDARD
'PUBLICwORISS
form if any Hazardous Materials are being used as part of this project
❑ LARGE
Z;-TTn DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑
U-fA TTARY SEWER
submittal of Building Permit application.
MAJOR
DISTRICT
❑ m rvmo ENTAL HEALTH
BldgApp_201 1. doc revised 06/21/11
S 9'SF
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: p p
�r .�10 PERMIT #
OWNER'S NAME: S1� t �I�S'�'q
PHONE #
GENERAL CONTRACTOR: 0,
BUSINESS LICENSE # 9 Z
ADDRESS: ".yvk
Vj 0(43 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 INSPECTION(S) WILL BE . SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND AL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
XI am not using any subcontractors:
Si n ture Date
Please check applicable subcontractors and complete the following information:
j/
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
Owner / Contractor Signature Date