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B-2017-1763 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1763 802 CANDLEWOOD DR CUPERTINO,CA 95014-4653(369 19 033) , ON-TIME AIR CONDITIONING& HEATING INC PLEASANTON,CA 94588 OWNER'S NAME: RUDD BARBARA 0 TRUSTEE DATE ISSUED: 10/12/2017 OWNER'S PHONE:408-507-7411 • PHONE NO:(925)872-7326 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-20 Lic.#817040 • Contractor ON-TIME AIR CONDITIONING&HEATING INC Date 09/30/2019 X BLDG _ELECT _PLUMB X MECH X RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is iu,full force and effe JOB DESCRIPTION: REPLACE FURNACE&COIL-SAME LOCATION;INSTALL(N)AC I hereby affirm unde .enalty of perjury one of the following two declarations: UNIT-SIDE YARD 1. I have •will niaintain a certificate of consent to self-insure for Worker's REV#1-REPLACE DUCT(50 SF),ADD VENTS(5)-ISSUED 11-14- Co sensation,as provided for by Section 3700 of the Labor Code,for the 2017 • pc ormance of the work for which this permit is issued. 'have and will maintain Worker's Compensation Insurance,as provided for by '�,'1` Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$16700.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 369 19 033 representatives of this city to enter upon the above mentioned property for • inspection purposes. (We)agree to save indemnify and keep har -ss-the • City of Cupertino against liabilities,judgments,costs,and ex.- ses which PERMIT EXPIRES IF WORK ISNOT STARTED may accrue against said City in consequence of the gr.- ng of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will co.-.y with all non-point source regulations per the Cupertino Munich.. ode,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature `'L-/ZA Date 11-14-2017 Issued by:AbbyAyende 5 Date: 10/12/2017 • OWNER-B'ILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for • compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date: 11-14-2017 I hereby affirm under penalty of perjury one of the following three declarations: • ALL ROOF COVERINGS TO BE C• LASS"A"OR BETTER 1. I have.and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have readthe hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous .- air contaminants as defined by:the Bay Area Air Quality ManagementDi I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Cha .• '.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sec',s ns 25505,'25533,a ' 534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized age //W • APPLICANT CERTIFICATION Date:11-14-2017 / r-wr I certify that I have read this application and state that the above information is .CONST CTION LENDING AGENCY correct.I agree to comply with all city,and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, • judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. I understand my plans shall be used as public records. Licensed Signature Date 11-14-2017 CONSTRUCTION PERMIT APPLICATION r` COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION B, l,,. , `"�' • 10300 TORRE AVENUE • CUPERTINO CA 95014-3255 (408) 777-3228 • buil din g@CUIDertino.ora PEMIT,1B- L 'I - CUPERTINO REV# I DEF# ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION E T.1. ❑MEP E RE-ROOF ❑SWIMMING POOL/SPA PROJECT ADDRESS /y�� L4.9e-O Q I APN g (-3 _ OWNER NAM 1 mfr- MAAA-16.5s PFSQN'5 b —7�// E-MAIL STREET ADDRESS , (/�`/� CITY TATE,ZIP • ffei CCOONNTT/RACT�OR NAME ❑OWNER-BUILDER COMPANY NAME �7 LICENSE NUMBER J( LICENSE TYPE lif '07 5TREET0S SAA GG `nA.2 y 1✓ CeTE, ' /,a - A/� •I -MAIL PHONE BUS.LIC p 2-5-4Ct: K ❑ARCHITECT ❑OWNER.❑OWNER AGENT CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT CONTACT NAME E- AIL / 6hiepo 04_,tag_L ST *,.._ 1 •_,•• ,6„;ta....& /REE�5 f IP HONE a C./ lfl�`�'�`S �!