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15060113 ApplicationCONSTRUCTION PERMIT APPLICATION J5C(�' COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228• FAX (408) 777-3333 • buildinga-cuoertino.org KNEW CONSTRUCTION ❑ ADDITION I I ALTERATTnW/Ti F� R7VTCT0V/r11=FFRRFTI nut(-.n.TeT '=T?VrrrL PROJECT ADDRESS i © I APN OWNERNAMEr, S PHONET r E-MAIL Y , l._ F 4 '� - L �-- L- `-t 64j • 2 3 Lf W?,�v �c r��� z,c�,. �i ►�, STREET ADDRESS, �O" `1' S-� S' T • CITYSTATEZIP , SOI 4 FAX FA CONTACT NAME,—�� l��� PHONE C.�, l� E-MAIL 1brOWN tD9COC477•�'L STREET ADDRESS CITY, STATE, ZIPCU e_#q,� FAX ❑ OWNER ❑ OWNER -BUILDER 01ANERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS L 1 / .r s / 7^ - CITY, STA P PHONE C T J ARCHTTECT/ENGDgEER NAME ID ),LICENSE NaiNSER BUS. LIC # COMPANY NAI.M SA'4'\45-- E-MAIL FAX STREET ADDRESS 1'1—"1� IST- CITY, STlIr�3'.1ZJiP.,� � PHOT I Q' • `I S�- Z QC DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE 4 STORIES 1 USE TYPE OCC. SQ.FT. VALUATION (S) EXZSTG AREA NEW FLOOR, AREA DEMO AREA TOTAL NET AREA BATHROOM. KITCHEN. OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK./PORCH AREA GARAGE AREA: DETACH ❑ ATTACH R DVIELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑ NO ADDITION? [:]NO PRE -APPLICATION ❑ ITS IF YES, PROVIDE COPY OF PLA.NNTING APPL ,' ❑ NO PLANNING APPROVAL LETTER I IS THE BLDG AN ❑YES EICHLER HORSE? ❑ NO I D: _ + ii:: 13. " ` ' TOTAL VALUATION: t o0 ` By my signature below, I certify to eac f t fbllovring I am the propertauthorize went to act on the property owner's behalf. I have read this application and the information I have rovid i corre I have read the Description of Work andverify it is accurate I agree to comply with all applicable local ordinances and state laws relating to b Ildin c n. I authorize re resentatives of Cupertino to enter the above dents d pro rty for inspection purposes. Signature of Applicant/Agent: Date: 15 SUPPLEMENTAL INTFORMATION REQUIRED -�-ss� New SFD or Multifamily d«vellings: Apply for demolition permit for existing building(s). Demolition is required to issuance building ���tVJ 04 RTH1rCO� CThTER r� �-SUIL`DING P1 A�REYIEii �� �4 permit prior of permit for new building. r� "fl�xrF,Ess �� k r GPI N � V,IEI, ,, x �'PM- _ Commercial Sldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.��gT4` a siA ARDr�,PUsr�w-. �2I Effi _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit �1�3A70Ra SYSERR�ITRI�o-. application. Bldg4pp_2011.doc revised 06/21/11