08090137 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ,C i)NTRACTORINFa.13i 70RMATION
3'n k' 'I
BUILDING ADDRESS: PERMITNO.
22487 SANTA PAULA AVE WESTSHORE ROOFING INC 08090137
OWNER'S NAME: PER.MTT W3E DATE
FROEBERG PETER L AND KATE C 2814 AIELLO DR C 09/22/2008
NE: SANITARY NO. CONTROL NO.
ARCHT2C(ENGINEER: BUILDING PERMIT INFO
RE-RF RMV EXTWD SHK INSTL BLDG EO m0 MO
uOp LICENSED CONTRACTOR'S DECLARATION
..
I hmffi
eby arm that l Am licensed under provisions of Chapter 9(commencing --._�.. .............. _ ._ _ .TAIL DC$CCJp[ion
E wire Sectietint )afDivWon7of me BusimssaM Profusions Cade.aM myllecnmu
w
in full farts aAal of s.
j�Z Liminal: 1^ comm CoDELL
ARCHITECTS DECLARATION
m 1 ueedcntsml my plans shall be used!as Public mCorm '
Ile
Licensed Professional .
3 OWNER-BUILDER DECLARATION
E I bereby If.Nal 1 Am exempt from mo Conusctor's Licenm Law for the
COO following mann.(section 103 1.5,Business aM Professiors Code:Any city or County
$ which Amquims A .it to ennswct aller.Impmw.m,nm lash,or mpoir any swctum
Prior to its issuance.also requires tie Applicant(orsuch permit to rile a signed SWICAI L
ECoGThat beAlicensed pursuant tommpmvisiomofthe Connector's License l..w(Chapmr9 Sq.Ft.Floor Area Valuation
y�h2 (commencing with Section 7(X)())of Division 3 ofmc Businnsand Professions Code)or
y`<-� mat he is exempt marefmm and the bas's for Alm alleged exemption.Any violation of
Sceton 70315 by say applicant fur A pcm1A subjects the applicant to a Civil pccalty of APN Number Occupancy e
not ewe man fim,hundred dollars(SM. P Y •Ty 7 P
Las owner .me property,re my atimemcns wire urge v ak(m.compensates,
will domework.and thestructure uetotinLMedaroffered awdotarsale(Sm.]014,"nor
and Professions Cade:The Conmctors License he Law don Out apply lf an pwmr of Required Inspections
propertywho
,prowimprovn Abemon,andwho me not intended
himselred WOAghhu
awn a however.
the wipfing or nproWmthatsuch impmwmwha art not seedbed maRered for sale.r-
bawews.Nerovete ades of imantumidwithin armleu Or(mproefar Alm owe of
builder MB have the dAnami of Proving that K did sus duW m improve(w purpose of
,ale.). .
Cl 1.As owner of use Property.Am exclusively contracting with licensed camrmtos to
Construct the project(See]ON,Business arta Profession Cade:)The CoaAraMrs Li-
mnm Law does raw apply to an owner of property who builds or improve Othman.and
who contracts for each projects with a con ancer(s)Iimnxd pursuant As the CmarmtoY,
License Law.
❑IameanmpAurtdm Set ,BkPCfwttismamo
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury am of the following dmluations:
1 haw and will maintain,comfiom of Consent As self-ileum far WerkersCompcn-
ntian,
As provided for by Section 37(K)of dm Lather Code,fur me perfmma c of the
week for which this permit u issued
❑I have real will maintain Workces Compensation luurance,As required by ScdwA
3700 of the Labor Cade.for tee performance ofthe Work for wbich this permit is issued. '
My Wortme,Compensation gaturamer artier and Policy number am:
Carver. CER/ PmicyNa:7603- ZOd8
TIFlGTE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissemlwe need Out Inc cmuplemd If the permit is forane hundo ddallN($I00)
or km)
I Certify mat in me performance of the work for which this Permit is issued.I shall not
employ any perm.in any manner so as to become subject to the Worken'Cwnp ocadon
Law,of Calif nnua.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Eaemption,you mould
become subject m the Wats m s Compensation provisions of the Labor Code,you most
.,O fOMwith comply with such previamis or mu Permit shall he dmmea Aewkcd.
