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08040196 CITY OF CUPERTINO Nus t ' r E BUIMOING DIVISION PERMIT BUILDING ADDRESS: - PERMIT NO. - 10055 CRESCENT RD TBD - TO BE DETERMINED 08040196 OWNER'S NAME: PERMIT ISSUE DATE 01, ELERATH JON G AND DEBRA A 04/28/2008 WINE: SANITARY NO. CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDGO ELECTO PLUMB MECHO Sop LICENSED CONTRACTOR'S DECLARATION rdC 1 hereby affirm that 1 w limmed under provisions of ChI 9(commencing Job Description ni with Section7ON0ofDivWian3oftheBuainexandProfrsd.mCade,andmylicensc1, 2 BTHRMS 7 RPLC TILE IN SHWR& INSTL FLR TILE,NO in full farm and cater. License Class Can 11 PLMBING,NO ELECTRICL&NO MECH WK; WTR RESTNG MTRL ARCHITECTS DECLARATION l,g � l tine,mod my plans shail W used u public mcnrN BHND TILE hoEp Licensed Prefaces...I - a, OWNER-BUILDER DECLARATION .�<g I hereby efrom that I am exempt from the Conuacmfs License Law for the C O O following mason.(Section 703 1.5,Business and Profamom;Cade:Any city or coumy 1§9 wh ch ex ulres a permit to cnnmw4 alms improve,demolish.Or repair any suuctoo prior in its issuance,also requiins the applicant for such Permit to file,signed emtencent €o that M is licensed pursuant to don previsions oftle,Consomm's Us=Law(Chapter 9 Sq.Ft.Floor Area Valuation $ (commencing with Section 7000)of Division 3 mme BmanxW ead Professions m Code)or $3000 �.. that he is exempt therefroand We but,for the alleged mammon.Any violation of Semon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty OfNumber O oar mom Wan five hundred dollar(ML 32616070 V( l Occupancy P y Type 0 Leaowner of tl a property,army employees with mgx u the'v min eompenastim, will do We work,aM the met.is notimearl or offered for in(Ste.70th,Business and Profemons Cae:dThe Cmu sum's Lka m e" Law danot apply to an owner of Required Inspections property who build,m iesprovee themon,and who does such wart himself or through her Own employva,provided that each impmvemants are nathembled aroffered fm We.if. however,the building or improvement is said within aro year of oomplamm.the owner- builder will have W burdan of proving that M did err Wild or impreve for purpose of "is). L..owner of the pmpeny,am exclusively connecting with licensed concessions to cansuum Ire project(Sec.7064.Business and Processors;Cade:)The Conaactor's LI, cam law does out apply an an owner of property who builds or impmvea thereon.and who contracts for each projects with a comsomr(a)licensed pereuanl to the Contransola License taw. 0 1 am exempt undo See B&P C for this moon Owner — Data WORKER'S COMPENSATION DECLARATION I hereby affirm under p ate ty of perjury ata of the following declasWow bare and will sa .sin a Certifieum of Consent On self-insurefor Worker',Compen- mt..,u providrd for by Section 3700 of the Labor Cade,far the perfm eanm of the work for which We permit is exact. 0 I have and will maintain Worker's Compensation Immonee,as inquired by Section 3700ar the labor Code,far de parfarmanee of Ne wart for which this permit is Issued ' My Warlar,Compensation Inmrerme carrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE Cihkxection treed mthecompleted Hubs permit W Loran hundred dollars(SIM) or lest) 1 Ondfy that in the PmfonmeCal of We work far which this Permit is issued.I shall am employ any person in any manrorsouahecama sabje l r rY6,sa:fmpetration Laws of Ca I.famla,.De OO Applleam T� NOTICE TO APPb?CXNT.1r.a0er malting this CeAficate of Exemption,you should become mbjecs m the Worker's Compere Ubm Provki.n!of Im tabm Code,you men .J O forthwith comply with such provisions or this Permit shall heem deed rooked. CONSTRUCTION LENDING AGENCY I hereby affirm Was them i,a construction lending agency for the performance of 6i n�i the work for which thin permit is issued(Sec.3157,Civ.C.) 14 Lc rices Name M Z land e.Addrex U Q L certify Was I have and this application