Loading...
0808004310 a idE :gym y�2 4 3�G gWU �pC ase _zt �kyy�C 1�- C) z 2 V ILL G. �^ UC UC O LL �z CITY OJ' CUPERTINO BUILDING DIVISION PERMIT CON,TRA QR-INVVURMATV ION r3 BUI 1 G DRESS: PERMIT NO. I BRET AVE ABLE SEPTIC 08080043 OWNER'S NAME: PERMIT ISSUE DATE MARIAN GREENFEST P 0 BOX 24819 08/05/2008 IF NE: SANITARY NO. CONTROL NO. (408)377-9990 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH l� 0 LICENSED CONTRACTOR'S DECLARATION Job Description li¢ed under potrisioru of output 9 (commencing 1 hereby affirm But I am w with Seem.7") of Division 3afdte Business and Profesm. Code,and my liccmc is ADDING PROP LINE CLEANOUT in full farce and effect. License Clsss Lie M Date Comneor ARCHITECTS DECLARATION I undersand my plans shall M used as public records Learned Proclumttal OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following mason. (Section 7W 1.5, Business and Pmfeasion Code: Any city or county which res ems a Permit to concoct, aim, improve, demolish. or mpur my suuctute ! prior to its issuance. use mauims the applicant far Such permit to rile a signed awoment to Contncmr's License Taw 9 Sq. Ft. Floor Area Valuation that he is licensed poommt the provisions of the (Chapter (commencing with Section TD'JB) of Division 3 of the Business and PrafLL[IOrn COMJar $ 1000 I . Nat he b esempt tMmfmm and the his is roe the alleged exemption. Any Halation of 37510025.E Occupancy 'i'pe Seeder,TlnLsbystory ."ficantfour apermit subjects dtapplicant to.eivilpenalty ofNumber notmam Ran fico hundred d.11m.(SM. Q I,uwner of Ne peapemy.ormy wployer with wageauthe'u sok comPensation, Required Inspections will da the won, and decoration, i, nmimmmded m olkmd foreale (Sm. 7016, Biomass and Profession Code: The Contmmr's License law does not apply to an owner of . Property who builds or im proves d amen, and who does such work himself or through his own employer, provided that smh improvemmu art not intended medicated for sale If. however. the Wilding or ireprose,nrnt is mid within oro year of completion, the awner- builder will have Ne burden of paoving that he did not Wild or improsc for purpose of sale.). Cyl. u owner of the property, am exuv.ively contracting with licensed contractors to domwct the project (Sec. 7(14, Business and Profession Code:) The Contractor's Li. cense sew don nm apply in n wiser of pm wly who Wild. or improve Nemon. and ' who cantracb forsuchivo' Mwi acw=wr(s)licrnmdpunnntwft Con=es Lim. law. ❑tun uemp(nderBBPC(or .reason Owner Data ^/ S D LARATION V I hereby affirm under penalty of perjury a Ithe following dwluWons: I have and will mainuin • Certificate of commit to.eIf-inure for Workers Compcn- ntim.. prorldad for by Same. 3700 of the liber code. rte site wife.. of site wart for which this Permit is issued. ' ❑ 1 have and will maintain Workers Compensation inmrutw, as res ohed by Section 37M of me, atom Cods, for the perorm am of Na work for which Nis Permit Is united ' My Workers Composition trimmed carrier and Policy number am: Cartier. Policy No.: . CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Dussectlon need not M completed lithe permit is foram hundred dollars (SIM) or less) I certify dco m Ne wff arta of B III for which Nis conn is ed. I shill nm employ any pecten ina mannerm b o bject toum laws oa.f ' Da i / Applicant f ` NC`DCET0lAPPtJCAW., a er E this Celli ¢ate o tpi ,you become subject 0 the Workers Comwnadon previsions of the or Code, in, m ferNwith comply with such president or this Permit shillM d.1sed. CONSTRUCTION LENDING AGENCY I hemhY affirm this Nen is • conbucthm lending agency for the performance of the work for which the .it IS mood (Sec. 3097, Civ. C.) Lender's Name . lenders Addma. ' I certify that I h.w< read this application and mm that the aWw kfomutian i, concot. 