10040054 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10200 MILLER AVE BLDG K CONTRACTOR:LEON CONSTRUCTION PERMIT NO: 10040054
OWNER'S NAME:
CUPERTINO,CA 95014 PHONE NO:(408)209-1272
❑ LICENSED CONTRACTOR'S DECLARATION r r BUILDING PERMIT INFO: BLDG ELECT PLUMB r
License Class Lic.#
MECH r RESIDENTIAL r COMMERCIAL r
Contractor Date
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SEISMIC UPGRADE,WINDOWS,GARAGE SHEAR
(commencing with Section 7000)of Division 3 of the Business&Professions WALLS;SEE
Code and that my license is in full force and effect. PERMIT#10040059 FOR FEES
1 hereby affirm under penalty of perjury one of the following two declarations:
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.
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 Sq.Ft Floor Area: Valuation:$200000
permit is issued.
APPLICANT CERTIFICATION APN Number:37503005.K Occupancy Type:
I certify that I have read this application and state that the above information is
correct.1 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 D YS FRO AST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. �^
Issued b Date:
Signature Date /O
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations:
have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(x)should I store or handle hazardous material.
Additionally,should 1 use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Heal(IL&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of Califomia. If,after making this certificate of exemption,1 �
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
certify that I have read this application and state that the above information is 1 hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-p 'nt urce regulations per the pertino Municipal Code,Section
9.18• DataI understand my plans shall be used as public records.
Signature ��� `b Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10200 MILLER AVE BLDG K CONTRACTOR:LEON CONSTRUCTION PERMIT NO: 10040054
0%VNER'S NAME:
CUPERTINO,CA 95014 PIIONE NO:(408)209-1272
❑ LICENSED CONTRACTOR'S DECLARATION r f r-
BUILDING BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class �`� Lic.9� 1� MECH r RESIDENTIAL r COMMERCIAL r
Contractor �' Date 1.�l
hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SEISMIC UPGRADE,WINDOWS,GARAGE SI-I1-AR
(commencing with Section 7000)of Division 3 of the Business&Professions WALLS;SEE
Code and that my license is in full force and effect. PERMIT#10040059 FOR FEES
11/4/201 I-REV#1-REVISE GLASS WINDOWS AT LIVING&DINING AREAS.
I hereby affirm under penalty of perjury one of the following two declarations: L'NLARGE GLASS PICTURE WINDOW,SLIDING GLASS DOOR TO BETE-MPI-RI-D-
I
ETEMPI RI-D-
1 have and will maintain a certificate of consent to self-insure for Worker's ISSUED 12/19/11
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
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
permit is issued. Sq.Ft Floor Area: Valuation:$200000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:37503005.K Occupancy-Type:
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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of die
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE Oil
with all non-p 'n urce regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Date Issued be. Dat —�Ips--S
❑ ONVNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is
1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS 7.O BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to scif-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Ilealth&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ileallb&
Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance wish the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I permit must __ a'��
forthwith comply with such provisions or this peit shall be deemed revoked. Owner or '
Dntc.
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCIIITECT'S DECLARATION
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT REVISION
BUILDING ADDRESS: 10200 MILLER AVE BLDG K CONTRACTOR:LEON CONSTRUC" f P
OWNER'S NAME:
CUPERTINO,CA 95014 PHONE NO:(408)209-1272
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class Lic.#
MECH RESIDENTIAL F- COMMERCIAL r
Contractor Date
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SEISMIC UPGRADE,WINDOWS,GARAGE SHEAR
(commencing with Section 7000)of Division 3 of the Business&Professions WALLS;SEE
Cade and that my license is in full force and effect. PERMIT#10040059 FOR FEES
1 hereby affirm under penalty 1/2412012-REV#2-REVISE MOMENT FRAME FOOTING AT FAMILY ROOM of perjury one of the following two declarations: LOCATION-REV#2 ISS'D 2/8/12
t 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.
I have and will maintain Worker's Compensation Insurance,tie provided for by
Section 3700 of the Labor Code,for the performance of die work for which this
Permit is issued.
