23400 - V 18,19,20BldgApp_2017.doc revised 01/01/21
APN #
OWNER NAME PHONE E-MAIL
STREET ADDRESS CITY, STATE, ZIP
CONTACT NAME
CITY, STATE, ZIP
OWNER
OWNER-BUILDER
OWNER AGENT CONTRACTOR AGENT ENGINEER DEVELOPER TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE COMPANY NAME
E-MAIL
STREET ADDRESS CITY, STATE, ZIP PHONE
STORIES #USE TYPE OCC SQ.FT. VALUATION ($) NEW FLOOR SF DEMO SF TOTAL NET SF
REMODEL KITCHEN
SF
REMODEL OTHR
PORCH SF DECK SF
ATTACHEDDWELLING
UNITS #
YES EICHLER NO
RECEIVED BY:
TOTAL VALUATION:
By my signature below I certify to each of the following: I 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 provided is correct. I have read the Description of Work and verify it is accurate. I agree
to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified property for inspection purposes. I acknowledge and authorize all information contained on this application form
to be made available for public record.
Signature of Applicant/Agent: _____________________________________________________ Date:_______________________
SUPPLEMENTAL INFORMATION REQUIRED
*New SFD/Second Dwelling Units/Multifamily Dwellings: A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • permitcenter@cupertino.org
B
EXISTING ROOF TYPE: BUILT-UP ROOF ASPHALT SHINGLES WOOD SHAKES WOOD SHINGLES OTHER (SPECIFY) ___________________
NO
YES
REMOVE /REPLACE IF NO
# OF LAYERS________
PLYWOOD ½” PLYWOOD TYPE:
THICKNESS CDX OTHER____________
PITCH: _____ :12 ROOF CLASSA
RE-ROOF
WOOD SHINGLES OTHER _____________
*HOA-Provide a letter of approval from the Home Owner's Association
SF __________ #of SQUARES ___________
NEW CONSTRUCTION ADDITION
EXISING
FIRE SPRINKLERS
YES
NO
SINGLE-FAMILY/DUPLEX MULTI-FAMILY INDUSTRIAL COMMERCIAL
SECOND STORY ADDITION
VINYL-LINEDFIBERGLASS GUNITE PREFABRICATED
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval
POOL - SF _______ SPA - SF _______
ALTERATION T.I.MEP
DESCRIPTON
DETACHED
YES
NO
SF
SECOND DWELLING
UNIT ADDITON:YES
NO
DETACHED
POOLS
TILE
OTHER__________
OSB
OTHER
STREET ADDRESS
PROJECT ADDRESS
E-MAIL PHONE BUS. LIC #
ARCHITECT
ATTACHED
S F ____________
TOTAL - SF __________SPA ATTACHED YES NO
EXISTING USE EXISTING SF
GARAGE
SF
REMODEL
BATHROOM SF
5/8”
WOOD SHAKES PROPOSED ROOF TYPE: BUILT-UP ROOF ASPHALT SHINGLES
*Provide a signed copy of the Cupertino’s Tear-Off Policy
3/8”
RE-ROOF
PERMIT #B - __________ - __________
SWIMMING POOL/SPA
DEF # ______
REV # ______
X
The Forum At Rancho San Antonio 650-944-0100 mailacurby@theforumrsa.com
23500 Cristo Rey Dr Cupertino CA 95014
X
Christina Johnson IQV Construction & Roofing 963219 B&C39
877 Chestnut Street San Jose CA 95110
cjohnson@iqvinc.com 408-594-0452 BL 405683
Remove existing standard weight tile and install new standard weight tile and asphalt shingles where future
solar will be installed.
55000
X
Concrete Tile
Concrete Tile
Concrete Tile
Concrete tile
X
X
X 5
X Concrete tile
4300 43
Christina Johnson 11/2/2023
23400 Via Ventura 18,19,20