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08030129CTTY OF CUPERTINO y��k,{� 61VISION PERNUT �-Rx'a�=�a�it.`g +�y�I}��`�,�"k��('��I;�� •_ O1T 'INO. BUILDING R l �..TW •I ^u,I�R,p�w"'. Bu11.gIr117.Aq�LES,q:EAVEN DR t5 AAA FURNACE 'L AIR PERMITNO. 08030129 , 'NER'S NAME: PERMR ISSUE DAM IF CHEN FRANK T AND ANNE S 1712 STONE AVE 03/24/2008 PHONE: SANITARY NO. CONTROL NO. (408)293-4717 ARCHITEGTfENGINEER: BUILDING PERMIT INFO BLDG O O O O LICENSED CONTRACTOR'S DECLARATION lob Description 1 bereby effim mat 1 am Ikxvad under provinces of Chapter 9 (commencing with Section 7010)aMiAsion 3 of the Boost. nM Pmfeadwu Cadt end my Beene 4 REPLACE FURNACE 100, OOOBTU In full cane Mtn ' Licmdmaosslm.I ' Daa:Contmor DEC AT CION d M1e l I vernJ my plI anse u Public remade -T/Gfi ommw sIW Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 em ucmpl form the Contractor's License Law far the following resume. (Section RD 1.5. Business and Prolmions Cade: Any city m county which rtqufrm a pandit to mmmom, elnr, improve, d ... Jim. m repsir my atorcmre prior to ib iasumm. slw mgolrta the applicant for Such permit to file a Signed mmmmt man is licensed to the of Cmarmu Liccnan law (Chapter 9 Sq. Ft. Floor Area Valuation he Innocent provisions the is $2350 (commencing with Section 7") of Division 3 of Ila Business and Profession, Coma) a for due alleged emptimt. Any violadan of ion M 4 exempt motorman and me bu4 xe 32()47058: Occu e panC y'i'p Section 7031.3 by any applicant far a permit ubjects ma applicant to a civil Penalty ofNumber not mare man five herniate dollars (M). VV• 0 I, sa owner of tiie property, Cir my employm with wegu u Nair sole wmM=Uon, .. ., Required Inspections will do the work and W s unrm isnot Intended oraf,.d for We (Sec. 70M, Business and Profs scans Cade: The Contractors License Law does rot apply to an owner of property who bunds or improver Neteon. and aha dm a wch work himaelr m through his ownemplaym, provided that such improvements, me at inmMom oo@rtdforsalclL however, the building or Imgovunmt 4 sold within ane year ofcmoVkdon, due moven builder will have W burden of proving met he did rot build or improve fn purpose of sale.). 0 1, u mer of do Property, m uclWvely mouacting aids licensed mnuraors to mmuect the project (Sec 70M. Business Mod Polushms Code) TTI Counselors IJ - mass caw dm rot apply to an owasr of property who wilum or Improves theme. and, who comnau for such projects with a eanuacwr(a) lican ed purwnt to me Convenors License Lew. ❑ I un caempt vomer See .B R P C for ds4 mason . Dam I or WORKERS COMPENSATION DECLARATION I hereby affirm comer pcwty of Perjury aro of the following declondme 01hem Momw lmainWna CutificaoofConsentto Ulf-bumfarWarenCompeo- ution, u Provided for by Section 3700 of the Labor Cade. for the perfamdmas of the , wart for which m4 permit 4 moment. 