08070163 CITY OF CUPERTINOro-,a�•-+'+,F ;a..f %�' s'° �°uR
BUILDING DIVISION PERMIT .CONTRACTORTNFORMATION�
BUI 1 GA RESS: PERMIT NO.
.(�3SO� IMPERIAL AVE TBD — TO BE DETERMINED 08070163
OWNER'S NAME: - PERMIT ISSUE DATE
Ilk MAURTCi3 MITCHELL - 07/23/2008
NE: S SANITARY NO. CONTROL NO.
ARCHITECffENGiNEER: `[ BUILDING PERMIT INFO
'BLDG ELECT PLUMB MECH
u O ci LICENSED CONTRACTOR'S DECLARATION O O O
m 1 hereby".to 1 me licclund under proviai«ts of Chapter 9(mmmc.ing Job Description
who Secdoe7")ofDivision 5of1WBusnevand Profeuiona Code,abut myli.is RE—RF INSTL PLYWD 20LB FLT CLS A 26SQ
ii Lidos a`u'ana`ry
Lk.• ELEMENT ROOFING PD FOR BUS LIC $.110. 00 7/23/8
Dam� C..urcur,e V ARCHITECTS OECLA0. ON
'2 1 uMervanJ my Plans sh,ll be usW u public«rnrda
6
c ucmma Pmreai.d
OWNER-BUILDER DECLARATION
c a I hereby.(firm Net I am.Brud from the Contribute,,turesCode:
:Any cense Law for do
i p O following mason. emit"]0513,Busies and w.dcon li Cade:Any city m county
$ which requires a permit m ume;the
utter.improve,ac permit
t ri repair any structure
due heitscureanca,a(so motto the proapplsant for s«hpmmit mfecoulle a t Law
O
dueheurw,n7Othe DO)drivW=3NeConuecmrmdif Sia Ch,pmr9 Sq.Ft.Floor Area Valuation
E+�s don accusing wit Schon]BOB)th Diriaiof J of the aged exemption.
Aniabu Cock)or $13000
to he u eumPt therefrom and the bests(«the allcgW esemptim Any violet."of
Section 70513 by any applicant for a permit subjects to applicant o a civil penalty of �,pN Number Occu ane T
.team tae five Worked napes U$MR 35719050 .'U'V' P Y YPe
01,uownerofthepropmy«mywploymwitwalesute velecompeuad.,
paid dodmwork,andie The Cona.ttsenam Lawdo does
11a(S«.Toa+.Beaiat of
and erywho.s cede:The monsters uceue law dam not apply lf rt owner is Required Inspections
propertytubabdproarirePravmch i.p.wveno am nmaltwanhireff «tm.gb his
owne ,the bac,provided to such imProveme.ts are not ear ca c«oResm for uta IL
however,tobuilding«Mpmaemrntstold whinot yesofimproved.,amowner-
builder NB have to bode"of pmHng that h did net build or improve for puryose of
sale.).
0 I,an owner of to prepmy.wo cacludvely.nbaefing wit Bcembut rtractan or
cououct to projem(Sec.70..,Busioeu and Professimu Code:)Te,Coamcmr's U. ... .
ceme law dam out apply m an owner of property,who Indhs or Mpovm thereen,am,
wlm contracts for such pmjecu wit a convacmr(s)licensed pursuant to to Contractors
License taW.
0 lameaempt.desea ,Bl PCf«thsmlm.
Ownu Dam
WORKERS COMPENSATION DECLARATION
1 hereby anbm under penalty,of pesjary e.of the following decluad«u:
1 have and will maintain a Cerdfimm of Consent to self-imeam for WorteYsC«npen-
ad.,an provided for by Secdan 3fKK)of to Labor Code,for to perfo.,nen or the
work f«which tis pemail is slued.
0 I have and will maintain Wa a Compcuadon Insurance,u rs'uisod by Section
5700 of Um labor Cade.for dm performance of dte wan forwhich tis permit s issued
MY Warkmrs pe eau.IbaPrnrt¢ rtier aM policy number are:
Carder. -, Policy No.: 7 LI
CERTIFICATE OF •%EMPTION FROM WO ERS
COMPENSATION INSURANCE
(Ths ami.Beed.t be completed little permit It f«.c hundma dolian(SIM)
or lcu)
I unify tet in to performance or dm won for which this Permit is issued.I shall not
employ..,person in any ma.rm an to become subject in Um Worlds'Compewdon
Laws cr Caiifomia.Dam
Applearn
NOTICE TO APPLICANT:If,after malting tis Cenificate of Eaemp im,you dmuW
Wtoms subject an to Wohels Cnmpemation provisions of to lab«Cera you must
.J O fortwit comply with inch provide.«ts permit.hall be doemcd.1ned.
z �•' CONSTRUCTION LENDING AGENCY
[—�
1 herebi,nine to tare s a.utncdnn lendin`agency our to pM«maaae of
ai Ne wen for which the permit is its.d(Sec 3097.Civ.C.)