and stir that the above informed..W tp,E Comm I a&=he comply with WE city and county ordinances UI sure law,missing to DU building construction,and hereby mNaian represoalasive,of this city in enter upon IN above-menuoned property for Inspection purposes. �y"y (We)agree to save,indemnify and keep harmless the City of Cupertino against V) incon=quadeofthegaming expenses oft. may in any way acme against said City 3 AcPLICANTe of the UNDERSTANDS of WWDWIL fr n ^^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCa$€GU(gATIDN�J = 7 y�*0� Re-roofs Stgnat a pplinHAZARDO L —sit HAZARDOUS MATERIALS expart ore Osumi Type of Roof - �— Will the a Casper ar future Municipal Co e.Chapter ,erre orand t e haxNousd Safety ed as dellncd by lin Cupe.ino Muninpd Calc.ChaPtr 9.12,and the HcaiW and Safety Cuda,Section 25532(a)7 � All roofs shall be inspected prior to any roofing material being installed. 0 Yu If a roof is installed without first obtainingan inspection,I agree to remove WIII We epPlicanr ser fuwm Wildingoccupant ase gqulpmant ar devices which P g ha'ragoue air contentment as defined by the Bay Area Air Quality Management all new materials for inspection. use cs? ❑Yea Nu I here read the noontime materials requirements underCltaplc6.95 of the Califor. ON Health&Sgcty Code,Secuaro25505,25533 and 25534.1 understand thnifthc building data oar cwrentir have a tenant. re nu whit u—st�&�L7 et gat,Li eri ry t notfy t cegwent nr the vanccr.canifcnofQCC Signature of Applicant Date/J04— Onummmthaircdagcns DamI All roof coverings to be Classor better CITY OF CUPERTINO • 2 ITEMS OF .2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32616070. 00 DATE ISSUED. . . . . . . : 04/28/2008 RECEIPT #. . . . . . . . . : BS000004596 REFERENCE ID # . . . : '08040196 SITE ADDRESS . . . . . : 10055 CRESCENT RD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER ELERATH JON G AND DEBRA A ADDRESS . . . . . . . . . . : 10055 CRESCENT RD CITY/STATE/ZIP . . . : CUPERTINO, 95014-1050 RECEIVED FROM . . . . : JON G ELERATH CONTRACTOR . . . . . . . : TBD - TO 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 3, 000. 00 0 .50 0. 00 0. 50 0. 00 1REMRESBAT SQ FEET 1. 00 551. 00 0. 00 551 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 551 . 50 0. 00 551.50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 551.50 MC --------------- TOTAL RECEIPT 551 . 50 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 PlansSee below 7Structural Install H.E. Irrigation, (details/spec)' L-1 2 points Permeable Paving, Note L-1 2 points Use 15 % Flyash Concrete, (note) S-1 5 points Uses Wood 1-Joist, (See Spec.) S-22 pointsUse Truss with heels, (detail) S-2 2 points 6. B. OSB Sheathing, detail S-2 2 oints 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/Spec) L-1 10 points G. Electrical 4. E. Ceiling Fans, (Note/Spec.) q-3 H. Appliances 1. Energy Star Dishwasher, (Note/Spec.) A-3 4 points 1 point 3. Energy Star Refrigerator, NotelS ec. A-3 1 oint P. Other 1. List Green Features on Plans A-1 1 point m TOTAL POINTS 40 points /db SS �resc�I—fid �-f-2�-off 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. .Site 1.Recycle Job Site Const action&Demolition Waste i 65°/=1 point;75%= 2 points;60%=4 points ( up to 4 Resource pts 0 2.Selvage Reusable Building Materials ! 4 Resource pis 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 S.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 pis y=yes 0 6.Design Resource•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 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 1 1 1 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 pts0 2.Use Recycled Content Aggregate 2 Resource pts y=yes 0 3.Insulate Foundation/Slab before backfill 3 Energy pis y=yes 0 1 1 1 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 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 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 pis y=yes 0 12.Use OSB —{ a.Subfloors 1 Resource pt y=yes 0 ® b.She 1 Resource pt y=yes 0 1 1 1.Use Sustainable Decking Materials a.Recycled content 3 Resource pis y--yes 0 . 