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BLD-2023-2091_applicationCONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 9 permitcenter@cupertino.org PERMIT #B - CUPERTINO I REV # DEF # ❑ NEW CONSTRUCTION ❑ ADDITION ©'ALTERATION ❑ T.1. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA PROJECT ADDRESS 2D 66 (� I (� f f 1'� \ v� o (v� , 11. (l �!/ \ APN # OWNER NAME ( PHONE LJ E-MAIL.) f, STREET ADDRESS J CITY�AT IP �+ 1 \ / �F— ❑ CONTRACTOR N ME OWNER-BUILDE COMPANY NAME LICENSE NUMBER LICENSE TYPE STREET ADDRESS CITY, STATE, ZIP E-MATT PHONE BUS. LTC # ❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT ❑ CONTRACTOR AGENT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTACT NAME E-MAIL STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTON i v G TOTAL VALUATION: ❑SINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL USE TYPE OCC SQ.FT. VALUATION ($) E10TIN0 USE I EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES # TOTAL NET SF REMODEL BATHROOM SF REMODEL KITCHEN SF REMODELOTHR SF GARAGE ❑ ATTACHED SF ❑ DETACHED EXISING ❑YES FIRE SPRINKLERS ❑.NO EICHLER ❑ YES SECOND ❑ NO STORY ADDITION ❑ YES ❑NO DWELLING UNITS # SECOND DWELLING ❑ YES ❑ ATTACHED ❑ DETACHED OTHER UNIT ADDITON: ❑ NO SF - POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED POOL - SF SPA - SF SPA ATTACHED YES ❑ NO TOTAL - SF Commercial or Multi -Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval RECEIVED BY: RE -ROOF EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ TILE OTHER (SPECIFY) REMOVE /REPLACE ❑ NO [:]YES# I IF NO OF LAYERS PLYWOOD ❑'h„ ❑ 3/8" PLYWOOD THICKNESS ❑ 5/r OTHER TYPE: ❑OSB ❑ CDX OTHER PITCH: .12 ROOF CLASS 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 p poses. I acknowledge d authorize all information contained on this application form to be made available for ublic 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 2017.doc revised 01101121