BLD-2023-2364_ApplicationBldgApp_2011.doc revised 06/21/11
NEW CONSTRUCTION ADDITION ALTERATION / TI REVISION / DEFERRED ORIGINAL PERMIT #_________________
PROJECT ADDRESS APN #
OWNER NAME PHONE E-MAIL
STREET ADDRESS CITY, STATE, ZIP FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY, STATE, ZIP FAX
OWNER OWNER-BUILDER OWNER AGENT CONTRACTOR CONTRACTOR AGENT ARCHITECT ENGINEER DEVELOPER TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC #
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC #
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
DESCRIPTION OF WORK
EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES
USE TYPE OCC. SQ.FT. VALUATION ($)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
BATHROOM
REMODEL AREA
KITCHEN
REMODEL AREA
OTHER
REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
ATTACH
# DWELLING UNITS: IS A SECOND UNIT YES
BEING ADDED? NO
SECOND STORY YES
ADDITION? NO
PRE-APPLICATION YES
PLANNING APPL # NO
IF YES, PROVIDE COPY OF
PLANNING APPROVAL LETTER
IS THE BLDG AN YES
EICHLER HOME? NO
RECEIVED BY: TOTAL VALUATION:
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.
Signature of Applicant/Agent: _________________________________________________________ Date: ___________________________________
SUPPLEMENTAL INFORMATION REQUIRED
___ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
___ Commercial Bldgs: 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.
PLAN CHECK TYPE ROUTING SLIP
⃞ OVER-THE-COUNTER ⃞ BUILDING PLAN REVIEW
⃞ EXPRESS ⃞ PLANNING PLAN REVIEW
⃞ STANDARD ⃞ PUBLIC WORKS
⃞ LARGE ⃞ FIRE DEPT
⃞ MAJOR ⃞ SANITARY SEWER DISTRICT
⃞ ENVIRONMENTAL HEALTH
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building@cupertino.org
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