BLD-2023-2388_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. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS ` ! /�C i _ / o
APN
OWNER NAME
E-MAIL
STREET ADDRESS /�
CITY, STATE, 'P� (,Iv V ^ � � �O /
�� C�
ONTRACTOR NAME ❑ OWNER -BUILDER COMPANY
NAME
LICENSE NUMBER
LICENSE TYPE
.5pc ��
Cam.(-- 10
�7z3gG
C
STREET ADDRESS a
CITY, STATE, ZIP _
E-MAIL PHONE
BUS. LIC #
41, s 710 — 8�S
❑ ARCHTI'ECT ❑ OWNER ❑ OWNER AGENT ❑ CONTRACTOR AGENT [I ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTON Re 6
TOTAL VALUATION:
3 00.
SINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
I EXISTING SF
NEW FLOOR SF
I PORCH SF
DECK SF
I 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
❑ YES ❑ ATTACHED❑ DETACHED OTHER
UNITS #
[SECONDDWELLING
IT ADDITON: ❑ NO S F
POOLS1
❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL - SF SPA - SF SPA ATTACHED ❑ YES ❑ NO I TOTAL - SF
RECEIVED BY:
Commercial or Multi -Family Buildings with Public Swimming Pools requires Department of Environmental Heath avnroval
RE -ROOF
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES❑ WOOD SHAKES ❑
WOOD SHINGLES ❑ TILE OTHER (SPECIFY)
REMOVE /REPLACE NO
IF NO %
I
PLYWOOD 3/8" PLYWOOD
TYPE:
PITCH: ROOF CLASS
12
;9YES
# OF LAYERS l
THICKNESS ❑ 5/8" OTHER
Obst; ElCDX OTHER
— • A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF PHALT SHINGLES ❑ WOOD SHAKES ❑WOOD SHINGLES ❑ OTHER
*Provide a signed copy of the Cupertino's Tear -Off Policy SF _2#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 and authorize all information contained on this application form
to be made available for public record.
Signature of Applicant/Agent: .�' Date: '�ti 2
SUPPLEMENTAL INFORMAT 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
B1dgApp_2017.doc revised 01101121