BLD-2024-0519_ApplicationCONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION RD
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 204- Q l' q
(408) 777-3228 • permitcenter@cupertino.org PERMIT #B -
CUPERTINO I REV# DEF#
❑ NEW CONSTRUCTION []ADDITION ❑ ALTERATION ❑ T.I. ❑ MEP [M RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS
APN#
STREETIA2DD
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SATE,
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4J V16
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�]�ONTRACTOR NAME ❑ OWNER -BUILDER
LICENSE NUMBER
LICENSE TYPE
�COMPANYNAME
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STREET ADDRESS
3 C Y P R ESS AV
CITY, STATE, ZIP
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E-MAIL C(j j�
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PHONE
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BUS. LIC #
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❑ ARCHITECT OWNER ❑ OWNER AGENT ❑ CONTRACTOR AGENT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTON
TOTAL VALUATION: 1
❑SINGLE-FAMILY/DUP2LEEX ❑MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
I EXISTING IF
I NEW FLOOR IF
PORCH
IF DECK IF
DEMO IF
STORIES #
TOTAL NET IF
REMODEL
REMODEL KITCHEN
REMODEL OTHR
GARAGE ❑ ATTACHED
BATHROOM IF
IF
IF
IF ❑ DETACHED
EXISING ❑ YES
FIRE SPRINKLERS ❑ NO
EICHLER ❑ YES
❑ NO
SECOND STORY ADDITION ❑ YES
❑ NO
DWELLING
SECOND DWELLING ❑ YES ❑ ATTACHED ❑ DETACHED OTHER
UNITS #
UNIT ADDITON: ❑ NO S F
I
POOLS
❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL - IF SPA - IF I SPA ATTACHED ❑ YES ❑ NO I TOTAL - SF
RECEIVED BY:
Commercial or Multi-Familu 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 ATTLE OTHER (SPECIFY)
REMOVE /REPLACE ❑ NO
IF NO
PLYWOOD ❑ lh" ❑ 3/8" PLYWOOD
TYPE:
PITCH:
12
ROOF CLASS
OYES
# OF LAYERS
THICKNESS ❑ 5/8" OTHER
❑ OSB ❑ CDX OTHER
•
A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER 2
*Provide
i �%�
a signed copy of the Cupertino's Tear -Off Policy IF #of SQUARES-_/ C
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 record.
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