08080152 CITY OF CUPERTINO �ap�' ��"1T=y�'�
BUILDING DIVISION PERMITCONTRACTQ.,� tTl'yOAT01 �;z
BUILOINGA DRESS: PERMIT NO.
/` V ERIN WAY R E ROOFING &. CONSTRUCTION 08080152
OWNER'S NAME: PERMIT ISSUE DATE
111, IJ.N JOHN C ET AL 15230 CLYDELLE AVE 08/20/2008
NE:
(408) 626-9320 SANITARY NO. CONTROL NO.
ARCHTTECTTENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
rxlop LICENSED CONTRACTOR'S DECLARATION Job Description
W❑ I bereby affirm that I un lhenxd under Provinces,of Chips,•+9(commencing
ZW
with SccuumTOADofDivision 3oftheBusiness and ProfessionsC .and mylieenwis RE-RF RMV EXT 1 LYR WDSHK& INSTL NEW 1/2" CDX,
°o<�m in full footstool effort �'����
pqz Date w 13c.g 30#FLT&PRES CMPT CLS A" 28SQ
^ Dak -"
s ARCHITE S DECLARAw
3 I uMmsund my pkrs,shall W u public ores
g iucl
C H Licensed Professional
3 OWNER-BUILDER DECLARATION
<I 1 hereby animt that I am exempt from the Conummr's Uconac Law for the
00 following mann.(Section]0313.Business and Profession Code:My dry oun
or cty
es
3$V which requira permit m conmmct alcor.impmne,demolish,or repair my swcwm
_iot prior to its Women.dm requires Me applicant farropernt
ch mit to Ilk a signed stateme
< thaz W is licensed pursuant to the provision of the CminexWes Liao Law(Chapter 9 Sq.Ft.Floor Area Valuation
E�G (commencing with Section 7000)of Division 3 of me Business and Prafessiou Code)or 13000
$ that he Is exempt mcrefimn and the buffs for Ne alleged exemption Any violation of
Section 7031.5 by any applicant for a permit subjects;the applicant in a civil penalty orT
not mom Mose five hundred dollars(S3 L 35921028 .E Number Occupancy P y yPe
❑Lot w M1c Mw themuy.ar intended
with mguutheirml.coapewness
and dathcwmus andtW swnomis anotkmndedorawd rarct apply in
an,Business
and Rarunou Cade TW Cosoxwea LinscromndwW law eau sal apply lf rt owner is Required Inspections
Property who Wilda fimprovuthimprove who dousuchwankb uttredthrough his .
moa employers,provided Mut sneb improvements art not intended orofieed forests,If.
however.Ne building or imgomnml is sold within one year ofcompiction.for the owner.
builder will haw tW WNen of proving that k did not build or improve(m purpose of
sak.l.
Q i,as owner of the property.am exclusively connecting wit licensed chnummu to
construct the project(See.Trials.Business"Promasiou Code:)Tie Commences LL
«me law doss not pply to an owner of property who Wilds or impnews Merton and
who convects for such projects with a eanuactor(s)licensed pursuant m the Canuaaor'a
Lines taw.
❑I as exempt under Sec ,B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 Wreby affirm under pemlty,or perjury,one or We following dalenuortm
t]I haw and will maintain a Cenificamor Consant to salt-ictureforWorker'sCompen-
action,as provided for by Section 37M of the Labor Code,for Ure performance of the
work for which this permit is issued.
❑1 haw and will admin Workces Compensation I..,as romired by Seem.
3700 of the UWr Code,for Ne performance ofthe work for which this permit tau issued. '
My Wor
con, on carrier and Policy number are ``
Geier•. Policy No.:�6
GTE EMPIION FROM WORKERS'
COM NSATION INSURANCE( rot bon mplcrcd if tW permit is leant hunthed mBae(510�
or 1.)
1 comfy 0.1 1.the performance of the worst for which this Permit u issued.l sIW I ran
employ any person in my manneran as w become subject to the Wertrri Coomccomon
Laws of Califomia Date
Applicant
NOTICE TO APPLICANT:If,after making this Cerafteate of Exemption,you shm5
become subject M Ne Workers Compensation provisions of tW labor Code,you most
.JO forthwith comply wish Inch pmvisku or Nu permit shall be daaed mated.
"' CONSTRUCTION LENDING AGENCY
[r.�. I hereby arum Itis th=rt iso a ureasomon heading agency for the perfurmmco of
a the work:for which thin permit ho iaaued(Sec.3119'!,Civ.C.)
aQ Landees Name
a z lender's Address
U C) 1 costiry that I haw read this application W show this the above information is
cornett I agree w comply with all city and county ordinmm and sum laws relating,he
C) building construction,and hereby authodw rtprtsuutivet of this city in tour upon Me
>W a e no-mentimud property for inspection purposes
(, W (We)agree to saw,indemnify and keep hamleas the City of Cottonton agaimt
lV1liabilitiu Wemcnho.cam mdexp=•...which may in my way acome agdrmt said City
UZ in of the
'norm.of this reran. L
q PLICA s AN ILL COMPLY WITH A NO -POINT Issued by: Date rJ
SOURCE EG
G �— ZJ Re-roofs
sienuurt sir app Mw �.
