BLD-2023-1489_ApplicationCONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • permitcenter@cupertino.org PERMIT #B -
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CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION ❑ T.I. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS () / q Q * � pq Iq rn vS
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STREET ADDRESS
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CITY, STATE, ZIP
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CONTRACTOR NAME ❑ OWNER -BUILDER ��rnqllck
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NUMBER LICENSETYPE
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❑ ARCHITECT ❑ OWNER ❑ OWi R ACfNT 1000NTRACTOR AGENT❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAM
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STREET ADDRESS 3 5 /� 1 / '!en Cc e,
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CITY, STATE, en IO (-/L- C4' 9AWS PHO
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DESCRIPTONO/`
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TOTAL VALUATION: O V
INGLE-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
REMODELOTHR GARAGE
❑ ATTACHED
BATHROOM SF
SF
SF SF
❑ DETACHED
EXISLNG ❑ YES
FIRE SPRINKLERS ❑ NO
EICHLER ❑ YES
❑ NO
SECOND STORY ADDITION ❑ YES
❑ NO
DWELLING SECONDDWELLING ❑YFS ❑ATFACHED❑DETACHED OTHER
UNITS # UNIT ADDITON: ❑ NO S F
POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL - SF SPA - SF SPA ATTACHED ❑ YES ❑ NO TOTAL - SF
RECEIVED BY:
Commercial or Multi-Fandlu Buildings with Public S¢oitnrningPools requires Department of Environmental Heath approval
RE -ROOF
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑
WOOD SHINGLES ❑ TILE OTHER (SPECIFY)
REMOVE (REPLACE ❑ NO
NO
PLYWOOD ❑❑ 3(8" PLYWOOD'FYPE:
PITCH:
ROOF CLASS
[]YES
(IF
# 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 for "�c
ccpurposes. I acknowledge and authorize all information contai ed on this application form
to be made available for public record. nn
7
Signature of Applicant/Agent: Date: 0 7 o S
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_2017.doc revised 01101121