08060242 •
-...0.4--:
CITY OF CUPERTINO - x4 � t^
BUILDING DIVISION..-. PERMIT •CONTACTOR NFORMATION •
BUILDING ADDRESS: PERMIT NO.
10465 BREWER AVE RESCUE AIR SERVICE 08060242 .
OWNER'S NAME: PERMIT ISSUE DATE
SACIi:I:N BESAI _ 6007 MAJORCA CT 06/30/2008
a NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
INSTALL NEW FURNACE ADD A/C BLDG ELECT PLUMB O
ei 0 C LICENSED CONTRACTOR'S DECLARATION
iu F 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
ca with Section701K1)of Division 3 of the Business and Professions Code,and my license is
m in full force and effect C,2.0 P?_(roe-Ln 1
)43 License Class Lie. -
g LT.c Dao In I ',(l l 0417Contractor
ARCHITECTS DECLARATION
g 're' I understand my plans shall be used as public cords
6
g O to Licensed PmfessioNI '
3 OWNER-BUILDER DECLARATION
eI hereby affirm that I em exempt from the Contractor's License Law for the
0
M O following reason.(Section 7031.5,Business and Professions Code:Any dry or county
m ff which requires a permit to construct alter.improve.dcmolkh,or repair any swam
4 prior a its issuance,also requirese the applicant for such permit to file a signed statement
x
< (commencing
licensed uredo totheprovisions o the ContractorindenseLaw(Chapter 9 Sq.Ft. Floor Area Valuation
y t-G heis tb Section d) basisasisar of theBusinessoAvs Code)or
y;� that V exempt therefrom and the for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars MOO). P Y YP
0 I.as owner of the property.or my employees with wages as their sole compensation.
will do the work.andthe structure is not intended or offered for sale(Sec.7014,Business
and Professions Code:The Contractornot apply to an s License Law does owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employees.provided that such improvements are notintended or offered for sale.If. •
however.the building or improvement is sold within one year of completion.the owner.
builder will have the burden of proving that he did not build or improve for purpose of
sake).
0 I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
0 I am exempt under Sec .13&P C for this mason
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
2 I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- '
atian.as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code.for the performance of the work for which Nis permit is issued '
My Worker's Compensation Insurance carrier and Policy number art: •
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
•
(T hissection need not hecompleted if the permit is for one hundred dollars($I00)
or less)
I certify that in the performance of the work for which this permit is issued.l shall not
employ any person in any manner so as to become sub t to Workers' ompensation '
Laws of Califon' a te Y •_
Applicant eVI•
NOTICE TO A w. :If.after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
0 Z forthwith comply with such provisions or thispermit shall be deemed revoked.
Zen CONSTRUCTION LENDING AGENCY
C the work erbyi� thrs affirm thatthereis a construction lending agency for the performance of
it is issued(Sec.3097,Civ.C.)
(St Q Lender's Name
=z Lender's Address
t,)0 I certify that I have mad this application and slate that the above information is
(g,U F carton I agree 10 comply with all city and county ordinances and sure laws relating to
,0 buildiingconovsruction,and forhereby orire representatives of this city to enter upon the
propertyinspectionpurposes /
_.y (We)agree to save,indemnify and keep harmless the City of Cupertino against
ff3 liabilities judgments.costs and expenses which may in any way accrue against said City , �I1
UZ in consequence of the granting of this permit.
^ APPLICANT UNDERSTAN S AND WILL COMPLY WITH ALL NON-POINT Issued by: *. ' Ile/,t�J Date U Gam.
SOURCEEG LATIONS.
( (T ^ bfRe-roofs
Dale
Signature Applicant/Contractor Dale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle haxasdous material .
as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code,Section 25532(0?
O Yes la Vo All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or form building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
• :mit hazardous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
District? 1
O Yes T:diNP •
I have real the hazardous materials requiremenu under Chapter 6.95 of the Califor-
nia Health&Safety Cede.Sections 25505.25533 and 25534.1 undersand Nu if the building
does not currently have a tenant that It is my responsibility to notify the occupant of the
requiremcn hk must xmet poor toissuance ofaCertificate ofOccupancy.
(D13o l % Signature of Applicant Date
Owner or am ohm 5g It Date' All roof coverings to be Class a%?a'or better
CITY OF CUPERTINO
' 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM
COPY # : 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN • 32641062 . 00
DATE ISSUED • 06/30/2008
RECEIPT # • BS000005285
REFERENCE ID # . . . : 08060242
SITE ADDRESS • 10465 BREWER AVE
SUBDIVISION
CITY • CUPERTINO
IMPACT AREA
OWNER • SACHIN 'BESAI
ADDRESS • 10465 BREWER AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1306
RECEIVED FROM • CHUNGKIM
CONTRACTOR • CHUNG H. KIM LIC # 29150
COMPANY • RESCUE AIR SERVICE
ADDRESS • 6007 MAJORCA CT
CITY/STATE/ZIP . . . : SAN JOSE, CA 95120
TELEPHONE • (408) 655-9916
41.