W� lenders Name
Z !aiders Ann..••
U O� 1 certify that 1 have man his application w tram to to.bow sro.ad.is
'LU i meL 1 agma m comply with
ail city ane coumy artinanera am serw laws relating m
O building comatruction,and herebyautobim represenmdves or this city m enmrunm the
above-m.do.d property for speed.parpmea
Fr+y (We)agree 1.save.indemnify and lump humlea to City of Cupertino against
h liabilities,Jutgmcnts,costs and eapcum which may In any way accrue against said City
(„)z in c«.'ounce of tier g.do,of is permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGUL9OONS.
Srp.ure of ApplicandContrac e, Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de applicant or future building occepaet nom or Write hamNmts mambiai
u dcB.d by to Cupertino Municipal Cade.Chapter 9.12,and to Health and Safety
Code.sca.9ey]No ssI5z(u]
ItI,Yes All roofs shall be inspected prior to any roofing material being installed.
Will tier applicant or room,Wilding occupant me eguipm.t or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I Imramnu air...I...It a deGnca by to Bay Area Air Quality Maragemem all new materials for inspection.
Dstrict7
0y. QNe
1 haw real to hemNous mauniais m,leirements under Clummr 695 of to Califor.
niceHenth e;on, urSafety Code.S«dmuhe,it.;mymnJ25554.1 to beamndtaiftm Wilding
J«.eot emmndy Mod a ccbc to it. 55 rm dM53 ity un MlirY the«mope"of era
requimmcmawhich in=Wmet oat mananmeofaCertificate arOccupancy. Signature of Applicant Date
Ow.r or eutamca agent�a7 7TzD08 All roof coverings to be Class'!?."or better
CITY OF CUPERTINO
• 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35719050 . 00
DATE ISSUED. . . . . . . : 07/23/2008
RECEIPT # . . . . . . . . . : BS000005556
REFERENCE ID # . . . : 08070163
SITE ADDRESS . . . . . : 10350 IMPERIAL AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MAURICE MITCHELL
ADDRESS . . . . . . . . . . : 10350 IMPERIAL AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : CHAD G MAIMONE
CONTRACTOR . . . . . . . : TBD -ATO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . .
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 13 , 000 . 00 1 . 30 0 . 00 1 . 30 0 . 00
1BUSLIC FLAT RATE 1 . 00 110 . 00 0 . 00 110 . 00 0 . 00
1REROOFRES SQ FEET 26 . 00 338 . 00 0 . 00 338 . 00 . 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 449 .30 0 . 00 449 . 30 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 449 . 30 MC
---------------
TOTAL RECEIPT 449 .30
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS - - 605 FINAL REROOF
•
v,J�070/ (o3
CITY OF CUPERTINO
�d REROOF
CITY OF
•CUPERTINO PERMIT APPLICATION
APN # 25 7 / 05D/ ,zl Date: . 7 2_o d'
Building Address:ff
! v U P D �9 J e,
Owner'sName-: Phone #:
C e- N o 20--' 1-2,6 6
Contractor: Phone #:
6_/eI) oL I I Fax #:
Cupertino Business License M. Contractor License #:
o O In
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
p 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.
- ` - re/
Job Description: jhS,AO �,�/ywoa ) jQpOwed _�C [t 0aJrs
d f /
Residential Commercial
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application o jj there are any restrictions: ❑
applicable,jnclude in plan set & the sheet index.
Valuation:
•1 Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
--------------------
Signature o
Revised 6/16/08
CITY OF CUPERTINO
REROOF
CUPER,TINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1RER00FRES Re-roof Residential B 1SFDWLROOF
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B IMFDWLROOF
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 1997 UBC Standards
and manufacturers specifications on re-roofing.
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 1/4 " 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: P, g i / --em /f Q, l
job Site Address: O ?S m71�20(,-�,
L t (I
, Iy rt
Roofing Company Name: � n C1
Applicant's Signature: --=v Date: /08
• Greg Casteel l
Building Official
Revised 11/2/04
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 int
L-1 2 os
C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 5 points
D. Structural 3. Uses Wood IJoist, (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 oints
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/S ec 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 paint
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.