0 1 baa and will maintaN Worker. Compensation Iruduawe u requited by Section 37M ofine labor Code. for the Performance ofW work farwMch m4 Permit it issued. ' My Worker. omPensation l unnca can cr and Polity numher art: Cartier: f Polley Na.: RTI CATS • NFRA WORK 5' COMPENSATIONSAnON INSURANCE (Thm ec0on reed ambecumplemd Hdo Permit is forevehunddsW da bus (SIM) or mag) I certify that In me Performance of me work for which this permit is Luted. I .hail rot employ any Person in my manner an as to become subject to the Worlmra'Compemation Laws of Caiifamm. Dm Applicant NOTICE TO APPLICANT. If. after making this Cedinue of Exemption, you should beeama subject tome Workers Compensation provisiom of the Labor Cede. you mut forthwith comply with such provisions W m4 Pemit shall be dccmed revaked. I CONSTRUCTION LENDING AGENCY I hemby afloat Wl mem is a construction landing agency for the Performance of the work for which this Permit 4 issued (Sm. 3097, Civ. C.) " Lenders Name lenders Add. 1 1 mudfy that I have read this application and sate that the shove Wo medon I. ' correct. l agree an comply with ail city and county omlaaraes me state taws elating to Wilding construction, and hereby suthadsa rtp scout lm of m4 city m inter upnn the above-mentioned maxnY for inspection puryoes (We) ago to save. indemnify and keep hamleu the City of Cupemmo against liabilities.jomgmeou.cuu and e.penres.Mch may he my way am .ids, wood City in consequence of sou panfn{ of this Permit. I APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SO CEREGULAMONS, /%%• D 3 R D/ Re -roofs Type of Roof Sigwute of ApplicanvCan ter Dom HAZARDOUS MATERIALS DISCLOSURE Will the applicant or form building oxupant nae or handle bavNau material defend by tin Cupummo Municipal Cade, Chapter 9.12 and do Holds and Safety Section 25532(a)? ❑ YuNa All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant due equipment a devices which colt haumaus air contortionist as defined by the Bay Arta Air Quality Management all new materials for inspection. District? OYm; �yNu 1 have rtad the hasaredns materials te proarroms imcl rChmace6.95 afore cabler- niaHcai"SefetyCode,Secdw21505.75533un12S534.I.&e dmnifthe building dm not cumnlly have a mount. dsm It 4 my wo mW btlity to notify do occupant of mo requirements which most be incl prior be issuance of a Certificate mf Accupmry� Signature of Applicant Date Z& " D71r_0� All roof coverings to be Class'%?" or better l�wner Dam or amharise age • CITY OF CUPERTINO 6 ITEMS OF 12 PERMIT RECEIPT • • Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32647058.00 DATE ISSUED.......: 03/24/2008 RECEIPT #.........: BS000004241 REFERENCE ID # ...: 08030129 SITE ADDRESS .....: 21739_ BEAVEN DR SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT AMOUNT --------------- 449.70 --------------- 449.70 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING OWNER ............: CHEN FRANK T AND ANNE S ADDRESS ..........: 21739 BEAVEN DR CITY/STATE/ZIP ...: CUPERTINO CA, 95014-1220 RECEIVED FROM ....: JIM RANDO CONTRACTOR .......: RANDO, JIM LIC # 8050 COMPANY ..........: AAA FURNACE & AIR CONDITIONING ADDRESS ..........: 1712 STONE AVE CITY/STATE/ZIP ...: SAN JOSE, CA 95125 TELEPHONE ........: (408)293-4717 FEE ID --------- UNIT QUANTITY ..'AMOUNT PD -TO -DT THIS REC NEW BAL 1BSEISMICR ------------ ---------- VALUATION 21350.00 --------------------- 0.50 0.00 ---------- 0.50 ---------- 0.00 1EPERMITFE FLAT RATE 1.00 40.79 0.00 40.79 0.00 1MPERMITFE FLAT RATE 1.00 40.79 0.00 40.79 0.00 1MRRAA UNITS 1.00 61.19 0.00 61.19 0.00 IPPERMITFE FLAT RATE 1.00 40.79 0.00 40.79 0.00 1TRAVDOC FLAT RATE 1.00 40.79 0.00 40.79 0.00 TOTAL PERMIT ---------- ---------- 224.85 0.00 ---------- 224.85 ---------- 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT AMOUNT --------------- 449.70 --------------- 449.70 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING is dio 3 01A7 C CITY OF CUPERTINO FURNACE/AC C1 OF CUPERTINO PERMIT APPLICATION.FORM APN #3.