08090117 CITY OF CUPERTINO
BUILIONG DIVISION PERMIT kCON�TRACTQIi INk'QRNTATIOKN,��",
BUIID NG DRESS: PERMIT NO.
�OlS DE ANZA BLVD ALL SEASONS ROOFING SERVICE 08090117
OWNER'S NAME: PERMIT ISSUE DATE
VARDY MIKE LLC 1720 SMITH AVE 09/17/2008
NE: SANITARY NO. CONTROL NO.
7- uc
Hlrecrn3NCINEEa:. INFO
RE-RF T/O 2LYRS TAR&GRVL BLDG BUILDING PERMIT
MECH
0 0 0 0
LICENSEDCOMAACfORS DECLARATION
Ibereby afrtm that iw Boostedunder provisions of Oupter 9(commncmg ^_.. -_,-..._ ,.__,._ ..Job Description
llto=aeff !ll fame arW cRecs ? 96
jLlnso❑asa La.R
c^ Da �G/�_Contractor .
` � te ARCHIIELTSDECLARATION $'1'YVtC¢S
f 1 uMcrmand my plans Nail W used u Public records
JWU
k a�a me
LlacJ Plufeuional
3 OWNER-exempt ro mDECLARATION
COC I Wroby (S" Nat I am exempt term to Contractors License Law for the
COC O which
ream..(gentian 703 L5.Busies was ve.deiNns Cade:Any city ase county
$ whim requires a permit to comucL altos.vnpmve,dcmal'tsh,Or mpbir ant swctum
-i< prior to its issuance,aim requires the applicant for such Permit o file a signed statement
Nat he is licensed pursuant to the provision of the ConlmctmS License Law(Chapter 9 Sq.Ft. Floor Area Valuation
(commencing wit Section]B00)of Division 3 of to Business and Pmfessimu Code)or
tat he Is exempt teteform and to hums for to alleged exemption.Any violation of
Section 70315 by my applicant for.permit subjects tc applicants to a civil penalty of APN Number Occupancy Type
not more to Tam lour red dollars ISMP Y YP
❑I,uownu of de pmpvtY•mmy wplaycu wit wgesu te4 sole compewtian,
and Product.
r de t.Ntl t- aWC ons la nal s Licaed of aR and tet Out a(icy.TDad.B neer of
antl arty wh ou Code Tile Contractor, nth who Law dans out apply lf an urger of _ Required Inspections
Property who Wildsurimpmveu Ther prewo who deessucntuded mrmestWough his
cow ever.the
Wilding
chs suchen I.old
wit are re car ldfd maBetCd for calm U. '
burner.de Weto mimprovementis soldwhinone gess of sumple Its to ower.
Wilder will love the buds of proving tat K did sur Wild or improve(w purpose of
sale.).
(]1.as owner of to property,am exclusively contacting wit licensed contractors to
construct use project(Sec 7061.Business and Professions Code:)The Contractor's U. .
cense law does not apply to an weer of property who Wits or impmvu lemon,and
who contacts for such pmjeets wit a contractar(s)licensed pursuant to the Contrsemes
Lice.law.
❑lameomptandu See ,B&PCfoOflms o
Owner Date
WORKER'S COMPENSATION DECLARATION
1 thereby affirm under pointy of perjury one of to following declaruiou:
1 ham and will maintain a Ccoulicar ofConsent insets-im.for Warkcra Cmnpcm
tion,as provided for by Section 3700 of to lather Code.for to pcoloommm of de
wort for which this parent is issued.
❑1 basic and will maintain Worker's Compensation Insurance,as mquimd by section
3700af to Lahm Code,for to pufarnmocc cr the wort rarwhlch chis permits Wood.
My Workers Compp�ewntion Inns curter sol Polig n�uamber art: �1 n
Cartier. A-l' f� �-� Polity No.: l2R O(x37. 0-7
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thesocom read sultan completed Hubs pontis faros herded donss(SIW) ,
m IML)
T candry dal in the performamc of to work for which this permit u issued.1"I net
employ anypctann in any matin,to as to beemne subject to We Workers'Compeuuien
Laws of California.Das
Applicant
NOTICE TO APPLICANT:TL after making to CcNftae of Exemption,you should
become subject to use Worker's Compensation provisions of the Latour Coda you most
.,O imbov t comply wit such providaru w abut permit shall tae deemed revoked.
z
r a'" CONSTRUCTION TENDING AGENCY
f-' 11,I.which Islas
thalMom uscdi IS...30 lending agercy sem de Performame of .
a'rz to wish for which this permit u iuoed(Sec.709'1.Civ.C)
fa7ry Q Landers Nurse
� z lender,Address
U Q I comity tat 1 have read this applicator and state tat due aWva informal..is
11. Cc L 1 agrne to comply wit all city and country anc
ty ordines and lose,slaws retailing On
ng
.0 Wilding conwunion.arW hereby auusorim representatives crania city to emo,upon One
� hove.mentmcd property for inspection purposes.. y • (We)agree to save,indemnify and keep hanolcss he City or Cupertino againal
fA IisbiliteaJudgments,cc.and expuues which may in my way.ag.%d,slid Cly
U z in eotuequimcc or to starting of this Permit. G
sew APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOUR REGULATITS.