CONSTRUCTION LENDING AGENCY
Ihereby affirm the mem is a mnsumunn leading a[mncy for the Performance of
LYi the week for which this RmiA u issued(Sec.3097,civ.C)
[21 Lendets Name
.7 z LaMef,Addcas
U Q I ceni(y that I ham read td,application and Aute that me Abuse information is -
ILa^. mmcL I agree to comply with all city and county oNiwcma and este laws relating to
.0 SV^ building Comuuction,and hereby mmmim¢premnthims of this city in enter upon me
W show-menudgm pmpcny for inspection
es purpoms
g3. (We)Agree to save,indemnify and Jump h.Im the City of Cupertino against
Z incoisequenco judgments.cons ing ex pensesmit. may in any way accrue Against Aid City
V APPLICANTeUNDEof the RSIANDS Aof AND WILL COMPLY WITH ALL NON-POINT Issued by: Date -0 6—
SOURCE,
REGULATIONS.
°t2 Re-roofs
ig u pp ACan on r
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me ap,Jim,or future dulling acevpant sem w Nndle hvudons material
As deRned by the Cupertino Municipal Code.Chapter 9.12,anal me"Cal And Safe,,
node.Smtia.235324)7All roofs shall be inspected prior to any roofing material being installed.
❑Tat No
Will Om applicant or future Wilding occupant use equipment Or devices which If a.roof is installed without firs[obtaining an inspection,I agree to remove
yveharudnns air contsmimns As defined by the Bay Area Air Quality Management all new materials for inspection.
❑Yrs No
I hers meet site hvao/mMoUlsmquitemcm under Chap crti.95 of theCalifor-
melicalthk Safety Cede,Secumn25305,25533 and 25534.1 understand thatifthe Wilding erA
don Amt cumody haw a mrom that IA u my responsibility to M61Y the occupant of oro ?,
mquiml.enm w It must to met ISN,Me Of a CertfKam Of QYa y.
Signature of Applicant Date
JSWIIE
waathari]2das D, All roof coverings to be Class'p."or better
CITY OF CUPERTINO
• 2 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35704052 . 00
DATE ISSUED. . . . . . . : 09/22/2008
RECEIPT #. . . . . . . . . : BS000006145
REFERENCE ID # . . . : 08090137
SITE ADDRESS . . . . . : 22487 SANTA PAULA AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : FROEBERG PETER L AND KATE C
ADDRESS . . . . . . . . . . : 22487 SANTA PAULA AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2715
RECEIVED FROM . . . . : BEN FOWLER
CONTRACTOR . . . . . . . : PAUL FOWLER LIC # 21417
COMPANY WESTSHORE ROOFING INC
ADDRESS . . . . . . . . . . : 2814 AIELLO DR C
CITY/STATE/ZIP . . . : SAN JOSE, CA 95111
TELEPHONE . . . . . . . . : (408) 694-0060
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 22, 500 . 00 2 .30 0 . 00 2 . 30 0 . 00
1REROOFRES SQ FEET 26 .50 344 . 50 0 . 00 344 . 50 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 346 . 80 0 . 00 346 . 80 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
Of 37
CITY OF CUPERTINO
REROOF
COF
'CUPERTINO PERMIT APPLICATION
APN # � 5 � O Y(' �� � � Date:
Building Address: 2 Z L 84 '50 r- M ect 14
Owner's Name: Pete Froebe13 Phone #: 8051
Contractor: V_,L-,5t2hoV�e KOdfiYjq i"G Phone #: (.�SG —a2oc7
Fax #: yS6 `0z33
Cupertino Business License #: •j I`,r-7 Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑. Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes A Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
o Other (Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report #
To be Removed ❑ Provide Mfgr. Installation Specs.