1 agree in comply with ill city and county on inancn and slue laws mating in Wilding mna mettian. and hereby authorise repprammatives of this city in enter upon the . albve-mentioned earInspection purposes. (Wc) a6 to rave, i mnify and kwp humlen the City of Cupertino against nm'cc liabilidn,judgm cab. cote expenses which may in any ¢me Atuntuid City in coturqueme Idle gran 6 of thb it. ANT NDERST NDS D LL COMP ON DINT Issued'b i; NS. 5 R Date y C REG roofs Signuum of ApplieanVConuee k HAZARDOUS MATERIALS DISC SURE Type of Roof Will site applicant or future Wilding dwupectmom handlchaummodav:riu Sit defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code. Section zs5321.Yy ❑Yes All roofs shall be inspected prior to any roofing material being installed. Will Ne, applicant Wilms occupant or which pP 6 w If a roof is installed without first obtainingan inspection, I agree to remove I1e .nit harardnus air contaminants u defimd,by Na Bay Arta Air Quality Managemcnl m Air u M... all new materials for inspection. District? / ❑ Yu Q?iu I have mad hvardttusm 'al.mauWmcnnunder CTapm6.95 fthe Cuifor- niceHcolN&Sent otic, Seetiom ) Juu12553d.Iundc d if the huiWing docs ml eWmn11Y ape a bnuN, 1 b my wvibilllY b coq m nus whim masa It met or arc rate Igj>�f Applicant Date All roof coverings to be Class '%¢" or better Owmraramhomcdagma • 4 ITEMS OF 4 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37510025.00 DATE ISSUED.......: 08/05/2008 RECEIPT #.........: BS000005700 REFERENCE ID # ...: 08080043 SITE ADDRESS .....: 10381 BRET AVE SUBDIVISION ....... CITY ..........:..: CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 OWNER ............: MARIAN GREENFEST ADDRESS ..........: 10381 BRET AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: MICAHEL D GREENFEST CONTRACTOR .......: GILBERT,'GLEN LIC # 21407 COMPANY ............ ABLE SEPTIC ADDRESS ..........: P 0 BOX 24819 CITY/STATE/ZIP ...: SAN JOSE, CA 95154 TELEPHONE ........: (408)377-9990 • FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL IBSEISMICR VALUATION 1,000.00 0.50 0.00 0.50 0.00 IPPERMITFE FLAT RATE 1.00 40.79 0.00 40.79 0.00 IPRSEWER UNITS 1.00 20.40 0.00 20..40 0.00 1TRAVDOC FLAT RATE 1.00 40.79 0.00 40.79 0.00 TOTAL PERMIT ---------- ---------- 102.48 ---------- 0.00 ---------- 102.48 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT AMOUNT --------------- 102.48 --------------- 102.48 VOICE ID DESCRIPTION ------- ------------------------ 106 SEWER & WATER 301 ROUGH PLUMBING 507 FINAL PLUMBING • REFERENCE NUMBER ------------- ------ VISA VOICE ID DESCRIPTION ---- ---------------------------- 202 UNDERFLOOR PLUMBING ' 400 SEWER/LATERAL r L CGQ-- CUPERTINO CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE PERMIT APPLICATION FORM DFoef OC) y� APN # Fee ID Date: Fee Permit Type Building Address:0 3 \I �r Owner's Name: R, ` ka 6 R2r-- 1PCSEWER Commercial building PhoV ca Contractor: Phone #: \ `>,J Fax #: Contact: 1BPREPIPE Phone #:' P 1CPRP Fax #: Contractor License #: Commercial Gas Piping System Cupertino Business License #: Job Description: 41 tact esidential Commercial ❑ Valuation:#t,n© Project Size: Express Standard Large Major Seismic Commercial Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. r Green Building Points: Seismic Residential Quantity Fee ID Fee Description Fee Permit Type Grou 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re -pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BSEISMICOM