4�:ret T� �/oli11h �7�Afi Re-roofsS—
ngmLmo ApplucmU .mwcmr M. f
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
WIII dto applicant or future building eceupantsom orhamdk havandous material
U defumd by to Cupertino Municipal Code.Chapter 9.11.and use Heslt and Safety
Code.Oy.25532t.)? 194. All roofs shall be inspected prior to any roofing material being installed.
WWill the appliequipmenttk
t or forubuilding occupant use equipment or vices which If a roof is installed without first obtaining an inspection,I agree to remove
lyiardliw tar Mose pantoj'defined by site Bay Area Air Quality Managcmcnt all new materials for inspection.
OYrs p/N„
1 have real Ne nasallous materials mqu W rrew under Chapur G93 of the Cali(or
ria HcalthSafcty Cade.Seedpu 25305.355J3 am125534.1 undrntand tazirdrc Wilding
dw nalc is h ham ak=1 dad it imy rtapois Cc tyb nattyde aaupant of de
main
n wwnm a melpartoss .cera alcoto,
Signature of Applicant Date
Ownalro dsmi.dagnnt Dow All roof coverings to be Class'W'or better
CITY OF CUPERTINO
• 2 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: . Sub: Blk: Lot:
APN . . . . . . . . : 35910060 . 01
DATE ISSUED. . . . . . . : 09/17/2008.
RECEIPT # . . . . . . . . . : BS000006117
REFERENCE ID # . . . : 08090117
SITE ADDRESS . . . . . : 10227 S DE ANZA BLVD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER VARDY MIKE LLC
ADDRESS . . . . . . . . . . : 10227 S DE ANZA BLVD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : ALL SEASONS ROOFING
CONTRACTOR . . . . . . . : GORSHTEIN, VLADISLAV LIC # 21035
COMPANY ALL SEASONS ROOFING SERVICES
ADDRESS 1720 SMITH AVE -
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE (408) 971-4455
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICO VALUATION 50, 000 . 00 10 . 50 0. 00 10 . 50 0 . 00
1REROOFCOM SQUARES 100 . 00 643 . 00 0 . 00 643 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 653 . 50 0. 00 653 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 1, 972 . 00 #24575
---------------
TOTAL RECEIPT 1, 972 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--- ----------------------------
- --- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
oinq 0/i-7
r
CITY OF CUPERTINO
`g g.. REROOF
tip.
• CUPEkTINO PERMIT APPLICATION
API # 2.5-n/ D C) / + O O / Date:
Building Address: I
Owner's Name: \4 r d ' S 2 w-tr\l� Phone #:
�i �y sok ^�, � 0� ^ceal-3s2 �
Contractor: Phone #: N o8-°I _jI—y y S-�S'
(-N\\
to 20s vv.< N- r 0,
crq Fax#:
Cupertino Busness License #: C�rgto License #:
C9 )
nq
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
• ❑ Wood Shingles ❑ Wood Shingles
t4 Other(Specify)-r± pts X Other(Specify) 5 P/y
Number of existing coverings .1c, pry A,' Provide I.C.B.O. Report # E(L - 5yp 3-
,Ni To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
-`'mar OPa�� ����. a� �� of ro —a cmc uzl w 2 at �c �Q✓ ob S v,51e ,
PV6. rstu., ,, 5 �\a V.. » oev_ laoEt
Residential ❑ Commercial
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation: C5 0."
J o,
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 6/16/08
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
• Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1.997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4• To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5• If plywood is installed, a plywood nail inspection is required.
6- Any roofing which is applied without first obtaining an inspection,
• will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
7• NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled
IMPORTANT:
1- Flat roofs must have a minimum of 1/4"per foot slope and demonstrate
that there is no ponding.
