B-2018-1743 APPLICATIONCONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE -• CUPERTINO, CA 95014-3255
��1 I (408) 777-3228 • building@cupertino.orQ PEMIT #B - 2 -
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION N ADDITION ❑ ALTERATION ❑ T.I. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS 2 /+. _ ,}..t �+4 APN n
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OWNER NAME Y I U J 1 LE W PHONE
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E-MAIL Zhu +i — `e ^ �sn , 60
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STREET ADDRESS ��'
t CITY, STATE, ZIP �
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rCONTRACTOR NAME ❑ OWNER -BUILDER COMPANY
NAME
LICENSE NUMBER LICENSE
TYPE
STREET ADDRESS
CITY, STATE, ZIP
E-MAIL
PHONE BUS. LIC #
❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT ❑ CONTRACTOR AGENT ENGINEER ❑ DEVELOPER ❑ TENANT •Z (.'l.... Q
CONTACT NAME
t_,'m o, [. ('M
E-MAIL
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STREET ADDRESS
TTy,STATEE,, ZIP V PHONE
DESCRIPTON
4-o S 3 sa s i vi'r, S' a,� a, Q
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❑SINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY []INDUSTRIAL []COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
I EXISTING SF
NEW FLOOR SF
PORCH
SF DECK SF
DEMO SF
STORIES #
TOTAL NET SF
REMODEL
BATHROOM SF
REMODEL KITCHEN
SF
REMODELOTHR GARAGE
SF SF
❑ ATTACHED
❑ DETACHED
FIRE IING El YES SPRINKLERS [I NO
EICHLER ❑❑ YES NO
YES
SECOND STORY ADDITION ❑❑ NO
DWELLING SECOND DWELLING ❑ YES ❑ ATTACHED[] DETACHED I OTHER
UNITS # UNIT ADDITON: ❑ NO S F
POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL - SF SPA - SF SPA ATTACHED ❑ YES ❑ NO TOTAL - SF
Commercial or Multi -Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval
IVED BY:
TOTAL VALUATION:
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RE -ROOF
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES❑ WOOD SHAKES ❑
WOOD SHINGLES ❑ TILE OTHER (SPECIFY)
REMOVE /REPLACE ❑ NO
El YES
I IF NO
# OF LAYERS
PLYWOOD ❑ '/�" ❑ 3/8"
THICKNESS ❑ 5/8" OTHER
PLYWOOD TYPE:
❑ OSB ❑ CDX OTHER
PITCH: �1
-12
ROOF CLASS
A
PROPOSED ROOF TYPE: ❑BUILT-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: �2 ZO! Q
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
BldgApp_201 7. doc revised 08101117
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