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant mom or handre shoomous mamrial
as defined by tW Cupenione Municipal Code.Chapter 9.12,and tW Health and Safety
Code,Section 25532(a)T
Oyes ON. All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
Will the air ci oun or fume building deied by ft Bt six Area
Air eat or device which P gra
emtrict?lt nu airconhominms,redefinedbytWBryAmeAirQWityManagcmut a serialsforinspection.
District?
Yes ON.
I have mad the hacardoumamdaHmqulremcoho undcr Chapwr6.95oftho Cal'or. /
nu ItIfSSad codes 505.255 Z5os.1 urrdeatvrd than if Wild _ �(V
vel currenMY mnmt Ne m rte hilily w roily N cu.,or A20 f Q
yuimmcnmw i rbntunt. d t Team ofa
u ofApplic Date
Owner orauthorisda DIM All roof coverings to be Class'JW'or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35921028 . 00
DATE ISSUED. . . . . . . : 08/20/2008
RECEIPT # . . . . . . . . . : BS000005848
REFERENCE ID # . . . : 08080152
SITE ADDRESS . . . . . : 7564 ERIN WAY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LIN JOHN C ET AL
ADDRESS . . . . . . . . . . : 7564 ERIN WY
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4321
RECEIVED FROM . . . . : R E ROOFING & CONST
CONTRACTOR . . . . . . . : PROCTOR, PAUL LIC # 20615
COMPANY . . . . . . . . . . : R E ROOFING & CONSTRUCTION INC
ADDRESS . . . . . . . . . . : 15230 CLYDELLE AVE
CITY/STATE/ZIP SAN JOSE, CA 95032
TELEPHONE . . . . . . . . : (408) 626-9320
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -------- ---- -- -- ----------
IBSEISMICR VALUATION 13 , 000 . 00 1 . 30 0 . 00 1 . 30 0 . 00
I.REROOFRES SQ FEET 28 . 00 364 . 00 0 . 00 364 . 00 0 . 00
---- ---------- - --- ----------
TOTAL PERMIT 365 . 30 0 . 00 365 . 30 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
--- ------ ------ --------
CHECK 365 . 30 #12322
---------------
TOTAI, RECEIPT 365 . 30
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
- ------------- --------- -------- --------- -------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
CITY OF CUPERTINO
REROOF
OF
• CUPEkTINO PERMIT APPLICATION
APN # Date:
Building Address: r fz, 11� V�J
Owner's Name:
rJ L rJ Phone #:
Contractor,* ,,- �{ C Phone #: 626 _ c132 J
I Fax #: o - -
Cupertino Business License #: U / Contractor License#: y
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report #
To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description�U06W (l k t S t 1 u t( ( LA^4 CIS- VV061) L 40, 1
�1V t NC�1 1/2" �bx, 3� � "1'RL�S ce�>�11a�`' C6AP
LI61J �
Residential Commercial
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the applicatio or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation:
I� 6UU ,
I e Rea nderstand a Will Comply—W4Cupertino's Tear-Off Policy:
Signature 1
Revised 6/16/08
CITY OF CUPERTINO
d REROOF
ITY OF
CUPEkTiNO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1RER00FRES Re-roof Residential B 1SFDWLR00F
/ 1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08
•
Community Development Department
Building Division
City of Cupertino
• 10300 Torre 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: ,J,b 'lJ
Job Site Address: �✓L� I ��!! lei/ � V
g �i �00FItJ6( l c)hJ ST1Zluil�lbN1 I��C
Roofing Com an Name:
• Applicant's Signature: � (0
Date: l
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
4
B. Site 9. Install H.E. Irrigation, (details/spec)' L-1 7points
11. Permeable Paving, Note L-1
C. Foundation 1. Use 15% Flyash Concrete, (note) S-1
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.) A-3 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 Refrigerator, (Note/Spec. A-3 1oint
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 Eneirgy 1ADIHealth
Ar. rte
I I.Recycle Job Site Construction&Demolition Waste
1 65%—1 point;75%= 2 points;80%=4 points up to 4 Resource pts 0
LSalvage Reusable Building Materials 4 Resource pts y=yes 0
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 Stonnwaler Practices 2 Resource pts y--yes 0
7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0
8 Design Resource-Efficient Landscapes and Gardens _ _ i 4 Resource pts y=yes 0
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 Flyashin 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=yes 0
11 1
C.Structural Frame
H.Substitute Solid Sawn Lumber with Engineered Lumber I 3 Resource pts y=yes 0
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=yes 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 0
8.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 0
c.Roof 3 Energy pts y=yes 0
10.Apply Advanced Framing Techniques 4 Resource pts y=yes 0
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes 0
12.Use OSB
a.Subfloors 1 Resource pt y=yes 0
• L b.Sheathing 1 Resource pt y=yes 0
1 1
xtenor mis
INPUT Resources Energy A011-lealth