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 3.Install House Wrap under Siding 1 IAQ/Health pt y=yes 0 4,Use Fiber-Cement Siding Materials 1 Resource of y=yes 0 1 1 1 E.Plumbing 1.Install Water Heater Jacket 1 Energy pt y=yes 0 2.Insulate Hot and Cold Water Pipes 2 Energy pts Y---yes 0 3.Retrofit all Faucets and Showerheads with 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 Tolled with Ultra-Low Flush Toilets (1 point each,up to 3 points) Up to 3 Resource pts.0 0 5.Install Chlorine Filter on Showerhead 1 IAQ/Health pt y=yes 0 6.Convert Gas to Tankiess 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 IAO/Health pts. 0 S.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0 r.rrecmcai 1,Install Compact Fluorescent Light Bulbs(CFLs) (6 bulbs=2 points,10 bulbs=3 points,12 bulbs=4 points) 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 is 4 Energy pts. 0 4.Install High Efficiency Ceiling Fans with CFLs (1 point each,up to 4 points) Up to 4 Energy pts. 0 1 1 1 G.Appliances 1,Install Energy Star Dishwasher 1 Energy pt y=yes 0 2.Install Washing Machine with Water and Energy Conservation Features i Energy pt y=yes 0 3.Install Energy Star Refrigerator 1 Energy pt 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 3.Install Recycled-Content,Fiberglass Insulation with No Added Formaldehyde 3 IAQ/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.ueuings 4 Resource pts y=yes 0 1 1 mLOWS INPUT Resources Energy IAQ/Health 1.Install EnergyEBicient Windows- -� I • a.Double-Paned 1 Energy pt y=yes D b.Low-Emissivity(Low-E) 2 Energy pts y=yes 0 c.-Low.Conductivity Frames 2 Energy pis y=yes 0 2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 0 1 1 1 J.Heating Ventilation and Air Conditioning 1.Use Duct Mastic on Ali 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 IAQ/Health pt y=yes 0 4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 0 5.Install Solar Attic Fan 2 Energy pts y=yes 7 0 6.Install Attic Ventilation Systems 1 Energy pt y=yes D 7.Install Whole House Fan 4 Energy pts y=yes D B.Install Sealed Combustion Units a.Furnaces 31AQ/Healthis P Y=Yes 0 b.Water Heaters 31AQ/Health 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. Install/Replace 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 41AQ/Health pts y=yes 0 i6.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pis y=yes 0 17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes 0 1 K.Renewable Energy and Roofing 1 1 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 Materiels 1 Resource pt y=yes 0 7.Install Radiant Barrier 3 Energy pts y=yes 0 1 1 1 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 1 1 1 . n oor r ue Iry an rn s es 1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAO Health pts y=yes 0 • 3.Use Low/No VOC Adhesives 31AQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.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 Particleboard or MDF 4 IAQ/Health pts y=yes 0 6.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pis y=yes 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes I 1 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 6 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts Y--yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpel with Low VOCs 4 Resource pts y=yes 0 1 1 1 Total Points Avat a e: r 1401 1301 57 Total Points Pro'ect Recelved:1 or 01 0 • G:datelprogs/greenbulldingguidellnes/remodelers/greenpoimsf nal2.12.04protemad.xls D H 019 (P CITY OF CUPERTINO ' ADDITION/REMODEL CUPEkTINO PERMIT APPLICATION FORM APN# Date: Building Address: I60 12�_ Mailing Address (if different from building address): Owner's Name: Phone# : OFr- a r'5. s3 yIgH SoN G. EIP✓tr QO&-2 -6 7 Contractor: