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B-2016-2415 ApplicationCONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ("/+/A' (408) 777-3228 • building •?cupertino.org PEMIT CUPERTINO REV >~J__ DEFT ❑ NEW CONSTRUCTION ❑ ADDITI>N ALTERATION T.I. ❑ MEP ❑ RE -ROOF []SWIMMING POOL/SPA ?IECT ADDRESS -2c7 Z 7 �� D � 4,V9— APN i Vwrvtic rvAMC %� �� I'nUrvC '/L[ --MAILfeW/ N1Z V4V li /� _{/�� r�GH/l STREET ADDRESS /4,0_3 AL Q _3 4N4�---�� CITY, STATE, ZIP CONTRACTOR NAME ❑ OWN ER -BUILDER COZ MANY NAME LICENSE NUMBER LICENSE TYPE STREET ADDRESS 3L562lNrS CITY, STATE, ZIP � Q E-MAILPHONE BUS. LIC x J ��h0� �t ? = 0&—m—!�'�Z- ❑ ARCHITECT [)OWNER . OWNER AGEI-Ok AGENT ENGINEER ❑ DEVELOPER ❑ TENANT CONTACT NAME E-MAIL / !F s,1,W1,4*i'7�""� STREET ADDRESS CITY, STATE, ZIP C�49�/ 71 © ECRIPTON Aw, - (1) date/ "riF /v 07v7 1 ase�aryz pgraR �. TV /ArDf F4Z 1 Ww% R4 r 11 1, ❑SINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL USE TYPE OCC SQ.FT. VALUATION (5) EXISTING USE I EXISTING IF I NEWFLOORSF I PORCH IF I DECK SF 1 DEMO IF I STORIES) TOTAL NEI IF REMODEL REMODEL KITCHEN REMODELOTHR GARAGE ❑ ATTACHED BATHROOM IF IF SF IF ❑ DETACHED EXISING ❑ YES FIRESPRINKLERS ❑ NO EICHLER ❑ YES SECOND ❑ NO STORY ADDITION [:]YES ❑ NO DWELLING SECOND DWELLING ❑ YES ❑ ATTACHED❑ DETACHED OTHER UNITS I UNIT ADDrrON: ❑ NO 5 F I POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED POOL - IF SPA - IF SPA ATTACH ED 0 YES ❑ NO TOTAL - SF Cmmmurcial or MuI1i-Family avildinys with Public 5winmiing Pools renuires Drnarfinent offnvirmmurnla) Hralh aohrvnal114 RE D BY: &A TOTAL VALUATION. f RE -R O OF EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑T13E OTHER (SPECIFY) REMOVE /REPLACE F] NO IF NO 3/8" PLYWOOD ❑ t [33/8"I—I—_ P PITCH: 12A ROOF CLASS []YES ! OFLAYERS THICKNESS ❑ 5/8" OTHER ❑OSB ❑ CDX OTHER PROPOSED ROOF TYPE: ❑BLRLT-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 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: l SUPPLEMENTAL INFORMATION REQUIRED "Flew 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 B/dgApp_2017.doc revised 08/0 1/17 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 •FAX (408) 777-3333 • buildinc(O�cugertino.org 1e3 s O 6 .LC/ Lb NEW CONSTRUCTION I—I ADDITION n ALTERATION/TI F— REVISION/DEFERRED ORIGINAL PERMIT !# I PROTECT ADDRESS `�.. \� /j. -V (ir/'t/ APE# PJ y . / `/ D f I I OWNE NAME L PHO ) E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAMF. Ij P ON8 &MAIL STREET ADDRESS .I-. -CONT CITY, STATE, ZIP - FAX El OWNER LlOWNER-BUILDER11OWNERAGEN'r El RACTOR 11 CONTRACTOR AGENT CHITECT ❑ ENGINEER ❑ DEVELOPER El TENANT CONTRACTOR NAME I LICENSENUMBER LICENSETYPE EUS. LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCIiITEC4/�N�ER NAME 11 LICENSE,NUP BER BUS, TIC 1�- COMPANYNAM\ E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK p� y EXISTIN USE PROPOSED US .y^ CONSTR.TYPE #STORIES USE TYPE OCC, SQ.FT. VALUATION ? " r , • // l' ($) EXIS G AREA NEWFLOOR I DEMO AREA AREA TOTAL NET AREA 0 .L BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODEL AREA ORCH AREA DECK AREA TOTAL DECK,VORCH AREA -377-- GARAGE AREA: Cl DETACH �� ATTACH #DWELLINGUNITS: ISASECONDUND' ❑YES SECOND STORY ❑YES DEINGADDED? E]NO ADDITION? ElNO PRE- APPLICATION DYES IF YES, PROVIDE COPY OF I ISTHE BLDG AN E] YES -":: KE TOTAL VALUATION: PLANNMGMPL# E]NO PLANNING APPROVAL LETTER I EICHLERHOME? E]NO V 11 By my signature below, I certify to each of the following: I am the property er at authonzeda ge on t r owner's behalf l have read this application and the information I have provided is eonect. I have read the Description of Wok an v n accurate, I agree mply with all applicable local ordinances and state laws relating to builddiimp construction. I authorize representatives ofCuperti enter the above-ide Ified property for inspection purposes. Signature of Applicant/Agent: y / Date: (J --�- -- L/ SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECR TY E " ROUTING SLIP ❑ Txe '" ❑ auamrvc New SFD or Multifamily dwellings: Apply for demolition permit for _ existing building(s). Demolition permit is required prior to issuance of building ovER cotmxER PLeliy aEvlEw permit for new building. EI -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 ":" ❑ elaE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior toLi ❑ submittal of Building Permit application. MAJOR EWER SANITARY Sewell msTmcT ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06121111