1.Use Sustainable Decking Materials
a.Recycled content 3 Resource pts y=yes 0 •
J.FSC Certified Wood 3 Resource pts y=yes 0
2.Use Treated Wood That Does Not Contain Chromium/Arsenic 1 IAQ/Health of y=yes 0
13.Install House Wrap under Siding 1 IAQ/Health pt y=yes 0
4.Use Fiber-Cement Siding Materials _ 1 Resource pt y=yes 0
1 1 1
E.Plumbing
1.Install Water Heater Jacket 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) Up to 2 Resource pts. 0
4.Replace Toilest with Ultra-Low Flush Toilets I
I(1 point each,up to 3 points) j Up to 3 Resource pts. 0
5.Install Chlorine Filter on Showerhead 1 AQ/Health pt y=yes 0
l1
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 IAC/Health pts. 0
B.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
1 1 1
r.tiecmcar
1.Install Compact Fluorescent Light Bulbs(CFLs) I
(6 bulbs=2 points,10 bulbs=3 points,12 bulbs=4 points) Up to 4 Energy pts. D
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 Dishwasher 1 Energy pt y=yes 0
12.Install Washing Machine with Water and Energy
(Conservation Features 1 Energy pt y=yes 0
I
�3.Install Energy Star Refrigerator 1 Energy pt y=yes 0
14.Install Built-In Recycling Center 3 Resource pts y=yes 0
H.Insulabon
1.Upgrade Insulation to Exceed Title 24 Requirements
a.Walls 2 Energy pts y=yes 0
b.Ceilings 2 Energy pts y=yes 0
2.Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0
13.Install Recycl6d-Corifent,Fiberglasslnsulatior with
tINoAdded Formaldehyde 31AQ/Health pts y=yes D
— -- -- - --- - - -
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 0 •
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
I).Cemngs 4 Resource pts y=yes 0
1 1
INPUT Resources Energy IA01HeaIth
mdows
1.Install Energy-Efficient Windows
• a.Double-Paned 1 Energy pt y=yes 0
b.Low-Emissivity(Low-E) 2 Energy pts y=yes 0
c,Low.Conductivity Frames l 2 Energy pts y=yes 0
-2.Install Low Heat Transmission Glazing - 1 Energy of y=yes 0
1 1 1
J.Heating Ventilation and Air Conditioning
1.Use Duct Wastic on All Duct Joints _1 2 Energy pts y=yes0
2.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0
3.Vent Range Hood to the Outside 1 IAQ/Health of y=yes 0
4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 0
5.Install Solar Attic Fan 1 2 Energy pts y=yes 0
6.Install Attic Ventilation Systems 1 Energy pt y=yes 0
7.Install Whole House Fan 4 Energy pts y=yes 0
8.Install Sealed Combustion Units
a.Fumaces 3 IAQ/Health pts y=yes 0
b.Water Heaters 31AQ/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 pts y=yes 0
13.Retrofit Wood Burning Fireplaces
• a.Install EPA certified wood stoveslinserts 1 IAQ/Health pt y=yes 0
b. Install/Replace Dampers 1 Energy pt y=yes 0
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 4 IAQ/Health pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAO/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 31AQ/Health pts y=yes 0
1 1 1
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes 0
2. Install Solar Water Heating System 10 Energy pts y=yes 0
3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=I B points) _ Up to 18 Energy pis 0
r 9 1 Resource t es
(6_Select Safe and Dureble Roofin Materials J p y=y 0
T.Install Radiant Barrier 3 Energy pts y=yes p
1 1
L.Natural Heating and Cooling 1
1.Incorporate Passive Solar Heating 5 Energy pts y=yes 0
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes p
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0
1 1 1
•
INPUT Resources Energy A01Heafth
M.indoor Air Quality an Inlshes
Use LowMo-VOC Pai t 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAO/Health pts y=yes 0 •
3.Use LowMo VOC Adhesives 3 IAQ/Health pts y=yes 0
Z_&Salvaged Materials for Interior Finishes 3 Resource pts y=yes D
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde. 6 IAQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
L7 Seal all Exposed Particleboard or MDF _ _ 4 IAQ/Health pts y=yes 0
8.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 3 IAQ/Health pts y=yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials _J 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 51AQ/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
Total Points Avai able: 1401 1301 57
Total Points Project Received: 1 01 0 0 •
G:da,arprogsrgreenbuildngguidelineshemodelersrgrmnpointsfiina12.12.04proleded.xis
•
.,., Community Development
10300 Torre Avenue
Fes' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
q�UPERTINO
Building De artment
JOB ADDRESS: ,5 �RI ^ ^ `� PERMIT # O VOl�
fJ �(V 2
OWNER'S NAME: 6 R PHONE # $ - le 26 OV3 2Z
-
GENERAL CONTRACTOR: V, FAX # p - --jj fo
I am not using any subcon actors: Zd 0 0
Si a Date
Please check applicable subcontractors and complete the following ' ormation:
6a 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
•
Owner/Contractor Signature Date