/r£UJ�3CITY ATE/ 1i( --, /6- DECRIPTON 6-() ,jeINr1.F-FAMILY/DUPLEX ❑MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES A TOTAL NET SF USE TYPE OCC , SQ.FT. • VALUATION(5) REMODEL REMODEL KITCHEN REMODEL OTHR ' GARAGE ❑ATTACHED BATHROOM SF SF ' SF SF ❑DETACHED EXISFIREIS SPRINKLERS 0 NO EICHLER 0❑ YES SECOND STORY ADDITION D YES 0 NO DWELLING- SECOND DWELLING D yEs 0 ATTACHED❑DETACHED OTHER UNITSI UNITADDITON: ' ❑NO 5F 'POOLS 0 FIBERGLASS ❑,VINYL-LINED 0 GUNITE ❑PREFABRICATED , ,POOL-SF SPA-SF ' 1 SPA ATTACHED❑YES 0 NO I TOTAL-SF / ' /• / REsE1BY (TOTAL VALUATION: Canuutrtiul or Multi-Family Buildings'with Pu61ir5ri�inuninq Pools requires Dem9ment of-Environmental anurm�- ,l\,1J RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES Q WOOD SHINGLES Q TILE OTHER(SPECIFY) REMOVE/REPLACE Q NO IF NO (PLYWOOD ❑2" ❑3/6" ' PLYWOOD TYPE: PITCH: ROOF CLASS DYES F OF LAYERS ' fl THICKNESS D 5/8" OTHER DOSS ❑CDX OTHER •12 A PROPOSED ROOF TYPE:OBUILT-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES OWOOD SHINGLES 0 OTHER *Provide a signed copy of the Cupertino's Tear-Off Policy SF sof 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 a • orize representatives of Cupertino to enter the above-identified1property for inspection purposes. I acknowledge an• a p. ze all i• ormation on -fined . this application form . .. to be made available for public record. / / Signature of Applicant/Agent:�, ' E I , . Date: /7' /r/ 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. i*Commercial Buildings: Prot%ide,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 Bldg,4pp_20/7.doc revised 08/01/17 CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems(formerly CF-1R7ALT HVAC) (Page 1 of 3) Project Name: JON GROSSMAN Date Prepared: 2017-10-12 A.General Information CF1R-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit.When multiple dwelling units must be documented,use one CF1R-ALT-02 document for each dwelling unit. 01 Project Name JON GROSSMAN02 Date Prepared 2017-11-14 03 Project Location 802 CANDLEWOOD DRIVE 04 Building Type Single family ` -.06 DwellingUnit Name HOUSE 05 CA City Cupertino -m P`4 i ,_ 07 I Zip Code 95014 Oa Dwelling Unit Conditioned 1• 259 ----:: '-'7.-----,''' Floor Area(ft2) .,F,:u r 7 in 117-7, Number of Space 09 Climate Zone 4 ; ,m `�-10 Conditioning(SC)Systems in 1 '-` this Dwelling Unit: I B.Space Conditioning(SC)System Information i ij a ` i 01 -02 - --- -03 04',2---.,---- V---1105'4_!'f--,--- I.,'-----, 0 '` I 07 08 09 10 Is the SC ulnstal nga, ,Pc s3''t:c intien I.I.,, . SC System SC System CFA served systeMt"jal-ri refrigerant Installing new SC' Installing Installing Installing Identification or Location or Area by this SC ducted containing system more than 40 entirely new entirely new Name Served System(ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type SYSTEM 1 LOCATION 1 . 1259 Yes Yes Yes Yes No No Altered space conditioning system C. Extension of Existing Duct System,Greater Than 40 Feet(Section150.2(b)1Diib) This section does not apply to this project. Registration Number:417-A020128366A-000-000-0000000-0000 Registration Date/Time:2017-11-14 15:53:56 HERS Provider:CHEERS CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-11-14 15:53:57 Schema Version:rev 10/16' CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 2 of 3) D.Altered Space Conditioning'System (Sections 150.2(b)1E and F) 01 02 03 04 05 06 07 08 09 10 11 12 Heating Cooling System Heating Altered Heating Minimum Altered Cooling Minimum Required New or Identification System Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat Replaced New Duct or Name Type Components Type Value System Type Components Type Value Type Duct Length R-Value All new All new Central gas Central split Greater than SYSTEM 1 furnace heating AFUE 0.8 AC cooling SEER 14 Setback 40 feet R-6 components components Required Documentation: "'',_; CF2R-MCH-01-E-Space Conditioning Systems i ` " y -Duct insulation requirement for the new portions of supply-air and return-air ducts or plenums Rfi(CZ 1 10 12 and13)and R8(CZ 11 and 14-16) CF2R and CF3R-MCH-20-H-Duct Leakage Test required when heating or cooling components are installed m ducted:systems,or when more than 40 ft of duct length is replaced -Leakage rate compliance:<=15%or<=10%leakage to outside,or seal all accessible leaks. Y..r>„ J �—i<J 5 _ CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containingcomonentsareinstalled or altered(applicable in CZ 2,8-15). CF2R and CF3R-MCH-23 Airflow Rate>=300 CFM per ton required when MCH-25 is required. - —5 /: Exceotions: -Duct systems registered with HERS provider as previously sealed are exempt from MCH-20 Duct Leakage'Testing requirements. -Heating-only systems and Air Handler Furnace changes do not require verification of Air Flow MCH-23,or Refrigerant Charge MCH-25. -Existing duct systems constructed,insulated or sealed with asbestos are exempt from MCH-20 Duct Leakage Testing requirements. r ' E. EntirelyNew or Complete Replacement Duct System, r:-.