BLD-2024-0593 APPLICATIONCONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
[is 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • permitcenter@cupertino.org PERMIT #B
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION ❑ T.I. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
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COMPANY NAME
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LICENSE NUMBER
LICENSE TYPE
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CONTACT NAME
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DESCRIPTON
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TOTAL VALUATIO
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SINGLE-FAMIL /DUPLE ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
EXISTING SF
NEW FLOOR SF
I PORCH
SF DECK SF
DEMO SF
STORIES #
TOTAL NET SF
REMODEL
REMODEL KITCHEN
I REMODEL OTHR
GARAGE ❑ ATTACHED
BATHROOM SF
SF
SF
SF ❑ DETACHED
EXISING ❑ YES
EICHLER ❑ YES
SECOND STORY ADDITION ❑ YES
FIRE SPRINKLERS ❑ NO
❑ NO
❑ NO
DWELLING
SECOND DWELLING ❑ YES ❑ ATTACHED❑ DETACHED OTHER
UNITS #
UNIT ADDITON: ❑ NO S F
I
POOLS
❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL - SF SPA - SF SPA ATTACHED 0 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 AASPHALT SHINGLES[] WOOD SHAKES ❑
WOOD SHINGLES ❑ TILE OTHER (SPECIFY)
REMOVE /REPLACE
NO
NO
IF NO
PLYWOOD El VI"❑ 3/8" PLYWOOD
TYPE:
PITCH:
12
ROOF CLASS
# OF LAYERS
THICKNESS ❑ 5/8" OTHER
❑OSB ❑ CDX OTHER
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PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES ❑WOOD SHINGLES ❑ OTHER �f
*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 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
45 b+ N B1dgApp_2017.doc revised 01101121