11 CYP sle�fi•
Job Description: �PV11Q1�2 2tT15� �'ny LWCk( J�j IGt� lV15m 11 30
445t'1 /1 Tea 15 PrdMe CRf5 B WW d 5VWi P�{ P-oof,
Ga
Residential /N Coinmercial ❑
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation: � Z Z) Soo
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Si re
Revised 6/16/08
CITY OF CUPERTINO
REROOF
C allior
CUPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
IREROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
2� 1REROOFRES Re-roof Residential B 1SFDWLROOF
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
IBSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08
•
Community Development Department
Building Division
City of Cupertino
10300 Tone Avenue
Telephone: (408)777-3228
Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 2007 IBC Standards
and manufacturers specifications on re-roofing. All roofs are Class "A"per Cupertino
municipal code 16.04.080.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City,the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
3) Final inspection approval.
• a) Spark arrester installation.
5. If plywood is installed,a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled
IMPORTANT:
1. Flat roofs must have a minimum of 1/a "per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: Fe 7 P fro e be-r�.
Job Site Address: - Z_ `1 n ay3 Sung Pa 1. I a //�I V.
Roofing Company Name: wefrShUVY VLC
Applicant's Signature: �2_ Dater
• Greg Casteel /
Building Official
Revised 07/30/08
Green Building Plan Check
Index of Green Building Points/Categories
A. Category Example of an Index or Table of Green Plan Sheet or Page Points
Building Points Categories that must be
shown and referenced on the Project
Plans See below
B. Site 9. Install H.E. Irrigation, (details/spec)' L-1 2 points
11. Permeable Paving, Note L-1 2 points
C. Foundation 1. Use 15% Flyash Concrete, (note) S-1 5 points
D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2 2 points
5. Use Truss with heels, (detail) S-2 2 points
6. B. OSB Sheathing, detail S-2 2 points
E. Ext. Finish 1. Composite Decking, (Note/Spec.) A-3 2 points
4. B. Fiber Cement Siding, (Note/Spec. A-4 2 paints
F. Plumbing 1. Insulate all H.W. pipes, (Note/Spec.) P-1 2 points
5. Tankless W.H., (Note/Spec.) A-2 2 points
11. A 2500 Gal. Tank, (Note/Spec L-1 10 points
G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 4 points
H. Appliances 1. Energy Star Dishwasher, (Note/Spec.) A-3 1 point
3. Energy Star Refrigerator, (Note/Spec. A-3 1 oint
P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS 40 points
•
Plan Review Process Work Book Page-12-Revised 3/25/08
Green Points Rating System for Remodeling Projects
Due to the diversity of remodeling project types,assigning a'total points'value to a project to be considered environmentally friendly is
• not feasible. However,25 measures have been highlighted to signify that every effort should be made to incorporate them into your
projects. These items have been chosen based upon their impact on the environment and the health of the home in coordination with
ease of implementation and relative low cost. These measures can be used as a starting point for'greening'your project.
INPUT Resources Enet_qy IAQIHeafth
A.Srte .
11.Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;BO%=4 points up to 4 Resource pts 0
2 Salvage Reusable Building Materials _ _ 4 Resource pts y=yes D
3. Remodel for Mixed Use,Adaptive Reuse,and
Historic Preservation 4 Resource pts y--yes 0
4.Protect Native Soil 2 Resource pts y--yes 0
5.Minimize Disruption of Existing Plants&Trees 1 Resource pt y=yes 0
6.Implement Construction Site Stormwater Practices 2 Resource pts y=yes 0
7.Protect Water Quality with Landscape Design 2 Resource pts y--yes D