A.Site
1. Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;8D%=4 points up to 4 Resource pts D
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 D
4.Protect Native Soil 2 Resource pts y=yes 0
5.Minimize Disruption of Existing Plants&Trees 1 Resource pt Y--yes D
S.Implement Construction Site Stormwater Practices 2 Resource pts y=yes 0
7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0
B.Design Resoume-Efficient Landscapes and Gardens 4 Resource pts y=yes 0
9.Reuse Materials/Use Recycled Content Materials
for Landscape Areas 2 Resource pts y=yes D
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=yesF F0
C.Structural Frame
1 1
`Substitute Solid sawn Lumber with Engineered Lumber _ � 3 Resource pts y=yes p
fra
2.Use FSC Certified Wood for ming
(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=yes1_
7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes _ 0
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
It.Wall 3 Energy pts y=yes 0
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 -- — — -- — -1
a.Subfloors
1 Resource_ pt y=yes p
• b.Sheathing _ __ i 1 Resource pt y=yes
0
1 1 1
D.Exterlgr Fimsh
1.Use Sustainable Decking Materials
a.Recycled content 3 Resource pts y=yes 0 •
i 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
13.Install House Wrap under Siding 1 IAOlHealth pt y=yes 0
14.Use Fiber-Cement Siding Materials 1 Resource of y=yes 0
E.Plumbing
1.Install Water Heater Jacket _j 1 Energy pt y=yes 0
2.Insulate Hot and Cold Water Pipes 2 Energy pts y=yes 0
3.Retrofit all Ti6Wit iina§hoow_etFe7ads_Wth 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 )
(1 point each,up to 3points) - { Up to 3 Resource pts. 0
S.Install Chorine Filler on Showerhead 1 AQ/Health pt y=yes 0
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/Heallh pts. 0
6.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
1 1 I
t-.tmcmcar -
1.InstalilCompacl Fluorescent Light Bulbs(CFLs)
(6 bulbs=2 points,10 bulbs=3 points,12 bulbs=4 points) r 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 Mth CFLs
(1 point each,up to 4 points) Up to 4 Energy pts. 0
1 1 F
G.Appliances
I(1.Install Energy Slai ishwasher 1 1 Energy of y=yes 0
2.Install Washing Machine with Water and Energy i
Conservation Features 1 Energy pt y=yes 0
'.Install Energy Star Refrigerator 1 Energy of y=yes 0
4.Install Built-In Recycling Center 3 Resource pts y=yes 0
H.Insulation
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
11 Install Recycled-Content,Fiberglass Insulation with
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 0 •
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
D.cemngs 4 Resource pts y=yes 0
1 1 1
HPUT Resources Energy IAWHeaftb
Windows
11.Install Energy-Efficient Windows
• a.Double-Paned 1 Energy P t Y=Y as 0
J.Low-Emissivity(Low-E) 2 Energy pts y=yes 0
c.Low.Conductivity Frames 2 Energy pts Y--yes 0
2.lnstall Low Heat Transmission Glazing 1 Energy of Y--yes D
1 1 !
J.Heating Ventilation and Air Conditioning
1.Use Duct Mastic on All Duct Joints 2 Energy pts Y--yes 0
2.Install Ductwork within Conditioned Space J 3 Energy pts y=yas 0
3.Vent Range Hood to the Outside 1 IAC/Health pt y=yes 0
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 0
7.Install Whole House Fan 4 Energy pts y--yes p
S.Install Sealed Combustion Units -
a.Furnaces 31AQ/Health pts y--yes
0
b.Water Heaters 31AQ/Health pis y--yes 0
9.Replace Wall-Mounted Electric and Gas Heaters with
Through-the-Wall Heat Pumps 3 Energy pis 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 pis y=yes 0
12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes 0
13,Retrofit Wood Burning Fireplaces
• a.Install EPA certified wood stovesrinserts 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 p
4.Install Zoned,Hydropic Radiant Heating 3 Energy pts y=yes 0
15.Install High Efficiency Filter 4 IAQ/Health pis 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 pis y= as 0
1 1 1
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar Water Heating 4 Energy pis 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= 8 points) _ Up to 18 Energy pis 0
16.Select a e and Durable RDefing Materials - _ _ 1 Resource pt y=yes p
7 Install RaoianfSarner - 3 Energy pis y=yes 0
1 1 1
L.Natural Healing and Cooling
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 0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pis y=yes 0
1 ! 1
INPUT Resources Energy ]A011,1ealth
.In oor Air Quality and Finishes .
!l.Use Low/No-VOC Paint 1 IAQ/Health pis y--yes 0
a Use Low VOC,Water-Based Wood Finishes 2 IAQMealth pts y--yes D •
3.Use Low&VOC Adhesives_ 3 IAQ/Health pts y=yes D
4.Use Salvaged Materials for Intedor Finishes 3 Resource pts y--yes 0
S.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes 0
6.Use Exterior Grade,Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Seal all Exposed Padicleboard or MDF - 4 IAQ/Health pts y=yes D
6.Use FSC Ce tified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource Pts Y--yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes D
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 6 Resource pts y=yes 0
i2.Use Rapidly Renewable Flooring Materials - J 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pis y=yes 0
4.Install Natural Linoleum in Place of Vinyl 51AQMealth pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts yeses 0
6,Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
1 1 1
Total Points Available: 1 1401 1301 57
Total Points Project Received: 0 0 0 •
Gdataipmgslgreenbuildinopu!dellneslremdelarslgreanpointsrmal2.12.D4prole.ted.x!s
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
WUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
"3S 0 ,nom 06-0-2016,_-)
OWNER'S N vLA P c M / ) PHONE # _C q— 2
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followm 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
Owner/Contractor Signature Date