MX-M1100_20160617_104753CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingfteuoertino.oro
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❑ OWNER ❑ OWNERBUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT '❑ ARCHITECT ❑ ENGWEER ❑ DEVELOPER ❑ TENANT
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DESCRIPTION OF WORK
EXISTING USE
PROPOSED USE
CONSTR. TYPE
# STORIES
USE
TYPE
OCC,
SQ.I"I'.
VALUATION ($)
EXISTO
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NETAREA
BATHROOM KITCHEN OTHER
RLMODELAREA REMODELAREA REMODLLARLA
PORCH AREA DECK AREA I ]'OTALDP.CK/1'ORCII AREA
GARAGE AREA: El DETACH
El ATTACH
#DWELLING UNITS:
ISASECONDUNIT DYES
SECOND STORY ❑YPS
BEING ADDED? ENO
ADDITION? ENO
PRE -APPLICATION FIYEs N YES PROVIDE COPY OF
ISTIIEBLDGAN I] YES
RECEIVED (
TOTAL VALUATION:
PLANNMGAPPLX ENO PLANNING APPROVAL LETTER
LICHLERHOME? LINO
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By my signature below, I certify to each of the following: I am the property owner or authm"ized agenl n t to aothe 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 t uilding conch "lion.ve-representatives of Cupertino to enter theabove-identified properly for inspection purposes.
Signature of Applicant/Agent: __ _ Date: 6 G
SUPPLEMENTAL INFORMATION ITQUIRELK3Pl,w
cxEcx TYPE
v❑
ROUTING SITE
_ New SPD or Multifamily dwellings: Apply for demolition penult for
OVER THE COITNTER-
IFTOBUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
❑
_
permit for new building.
EXPRESS
PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ 'PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ mAjoul
SANITARY SEWER DISTRICT
submittal of Building Pennit application.
_-
❑ ENVIRONMENTAL HEALTH
B1dgAp1o_2011.doc" revised 06121111