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
1BSEISMICR VALUATION 9, 000 . 00 0 . 90 0 . 00 0 . 90 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
I.MPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1MRRAA UNITS 2 . 00 122 . 38 0 . 00 122 . 38 0 . 00
1PPERMITFE 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 : 286 . 44 0 . 00 286 . 44 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
CREDIT CARD 286 . 44 VISA
TOTAL RECEIPT : 286 . 44
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
fl CITY OF CUPERTINO
FURNACE/AC
P
CUCITY
PERMIT APPLICATION FORM
D ea ,042-5/z
APN # Date:
zcv yl d 10 -o()
Building Address:
IO4 L 1?)Y2E-lu Grz PSE
Owner's Name: Phone #:
YhrL. S AC t-t 1
Contractor: Phone #:
444- c05S-v.\ 1 b
Scut t2V SCE � �- t\ t4
Fax #: t - Z.
Contractor License #: Cupertino Business License #:
8i-(0 2-01 2-y X50
Contact: Phone#:(,03_ce'S._ 0\til\b
C 1t u% i ,
Fax #: ` kA, 3-22S p- 15 I-1/2(p
Building Permit Info:
Elect ❑ Plumb ❑ Mech (°I
• Residential EI,V Commercial L
Job Description:
`NT Ar.\A_ NNE:>" XW'),A-&E, D.:N,0 N rJo L.
For Residential Installations:
Attic }-- 1st floor ❑ 2nd 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):
Q . ooU "=
Strapped ❑ On Platform ❑ Bonded
❑ New Location Replacement ❑
Project Size: Express ❑ Standard Large ❑ Major❑
Valuation:
Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the
application or if applicable, include in plan set & the sheet index.
• Revised 6/16/0
CITY OF CUPERTINO
FURNACE/AC
OF
�JPERJINO 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
installation 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.
IBSEISMICO 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 install/relocate/or M
replacement of ea appliance vent
install & not incl in an appl permit.
CITY OF CUPERTINO •
FURNACE/AC
COF
CUPERJINO PERMIT APPLICATION FORM •
APN# Date:
Building Address: •
Owner's Name: Phone#:
Contractor: • Phone#:
Fax #:
Contractor License#: Cupertino Business License#:
Contact: Phone#: .
. Fax #:
Building Permit Info:
Elect ❑ Plumb ❑ Mech ❑
Residential ❑ Commercial ❑
•
Job Description:
For Residential Installations: -
Attic ❑ ls` floor ❑ 2nd 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):
Strapped ❑ On Platform ❑ Bonded ❑ New Location ❑ Replacement ❑
Project Size: Express ❑ Standard ❑ Large ❑ Major ❑
Valuation:
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set & the sheet index. •
Revised 6/16/08
CITY OF CUPERTINO
FURNACE/AC
•CUF[KnNO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1PGASRES Residential for ea gas piping system of P
1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
1BSEISMICR Residential Seismic B
1MECPLNCK , Mechanical Plan Check M
1MFR=<100 Furnace Syst<=100k BTU install or M
relocate ea forced-air/gravity type
furnace/bumer, ints
• attached to such applianceclducts/venup to and
include 100,000 Btu/h
1MFRN>100 Furnace Syst> 100k BTU install or M
relocate ea forced-air/gravity type
furnace/burner, incl ducts/vents
attached to such appliance over
100,000 Btu/h
1EPERMITFEE Electric Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
IPPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
1BUSLIC Business License•
B
•
CITY OF CUPERTINO
FURNACE/AC .
CUP k iNO FEE SCHEDULE •
Quantity Fee ID Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
1BCAIRHAN Commercial A/C Units<= 10k CFM B
1MCRAA Commercial Mech Repair/alt/add M
1BSEISMICO Seismic Commercial B
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1PGASRES Residential for ea.gas piping system P .
of 1-4 Outlets
•
1BPGAS For each gas piping system of 5 or P
more per outlet. Comm/Resid
1BREMAIRHAN Residential A/C units <= 10k CFM B
I 1MRRAA Residential Mech Repair/alt/add M
1BSEISMICR Seismic Residential B •
j 1EPERMITFEE Electric Permit , E
1MPERMITFEE Mechanical Permit M
1 PPERMITFEE Plumbing Permit P
1 TRAVDOC Travel Documentation' B
1BUSLIC Business License B
•
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
T K
v�iyy ? Plans See below
a :g6 w.en s�`i +T v.crol{. .-vd :'otic^,P yb^ 4. *i:14 :n-e0,;,..4,'Hf'� . V', R€ i�ni , e. `^, /tJli.^ jtiAa. x.�.:r'..riX
B. Site 9. Install H.E. Irrigation, (details/spec)* -1 2 points
11. Permeable Paving, (Note) L-1 2 points _
C. Foundation 1. Use 15% Flyash Concrete, (note) S-1 5 points
D. Structural 3. Uses Wood I-Joist, (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 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 1 point
P. Other 1. List Green Features on Plans A-1 1 point
C ":3', '•1:ii i:A %_'S- TOTAL POINTS `rte 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 Energy 1/10/Health
A.Site
1.Recycle JobSite Construction&Demolition Waste.