�,' q %O✓a . ,e-, U Date: �3^ d d� Building Address: Owner's Name: Phone #: y�4 yob- 6-1Jiol Contractor: Phone #: l/ ( Fax #: Contractor License #—/adPdoi/ Cupertino Business License #: Contact::/ Phone #: 4;W — 019.7- 5--7 1�2 b�X�l /IGLU 2 E/G . Fax #: Building Permit I ifo: Elect ❑ Plumb ❑ Mech Residential Comm r'I Job Description: For Residential Installations: Attic ❑ I" floor 2" d floor ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): 3 0/ lz-c� Strapped F1 On Platform ❑ Bonded ❑ New Location Replacement Valuation: oZ�SD;Qo Green Building: Must attach Green Building Check list to this application aclor CUPEkTINO CITY OF CUPERTINO FURNACE/AC FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1MCRAA Commercial-Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl -install ation.of_controls.regulated_by_this code. 1MCREPALT Commercial for the repair of alt/add to M ea heating appliance,refrigeration unit,cooling unit,VAV boxes, absorption unit or ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. 1MCSUSHTR Commercial Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 1MCAPPVNT Commercial for the instalUrelocate/ or M replacement of ea appliance vent installed & not incl in an appliance permit.. 1BSEISMICO Commercial Seismic B 1MRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1MRSUSHTR Residential Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1MRAPPVNT Residential for the instalUrelocate/ or M replacement of ea appliance vent install & not incl in an appl permit. CITY OF CUPERTINO � Ifill FURNACE/AC CUP` CITY FEE SCHEDULE Quantity Fee ID Fee,Description Fee Group Permit Type FURNACE FURN/AC 1PGASRES Residential for ea gas piping system of 1-4 Outlets P 1BPGAS For each gas piping system of 5 or more per outlet. P 1BSEISMICR Residential Seismic B 1MECPLNCK Mechanical Plan Check M 1MFR=<100 Furnace Syst <=100k BTU install or relocate ea forced-air/gravity type furnace/burner, incl.ducts/vents attached to such appliance up to and include 100,000 Btu/h M 1MFRN>100 Furnace Syst > 100k BTU install or relocate ea forced-air/gravity type furnace/bumer, incl ducts/vents attached to such appliance over 100,000 Btu/h M lEPERMITFEE Electric Permit Fee. E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit P 1TRAVDOC Travel Documentation B 1BUSLIC Business License B 0 CITY OF CUPERTINO 4FURNACE/AC CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type AIR CONDITIONING FURN/AC 1BCAiRHAN Commercial A/C Units <= lOk CFM B 1MCRAA Commercial Mech Repair/alt/add M 1BSEISMICO Seismic Commercial B 1PGASCOM Commerical for ea gas piping System 1-4 outlets P -1PG7ASRES -Residential-for ea gas piping em of 1-4 Outlets —P— 1BPGAS For each gas piping system of 5 or more per outlet. Comm/Resid P 1BREMAIRHAN