TR-2018-43 Application.pdf�t2-2011 -43
Revised 1j/2017
TREE REMOVAL PERMIT APPLICATION FORM
Communih,/ Development Department
10300 Torre Avenue (408) 777-3308 / Fax (408) 777-3333
C O P E RTI N
O
Cupertino, CA 95014 planning@cupertino.org
http://www.cupertino.org/ planning
Property Owner Phone (w) Phone (h)
XGREF Results Way LLC & BVK Perimeter Square Retail LLC 415-262-2011
Street Address Fax Cell
1101 California Street, Suite 2600
City, State, Zip Code E -Mail
San Francisco, CA 94111 andrew-rbrown@dws.com
Project Contact Person Phone (w) Phone (h)
X Sam Oakley 925-518-2028
Street Address Fax Cell
2337 American Avenue
City, State, Zip Code E -Mail
Hayward, Califomia 94545 soakley@arborwell.com
Project Address APN (s)
5 Results Way
Application Requirements:
Justification Statement: Explanation of why the tree(s)
should be removed and, if needed, ISA certified
St_c (diameter at
4.5 feet front
rade)
Species
Arborist report. Tree A
Q Site Plan: show the location of existing/ replacement
30"
Monterey Pine (dead)
I Monterey Pine dead
tree(s), buildings, and improvements. 'free B
oX Replacement Plan: Site plan showing a location for the
replacement tree, approved by an ISA certified arborist Tree C
12"
24"
Monterey Pine dead
when needed. Tree D
Fees and Deposits
frees
Attach sheet for additional
0 t certify that the foregoing statements are trite and correct to file best of my knowledge. f understand that a
Initials misrepresentation of any sttbntttfed data nray invalidate an approval by the City Council of this application. t understand
that lite application nray be uuthdrawn if t, or my authorized representative, is not present at required s_lreduled
nteeting(s), unless a rtirrtten request for postponement has been presented to lire applicable revnuo body
1 declare tinder penalty of pcgtiry that l mn fire owner of said property or have Pe-rivr of Attorney (attach copy) frorn said
Initials property owner and that h consent to lite above-described application and l attthorive City staff and consultants to visit file
site in order to take photographs; slides andjor videotape that rnm./ be shown at city meetings.
t� For R1, R2, RHS, A, and Al Zones, I understand that the replacement tree(s) will be considered protected and
Initials will require a tree removal permit if I choose to reprove them in the future. I will demonstrate compliance ioith
the approved replacement tree(s) lnj providing photographs to lite Planning Department and will tuailrtaill
replacement tree(s) to ensure survival.
X �5a4lu� O 9/26/2018
Applic 's Signature Print Applicant Name Date
X r tcw ,20 /v ,5 tB
Property Owner's Signature Print Property Owner's Name Date
Staff use only: (Do not write below this line.
Application accepted on to/ F I i f ❑ Specimen Tree (between 12" and 24" DBFI) d Development Tree
BY t SG SES ElSpecimen Tree (greater than 24" DBH) ❑ Part of a Tree Management Plan
❑ Privacy Protection Tree ❑ Heritage Tree
Revised 1j/2017