B-2018-1773 APPLICATIONCONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 d
(408) 777-3228 • building@cupertino.org PEMIT #B - 20 [ D 12�3
CUPERTINOREV# DE_
❑ ❑ NEW CONSTRUCTION ADDITION ❑ ALTERATION I —I l I n %4EP n RE -ROOF El SWIMMING 13001 iCDe
PROJFCT.gDDRESS 1
l
OWNER NAME
PHON _
L1
E-MAIL
STREET ADDRESS _
1 U, CITY, STATE, ZIP
U J 6 � S1 i�l�� ���
1 0155
❑ CONTRACTOR NAME ❑ OWNER -BUILDER COMPANY NAME LrcF44SF NUMBER LICENSE TYPE
N"M e,Ir duo
STREET ADDRESS
CITY, STATE, ZIP
C
E-hLaIL Crc� rn , tc; , s � �z
To, cob - PHONE BU S. LICu
Ch nuw o�v e �o � curd � ZU ?, - I
❑ ARCHITECT ❑OWNER AGENT ❑ CONTRACTOR AGENT ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME j�r U � E-MAIL
1 Chc� 7 Chin �U►�
o n w� Ec��n
STREET ADDRESS A CITY, STATF, ZIF� ., PHONjE
1
V ' `t L U
DESCRII'TON
I
..1ur 0 3 U+1 ��i1 US . �
` I of - � (� b e 1" (01
❑SiNGLE-FAMILY/DUPLEX ❑MULTI -FAMILY ❑ INDUSTRIAL COMMERCIAL
L`SE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
I EXLSnNG SF NEW FLOOR SF
PORCH
SF DECK SF
DEMO SF
STORIES A
TOT.gL NET SF
REMODEL REMODEL KITCHEN
REMODEL OTHR
GARAGE ❑ .Ci'G�CIIFD
BATHROOM SF SF
SF
SF ❑ DEJACHH)
`
V
EXLSING ❑ YES
FIRESPRINKLERS ❑ NO
EICHLER ❑ YES SECOND
❑ NO
STORY ADDITION ❑ YES
❑ NO
DWELLING
SECOND DWELLING ❑ YFS ❑ ATTACHED DETACHED OTHER
UNITS s
UNIT ADDITION: ❑ NO S F
POOLSI ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL -SF SPA - SF SPA ATTACHED El YES ❑ NO TOTAL tiF
RECEI
TO AL VALUAT7ON:
Dmmmiid or Multi Family Buildings wifh Public Swimmin& Pools requires Department of Environmental Heath awroval
RE-Rooil
EXLSTTNG ROOF TYPE: ❑ BUILT UP ROOF ❑ ASPHALT SHINGLES❑ WOOD SHAKES ❑
WOOD SHINGLES ❑ TILE OTHER (SPECIFY)
REMOVE /REPLACE Q NO
IF NO
PLYWOOD ❑ A„ ❑ 3/8'"
PLYWOOD TYPE:
PITCH:
'12
ROOF CI .
❑ YES
t OF LAYERS
THICKNESS❑ 5/8" 077iER
❑OSB ❑ CDX OTHER
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 +tof 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 elating to building construction. I authorize representatives of Cupertino to
enter the above -identified property for inspection acknowledge and authorize all information contained on this application form
to be made available for public record. Date:_ ZP 7
Signature of Applicant/Agent:
SUPPLEMENTAL INFORMATION REQUIRE
*New SFD/Second Dwelling Units/Multifamily Dwellings: A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Disclosure form if any Hazardous Materials are being used as part of this
Buildings: Provide a completed Hazardous Materials 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
r /
,77V l — Z G, 2 BIdgAPP 2017.doc revised 08101117
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