Residential A/C units <= l Ok CFM B 1MRRAA Residential Mech Repair/alt/add M 1BSEISMICR Seismic Residential B IEPERMITFEE Electric Permit E 1MPERMITFEE Mechanical Permit M 1PPERMTTFEE Plumbing Permit P 1TRAVDOC Travel Documentation B 1BUSLIC Business License B Is • C J Single Family GreenPoint Checklist dam: —2 `t The GreenPoint Checklist is based on the various green features Incorporated into Ne home and is the heals for the GraonPoint Rated program. A home can be considered green If It fulfills the prerequisites, Dams at least 50 poims, and meets the minimum points per category Energy (30), Indoor AIr Oualilyl Health (5), Resources (6), and Water (9), Please contact Build It Green for a list of qualified GreenPoint Raters It you are Interested in pursuing third -party verification. The green building practices listed below are described In the New Home Construction Green Building Guidelines, available at Www.bulldiloreen.om. Build It Green SmartSoludons From The Ground Up H. FOUNDATION � �,Points Available Per Measure ' 1. Replace Portland Cement in Concrete vile, Recycled Flynh or Slag - —❑ a. Minimum20%FylasashaSlag - El h. Minimum 25% ash or 61a Points Available Par Measure: k\ V' 0 p 2.Un Frost-Protaimad Shallow Foundationin Coul Ares(C.E.C. Climate Zone 16) 0 3 e. Use Radon Resistant Construction (in At -Risk Locations Only) 0 0 4. Design and Build Structural Pest Controls ❑ - a Install Tamils Shields 6 Separate All Eldedor Wood-te-Concrele Connections by Metal or Piasdc FastanerslDividers b. All New Plants Have Tn.mK Base, or Stem Located At Least 35 Inches from Foundation 0 ! 0 0 0 3 chat Pants C. LANDSCAPING - - - Pohis.1haflable Per Measure Points Available Par Measure: ❑ ❑ El 1. Construct Resource -Efficient Landscapes a. No Imashie Species Listed by Cal -IPC Ara Planted b. No Plant Species Will Require Hatlginp C. 75% of Plants Are Drought-tDlarant California Natives, Mediterranean, or Other Appropriate Species o 0 ! 1 0 ! 0 i le 3 77 2 Use Fire -Sate Landscaping Techniques 0 1 i 1 ❑ ❑ ❑ E3d. ❑ a. Minimize Tud Areas in Landscape Installed by Bufidn a. All Tud W61 Have a Water Requiremem Less than a Equal to Tell Fescue (50.6 plant factor) It. Tud Shall Not Be Installed on Slopes Exceeding l0% or In Areae Less than 6 Feet Wide c. Tud Is 93% of Landscaped Area holal2 points) Tud is 510% of Landscaped Area (IOMI 4 points))i rl P 4. Plant Shade Than 0 ( i 1 0 -- i T7 0 0 2 0 1 T 1 2 no ( 1r x u 2 7 3 S. Group Planta by Water Needs ydreaonin)2 0 [3a. ❑ S. Install High -Efficiency litigation Systems , System Uses OnlyLow-Flow Drip, Sundials, or Low -fin Sprinklers b. System Has Smarl Contielers - 0 2 p L'ncorpohete Two Inches of Compost in the Top 6 to 12 Indian of Soil 0 ! 3 6. Mulch All Plantlng Bed, to the Greater of 2Inches or Local Water Ordinance Requirement 0 2 B. Use 50%Salve ed or Re Dietl-0onknl Materials for 50% of Non -Plant Landscape Elements 0 1 10. Reduce LI 61 Poliutlon by Shielding Ratures endfor Directing Light Downward D I 1 I mel Paint, AvaezCla in i and—Khrin - ill n I D. STRUCTURAL FRAMB R BUILDING ENVELOPE - Points Available Par Measure: ❑ ❑ ❑ 1. Apply Optimal Value Engineering R. Place Rehers and Studs at 24 -Inch On Canter Framing b. Size Door and Window Headare for Load c. Use Only Jack and Cripple Studs Required for Load o o ! 