04070195 ' I
..+_ ` Community Development
10300 Torre Avenue
? ✓ Cupertino CA 95014 .
Telephone(408) 777-3228
CIN OF Fax(408) 777-3333
UPEkTINO
/
Building Department
JOB ADDRESS: PERMIT # /
et
OWNER'S NAME: l c C! , e „ c PHONE # ti u ) a. a-C i 3 a
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: J,T"' 1; r, t l p /' b 9 i O lI
Signature Date
Please check applicable subcontractors and complete the follow**n information: 1
60 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 4
Sheet Metal I r
Sheet Rock ` '
Tile
T 79 0
Owner/Contractor Signa e''� Date