BLD-2023-2373_Construction PermitCONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • permitcenter@cupertino.org PERMIT #B -
CUPERTINO I REV# DEF#
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION ❑ T.I. ❑X MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS 10212 Denison Ave
APN# 316-28-016
OWNERNAME
STREET ADDRESS
CITY, STATE, ZIP
10212 Denison Ave
Cupertino, CA 95014
❑x CONTRACTOR NAME ❑ OWNER -BUILDER COMPANY
NAME
LICENSE NUMBER
LICENSE TYPE
Kong Nguyen
Mike Counsil Plumbing
679261
C36
STREET ADDRESS 1915 Otoole Way
CITY, STATE, ZIP San Jose, CA 95131
E-MAIL PHONE
BUS. LIC #
Permits@mcplumbing.com 408-272-4900
403430
❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT ❑ CONTRACTOR AGENT ❑ ENGINEER ❑ DEVELOPER ❑ TEN.A\T
CONTACT NAME
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTON Underfloor drain/waste line replacement for 2 bathrooms (6 fixtures).
TOTAL VALUATION:
$16,665
■❑SINGLE-FAMILY/DUPLEX ❑MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
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 S
EICHLER
❑❑ S
SECOND STORY ADDIT❑ION YES
FIRE SPRINKLERS [I N
N
❑ NO
DWELLING
SECOND DWELLING ❑ YES ❑ ATTACHED❑ 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 -Family Buildings with Public Swimming Pools 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
IF NO
PLYWOOD ❑'�z" ❑ 3/8- PLYWOOD
TYPE:
PITCH:
ROOF CLASS
❑ YES
# OF LAYERS
I
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 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: 10/25/23
SUPPLEMENTAL INFORMATION REQU RED
*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