65%=1 point;75%= 2 points;80%=4 points up to 4 Resource pts' 0
2.Salvage 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 Stormwater 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 4 Resource pts y=yes, D
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
0 0 0
B.Foundation
1.Incorporate Recycled Flyash in 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
0 0 0
C.Structural Frame
1.Substitute Solid Sawn Lumber with Engineered Lumber 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 • D
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
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 •
b.Sheathing 1 Resource pt y=yes 0
0 0 0
•
.. ` . I INPUT Resources Energy 140/Health
I.Wm•ows
• 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 2 Energy pts y=yes 0
•
2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 0
0 0 0
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 3 Energy pts y=yes 0
3.Vent Range Hood to the Outside 1 IAQMealth pt y=yes 0
4.Clean all Ducts Before Occupancy 2 IAO/Health pts y=yes 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 0
8.Install Sealed Combustion Units
a.Furnaces ' 3 IAQ/Health pts y=yes 0
b.Water Heaters 3 lAQMealth 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 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes 0
• 13.Retrofit Wood Burning Fireplaces
a.Install EPA certified wood stoves/inserts 1 IAQ/Health pt y=yes 0
b. InstalVReplace 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 lAO/Health pts 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 pts y=yes 0
I 0 0 0
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=18 points) Up to 18 Energy pts 0
6.Select Safe and Durable Roofing Materials 1 Resource pt y=yes 0
7.Install Radiant Barrier 3 Energy pts y=yes 0
•
I 0 0 0
L.Natural Heating 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 pts y=yes 0
• I 0 0 0
I!. .- - RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number: 326— L( (- 22,;(2
Name of owner. \" t , S Ai CJ 1-i t t,
Project address. 'b Lt(S 1112--EVV-ER {\\t
. Contact person. C hunkL-, Phone. L op3- (oSS- C\R\(p
Fax.
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Ga age: - 5<1
floor: \
Garage _....
TOTAL: '
/
• /'
Ore there at least two 10 foot by 20 foot clear spaces inside the garage? Y
Is privacy protection planting required for the project? .j ._
On what floor(s) is work being done? LOw-2 c 20oc. 4.-77\C '
Brief description of work. ZnS4o`\\ Ntv >rv,2lV r.),L , k-DI, t. ,1 C
Code editions: 2008 CBC2 8
C 9C''- N)2008 CMC 62 N) •
2008 CPC N-ACCOKUT Q2Spi k QiE C L,N)
CUP1EERTINO CODES AND ORDINANCE. ��
�,OO-Ciel--
Effective 1/1/08 171
)ATE
SIGNED C.2"-----2"------77-7----
mow O_y„ tiU�? -vig ~ �n{'j
This set ut plans and specifications d� T73
This
u
Cie kept on the job achaall
ngestimes
o aeration•
ayfuL to make any permission from
Crin semi without written PQ
ne building Dept City of Cupertino. C ,
rhe stamping of this Wen end specification<
HALL NOT be held to Permit or to be ar Qrowsm
• oproVal of the violation of any p
-fl„ City flmmance or Smtp Irw
Plan Review Process Work Book Page-8-Revised 1/1/08
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RESIDENTIAL PROJECT COVER SHEET
•
Assessor's Parcel Number:
Name of owner. \\'-\- , SIC H \
Project address. \b 'cLorj 3r2tV R {\\tE
Contact person. C F-\ Phone. LO1e- (OSS- CD1R\(p
Fax.
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
ere there at least two 10 foot by 20 foot clear spaces inside the garage? N
Is privacy protection planting required for the project?
On what floors) is work being done? \--Uv,)-2 r^ 12 oc' 4-77
l C,
Brief description of work. TnS-1-0\.1v\..) C , Q-DIM I.;1
Code editions: 2008 CBC ( - N)2008 CFC � -N)2008 CMC N)
2008 CPC (6,- N)2008 NEC 6" -N�
Effective 1/1/08
efr
Air t9)" vg-e4,
eib
•
Plan Review Process Work Book Page-8-Revised 1/1/08
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Community Development
10300 Tone Avenue
Stat541 Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
•UPEICTINO
Building Department
JOB ADDRESS: PERMIT #
1 O 4(05 13 etwtz ,d0-4 z_Lr't—
OWNER'S NAME: 'Mn , s c c ti ,J PHONE # 4oA_co5s_ 99
GENERAL CONTRACTORQ{ScUF Ain sGlay t(F FAX #
I am not using any subcontractors: Le-a (O( 10 ( O
Signature Date
Please check applicable subcontractors and complete the following information:
Ea 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
• O(Dl 3d ( off
Cl � �
er/ ontractor Signature Date