Seismic Commercial P r 1BSEISMICR Seismic Residential p IPRSEWER Residential building P IRPSS sewer/sanitary sewer C Ty of CUPERTINO CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE FEESCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type IPRREPIPE Residential re -pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 1BPWATER Install/alter Water Pipe P 1BPFD:TURE Plumbing Fixture P 1PGASRES Residential Gas Piping System 1-4 Outlets P 1BPGAS Gas Piping System 5+ Outlets P IPPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B Revised 6-16-08 0 • 0 • Plan Review Process Work Book Page -12-Revised 3/25/08 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 11. Permeable Paving,Note L-1 C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 72points D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2 5. Use Truss with heels, (detail) S-2 6. B. OSB Sheathing,detail S-2 E. Ext. Finish 1. Composite Decking, (Note/Spec.) A3 2 points 4. B. Fiber Cement Siding, (Note/Spec. A-4 2 points 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 Refrierator, (Note/Spec. A-3 1 P. Other 1. List Green Features on Plans A-1 1 apont NVAMMIFAM TOTAL POINTS 40 • 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. IF Re—cycle—Job-Site Construction & Demolition Waste 65%=1 point; 75%= 2 points; 80%= 4 points up to 4 Resource 12. Salvage Reusable Building Materials 4 Resource pts y= 3. Remodel for Mixed Use, Adaptive Reuse, and 2. Use FSC Certified Wood for framing Historic Preservation 4 Resource pts y= 4. Protect Native Soil 2 Resource pts y= 5. Minimize Disruption of Existing Plants & Trees 1 Resource pt y= 6. Implement Construction Site Stormweter Practices 2 Resource pts y- 7. Protect Water Quality, with Landscape Design 2 Resource pts y= I8. Design Resource -Efficient Landscapes and Gardens 4 Resource pts y= 9. Reuse Materials/Use Recycled Content Materials 8. Use Recycled Content Steel Studs for Interior Framing 2 Resource pts for Landscape Areas 2 Resource pts. y- 10. Install High -Efficiency Irrigation Systems 2 Resource pts y- 11. Provide for On -Site Water Catchment / Retention 2 Resource Dts v= 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 2. Use Recycled Content Aggregate 2 Resource pts y=yes 3. Insulate Foundation/Slab before backfill 3 Energy pts y=yes C. Structural Frame rr r 0 r 0 r 01 0 0 r r r `7. Substitute Solid Sawn Lumber with Engineered_ Lumber ' 3 Resource pts y=ya 2. Use FSC Certified Wood for framing (For every 10% of FSC lumber used =2 points, up to 10) up to 10 Resource pts 3. Use Wood ]-Joists for Floors and Ceilings 2 Resource pts y=ye: 4. Use Web Floor Trusses 2 Resource pts y=ye: 5. Design Energy Heels on Trusses 6' or more 2 Energy pts y=ye! 6. Use Finger -Jointed Studs for Vertical Applications 2 Resource pts y=yes 7. Use Engineered Studs for Vertical Applications 2 Resource pts y=ye: 8. Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yeE 9. Use Structural Insulated Panels (SIPS) a. Floors 3 Energy pts y=yes b. Wall 3 Energy pts y=yes C. Roof 3 Energy pts y=yes 10. Apply Advanced Framing Techniques 4 Resource pts y=yes 11. Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes 12. Use OSB a. Subfloors - 1 Resource of y=yes J. Sheathing • 1 Resource pt y=yes rr r 0 r 0 r 01 0 0 r r r ,1. Use Sustainable backing Materials a. Recycled content 3. Resource pts y=yes b. FSC Certified Wood 3 Resource pts y --yes i2. Use Treated Wood That Does Not Contain ChromiumlArsenic 1 IAQ/Health pt y=yes ,3. Install House Wrap under Siding 1 IAQ/Health pt y=yes A. Use Fiber -Cement Siding Materials 1 Resource pt y --yes E. Plumbing 1. Install Water Heater Jacket 1 Energy pt y=yes 2. Insulate Hot and Cold Water Pipes 2 Energy pts rgae 3..Retmfit all Faucets and Showerhsads with Flow Reducers a. Faucets (1 point each, up to 2 points) Up to 2 Resource pts b. Showerheads (1 point each, up to 2 points) Up to 2 Resource pts 4. Replace Toilest with Ultra -Low Flush Toilets (1 point each, up to 3 points) Up to 3 Resource pts 5. Install Chlorine Filter on Showerhead 1 AQ/Health pt y=yes 6. Convert Gas to Tankless Water Heater 4 Energy pts y --yes 7. Install (Nater Filtration Units at Faucets (2 points each, up to 4 points) Up to 4 IAQ/Health pts B. Install On -Demand Hot Water Circulation Pump 4 Resource pts yges r. tiecrncai kkInstall Compact Fluorescent Light Bulbs (CFLs) bulbs=2 points, 10 bulbs =3 points, 12 bulbs -= 4 points) 2. Install IC -AT Recessed Fixtures with CFLs (1 point each, up to 5 points) 3. Install Lighting Controls (1 point per fixture, up to 4 points) 4. Install High Efficiency Ceiling Fans with CFLs (1 point each, up to 4 points) G. Appliances f7. Install Energy Star -Dishwasher 12. Install Washing Machine with Water and Energy Conservation Features 9.Install Energy Star Refrigerator 14. Install Built -In Recycling Center H. Insulation 1. Upgrade Insulation to Exceed Title 24 Requirements a. walls b. Ceilings 2. Install Floor Insulation over Crawl Space :3. Install Recycled -Content, Fiberglass Insulation with Oo Added Formaldehyde 4. Use Advanced Infiltration Reduction Practices 5. Use Cellulose Insulation a. Walls b. Ceilings 6. Alternative Insulation Products (Cotton, spray -foam) a. Walls o. uenings Up to 4 Energy pts. Up to 5 Energy pts. Up to 4 Energy pts. Up to 4 Energy pts. 1 Energy pt 1 Energy pt 1 Energy pt 3 Resource pts 2 Energy pts y=yes 2 Energy pts y=yes 4 Energy pts y=yes 31AQ/Health pts y=yes 2 Energy pts y=yes 4 Resource pts y=yes 4 Resource pts y=yes 4 Resource pts y=ye! 4 Resource pts y=yes • • • 1 i_ 2 Energy pts y=yes 2 Energy pts y=yes 4 Energy pts y=yes 31AQ/Health pts y=yes 2 Energy pts y=yes 4 Resource pts y=yes 4 Resource pts y=yes 4 Resource pts y=ye! 4 Resource pts y=yes • • • 1. Install Energy -Efficient Windows y=yes • a. Double -Paned 1 Energy pt b. Low -Emissivity (Low -E) 2 Energy pts c. Low. Conductivity Frames 2 Energy pts 2. Install Low Heat Transmission blazing 1 Energy pt J. Heating Ventilation and Air Conditioning '1. Use Duct Mastic on All Dud Joints 2. Install Ductwork within Conditioned Space 3. Vent Range Hood to the Outside 4. Clean all Ducts Beiore Occupancy 5. Install Solar Attic Fan 6. Install Attic Ventilation Systems 7. Install Whole House Fan B. Install Sealed Combustion Units a. Furnaces b. Water Heaters 9. Replace Wall -Mounted Electric and Gas Heaters with Through -the -Wall Heat Pumps 10. Install 13 SEER/11 EER or higher AC with a TXV 11. Install AC with Non -HCFC Refrigerants 12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace 13, Retrofit Wood Burning Fireplaces • a. Install EPA certified wood stovesrnsads b. Install/Replace Dampers c. Install Airtight Doors 14, Install Zoned, Hydronic Radiant Heating 15. Install High Efficiency Filter 16. Install Heat Recovery Ventilation Unit (HRV) 17. Install Separate Garage Exhaust Fan K. Renewable Energy and Roofing 1. Pre -Plumb for Solar Water Heating 2, Install Solar Water Heating System 3. Pre-Wre for Future Photovoltaic (PV) Installation 4. Install Photovoltaic (PV) System (1.2 kw = 6 points, 2.4 kw =12 points, 3.6 kw =18 points) 6. Select Safe and Durable Roofing Materials T. Install Radiant Barrier - L. Natural Heating and Cooling 1. Incorporate Passive Solar