BLD-2024-0369_ApplicationCONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
l-1 (408) 777-3228 • permitcenter@cupertino.org PERMIT #B - -
CUPERTINO WWI
REV # DEF #
❑ NEW CONSTRUCTION ❑ADDITION ALTERATION ❑ T.I. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS
APN #
OWNER NAME
R r PHONE
40� � J� 4�94
E-MAIL
1j J
STREETADDRESS
PC 4 ► (1 1, n
CITY, STATE, ZIP
v P E-f_T-1W TD
CONTRACTOR NAME ❑ OWNER -BUILDER COMPANY
NAME
LICENSE NUMBER LICENSE
TYPE
4) 4-
STREET ADDRESS
CITY, STATE, ZIP
E-MAIL PHONE
BUS. LIC
❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT CONTRACTOR AGENT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NANIE
e n� C
E-MAIL
"/i
STREET ADDRESS
�� Pl-S'�
CITY, STATE, ZIP PHONE
.221 � � o
DESCRIPTON t
,41,ti G 1 t%�T �� G Sr J� V) - � L,�, V_
) jkT 60 7` / 00
TOTAL VALUATION:
SINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ LNDUSTRL4L ❑ CONIlVIERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
(EXISTING USE
EXISTING SF
NEW FLOOR SF
PORCH
SF DECK IF
DEMO SF
STORIES S
TOTAL NET SF
REMODEL
REMODEL KITCHEN
REMODELOTHR
GARAGE ❑ ATTACHED
BATHROOM SF
SF
SF
SF ❑ DETACHED
EXISING ❑ YES
FIRE SPRINKLERS ❑ NO
EICHLER ❑ YES
❑ NO
SECOND STORY ADDITION ❑ YES
❑ NO
DWELLING
SECOND DWELLING ❑ YES ❑ ATTACHED ❑ DETACHED OTHER
UNITS #
UNIT ADDLTON: ❑ NO S F
POOLS
❑ FIBERGLASS ❑ VLNYL-LINED ❑ GUNITE ❑ PREFABRICATED
T_
POOL - SF SPA - SF SPA ATTACHED YES ❑ NO TOTAL - SF
RECEIVED BY:
Comrnercia! or Multi -Family Buildbizs with Public Swimming Pools requires Deyartment of Envirmnnental Heath avproval
RE -ROOF
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES❑ WOOD SHAKES ❑
WOOD SHINGLES ❑ TILE OTHER (SPECIFY)
REMOVE /REPLACE ❑ NO
IF NO
PLYWOOD ❑'�' " ❑ 3/8" PLYWOOD
TYPE:
PITCH:
ROOF CLASS
YES
# OF LAYERS
THICKNESS ❑ 518" OTHER I
❑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 #oI 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 Wort; 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. / J,
Signature 2— )& �y
of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION RE UIRED
*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