T� Phone#: Y66 � fev� Fax I i IP Fax Contractor License#: Cupertino Business License#: Contact: a Phone#: Fax#: Building Permit Info: CN&A-V oom *--_P1c� +-,V- GaA4 *&,-? Bldg. [ Elect. ❑ Plumb. ❑ Mech. ❑ Hillside ❑ Job Description: Addition (adding sq footage): What is being remodeled? ��p����� ft�9 n� ^ `� -" - - r MO A& e (r��r<� �ro�k� � !UQG� Remodel Includes Re-Roof: Yes ❑ No © If yes list number of squares Remodel Includes Structural: Yes ❑ No Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen Bath 415— Other Type of Construction (Usage Class): Occupancy Type: 1A, 11B ❑ 11, 111, V-A ❑ 11, 111, 1VV-13 4�slob°. ))A V 3 Valuatio / Please check this box if the project is a 3600 second-story addition ❑ Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, Green Building Points Achieved: �r1 include in plan set& the sheet index. ***For Office Use Only*** Over-the-Counter ❑ 4AF CITY OF CUPERTINO i_qy ADDITION/REMODEL CUPERTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft ADDITIONS 1R3SFDADD PLLONGRNGR Long Range PL Plannin Residential 1R31NSP Dwellings Inspections B 1R3PLNCK Dwellings plan check B 1R3REPINSP Dwellings Repeat B Inspection 1R3REPPLNC Dwellings Repeat Plan B Check 1R3HINSP Dwellings Hillside B inspection 1 R3HPLNCK Dwellings Hillside plan B check 1R3HREINSP Dwellings Hillside B Repeat Ins ection • 1R3HREPLNC Dwellings Hillside B Re eat Plan Check IR3ALTINSP Dwellings Alternate B Materials Inspection I R3ALTPLNC Dwellings Alternate B Materials Plan Check 1PCESS Cesspool P IPPRSEWG Ea. Private Sewage P Disposal System 1PRSEWER Sewers P 1BPSPRINK Lawn Sprinkler/Backflow P IBPWSVCS Main Water Service P IBSEISMICRE SeismicResidential B DECKS 1R3SFDADD OR 1R3SFDREM IDECKWOOD Deck(Wood)-Each B Each 1DECKRAIL Deck Railing-Each B (Each) AL CITY OF CUPERTINO ADDITON/REMODEL FEESCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft GARAGES 1R3SFDADD OR IR3SFDREM 1GARDTW<=1K Wood Frame up to B 1,000 SF 1GARDTM<=1K Masonry up to 1,000 SF B BCONSTAXR Construction Tax Res (new detached garage) PATIO'S OPEN 1R3SFDADD OR 1R3SFDREM IPATIOWOOD Wood Frame up to 300 B SF 1 PATIOMETAL Metal Frame up to 300 B SF 1PATIOOTHER Other Frame up to 300 SF B PATIO'S CLOSED 1R3SFDADD OR 1R3SFDREM 1PATIOENCLW Enclosed Wood up to 300 B SF 1PATIOENCLM Enclosed Metal up to 300 B . SF 1PATIOENCLO Other Enclosed Patio up B to 300 SF 1COVPORCH Porch Covered-Each B Each IREROOFRES Residential Re-roof Each B 100 SF REMODELS 1R3SFDREM 1 REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan 300 SF check 1REMRESBAT Bath Remodel up to 300 B (f SF 1REMREOTH Other Remodel up to 300 B SF REMODEL PLNCK 1STPLNCK (1-3 for Standard Plan Check B NOT FOR OVER THE remodel) COUNTER PLAN CKS. 3of3 CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft WINDOW/SLIDING 1R3SFDREM GLASS DOOR 1 WINREP Replacement windows B ea 8 windows 1 WINNEWNSTR New Window (non- B structural 1WINMEWSTR New Window (Structural B Shear Wall/Masonry) 1 WINBAYSTR Bay Window (Structural) B SKYLIGHTS 1R3SFDREM 1 SKYL<I0 SF Skylight less than 10 sf B 1 SKYL>10SF Skylight greater than 10 B sf or structural 1STAIRS Stairs-first flight/ea addt'l B • IEPERMITFEE Electrical Permit Fee E IMPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P IELCPLNCK Stand Alone Electric Pln E Ck (hourly) IMECPLNCK Stand Alone Mechanical M Pln Ck our] 1PLMPLNCK Stand Alone Plumbing P Pln Ck(hourl 1BSEISMICRE Seismic Residential B 1TRAVDOC Travel & DocumentationPB 1BUSLIC Business License 4 of 3 S,tja Community Development 10300 Torre Avenue Cupertino CA 95014 11 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ' UPERTINO Building Department JOB ADDRESS: PERMIT # ooS� C°R�Pw1-RC O O(4` OWNER'S NAME: �/ tL, PHO # Ofr Jjo- 9 GENERAL CONTRACTOR: T to FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 6a 1 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 r!� Owner/Contractor Signature Date