13050078 CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION r
10300 TORRE.AVENUE-CUPERTINO,CA 95014-3255
(408).777-3228•FAX(408)777-3333•buildin Pcupggino.orq
co
NEW CONSTRUCTIONLJ ADDITION ALTERATION/TI ® REVISION t DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS ✓ r 8 .. AFN# 69
— 0l( Z, r 1
OWNER NAME OPI�� EMAIL
STREET'AD RF p s CI CY,STATE,ZIP FAX
CONTACT INAME P PHONE EMAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER. ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AMU ❑ ARCHITECT ,❑���E���NGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME ° LICENSE NUMBBR q BUS.LIC#
COMPANY NAME j EMAIL'` e FAX ry '11,
STREET ADDRESS (� CITY,STAT ZIP W N .y
t�« 1111 d G
ARCHITECTIENGINEER NAME a LICENSE NUMBERCdn "a BUS.LIC#
COMPANYNAME E—MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE ; 4
DESCRIPTION OF WORK
a.
EXISTING USE PROPOSED USE CONSTR TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION($}.
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA Cj
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
.PORCH AREA ' ..DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH
®ATTACH
#DWELLINGUNrrS:-' ISA'SECONAUNTT ❑YES SECOND STORY DYES
BEING ADDED? ®NO ADAPTION? ®NO
.PRE-AFPLiCATIOx OYES IF YES,PROVIDE COPY OF. IS THE BLDG AN ❑XES .. I ^`} ''�` „' Ig-'," TOTAL VALUATION:
❑NO PLANNING APPROVAL LETTER EICHLERHOME? ®
PLANNINGAPPL#, N x
"s00v.�'"tIc4"
By my signature below,I certify to eacgv
ll wi : 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 ps o ect. have read the Description of Work and verify it is accurate. I agree to comply with all applicable Iocal
Ord and state laws relating to buo authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
.SUPPLEMENTAL RMATION REQUIRED
New SFD ox-Multifamily dw lings: Apply for demolition permit for flys Inc BUTLDaIvc
existing buildirig(s)...Demolitian ermit is required prior to issuance of buildings
permit for new building. ;
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosuresr
farm if any Hazardous Materials are being used as part of this project.
ffim
_Copy of Planning Approval Letter or,Meeting with Planning prior to
submittal of Building Permit application.
� �
BZdgApp_201 Ldoc revised 06/21/I1
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20450 STEVENS CREEK#150 DATE: 05109/2013 REVIEWED BY: MELISSA
APN: 369 01 027.150 BP#: VALUATION: $279,630 -
PERMIT TYPE: Building Permit QLA�NCHECKTYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 16 TI
USE: g PERMIT TYPE: A
WORK T. I. TO CREATE N OFFICE SPACES INCLUDING N L!GHTlNG FIXTURES AND OUTLET
SCOPE RECEPTACLES. REMODEL(E} BREAKROOM WITH M.E.P.-S
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
B(Tenant Improvements) I-A,1-B 6,450 $3,504.75 IBTIPLNCK $7,336.50 1BTIINSP
TOTALS: 6,450 $3,504.75 $7,336.50
�Mcnu,t) RLY . YVs, Xv' TIL M01110VRILY �� � ��5I1�►' :1t'es I Nom'
9tzr:h. Plan Checkl'lr tarp,/'lcrrr C;:"hc>rT Elec;,./'lata Cheelr
tk>ch./errant Fee 1111=M&Permit F�e: Elec.leer^unit Tee:
Other A,k,a ls.Insp, Li I Other T'I imb Ins, Other Elec.:nsla.
EIF
2-2=
Alfech.fn,pp, Fee: Plumb. hi slt, 1"Pe I tec Inst Fee_
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,ete . These ees are based on the relimina in ormation available and are onl an estimate Contact the De t ar addn'l in o.
FEE ITEMSEee Resolution 11-053 Eff 711112} FEE QTY/FEE MISC ITEMS
Plan Check Fee: $3,504.75 Select a Misc Bldg/Structure
Suppl.PC Fee: 0 Reg. 0 OT 0.0 hrs $0,00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $7,336.50
Suppl.Insp.Feer Reg. 0 OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? 0 Yes No $0.00
Advanced Planning Fee: $0,00 Select a Nan-Residential
Building or Structure O
Strong Motion.Fee: IBSEISMICO $58.72 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1200
uffouLs" ri0,91'1.97 $0.00 $10,911.97
Revised: 04/29/2013
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
LM Telephone: 408-777-3228
CUPERTINO Fax: 408-777-33°33
CONTRACTOR 1 SUBCONTRACTOR LIST
JOB ADDRESS: t5(9 PERMIT# 19 0-50'5
OWNER'S NAME: CYA ,&,o CA-( PHONE#
GENERAL CONTRACTOR: VV ICIM; BUSINESS LICENSE#
, ADDRESS: I,� A� 5�/Cai CITY/ZIPCODE: SAViN <ZLA.-A I C-, CtzSQ
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
-Z,
/Owner/Contractor Signature Date