B-2019-0034 applicationCONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
_ 1 I (408) 777-3228 • building@cupertino.org PEMIT #B -_ - V U
CUPERTINO REV # DEF #
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION ❑ T.I. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS
fl YA
9—
APN #
OWNER NAME o (P � PHO
(� V A
E-MAIL
STREET ADDRESS
;STATE, ZIP
0 CONTRACTOR NAME ❑ OW NER-BUILDER
NY NAME
LICENSE NUMBER LICENSE
TYPE
JORGE BECERRA
7AWHAP
1627368 C-36
STREET ADDRESS
CITY, STATE, ZIP
28358 CONSTELLATION RD.
VALENCIA, CA 91355
E-MAIL
PHONE BUS. LIC #
jorge@awhap.com
(855)345-9048 400652
❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT ❑ CONTRACTOR AGENT❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP PHONE
DESCRIPTON
O%
R & R GALLON WATER HEATER
SAME LOCATION= '1
❑SINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
I EXISTING IF
NEW FLOOR IF I
PORCH
IF DECK IF
DEMO IF
I STORIES #
TOTAL NET IF
REMODEL
REMODEL KITCHEN
REMODEL OTHR GARAGE
❑ ATTACHED
BATHROOM IF
IF
IF SF
❑ DETACHED
EXISING ❑ YES
EICHLER ❑ YES
SECOND STORY ADDITION []YES
FIRE SPRINKLERS ❑ NO
❑ NO
❑ NO
DWELLING []YES [:]ATTACHED[] DETACHED OTHER
ISECONDDWELLING
UNITS # UNIT ADDITON: ❑ NO S F
POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL - IF SPA - IF SPA ATTACHED ❑ YES ❑ NO I TOTAL - SF
RDB
I
TOTVALUATION:
Commercial or Multi -Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval
`4�dun _/ I I /�-_]
� ((��VV
RE -ROOF
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES Q
WOOD SHINGL 1] OTHER (SPECIFY)
REMOVE /REPLACE Q NO
IF NO
PLYWOOD ❑'h" ❑ 3/8- PLYWOOD
TYPE:
PITCH:
ROOF CLASS
❑ YES
1 # OF LAYERS
THICKNESS Q 5/8" OTHER
❑ OSB ❑ CDX OTHER
.12
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 in cti urposes. I acknowledge and authorize all information contained on this application form
to be made available for public record.
Signature of Applicant/Agent: Date: 1-7-2019
SUPPLEMENTAL INFORMATION RE Q RE
*New SFD/Second Dwelling Units/Multifa ily D ellings: A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a complet H ardous 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