IB.DesignResource-Ef6cient Landscapes and Gardens _ 4 Resource pts y=yes D
9.Reuse Materials/Use Recycled Content Materials
for Landscape Areas 2 Resource pts y=yes 0
10.Install High-Efficiency Irrigation Systems 2 Resource pts y=yes 0
11.Provide for On-Site Water Catchment/Retention 2 Resource pts y=yes 0
1 1 1
B.Foundation
1.Incorporate Recycled Flyash in Concrete
• 25%Recycled Flyash=2 points;Add 1 point for every 10%
increase of flyash,up to 5 points up to 5 Resource pts 0
2.Use Recycled Content Aggregate 2 Resource pts y=yes 0
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yesFI� 0
1 1 1
C.Structural Frame
,1.Substitute Solid Sawn Lumber with Engineered Lumber 3 Resource pts y--yes p
2.Use FSC Certified Wood for framing
(For every 10%of FSC lumber used=2 points,up to 10) up to 10 Resource pts. 0
3.Use Wood I-Joists for Floors and Ceilings 2 Resource pts y=yes 0
4.Use Web Floor Trusses 2 Resource pts y=yas 0
5.Design Energy Heels on Trusses 6'or more 2 Energy pts y=yes 0
6.Use Finger-Jointed Studs for Vertical Applications 2 Resource pts y=yes 0
7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes D
B.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0
9.Use Structural Insulated Panels(SIPS)
a.Floors 3 Energy pts y_yes 0
b.Wall 3 Energy pts y=yes D
Q.Roof 3 Energy pts y=yes D
10.Apply Advanced Framing Techniques 4 Resource pts y=yes 0
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y--yes p
12.Use OSB -- - -
a.Subfloors•
b.Sheathing Resource of y=yes p
1 Resource of y=yes p
1 1
r
n
xtenor Fims
1.Use Sustainable Decking Materials
, a.Recycled content 3.Resource pts y=yes 0 •
b.FSC Certified Wood 3 Resource pts y=yes 0
,2.Use Treated Wood That Does Not Contain Chromium/Arsenic ' 1 IAQ/Health pt y--yes 0
3.Install House Wrap under Siding 1 IAQlHealth pt y--yes 0
14.Use Fiber-Cement Siding Materials 1 Resource pt y=yes 0
E.Plumbing
1.Install Water Heater Jacket - - y, 1 Energy pt y--yes 0
2.Insulate Hot and Cold Water Pipes 2 Energy pts y=yes 0
3.Retrofit all Faucets and Showerheads with Flow Reducers
a.Faucets(1 point each,up to 2 points) Up to 2 Resource pts. 0
b.Showerheads(1 point each,up to 2 points) I Up to 2 Resource pts. 0
4.Replace Toilest with Ultra-Low Flush Toilets
(1 point each,up to 3 points) _ Up to 3 Resource pts. 0
Instal 5. Chlorine Filter on Showemead_ 1 IAQ/Health pt y=yas D
6.Convert Gas to Tankless Water Heater 4 Energy pts y=yes 0
7.Install Water Filtration Units at Faucets
(2 points each,up to 4 points) Up to 4 IAQ/Health pts. 0
B.Install On-Demand Hol Water Circulation Pump 4 Resource pts y--yes 0
I 1 1
r.trecmcai
i1 Install Compact Fluorescent Light Bulbs(CFLs)
(6 bulbs=2 points,10 bulbs=3 points,12 bulbs=4 points) Up to 4 Energy pts. 0
2.Install IC-AT Recessed Fixtures with CFLs(1 point each,up to •
5 points) Up to 5 Energy pts. 0
3.Install Lighting Controls(1 point per fixture,up to 4 points) Up to 4 Energy pts. 0
4.Install High Efficiency Ceiling Fans with CFLs
(1 point each,up to 4 points) Up to 4 Energy pts. 0
1 1 1
G.Appliances
1.Install Energy Star bishwasher 4 1 Energy pt y=yes 0
i2.Install Washing Machine with Water and Energy
(Conservation Features 1 Energy pt y=yes 0
!3.lnstall Energy Star Refrigerator 1 Energy pt y=yes 0
4.Install Built-In Recycling Center 3 Resource pts y=yes 0
1 1 1
H.Insulation
1.Upgrade Insulation to Exceed Title 24 Requirements
a.Walls 2 Energy pts y--yes 0
b.Ceilings 2 Energy pis Y--yes 0
2.Install Floor Insulation over Crawl Space 4 Energy pts y--yes 0
i3.Install Recycled-Content,Fiberglass Insulation witli
[No Added Formaldehyde 31AQ/Health pts y=yes 0
4.Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes . 0
5.Use Cellulose Insulation -
a.Walls 4 Resource pts y=yes 0
b.Ceilings 4 Resource pts y=yes C •
6.Altemative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes D