Sq.Ft Floor Area: Valuation:$200000
APPLICANT CERTIFICATION
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 APN Number:37503005.K Occupancy Type:
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.
costs,and expenses which may accrue against said City in consequence of the PERMIT EXPIRES IF WORK IS NOT STARTED
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section WITHIN 180 DAYS OF PERMIT ISSUANCE OR
9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date
Issued bye--_---" Daft_ C7-
❑ OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons: RE-ROOFS:
I,as owner of the property,or my employees with wages as their sole compensation, All roofs shall be inspected prior to any roofing material being installed.If a roof is
will do the work,and the structure is not intended or offered for sale(Sec.7044, installed without first obtaining an inspection,I agree to remove all new materials for
Business&Professions Code) inspection.
L as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). Signature of Applicant. Date:
hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
performance of the wort:for which this perhit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
California Health
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Sections 25505,25533,and l
compliance with thee and( 1 will maintain
Cupertino Municipal Code,Chapter 9.12 and the Health&
permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I certify that in the performance of die work for which this permit is issued,I shall Additionally,should I use equipment or devices which emit hazardous air
not employ any person in any manner sow;to become subject to the Worker's contaminants as defined by the Bay Area Air Quality Management District 1 will
Compensation laws of California. If,after making this certificate of exemption,I maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
become subject to the Worker's Compensation provisions of the Labor Code,I must Health&Safety Code,Sections 25505,25533,and 25534.
forthwith comply with such provisions or this permit shall be deemed revoked. Own
Dater
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of work's
upon the above mentioned property for inspection purposes.(We)agree to save for which this permit is issued(Sec.3097,Civ C.)
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Name
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply Lender's Address
with all non-po' t source regu ati is per the Cupertino Municipal Code,Section
9.18. �^ ARCHITECT'S DECLARATION
Signature Date d I understand my plans shall be used as public records.
Licensed Professional
ML
CITY OF
CUPEI�TINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
/(0(01 <0 05LI
APN !0 5 0 0 05, �, 1 K Date:
l/ C� q%, 1
Building Address:` ,
10-2-0p AAL (, o rAve- C u e r -h h o crar
Mailing Address (if different from building address):
A,— � � -.( c,-- k_
Are Hazardous Materials being used as part of this project? Yes No
HOA:(Exterior work only) Yes Ej No ❑ If yes, provide letter from HOA
Owner's Name:
Vol'-) 9C-(4 USA
Phone #:
9IC- 2,44
Contractor: y
�- - vt C n S _f V1L,, Or
Phone: r 9 L� Z
Fax:
Contractor License #: $ (o e '}
Cupertino Business License #:
Contact:
�,rkt r. S o1i�
Phone: —Z oCf R �Z
4
F
Fax.
Residential Commercial
Job Description:
Building Permit Info:
Bld El Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
I -A, I-B ❑ II/III/V-A ❑ II/III B, IV -HT, V
Valuation- Square Footage:
2 V 0
-1 0 (5) 0
Project Size: tandard Large El Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at www.builditgreen.org
Revised 07/14/09
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building-5cuperbno.org
❑ NEW CONSTRUCTION I —I ADDITION
❑ ALTERATION / T1 [�N- REVISION / DEFERRED
ORIGINAL PERMIT # A'
PROTECT ADDRESS J i I APN
L
OWNERN P E- `
STREET ADDRESS
C
6-d
LD
CONTA NAME , �
PH !
E ul ry r
STREET ADDRESS��
vZoo
Ff —bII
❑ OWNER ❑ OWNER -BUILDER OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CO CTOR NAME
(G11�
LICF,IJ E /
(�P
BUS. LIC #
COw=P 47 / 1 S;1 S
Gib J'1/vG?1Ci%1/HuAX
E /C //J� r
Fes.-r....
STREET ADDRESS / / p Y
' O 1
CITY. se 'r- ` .
