B-2018-0788 CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT®BUILDING DIVISION
10300 TORRE AVENUE®CUPERTINO,CA 95014-3255
(408)777-3228® building@cupertino.org PEMIT NB- G DI7Y-) 1 TX7
CUPERTINO REV# DEF#
❑NEW CONSTRUCTION ❑ADDITION ALTERATION❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROIECTADDRESS2 O APN# / _�O O Q
OWNERNAME P ONH &MAIL `
duel te- �[od IQU -221
STREETADDRESSCITY,STATE,ZIP
75�CONTRACTOR NAME ❑OWNER-BUILDER I COMPANY N {-Fp Vd b i e, LICENSE NUMBER LICENSE TYPE
Wal er Heater-J �q2-131p C' l
STREETADDRESSCITY,STATE,ZIP
28353" # Acca �l !3
E-MNL PHONE BUS.L C#
Q✓m ifi a wh�, c� � °3 . - s 2-
❑ARCHITECr ❑OWNER DOWNER AGENT CONTRACTOR AGENT❑ENGINEER❑DEVELOPER❑TENANT
CONTACT NAME E-MAIL
STREET ADDRESS �r 3 S /R-f'/-�%r� CITY,STATE,ZIP PHONH
� c a 35P s_s3 — loft
DESCRB'TON
w i
r o a
ct o
I"ASINGLE-FAMILY/DUPLEX ❑MULTFFAMILY ❑INDUSTRIAL ❑COMMERCIAL
EXISTINGUSE EXISTINGSF NEWFLODRSF PORCH SP I DECK5P DEMO SP STORIES TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODGL KITCHEN REMODEL OTHUt I GARAGE EJ ATTACHED
BATHROOM SF SF SP SF ❑DETACHED
EWING ❑— BtOHLHR ❑YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS❑NO ']NO ❑NO
DWELLING SECONDDWELLING E]YE•S[]ATrACHED❑DETACHED OTHER
UNITS# UNITADDITON: EINO BI-
7B!RGLLASS
INBBRGLASS❑VINYL-LINED❑GUNTTE ❑PREFABRUCATED
POOL-SF SPA-SP_ SPA ATTACHED[IYES ❑NO TOTAL-SF
IVED BY: TOTAL VALUATION:
Com—d,l ar Multi-&.ft Buildings with Public Swimming Pools requires D,,,,b.nt o(Envirronmental H,,th,op—1 1
RE-ROOF EXISTINGROOFTYPE: E]BUILT-UP ROOF E]ASPHALT SPBINGLES❑WOOD SHARES❑WOOD SHINGLES[_]TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO IF NO PLYWOOD ❑w ❑3/8" PLYWOOD TYPE: PITCH: ROOFCLASS
®YES #OF LAYERS THICKNESS E]51r OTHER ❑OSB [:] TH
COX OER —•12 A
PROPOSED ROOF TYPE:OBUB.T-UPROOF DASPHALTSHINGLES❑wOODSHAKEs OWOODSHMGLES❑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. 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
B1dgApp_2017.doe revised 08101117