05200092 aCOF
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
OUPEkTINO
Building Department
JOB ADDRESS: 975 s t�,r Z>r. PERMIT#
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OWNER'S NAME: 14cu cl DoA' 4To P.Sa y PHONE #
GENERAL CONTRACTOR p FAX #
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
e — 7- z i --er i
Owner/Contractor Signature Date