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BLD-2024-0358_ApplicationCONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014=3255 (408) 777-3228 • permitcenter@cupertino.org PERMIT #B - CUPERTIN© I REV # DEF # ❑ NEW CONSTRUCTION ❑ ADDITION ,❑ ALTERATION ❑ T.I. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA PROJECT ADDRESS 1 APN # , ti. OWNER NAME a PHONE VIA E-MAIL v�� STrET ADD R SS STATE, ZIP 0�� CONTRACTOR NAME ❑ OWNER -BUILDER I COMPANY NAME LICENSE NUMBER LICENSE TYPE ,Q AWyU&tUV e�-jqj, c 50 STREET ADDRESS.—V C STATE, ZIP d!!71— . ZIS (2J-p E-MAIL PHONE ^ �s r BUS. LIC 4 q ,(`�},..�t -3QZ ARCHITECT M OWNER ❑ O A ❑ CONTRACTOR AGENT [I ENGINEER ❑ DEVELOPER ❑ TENANT CONTACT NAME E-MAIL STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTONUnt p� n X `, t ✓ ` y 1Io`— Y 41 O LP TOTAL VALUATION: �JL 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 It TOTAL NET SF REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ ATTACHED BATHROOM SF SF SF SF ❑ DETACHED EXLSING ❑ YES EICHLER ❑ YES SECOND STORY ADDITION ❑ YES FIRE SPRINKLERS ❑ NO ❑ NO ❑ NO DWELLING SECOND DWELLING ❑YES ❑ ATTACHED ❑DETACHED�WER UNITS # UNIT ADDITON: ❑ NO SF- V LkV4 I�( POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNTTE ❑ PREFABRICATED POOL - SF SPA - SF SPA ATTACHED E3 YES ❑ NO I 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 PLYWOOD El,"' ❑ 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 poq state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspe on urposes. I acknowledge and authorize all information contained on this application form to be made available for public record. 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 BldgApp_2017.doc revised 01101121