Heating 2. Install Overhangs or Awnings over South Facing Windows 3. Plant Deciduous Trees on the West and South Sides 0 2 Energy pts 3 Energy pts 1 IAO/Health pt 2 [AD/Health pts 2 Energy pts 1 Energy pt 4 Energy pts 31AQ/Health pts 31AQ/Health pts 3 Energy pts 3 Energy pts 2 Resource pts 2 Energy pts 1 IAQ/Health pt 1 Energy pt 1 Energy pt 3 Energy pts 41A0/Health pts 5 IAQ/Health pts 31AQ/Health pts 4 Energy pts y=yes 10 Energy pts y=yes 4 Energy pts y=yes Up to 15 Energy 1 Resource pt y- 3 Energy pts y==' 5 Energy pts y=yes 3 Energy pts . y=yes 3 Enerov ots v=vas 1. Use Low VONo-VOC Paint _ 1 IAO/Health pts y=yes 2. Use Low C, Water -Based Wood Finishes 2 IAO/Health pts y=yes . 13. Use LowMo VOC Adhesives 31AQ/Health pts y=yes 4. Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 5. Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes B. Use Exterior Grade Plywood for Interior Uses 1 IAO/Health pts y=yes 7 Seal all Ex-posetl Parficleboard or MDF 41AQ/Health pts y --yes 6. Use FSC Cefified Maladals ions Interior Finish 4 Resource pts y=yes 9. Use Finger -Jointed or Recycled -Content Trim 1 Resource pts y=yes 1D. Install Whole House Vacuum System 31AQ/Health pts y=yes B Resource pts D 0 0 L2. Use Rapidly Renewable Flooring Matenals 0 0 0 • 0 D D 0 y=yes 3. Use Recycled Content Ceramic Tiles 4 Resource pts y --yes 4. Install Natural Linoleum in Place of Vinyl 5IAQ/Health pis y=yes 5. Use Exposed Concrete as Finished Floor 4 Resource pis y --yes 6. Install Recycled Content Carpet with Low VOCs N. Flooring 1. Select FSC Certified Wood Flooring B Resource pts y=yes L2. Use Rapidly Renewable Flooring Matenals 4 Resource pts y=yes 3. Use Recycled Content Ceramic Tiles 4 Resource pts y --yes 4. Install Natural Linoleum in Place of Vinyl 5IAQ/Health pis y=yes 5. Use Exposed Concrete as Finished Floor 4 Resource pis y --yes 6. Install Recycled Content Carpet with Low VOCs 4 Resource ots V=VeS Total Points Available: Total Points Project Received: 1401 1301 57 01 01 0 • G:da;arprocsrgmeohuildingguidefines4emodelerslgreenpoinlsfinal272.04prolededads LJ o g 08 0 01-I 3 OWNER -BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform: • A. All the work authorized by this permit B. ;%n, portion of the work C. None of the work If B or C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. All of the work B. -H-�A portion of the work (complete section below) Contractor Address/City Phone # State License # Type of work to be performed • 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. I declare under penalty of perjury Owner -Builder Information (kevei Property Owner's Signature: Job Address: Phone Number I Type of work to above is true ak correct. I have read and understand the Date: Permit # Any changes to the information provided on this form shall be submitted to the City of Cupertino Build • Department. CITY OF City of Cupertino Building Departmen. 10300 Torre Avenue CUPS TIN 0 Phone: (408) 777-3228 Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner -builder you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation • contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner -builder building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street, Sacramento, Califomia 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, City of Cupertino • Printed on Recycled Paper CITY OF 4UPEKINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB I O �� V PERMIT # ! jy 6 ,p 6 6 T3 OWNER'S NAME: © PHONE # GENERAL CONTRACTOR: FAX # • I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Date 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 ock Tile — Date