BLD-2021-2022 - AMMRAltform_2015.doc revised 07/01/15
REQUEST FOR MODIFICATION OF CODE (CBC 104.10, CFC 104.8)
REQUEST FOR ALTERNATE MATERIAL, DESIGN OR METHOD OF CONSTRUCTION (CBC 104.11, CFC 104.9)
REQUEST FOR HARDSHIP EXEMPTION OR EQUIVALENT FACILITATION (HEALTH AND SAFETY CODE 19957)
To apply for this request, complete sections 1, 2, & 3 (ink or type)
SITE
ADDRESS
APN DATE
Owner ............................................................................................................................
Address .........................................................................................................................
PC #: ...................................
Permit #: ...............................
PLN #: ..................................
Dept./Div. ..............................
Job Status: ...........................
Type: ....................................
Stories: .................................
Occupancy: ...........................
Floor Area:.............................
Occ. Load: ............................
Use of Bldg: ...........................
1 Email…................................................ .......... Phone……………….........................
Applicant ................................................................. Title ...............................................
Address ..........................................................................................................................
Email..................................................................... Phone ..............................................
2 REQUEST: For code modifications, please state the applicable code requirement and the extent of relief desired. For alternate requests, state the type of system
proposed and design methods. Submit plans if necessary to illustrate request. Additional sheets or data may be attached.
3 JUSTIFICATION/FINDINGS OF EQUIVALENCY: For code modifications, applicant shall demonstrate that
special, individual reasons exist that make compliance with the strict letter of the ordinance impractical and that
equivalency is provided. For alternate requests, applicant shall demonstrate suitability, strength, effectiveness, fire
resistance, durability, safety and sanitation that is equivalent to the code for a similar use.
Code Section(s):
Attach additional sheets if necessary.
Petitioner's
Signature: ................................................. Position: ................................. Date: .....................
Reviewed
By: ................................................... Date: ..........................
The Request is: GRANTED DENIED Dept. Comments:
CONDITIONS OF APPROVAL:
No. of Items: .............................
Fee Due: $ ................................
Date Paid: ................................
Receipt No.: ..............................
Processed by: ............................
Building Official: ................................................................................ Print: .................................................................................. Date: ..................................
Fire Marshal: ..................................................................................... Print: ................................................................................. Date: ..................................
DEPARTMENT ACTION: After determination, copies to: 1) applicant, 2) permit file
ALTERNATE MATERIALS AND METHODS / MODIFICATION FORM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building@cupertino.org
LEGEND
EXISTING 2ND FLOOR
EXISTING 1ST FLOOR
PROPOSED SITE PLAN
SCALE: 3/32" = 1'-0"N
EXISTING &
PROPOSED
SITE PLAN
Pr
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j
e
c
t
:
A1.1
Engineer:
CC
W
E
N
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I
N
E
E
R
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1
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EMPIRE AVE.
(E) 2-STORY RESIDENCE
1ST FLR: 1,939 SF
2ND FLR: 1,263 SF
TOTAL: 3,202 SF
(E) GARAGE
426 SF
(E) FRONT PORCH
149 SF
(N) CONC. TO ADU ENTRY
NEW ADU
85.00' P.L.
95
.
0
0
'
P
.
L
.
95
.
0
0
'
P
.
L
.
85.00' P.L.
(E) COVERED PATIO
345 SF
5'-0"10'-0"
20
'
-
0
"
20
'
-
0
"
FRONT SETBACK LINE
REAR SETBACK LINE
SI
D
E
S
E
T
B
A
C
K
L
I
N
E
SI
D
E
S
E
T
B
A
C
K
L
I
N
E
(E) POWER POLE
(E) SIDE WALK
25
'
-
0
"
(E) CONC.
DRIVEWAY
(E) LAWN
(E) PAVER
(E) ADJECENT
1-STORY
RESIDENCE
(E) ADJECENT
2-STORY
RESIDENCE
(E) 2ND FLR
BALCONY
197 SF
(E) SHED
90 SF
TO BE REMOVED
EMPIRE AVE.
(E) 2-STORY RESIDENCE
1ST FLR: 1,939 SF
2ND FLR: 1,263 SF
TOTAL: 3,202 SF
(E) GARAGE
426 SF
(E) FRONT PORCH
149 SF
85.00' P.L.
95
.
0
0
'
P
.
L
.
95
.
0
0
'
P
.
L
.
85.00' P.L.
(E) COVERED PATIO
155 SF
5'-0"10'-0"
20
'
-
0
"
20
'
-
0
"
FRONT SETBACK LINE
REAR SETBACK LINE
(E) POWER POLE
(E) SIDE WALK
25
'
-
0
"
(E) CONC.
DRIVEWAY
(E) LAWN
(E) PAVER
(E) ADJECENT
1-STORY
RESIDENCE
(E) ADJECENT
2-STORY
RESIDENCE
(E) 2ND FLR
BALCONY
197 SF
(N) 1-STORY ADU
701 SF
5'
-
0
"
(E) WOODEN GATE
(E) GAS METER
(E) ELEC MAIN
PANEL 200 AMPS
SI
D
E
S
E
T
B
A
C
K
L
I
N
E
SI
D
E
S
E
T
B
A
C
K
L
I
N
E
(E) WOODEN GATE
(E) GAS METER
(E) ELEC MAIN
PANEL 200 AMPS
(E) CURB CUT
NE
W
A
T
T
A
C
H
E
D
A
D
U
10
1
8
1
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P
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A
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E
N
U
E
,
CU
P
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,
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9
5
0
1
4
EXISTING SITE PLAN
SCALE: 3/32" = 1'-0"
(E
)
P
A
V
E
R
(E
)
P
A
V
E
R
(E) PAVER (E) PAVER
(E) PLANTER (E) PLANTER
(E
)
P
A
V
E
R
(E
)
P
A
V
E
R
(N) TANKLESS WATER
HEATER FOR ADU, PROVIDE
A DEDICATED 1 1
4" PIPE
FROM GAS METER
(N) HEAT PUMP FOR ADU
N
(E) AC (E) AC
(N) 1H FIRE PROTECTED
EAVE ABOVE, SEE DETAIL
ON SHEET A5.1
(N) 1H FIRE PROTECTED
EAVE ABOVE, SEE DETAIL
ON SHEET A5.1