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BLD-2024-0582_ApplicationCONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT * BUILDING DIVISION 10300 TORRE AVENUE * CUPERTINO, CA 95014-3255 (408) 777-3228 * permitcenter@cupertino.org PERMIT #B LD-7�- Q Z CUPERTINO I REV# DEF# ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION ❑ T.I. ❑ MEP �❑ RE -ROOF ❑ SWIMMING POOL/SPA PROJECT ADDRESS ( I � APN 8 QV } ©O \> OWNER NAME m PHONE STREET ADDR S 19 i, CITY, STATE, ZIP CONTRACTOR NAME ❑ OWNER -BUILDER COMPANY NAME � LICENSE TYPE ' [1I�NUMBERS ,, C� STREET ADDRESS vsz i4sI 2 TY, STATE, ZIP r'sd C_ E-MAIL / f V re - -) n � S � � V I PHONE N Q--� �U g . � `� 2 - g � nl �l BUS. LI # � LiC� .-b Y� t 13 q(_i ❑ ARCHITECT ❑ OWNER OWNER AGENT ❑ CONTRACTOR AGENT❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTACT NAME E-MAIL STREET ADDRESS\ D ! /�` CITY, STAT ZIP / 1 ' 1 PHpNE 13� - Z DESCRIPTON 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 �REMODELOTHR GARAGE ❑ ATTACHEb BATHROOM SF SF SF SF ❑ DETACHED EXISING ❑ YES FIRE SPRINKLERS ❑ NO EICHLER ❑ YES ❑ NO SECOND STORY ADDITION 13 NS O DWELLING SECOND DWELLING ❑ YES ❑ ATTACHED ❑ DETACHED OTHER UNITS # UNIT ADDITON: ❑ NO SF POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNnE ❑ 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'S TILE OTHER (SPECIFY) REMOVE /REPLACE ❑ NO IF NO PLYWOOD ❑ w ❑ 3/8- PLYWOOD TYPE: PITCH: ROOF CLASS ❑YES # OF LAYERS I THICKNESS ❑ 5/8' OTHER ❑ OSB ❑ CDX OTHER ' 12 I 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 Jeeal-ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for ' spe on purposes. I acknowledge and authorize all information contained on this application form to be made available for public record. _ Z _ 13 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 M-3 „ v-1�p C 1, — 7,6 �1dgA 6 2D17'.�c revised 01101121