-r-- ..,...1.,,, ith or w thoutE' ui ment Chan eout(Sections 150.2 b 1Diia and 150.2(b)1E, p p Y y ',7,:::0-,A,----,r q p 6 3g�.pit� ( ) F) le.i, t-o-lyr)1'��i y!...svii... w-p., I .1;._!fft This section does not apply to this-project. F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C) This section does not apply to this project. Registration Number:417-A020128366A-000-000-0000000-0000 Registration Date/Time:2017-11-14 15:53:56 HERS Provider:CHEERS CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-11-14 15:53:57 Schema Version:rev 10/16 r CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 3 of 3) Documentation Author's Declaration Statement 1. I certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: • Documentation Author Signature: April Rodriguez ApribRodrlguele Company: Signature Date: I Permit E Raters 2017-11-14 Address: CEA/HERS Certification Identification(if applicable): 31225 La Baya Drive City/State/Zip: yl^ ,Phone: Westlake Village CA 91362 ''';', ;li .;818_735-7876 Responsible Person's Declaration statement 1 '' __ I' I certify the following under penalty of perjury,under the laws of the State of California: ` 1. The information provided on this Certificate of Compliance is true and correct. _ - 2. I am eligible under Division 3 of the Business and Professions Code to accept responsibiIiit'y forthe building design or system design identified on this Certificate of Compliance(responsible designer). 3. That the energy features and performance specifications,materials,components,and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24,Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents,worksheets, calculations,plans and specifications submitted to the enforcement agency for approval,with this building permit application. 5. I will ensure that a registered copy of this Certificate of Compliance'shall be madevailatiln`with the tiuilding:permit(s)-issued for the building,and made available to the enforcement agency for all applicable inspections.I understand that a registered copy of this Certificate of Compliance is requireifto belnc`luded with'the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: — Responsible Signature: L nd Rose R'coi gi il'•; Y Y Company: Date Signed: On-Time Air Conditioning&Heating Inc dba Service Champions 2017-11-14 Address: License: 7020 Commerce Drive 817040 City/State/Zip: - Phone: - Pleasanton CA 94588 925-444-4444 Digitally signed by CHEERSTM. This digital signature is provided in order to secure the content of this registered document, and in no way implies Registration Provider responsibility for the accuracy of the information. Registration Number:417-A020128366A-000-000-0000000-0000 Registration Date/Time:2017-11-14 15:53:56 HERS Provider:CHEERS CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-11-14 15:53:57 Schema Version:rev 10/16 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1763 802 CANDLEWOOD DR CUPERTINO,CA 95014-4653(369 19 033) ON-TIME AIR CONDITIONING& HEATING INC PLEASANTON,CA 94588 OWNER'S NAME: RUDD BARBARA 0 TRUSTEE DATE ISSUED: 10/12/2017 OWNER'S PHONE:408-507-7411 PHONE NO:(925)872-7326 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-20 Lic.#817040 Contractor ON-TIME AIR CONDITIONING&HEATING INC Date 09/30/2019 X BLDG _ELECT _PLUMB X MECH X RESIDENTIAL_COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: REPLACE FURNACE&COIL-SAME LOCATION;INSTALL(N)AC I hereby affirm under pe.• ty of perjury one of the following two declarations: UNIT-SIDE YARD 1. I have and •ill maintain a certificate of consent to self-insure for Worker's Comp- sation,as provided for by Section 3700 of the Labor Code,for the • ormance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance,as provided for by • Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: 'Valuation:$16700.00 APPLICANT CERTIFICATION • I certify that I have read this application'and state that the above information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 369 19 033 representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree tosave indemnify and keep . -ss the City of Cupertino against liabilities,-judgments,costs,a • - penses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in corisequence of t..