BLD-2023-2802_ApplicationCONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
IM 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • permitcenter@cupertino.org PERMIT #Bi,9 2bZ- — 2
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION ❑ T.I. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS o 104 Q a cA
APN #
OWNER
z l D q L. a K 0 CIA G
CITY, STAITE, ZIP
G t✓ pop, r+ L& v
NAME❑OWNER-BUILDER COMPANY
NAME
LICENSE NUMBER
LICENSE TYPE
CONTRACTOR
LTA /�%cl p ric,I
AL-TAr 510- 'Fr(,J
STRE/�'A-7DDRESS / r ZJ
I Lr-1j4 ✓_ ,0 O �+
CITY, STATE, ZIP ^ Q
& e figE-M
�t
AIb
Q lL a @ e C 1 f 1 Coc 1 GW l SHONE , e a O 0 Cl — 9, 2- 9-/�j BUS. LIC a
❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT CONTRACTOR AGENT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CE o A Y` � ' `o S �GA� ZdCCL G OXTACT NAMEEMAIL
�t E_4 l L� c 4 r �' e, I y �i �{ p G
STREET ADDRESS
6 7 � t 51W0 R-cL
CITY, STATE, ZIP
Sam Se
PHO E
�d'-309�` 25�0
04
C�9S'/2-D
DESCRIPTON
ro 2 G
TOTAL VALUATION:
❑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
DEMO SF
STORIES #
TOTAL NET SF
REMODEL
REMODEL KITCHEN
REMODEL OTHR
GARAGE ❑ ATTACHED
BATHROOM SF
SF
SF
SF ❑ DETACHED
EXISING ❑ YES
FIRE SPRINKLERS ❑ NO
EICHLER ❑ YES SECOND
❑ NO
STORY ADDITION ❑ YES
❑ NO
DWELLING
SECOND DWELLING ❑ YES ❑ ATTACHED ❑ DETACHED OTHER
UNITS #
UNIT ADDITON: ❑ NO S F
POOLS
❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL - SF SPA - SF SPA ATTACHED ❑ YES ❑ NO TOTAL - SF
RECEIVED BY:
Commercial or Multi -Family Buildings with Public Swimming 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
❑'h
PLYWOOD - ❑ 3/8" PLYWOOD
TYPE:
PITCH:
ROOF CLASS
❑ YES
# OF LAYERS
I
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 r rd. 9
E 2 Z
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
3 O 1 % _GZ, BldgApp_2017.doc revised 01101121