BLD-2023-2498_ApplicationCUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • permitcenter@cupertino.org PERMIT #B -
REV #
DEF #
❑ NEW CONSTRUCTION ❑ ADDITION V ALTERATION ❑ T.I. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS
10194 ALPINE DR, CUPERTINO, CA 95014
APN #
32615025
OWNER NAME PHONE
STREET ADDRESS 10194 ALPINE DR
CITY, STATE, ZIP CUPERTINO, CA 95014
CONTRACTOR NAME ❑ OWNER -BUILDER COMPANY
NAME
LICENSE NUMBER
LICENSE TYPE
Hussey Brothers Heating
Hussey Brothers Heating
675669
C20
STREET ADDRESS 1752 Junction Avenue Suite 6
CITY, STATE, ZIP San Jose, CA 95112
E-MAIL
corina@husseybros.com
PHONE
408-733 6360
BUS. LIC #
404829
❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT ® CONTRACTOR AGENT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME
Andrea Sams
E-MAIL andrea.Sams ener u com
@ 9 y
STREET ADDRESS
CITY, STATE, ZIP
PHONE
26111 YNEZ RD. UNIT C3
TEMECULA,CA 92591
310-919-3428
DESCRIPTON To replace existing gas furnace with a new 2 ton ducted heat pump Dual Fuel system
EQUIPMENT: Mitsubishi Model #PAA-A24BA1, INTELLI HEAT A COIL 2T 17.5" W,
American Standard FURNACE Model- o 60K, 1 -STG+EGM,
Mitsubishi Model #PUZ-A24NHA7 MITSU HEAT PUMP OUTDR 230V
TOTAL VALUATION:
16812.62
®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
EXISIREISPRINKLERS ❑ NO
EICHLER ❑❑ No
SECOND STORY ADDITION YES
❑ NO
DWELLING
SECOND DWELLING ❑ YES ❑ ATTACHED ❑ DETACHED OTHER
UNITS #
UNIT ADDITON: []NO S F
❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
SPA - SF
SPA ATTACHED ❑ YES ❑ NO
TOTAL - SF
RECEIVED BY:
Multi -Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval
PREMOVE
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑
WOOD SHINGLES ❑ TILE OTHER (SPECIFY)
PLACE ❑ NO
IF NO
PLYWOOD ❑ l�z' ❑ 3/8"
PLYWOOD TYPE:
PITCH:
ROOF CLASS
❑ YES
I # 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 inspection purposes. I acknowledge and authorize all information contained on this application form
to be made available for public record.
.�QyZ,;��2.Q.C� �G%>
Signature of Applicant/Agent: Date: I/912023
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
NA
BldgApp_2017. doc revised 01101121