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B-2018-0933 (2) CONSTRUCTION PERMIT APPLICATION 1 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255 rnf ,G (408) 777-3228 • buildin„;r�pertino.orQ PEMIT#B- ( - ,`� - Lj CUPERTINO REV# DEF# ❑ NEW CONSTRUCTION ❑ADDITION 4ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMIVIING POOL/SPA PROJECT ADDRESS O /�� �%� C 1 APN#01 o - ,g 9 - D OWNER NAME �` PH N ✓� E-MAIL o ® e.?�'2 ZS'6 STREET ADDRESS CITY, STATE,ZIP © 1 V ,G'2�h o �-S'O ❑CONTRACTOR NAME ER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE a 14 t 6 !3 STREET A DRESS CITY,STATE, ZIP E-MAIL PHONE BUS.LI # �- -/,i S-1 D -6-2-z 1 V / ❑ARC ECT ❑OWNER OWNER AGENT EaCONTRACFOR AGENT El ENGINEER❑DEVELOPER ❑TENANT CONTACT NAME E-MAIL STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTON ❑SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY ❑INDUSTRIAL VCOMMERCIAL EXISTING USE I EXISTING SF NEW FLOOR SF I PORCH SF I DECK SF DEMOS S RIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($) REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED BATHROOM SF SF SF SF ❑DETACHED EXISING ❑YES EICHLER ❑YES SECOND STORY ADDITION ❑YES FIRE SPRINKLERS❑ NO ❑ NO ❑NO DWELLING ISECONDDWELLING []YES ❑ATTACHED❑DETACHED OTHER UNITS# UNIT ADDITON: ❑NO S F POOLS ❑FIBERGLASS ❑VINYL-LINED ❑GUNITE ❑PREFABRICATED POOL-SF SPA-SF SPA ATTACHED❑YES ❑ NO TOTAL-SF RECEIV ON: Commercial or Multi-FamilyBuildings with Public Swimming Pools requires DMartmewt of Environmental Heath approval RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY) REMOVE/REPLACE❑NO IF NO PLYWOOD ❑Vz ❑3/8” PLYWOOD TYPE: PITCH: ROOF CLASS ❑YES I #OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER •12 I 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 inspectio urposes. I acknowledge and authorize all information containe on this pplication form to be made available for public record. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION UI *New SFD/Second Dwelling Units ultif Iry ellings:A Demolition permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a pleted 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.doc revised 08101117