B-2016-1153 ApplicationCUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300TORRE AVENUE • CUPERTINO, CA 85014-3255
(408) 777-3228 - FAX (408) 777-3333 - building a cuoertino.ora
❑ NEW CONSTRUCTION El ADDITION .'9ALTERATION / TI ❑ REVISION / DEFERRED ORIGIN.AL PERMIT
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OWNER ❑ OW TF.-RUI DER ❑ Og7vLR AGEh7 ❑ CONTRACTOR ❑ COMPACTOR P.OENT F.RCM7-.CT El ENGA-cR ❑ DEVELOPER ❑ TENANT
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DESCRIPTION OF WORK
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VALUATION (S)
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AREA NEW FLOOR
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REMODELAREA REMODELAREA REMODEL AREA
PORCHAPPA DECKAREA
TOTALDECK/PORCHAREEA
GF.RAGE AREA: X ETACH
% ACI
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m DUELLING UnTPS:
1SASECONDUNIT ❑YES
SECOND STORY ❑Y-S
BEING ADDED? �0
ADDITION?
PRE APPLICATION ❑ YES IF YES, PROVIDE COPY OF I
PL/.NN711G.4PP1: ❑NO PLATT'Il�G APPROVAL LETTR
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TOTAL VALUATION: _l
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By my signature below, I certify to each of the fcllowine: I am the propery orsmer or authorized eeent to act on the property owmer's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Rrork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin - o ilding can tnI on. 1 authorize representatives of Cupertino to enter the above-identi5ed property for inspection purposes.
Signature of Applicant/Agent: s- �_ Date:
SUPPLEMENTALINFOR1,4ATIONREQUIRED
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New SFD or Multifamily dwellings .Apply for demolition permit for
❑ORiCOL�IER
BSRLDL�GPLAn Rar{UEw-
existing building(s). Demolition pemlit is requrred poor to Issuance of builamv
- permit for new building.
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_ Commercial Eldgs• Provicieacompleted Hazardous Materials Disclosure
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Pu-sL� svGRTcs, �_
iOM if any Hazardous Materials are being used as pert of this project.
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r�4ARGE _ �4.�4v
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_ Copy of Planning Approval Letter or h4eeting with Planning prior to
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submittal of Building Permit application._-__4
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BldApp_2011.doc revised 06l21/11