C-� q 5b /
� � —1
a
0 .� S rE R N ,q v � En:n w o J
« r 0
ARC1KrECT GiNEER N,
LICENSE NUMBER C l Lq-7
BUS. UC # -D
d j�'(`�a
COMPANY
E-MAIL %y1 l "�D rKLi
F
D 3 J
1 { LQ . �GL
J T
STREET A1DR /, `D n
CITY, STATE • O
PHONE -
_ (r l u
ev r� %
ly
DESCRIPTION OF WORK 4 o y- -' ` C. � 0��T � r zSTII A06- 7W At �- Q 4P
�TJ Cl
say.�l/,L+r{.}�(,U
EXISTING USE
PROPOSED USE CONSTR
TYPE
I STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (5)
EMSTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
'NETAREA
-
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA DETACH
ATTACH
#DWELLING UNITS:
ISASECONDUM1IT ❑YES
SECONDSTORY ❑YES
BEIIYG ADDED? [-]NO
ADDMON? []NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIVED BY:
VALUATION:
PLANNING APPL # []NO PLANNING APPROVAL LETTER
EICELER HOME? ❑ NO
/
rpprpperty
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the owner's behalf. I have read this
application and the information I have pro ' ed is correct I have the Description of Worst and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b ' constructio I autho representatives of Cupertino to enter the abo -id mt ed pyO� erty for inspection purposes.
` Z
% // 7-
Signature of ApplicantfAgent: Date:
SUPPLEMENTAL INFORMATION REQ
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER.THE-COUNTaR
IlvG PLAN 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.
❑ ExPRESS
❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
STANDARD
❑ PUBLIC wORxs
_
form if any Hazardous Materials are being used as part of this project.
El LARGE
❑ mz umT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL BEAI TH
Z2
::Of;,
BldgApp_2 011. doc revised 06121/11
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) T17-3333 - building(@cupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ,•REVISION / DEFERRED
ORIGINAL PERMIT # / OD W 6 .r1
PROTECT ADDRESS
L 0 J 10I7LPr ,,�VQ
APN #
OWNER NAME � � � �
PHONE�/' // ,
E-MAIL
STREET ADDRESS , -` -mac l ` _�
CITY, STAB ZIP
CONTACT NAMEI C->'z1z�Z
PHONE � y , L /6 ,T J l
t �y
E-MwII y �O e' C
L/FFAX
STREET ADDRE .. I'!, G ^
CITY, S j�\ ZIP / _
❑ OWNER ❑ OWNER -BUDDER WNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANr
coNTUcTOR NAME , L LICENSE NUMBER LICENSE TYPE
BUS. LIC #
COMPANY NAME �Q ! m / E-MAII-
FAX
STREET ADDRESS CITY, STATE, ZIP
PHONE
ARCHTTECT/ENGINEER NAMEV I / �L
LICENSE NUMBER /a
(
BUS. LIC #
COMPANY NAME w m^
,
E-MAIL
F101
STREET ADDRESS
CrrY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
�S t,(_/ r f' / i22
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
I
USE
TYPE
OTC.
SQFI-.
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 DECKRORCH AREA
GARAGE AREA DETACH
ATTACH
# DWELLING UNITS: IS A SECOND UNIT []YES
SECOND STORY ❑ YES
TBEINGADDED? []NO
ADDITION? []NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPL # ❑NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO`L7`)--
RECEIVED BY-
TOTAL VALUAITLIj`I:
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 1 g constructio I aut representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant(Agent.- Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
SL IP
_ New SFD or Multifamily dwellings: Apply for demolition permit for
❑ OVER-THE-CGUMMIX
�, GROUTING
tun D G PLAN REv>�w
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑❑ Exp
pI pNNIIVG PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
IIYs ANDARD
❑ PUBUCWORKS
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
❑ KA.IGR
❑ SANTrARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENvmoN351ErrrAl. HEAI.TEt
)r1'
BldgApp 2011.doc revised 06121111
CITY OF CUPERTINO
fal'. l it FEE ESTIMATOR - BUILDING DIVISIOAW
/oocd6o d'S
loo
�ooy�bsy
ADDRESS: miller/sorenson ave.
DATE: 01/24/2012ia
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION:
Iso
-PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi -Family Dwelling
USE:
Buildino is
3 Stories ® Yes ® No
PENTAMATION iGENRES
PERMIT TYPE:
WORK
revise moment frame footing at mily room location.
SCOPE
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the Drelininarv, information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution II-053 E . 7/11111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. ® OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
G
Work Without Permit? Yes (E) No
$0.00
Advanced Planning Tee:
$0.00
Select a Non -Residential
Building or Structure
Strong Motion Fee:
$0.00
F 1-1 #
$783.00
Revision
IREVSFDWL SFDWL
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$783.00
TOTAL FEE:
$783.00
Revised: 1 /19/2012