BLD-2023-2348_Construction PermitCUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • building@)cupertino.orar PERMIT ttB - -
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APN #
OWNER NAME
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nNTRACTOR NAME ❑ OWNER -BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
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STP.EET DRESS STATE, ZIP
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E-MAIL PHONE
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❑ ARCHITECT ❑ OWN ❑ O"PTNfR AGENT ONTRACTOR AGENT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONT T NAME E-MAIL
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DESCP.IPTON
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SINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY []INDUSTRIAL ❑ COMMERCIAL
EXISTINNG USE EXISTINtSFNEWFLOOR SF PORCH SF DECKSF DEMO SF STORIES # TOTAL NET SFUSE TYPE OCC SQ.FT. VALUATION(S)
REMODEL DEL KITCHEN REMODEL OTHR GARAGE ATTACHED
BATHROOM SF SF DETACHED
EXISING ❑YER ❑ Y SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS ❑ NNO ❑ NO
DWELLING S - - -DWELLING ❑YES [:]ATTACHED[] DETACHED
OTHER
UNITS liNIT ADDITON: ❑ NO S F
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POOLS
❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREF
POOL - SF SPA - SF SPA YES ❑ NO I TOTAL - SF
Conmrercinl or - andly Buildin s with Public Swimming Pools requires Department o Environmental Heath approval—
RECEIVED BY:
IT TAL UATION:
I
RE -ROOF
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES[]
WOOD SHINGLES []TILE OTHER (SPECIFY)
REMOVE /REPLACE ❑ NO I IF NO PLYWOOD ❑ Yz" ❑ 3/8" COD TYPE: PITCH: ROOF CLASS
❑YES #OFLAYERS THICKNESS 5 R ❑OSB ❑ CDX 12I
OTHER A
PROPOSED ROOF TYPE: ❑BUILT- ' ALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
*Provide a ' 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 f spection purposes. acknowledge and authorize all information contained on this application form
to be made available for public recor
Signature of Applicant/Agent: ��Y Date: to
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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 being
are 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 08101,117