BLD-2023-2657_ApplicationCONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO CA 95014-3255
1#1
(408) 777-3228 • permitcenter@cupertino.org PERMIT #B - WL�J -�
CUPERTINO I REV # DEF #
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION ❑ T.1. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS
APN #
OWNERNAME PA'(Yv� PHONE
-
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STREET ADDRESS
CITY, STATE, ZIP
CONTRACTOR NAME ❑ OWNER -BUILDER COMPANY
NAME
LICENSE NUMBER
LICENSE TYPE
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StRE& ADDRESS
CITY STATE, ZIP
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E-MAIL
PHONE BUS. LTC ##
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❑ ARCHITECT OWNER ❑ OWNERAGENT ❑ CONTRACTOR AGENT❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTON
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TOTAL VALUATION:
b-t
❑SINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
I EXISTING SE
NEW FLOOR SF
I 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
EICHLER ❑ YES SECOND
STORY ADDITION YES
FIRE SPRINKLERS ❑ NO
❑ NO
NO
DWELLING
SECOND DWELLING ❑YES ❑ ATTACHED ❑DETACHED OTHER
UNITS #
UNIT ADDITON: ❑ NO S F
I
POOLS
❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL - SF SPA - SF SPA ATTACHED ❑YES ❑ NO TOTAL - SF
RECEIVED BY:
Commercial or Multi -Family Buildings with Public Smimmin2 Pools requires Devartment ofEnvirownental Heath approval
RE -ROOF
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF []ASPHALT SHINGLES❑ WOOD SHAKES ❑
WOOD SHINGLES [:]TILE OTHER (SPECIFY)
REMOVE /REPLACE ❑ NO
TF NO
PLYWOOD ❑'� ❑ 3/8" PLYWOOD
TYPE:
PITCH:
ROOF CLASS
❑YES
# OF LAYERS
THICKNESS ❑ 5/8" OTHER. I
❑ OSB ❑ CDX OTHER
9
.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 for inspection purpose .j 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.
*HOA-Provide a letter of approval from the Home Owner's Association
BldgApp 201 T doc revised 01101121