- ranting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and =- comply with all non-point source regulations per the Cupertino 'cipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. IAA o a'erre Date 10/12/2017 Issued by:Abby Ayende Date: 10/12/2017 41,OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date: 10/12/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1.. I have and will maintain a Certificate of Consent to self-insure for Worker's - Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I-will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section,25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit haza s air contaminants as defined by the Bay Area Air Quality Manageme- i'strict I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code ' apter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, , h 25505,25 . ,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. otiGher or authorized agent:/. APPLICANT CERTIFICATION • Date: 10/12/2017 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. I understand my plans shall be used as public records. Licensed Signature Date 10/12/2017 CONSTRUCTION PERMIT APPLICATION \ ' B COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION .. 10300 TORRE AVENUE • CUPERTINO CA 95014-3255 1 5rc° • 2'06 riCe3 . r • (408) 777-3228 • huilding�?cupertino.or PEMIT#B- CUPERTINO REV# DEFir ❑ NEW CONSTRUCTION ❑I ADDITION ❑ALTERATION or; APN ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA PROJECT ADDRESS ?� C /� 'I ©�d APN I �1 a ''- 1^ _ OWNER NAME �l//1 LCL/ PH NE `,J I V rI(/lr E-MAIL/t l'N 50 v. &itvc 5 W�a-h- :,0 -:-Y!/ STREET ADDR CITY,STATE,ZIP pQNTRACTOR.NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE x[75ISTREE DDRESS • eloo 'sA n JJ� r` Q E, ZIP 4, 4, /'v YfG I yr-MAIL aohi ' ✓['v- PHONES l= BUS.LICA C✓ ? 9i,6-7s3-Vs ❑ARCHITECT ❑OWNER ❑OWNER AGENT CONTRACTOR AGENT 0 ENGINEER❑DEVELOPER 0 TENANT ' ' CONTACT NAMEE AIL ii led ;47,r,fez&yes,...44 STREESS C � TP NE Jtt ( ° elDS (,e ,' (d�a- C -aWa .6- DECRIPTON - E00 G ►t rttALtafJe- a ovk eId J aoi add qk 3 i54 -Qe47____ (Lie- 7cie ,tom - ❑SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL ❑COMMERCIAL I :EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES I TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5) J REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED r'� BATHROOM SF SF SF SF 0 DETACHED ilk V°,. EXiSTNG 'CI YES EICHLER I: YES, SECOND STORY ADDITION ID YES (FIRE SPRINKLERS❑ NO 0 NO ❑NO I1DWELLINC SECOND DWELLING ❑YES ❑ATTACHED DETACHED OTHER lumisII UNITADDITON: ' ❑NO SF POOLSI 0 FIBERGLASS ❑VINYL-LINED ❑GUNITE ❑PREFABRICATED I POOL-SF SPA,-SF ' ; I j SPA ATTACHED El YES 0 NO I TOTAL-SF RECEIVAD BY: TOTAL VALUATION: 'Commercial or Multi-Familu 6uildmps with Public'Swimrnin¢Pools requires Department of Environmental Heath approval rU Ori //n�,DN❑ p ,DQ A�� 17U0 RE ROOFI EXISTING ROOF TYPE:i,;O BUILT-UP ROOF❑ASPHALT SHINGLESE WOOD SHAKES❑WOOD SHINGLES TILE OTHER(SSPECIFY) f l REN'IOVE/REPLACE❑NO IF NO ' : PLYWOOD El 1/2" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS ❑YES #OFLAYERS THICKNESS❑5/8" OTHER ❑OSB E CDX OTHER °12 A PROPOSED ROOF TYPE:OBUILT-10,ROOF DASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES ❑OTHER [PROPOSED a signed copy of the'Ciupertino's Tear-Off Policy SF Sof SQUARES Byimy signature below I certify to each of the following: I am the property owner. .uthorized agent to act on the property owner's behalf. I have read this application'and-the information I have provided is correct. I h. 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 construction. I authorize representatives of Cupertino to ;enter the above-identifiedproperty'for inspection . _: I ackn• edge and authorize all information contai led on t s application form fipto be made available for public record. n ;Signature of Applicant/Agent. --r ./__ _ Date: V 2-' y SUPPLEMENTAL INFORMATION REQUIRE :,*New SFD/Second DwellingUriits/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 „ '1 'II, ;' ' I ' 4 ` BldgApp_2017.doc revised 08/01/17