BLD-2023-2004_ApplicationDemoApp_2019.doc revised 08/18/22
PROJECT ADDRESS APN #
OWNER NAME PHONE E-MAIL
STREET ADDRESS
STREET ADDRESS CITY, STATE, ZIP
OWNER ARCHITECT ENGINEER DEVELOPER TENANT
E-MAIL
STREET ADDRESS CITY, STATE, ZIP PHONE
DESCRIPTION
TYPE COMMERCIAL
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING
DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • permitcenter@cupertino.org
D
SWIMMING POOL/SPABUILDING/STRUCTURE
SINGLE-FAMILY/DUPLEX MULTI-FAMILY SQ.FT. VALUATION ($)
LANDSCAPE PURPOSE ONLY
USE
RECEIVED BY
CONTACT NAME
CONTRACTOR NAME COMPANY NAME LICENSE NUMBER LICENSE TYPE
CONTRACTOR AGENT
PHONE E-MAIL BUS. LIC #
PERMIT #BLD ___________-___________
OWNER AGENT
SWIMMING POOL ATTACHED SPA DETACHED SPA
STRUCTURE TO BE BUILT
No structural or floor slab support shall be built unless the pool shell is removed in its entirety.
Backfill must be certified by a licensed Geotechnical or Civil Engineer to verify backfill materials,
soil type and compaction percentage of 90% maximum density prior to inspection.
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:_______________________
CITY STATE ZIP
TOTAL
INDUSTRIAL
ASB# # DWELLING UNITS OTHER:
NOTES:
OWNER-BUILDER