o.uellings 4 Resource pts y=yes 0
1 1 1
lNPU7r Resources Energy AO/Health
I.Windows
• �1.Install Energy-Efficient Windows
• a.Dduble-Paned 1 Energy pt y=yes 0
b.Low-Emissivity(Low-E) 2 Energy pts y=yas 0
c.Low.Conductivity Frames _ 2 Energy pts y=yes D
2.Install Low Heat Transmission Glazing 1 Energy pt y=yes D
1 1 1
J.Heating Ventilation and Air Conditioning
11.Use Du Mastic on All Duct Joints _._ 1 2 Energy pts Y--yesD
2.Install Ductwork win C
ithonditioned Space 3 Energy pts y_yes 0
3.Vent Range Hood to the Outside 1 A0/Health pt y=yes D
4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 7
0
5.Install Solar Attic Fan 2 Energy pts y--yes 0
6.Install Attic Ventilation Systems 1 Energy pt y=yes D
7.Install Whole House Fan 4 Energy pts y=yes D
B.Install Sealed Combustion Units
a.Furnaces 3 IAQ/Health pts y=yes D
b.Water Heaters 3 IAQ/Health pts y=yes 0
9.Replace Wall-Mounted Electric and Gas Heaters with
Through-the-Wall Heat Pumps 3 Energy pts y=yes 0
10.Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y=yes 0
11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yes 0
12.Install 9D%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pis y=yes 0
13.Retrofit Wood Burning Fireplaces
• a.Install EPA certified wood stoves/Ihserts 1 IAQ/Health pt y=yes 0
b. Install/Replace Dampers 1 Energy pt y=yes D
c.Install Airtight Doors 1 Energy pt y=yes 0
14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0
15.Install High Efficiency Filter 41AQ/Health pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes p
1 1 1
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes p
2.Install Solar(Nater Heating System 10 Energy pts y=yes p
3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes D
4,Install Photovoltaic(PV)System
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=1 B points) Up to IS Energy pts D
8.Select Safe andDurable Roofing Materials _ _ 1 Resource of y=yes 0
7 Install Rsd'iant Harrier 3 Energy pts y=yes 0
1 1 1
L.Natural Heating and Cooling
1. Incorporate Passive Solar Heating 5 Energy pts y=yes D
2,Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes 0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pis y=yes777
p
1 1 i
•
INPUT Resources Energy [AO/Hea Ith
M.Indoor Air Quality and Finishes
5.Use Low IJo VOC Paint 1 IAQ/Health pts y--yes0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes D •
3.Use LowMo VOC Adhesives 3 IAQ/Health pts y=yes D
4.Use Salvaged Materials for Inta or Knishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Inter or Uses 1 IAQ/Health pts y=yes 0
17:Seal all Exposed Particleboard or MDF_ _ 4 IAQ/Health pts y--yes 0
S.Use FSC Certified Materials for Interior Finish 4 Resource pts y--yes; 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y--yes D
10.Install Whole House Vacuum System 31Ao/Health pts y=yes D
1 e 1
N.Flooring
1.Select FSC Certified Wood Flooring B Resource pts y=yes 0
2.Use Rapidly'Renewable Flooring Matenals 4 Resource pts 'y=yes 0
3 Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes D
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
1 1 1
Total Points Available: 1 1401 130 57
Total Points Project Received: 0 0 0
G:datalprogsrgreenbuildingguidelineslremodele-/gree npointsfinal2.12.Nprprol`eel=.xls
•
Community Development
'ffivJ^ 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
45UPEkTINO
Building De artment
JOB ADDRESS: JGM, ,rvuu )� V. PERMIT #
b �o �o� 37
OWNER'S NAME: r,'P--fr F(oc.6ac.. PHONE # 6 v
GENERAL CONTRACTOR: ()# / — ,?3
I am not using any subcontractors:_
Signature Date
Please check applicable subcontractors and complete the following information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
• Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
� !%/a z
Owner/Contractor Signature Da e