1 0 ! ( 1 ❑ ❑ ❑ E] ❑ ❑ ❑ 2. Use Engineered Lumber a. Seems and Headers b. Insulated Engineered Headers c. Wood Wats a Web Trusses far Floors d. Wood Woisis fa Roel Rafters e. Engineered a Anger -Jointed Studs for Vertical Applications - f. Oriented Shand Boartl for Subflox g. Created Strand Board for Well and Roof Sheathing - 0 1 _L 0 _ 1 0 ( i 1 0 -- i T7 1 -- 0 i�l p I 0 —T 1 T 1 ❑ ❑ ❑ ❑ 3. Use FSC-Certlfied Wood a. Dimensional Lumber, Studs and Timber. Minimum 4D% b. Dimensional Lumber, Studs and Timber. Minimum 70% c. Papal Products: Minimum 40% d. Panel Practices: Minimum 7D% - 0 0 _T 0 _ _� 0 1 02D07 Build It Green Single Family GreenPoint Checklist 2007 Version Page 1 014 -- - - - Toted Poimc Available in Model Sulking Frame and Emalope z 361 D E. EXTERIOR FINISH 1. Distribute Domnes Hot Water Efficiency (MAXIMUM 7 Polnte7 . Palms Available Per Measure 1. Uea R• clad -Content No VIr In Placoc or FSC-CemBed Wood Deciding D 2 Cr 2Install a Role Screen Well System 0 ENTER PROJECT NAME 0 I 4. Select Durable and NoncombuNhle Roofing Materiels 0 2 ❑ ' Total Polnts Available In Extoda Finish.7 0 0 1 2 F. INSUE.ATION Pmbing Use Control Points Available Per Measure 1. Install Insulation will, 76% Recycled Contest ❑ a Wage al Floor —E]—b.. Ce51n 0 0 ---I--- I 1 —i —i— . 2 Install Insulation that is Low -Emitting (Callfed Section 01350) ❑ a. Walls endlor Flom ❑ b. Ceilings 4. Use Solid Wall Systeme (Included, SIP41CFa, B Any Non -Slick Fmme, A bly) _ 1 i 1 3. Ins ed Oul of Insulation Installation before Applying Drywall 0 1 ❑ a. Floors 0 1 2 I 2 ❑ b. Wella 0 2 i 2 ❑ c. Ramo d. Pressure Balance the Ductwork System _ _ I i — T ❑ e. Protect Duce during Construction and Clean All Dude before Occupancy 5. Reduce Poll Emitting the Home from the Geroge 1 ❑— e. Install High Efficiency HVAC Filter (MERV 6s, 0 ❑ a Tightly Seel the Ah Banner between Garage and Living Ma 0 7. Dont Install Fireplace or Install Sealed Gas Flmpleces with Effclency Rating Not Lees Than 60% 1 i 1 ❑ b. Install Garage Exhaust Fan OR Bulld a Dea ched Gangs 0 1 e. Design Energy Heels on Trustees (75% of Alto Insulation Height at Outside Edge of Exterior Wel 0 1 ❑ e. Install ENERGY STAR Bathroom FangVenod to the Outside 0 7. Dad n Roof Tronas W Accommodate Ductwork ' 0 1 i ❑ e. Use Re cied-Comae stem Studs, for 00% at Imsrior Well Foreleg 0 1 1 B. Thermal Mese Walla: when Drywall on All Interior Welts or Write Weighing more then 40lbleu.R 0 1 � ❑ 10. Install Overhangs and Outten _ 0 1 ❑ c. Automatically Controlled Integrated System ❑ A Minimum 16 -Inch Overhangs and Sunni D d. Automatically Controlled Integrated System with Variable Speed Contrd 0 3 ❑ b. Minimum 24 -Inch Ovartramigs and Gucac D 1 ❑ I -- - - - Toted Poimc Available in Model Sulking Frame and Emalope z 361 D E. EXTERIOR FINISH 1. Distribute Domnes Hot Water Efficiency (MAXIMUM 7 Polnte7 . Palms Available Per Measure 1. Uea R• clad -Content No VIr In Placoc or FSC-CemBed Wood Deciding D 2 Cr 2Install a Role Screen Well System 0 1 2 5. Use Durable and Noncombustible Skill Materiels 0 I 4. Select Durable and NoncombuNhle Roofing Materiels 0 2 ❑ ' Total Polnts Available In Extoda Finish.7 0 0 1 2 F. INSUE.ATION Pmbing Use Control Points Available Per Measure 1. Install Insulation will, 76% Recycled Contest ❑ a Wage al Floor —E]—b.. Ce51n 0 0 ---I--- I 1 —i —i— . 