BLD-2023-2522_ApplicationCONSTRUCTION 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 16 ALTERATION ❑ T.I. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
PROJECI ADDRESS
APN #
OWNER NAME P
E-MAIL .--
6
CONTRACTOR NAME ❑ OWNER -BUILDER COMPANY
NAME
LICENSE NUMBER
LICENSE TYPE
r
:RC)
STREET ADDRE S
CITY, STATE, ZIP
.. ®CUNE
BUS. LIC #
IE-MAILf�
m (
C)o 2❑
ARCHfTECT ❑ NER
[IOWNER A ENT [ICONTRACTOR AGENT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTON (�
TOTAL -VALUATION:
❑SINGLE-FAMILY/DUPLEX 'MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
I 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 ❑ YES
EICHLER ❑ YES
SECOND STORY ADDITION ❑ YES
FIRE SPRINKLERS ❑ NO
❑ NO
❑ NO
DWELLING [:]YES ❑ ATTACHED ❑ DETACHED OTHER
�SECONDDWELLING
UNITS # UNIT ADDITON: ❑ NO S F
POOLS
❑ 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 SwimnvinQ 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 ❑ '/2 " ❑ 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 pu os . cknowle ge and authorize all information contained on this application form
rik
to be made available for public 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
B1dgApp_2017.doc revised 01101121