B-2018-1762CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-?"028 • building@cupertino.or PEMIT #B -2-1!5)(V
CUPERTINO
❑ NEW CONSTRUCTION M ADDTTTnN I X I AT TFR ATTnXT M 1 T n . .n
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APN #
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ElCONTRACTOR NAME ❑ OWNER -BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
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STREET ADDRESS CITY, STATE, ZIP
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E-MAIL PHON BUS. LIC #
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❑ AR ECT ❑ OWNER 0 OWNER AGENT ❑ CONTRACTOR AGENT ENGINEER ❑ DEVELOPER ❑ TENANT
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CONTACT NAME
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DESCRIPTON kI
;MNGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
nnEXISTING SF NEW FLOOR SF
LI ��
PORCH
SF I DECK SF
I DEMO
SF I STORIES #
TOTAL NET SF
REMODEL REMODEL KITCHEN
REMODEL OTHR
ISF
GARAGE ATTACHED
BATHROOM SF SF
SF
DETACHED
EXISG ❑YES
FIRE S
FIRE SPRINKLERS ❑ NO
SECOND
EICHLER YES13
❑ NO
STORY ADDITION 0 NOS
DWELLING
SECOND DWELLING ❑ YES ❑ ATTACHED ❑ DETACHED OTHER
UNITS #
UNIT ADDITON: ❑ NO S F
POOLS
❑ FIBERGLASS ❑ VINYL -LINED GUNITE ❑ PREFABRICATED
POOL - SF SPA - SF SPA ATTACHED 13 YES ❑ NO TOTAL - SF
Commercial or Multi -Family Buildings with Public Su immink Pools requires Department e[Environmental Heath apyroval
CEIVED BY:
TOTALYALUATION:
RE -ROOF
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑
WOOD SHINGLES ❑ TILE , OTHER (SPECIFY)
REMOVE /REPLACE ❑ NO
IF NO
PLYWOOD ❑'�z" ❑ 3/8"
PLYWOOD TYPE:
PITCH:
ROOF CLASS
❑ YES
I # OF LAYERS
THICKNESS ❑ 5/8" OTHER
❑OSB ❑ CDX OTHER
• 12
A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF DASPHALT 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 1*9,Wction purpo s. I acknowledge and authorize all information contained on this application form
to be made available for public recor .
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
BldgApp_M 7. doe revised 08101117