2 Install Insulation that is Low -Emitting (Callfed Section 01350) ❑ a. Walls endlor Flom ❑ b. Ceilings 0 0 _ 1 i 1 3. Ins ed Oul of Insulation Installation before Applying Drywall 0 1 Palms Available In Insulation Total Points H. HEATING VENTILATION & AIR CONDITIONING 1. Distribute Domnes Hot Water Efficiency (MAXIMUM 7 Polnte7 . PolntB Available Per Measure ❑ a. Icnulele Hot Water Pipes from Water Heiner to Kill 0 ❑ b. Insulate All Hot Water Pipes _ 0 1 rte— i ❑ c. Use Engineered Parallel Plping 0 a FicmacbB • Use Parallel n Loop with Demand Controlled Cion 2 ❑ ' wited h Loo e. Use SWCWretl Plumbing wth Damentl Controlled Circulation Imp ed 1 0 1 2 ❑ Pmbing Use Control 0 Total Points H. HEATING VENTILATION & AIR CONDITIONING PolntB Available Per Measure 17 1. Design and Install HVAC System to ACCA Manual J. D, and S Recommendations 0 4 i 2. Install Settled CpmbRction Unit ❑ a FicmacbB • 0 2 ❑ to. Water Healere 0 2 Lj 0. Install Zoned. Hydronle Radiant Heal with Stab Edge Insulation o 17 1 e, Install High Efficiency Air Conditioning with Environmentelty Responsible Remgae is 0 1 5. Design and Install EfecOvs DUctwDrk ❑ a. Install HVAC Unit and Ducal within Con inbred Space 0 3 � ❑ b. Use Duct Mastic on All Dud Joints and Seams 0__ _-1 1 [3 c. c. Install Dunder Alto Insulation (Buded Duct) 0 1 1 ❑ d. Pressure Balance the Ductwork System 0 _ I i — T ❑ e. Protect Duce during Construction and Clean All Dude before Occupancy 0 1 ❑— e. Install High Efficiency HVAC Filter (MERV 6s, 0 _ _� 1 _ ❑ 7. Dont Install Fireplace or Install Sealed Gas Flmpleces with Effclency Rating Not Lees Than 60% D i 1 using LSA Standards B. Install Effective Eshaud Systems in Ballrooms and IDtchens ❑ e. Install ENERGY STAR Bathroom FangVenod to the Outside 0 ❑ b. All Bathroom Fens Are on Timer or Humidlstat 0 ❑ c. Install Kitchen Range Hood Vented to the Outside 0 1 e. Install Mechanical Ventilation System for Cooling (Madrel 4 Pointe) ❑ a Install ENERGY STAR Cal0ng Fens 6 UgM Kite in Living Ma s Sedroome 0 ❑ b, Install Whole House Fen with Variable Speeds _ 0 1 ❑ c. Automatically Controlled Integrated System 0 _ _ 2 —� ❑ d. Automatically Controlled Integrated System with Variable Speed Contrd 0 3 10. Install Mechanical Fresh Air Ventilation System (Material 3 Points) ❑ a. Any Whole House Vemkaticn System That Meeh ASHRAE 622 0 ❑ h. install Ah-teAlr Heat Exchanger that mean ASHRAE B22 0 1 2 LJ 11, Install Carbon Monoxide Atemes) 0 1 Tote Points Avellable in Heading. Venial and As Condlgoning=3D 0 1 02007 Build It Green Single Family GreamPoint Checklist 2007 Version Pace 2 of 4 C OF OCUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: .1/7 PERMIT # �6 '(0 4 OWNER'S NAME: /vtiE PHONE # p - p GENERAL CONTRACTOR: a,\ cLo -4,4za= FAX # I am not using any subcontractors: A -a a, Signature Date Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature 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 Rock Tile Owner/ Contractor Signature Date