B-2016-1165 PERMIT APPLICATIONCUPERTINO
❑ I'mW CDNSTRUC
CONSTRUCTION PERMIT APPLICATION
COMMUNI T Y DEVELOD10EN T DEPARTMENT BUILDING DIVISION
10300TORRE AVENUE • CUPERTIKID, CA 95014-3255
(40ff8) 777-322B • FfiX (408) 777-3333 • buildino(Dcuperino.oro
lON LJADDITION ❑ALTEit-kTjo- /TI ❑ R wsiON/Dint.R_--.D my -,NA PEtiter'
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VALUATION IS)
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ARAF100a
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RElfOD7..:REA I R_',. OD=L AR&.
?OACd /.R?.1 DECK AREA
TOTAL DECK,: DACi A:�/. GARA AREA:
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§D1'FEU.INCIP.TS:
ISASECONDVNT ❑Yas
SECONDsTORY QYS
BEING ADDED? nvo
I ADDITION' r-INO
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?Pc -A —CATION tJY?S - YS, 7%Ovm- COPY Or I ISTIREaLDGA-V 02S I- V� TOTIVA T:ION
?IhN!v'OtO aaPLe i']NO PLAY' *NGA?RDVALL-„_. EICY.LERSONIEt ENO D O
By my sin=_mre below, I ce-iy to each of the fello.:daE: I an the prope ty orner or authorized agent to act on the property owner's behalf. I have read this
app!im-don and the information I have provided is carat I have read the Description of Work and verify it is accurate. I aeree to.cc nply wi,h alI applicable local
ordi,nmms and state laws relEgrg to budding construction. I avho; i> epresen_ ves of CuDcrinD to enter the €bove-identified propel for insrxtion purposes.
Si�:etere of knplicand.AEea:: Dare:
SUPPLEl,r NTAL UK ORMATION I2EQU! rD
New SFD or dwellia : Apply for e, olifion per
existing buildine(s). Demolition perits required Drier to isSuar cc of buid+gig
pef-it for new buildi,
_ Co mercial Bldes: Provide a coamleted Hazesdous Materials Disclos-,re
Yom if a y H=dous Meterials e e being used as Daft of this project.
Copy ofPI=i...g Approval Letier or ?s5eetin Math Planning prior to .
54b� i$al of Building Pe Lf application.
Bldof_AD_ 011.doc revised 0612?111
�����,�,��, CITY OF CUPERTINO
11� wal FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10399 Rivercrest Ct
DATE: 01/12/2016
REVIEWED BY: Sean
APN:
BP#:
'VALUATION:
$1,200
"PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration I Repair
PRIMARY
USE: SFD Or Duplex
PENTAMATION
PERMITTYPE: 1GENRE
WORK
Remove existinq two sided fireplace and infill openings.
SCOPE
t, cia. P:.. r: n;: h.,:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
1)htrirt. ntr-L These tees are based on the nre/inrinary information available and are anly an estimate. Contact the Dent for addn'l into.
FEE ITEMS (Fee Resolution l I-053 Gf[ is b73)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly
Only? 0 Yes 0 No
$0.00
F-71 hours Plan Check, Hourly
$143.00 ISTPLNCK
Suppl. PC Fee: e) Reg. Q OT 0.0
1 Ins
$0.00
-PME Plan -Cheek:
$0.0
Permit Fee: Hourly Only? C) Yes Q No
$0.00
Suppl. Insp. Fee:Q Reg.
Q OT 0.0
1 firs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C onstrifelion JCL _
A&&ninistratiee Fee:
0
G)
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
2 hours Inspections
$286.00 /ST/NSP Inspection, Hourly
Trave! Documentation Fens_
Strong Motion Fee:
I BSEISMICR
$0.50
Select an Administrative
Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
1 $1.50
$42-9.0-01
TOTAL FEE:
6 $430.50
Revised: 01/01/2016