B-2019-0026 ApplicationCONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • buildin @cu erfino.or PEMIT #B - '
CUP
REV # DEF #
I —I NEW CONSTRUCTTON f i ADDTTT()N F� AT.TFRATTnT\T f I T T n Amp n RR.-Rnn-P n gWTMMTNr PnnT ignA
PROJECT ADDRESS M7 �� �.,
APN #
OWNER NAME +
.•
*�
E-MAIL
STREET ADDRESS
40Z O 1 Q.0
CITY STATE, ZIP
64 e? S 6! 4+
[A CONTRACTOR NAME ❑ OWNER -BUILDER COMPANY
NAME
LICENSE NUMBER LICENSE
TYPE
J
G i
STREET ADDRESS
Ole.,
CITY, STATE, ZIP
E- IL
.00 A4 co �007
PHONE
BUS. LIC #
6
❑ ARKiTTECT ❑ OWNER ❑ OWNER AGENT , CONTRACTOR AGENT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CT NAME
E-MAIL
ADDRESS
kDESCRIPTON
CITY, STATE, ZIP
PHONE
14
6 W
0 Q, k
'SINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
EXISTING SF
NEW FLOOR SF
PORCH
SF DECK SF
DEMO SF
STORIES #
TOTAL NET SF
REMODEL
REMODEL KITCHEN
REMODEL OTHR
GARAGE ❑ ATTACHED
BATHROOM SF
SF
SF SF
❑ DETACHED
EXISING ❑ YES
FIRE SPRINKLERS ❑ NO
EICHLER ❑ YES SECOND
❑ NO
STORY ADDITION ❑ YES
❑ NO
DWELLING
SECOND DWELLING ❑ YES ❑ ATTACHED []'DETACHED OTHER
UNITS #
UNIT ADDITON: ❑ NO SF
POOLS [] FIBERGLASS ❑ VINYL -LINED [] GUNITE ❑ PREFABRICATED
POOL - SF SPA - 5F SPA ATTACHED ❑ YES [I NO TOTAL - SF
Commercial or Multi-Famil Buildings with Public Swimming Pools requires Department of Environmental Heath approvalLOA
REC E BY:
VALUATION:
,
n
RE -ROOF
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF [] ASPHALT SHINGLES ❑ WOOD SHAKES [❑ WOOD SHINGLES [❑fiLE OTHER (SPECIFY)
REMOVE /REPLACE ❑ NO
IF NO
I
PLYWOOD ❑ W' ❑ 3/8" PLYWOOD
TYPE:
PITCH:
ROOF CLASS
❑ YES
# OF LAYERS
THICKNESS ❑ 5/8" OTHER
❑ OSB ❑ CDX OTHER
• 12
A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑WOOD SHINGLES ❑ OTHER
'Provide a signed copy of the Cupertino's Tear -Off Policy SF #of SQUARES
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 fo inspection Viyposes. I acknowledge and authorize all information contained on this application form
to be made available for public rec l
Signature of Applicant/Agent:
gnDate.
SUPPLEMENTAL INFORMATION KEQUIRED
'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.
WHOA -Provide a letter of approval from the Horne Owner's Association
BldgApp_2017, doc revised 08101117