2• An LC.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
\J Homeowner's Name: O.+^C�l^ T7 , `� 2
Job Site Address: �� `�a—] �` Yet y1 Z`a �� U r� y�� CIA q yol l,`
Roofing Company Name:. (�� � S�t8(MS p p( ,h r� C_ Q,kAU s USQ
Applicant's Signa a C � Date. ', �' w
Greg Casteel
• Building Official
Revised 11%2/04
CITY OF CUPERTINO
F REROOF
1UPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
(�d 1RER00FRES Re-roof Residential B 1SFDWLR00F
/ 1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLR06F
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08
•
CITY OF CUPERTINO
'���` REROOF
OF
CUPERTINO PERMIT APPLICATION
APN # Date:
Building Address:
Owner's Name: Phone #:
Contractor: Phone #:
Fax#:
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
a Built-Up Roof ❑ Built-Up roof
o Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
Residential Commercial ❑
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation:
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
•
Signature
Revised 6/16/08
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.
A.Site INPUT Resources Energy A0111ealto
1.Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;60%=4 points up to 4 Resource pts 0
!2.Salvage Reusable Building Materials 4 Resource pts y=yes D
3.Remodel for Mixad Use,Adaptive Reuse,and
Historic Preservation 4 Resource pts y=yes 0
4,Protect Native Soil 2 Resource pts y=yes D
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
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 D
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
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=yesl;;F 0
1
C.Structural Frame 1 1
11.Substitutee S01id Sawn Lumber with Engineered Lumber 3 Resource pis
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
b.Wall y=yes 0
3 Energy pts y=yes 0
c.Roof 3 Energy pis y=yes 0
10.Apply Advanced Framing Techniques 4 Resource pts y=yes p
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes p
72.Use OSB - -
a.Subfloors 1 Resource pt y=yes 0
b.Sheathing 1 Resource pt y=yes
0
• 1 1 1
__ INPUT Resources Energy lAQ1Hea1th
D.Exterior Finish
1.Use Sustainable Decking Materials
a.Recycled content 3 Resource pts y=yes 0 •
l b.FSC Certified Wood 3 Resource pts y--yes 0
�2.Use Treated Wood That Does Not Contain ChromiundArsenic 1 IAQ/Haalth pt y=yes 0
3.Install House Wrap under Siding 1 IAQ/Health pt y--yes 0
14.Use Fiber-Cement Siding Materials 1 Resource pt y=yes 0
E.Plumbing
1.Install Weter Heater ackat t Energy pt y=yes 0
2.Insulate Hot and Cold Water Pipes 2 Energy pts y=yes 0
F3.Retrofit all Fauoets and Showerheads with FlowReducers ,
a.Faucets(1 point each,up to 2 points) Up to 2 Resource pts. 0
i
b.Showerheads(1 point each,up to 2 points) Up to 2 Resource pts. 0 -
4.Replace Toilest with Ultra-Low Flush Toilets
(1 point each,up to 3 points) Up to 3 Resource pis. 0
5.Install Chlorine Filter on Showerhead 1 IAQ/Health pt y=yes 0
6.Convert Gas to Tankless 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 IAQ/Health pts. 0
B.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
1 1 1
r-.eiecmcai
f1.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 to 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 I 1
G.Appliances
11.Install Energy Star Dishwasher 1 Energy pt y=yes 0
12.Install Washing Machine with Water and Energy
Conservation Features 1 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
13.Install Recycled-Conterit,Fiberglass Insulation with
INo Added Formaldehyde 31AQ/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
o.t;eungs 4 Resource pts y=yes 0
1 I 1
INPUT RESDUTCeS Energy 1ADIHealth
L Win 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--yes0
2.Install Low Heat Transmission Glazing 1 Energy pt Y--yes0
1 1 1
J.Heating Ventilation and Air Conditioning
ii.Use Dud 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 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 0
7.Install Whole House Fan 4 Energy pts Y--yes 0
8.Install Sealed Combustion Units
a.Furnaces - 31AQ/Health pts y--yes 0
b.Water Heaters 3 IAQ/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 D
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 stovesfinseds 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 4 IAQ/Health pis y=yes 0
16.Install Heal Recovery Ventilation Unit(HRV) 51AQ/Healh pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAQMealth pts y=yes D
1 1 1
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes D
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 1 B Energy pts D
�6.Select Safe and Durable Roofing Materials 1 Resource pt y=yesp
7.Install Radiant Barrier 3 Energy pts y=yes .D
1 1 1
L.Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy pts y=yes D
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes D
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 1 0
1 1
•
1101111111111111 Loggia I
M.Indoor Air Quality and Finishes
.1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes D
13.Use Low/No VOC Adhesives 3 IAQ/Health pts y--yes 0 •
4.Use Salvaged Mater als 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
---- . ,.-- - — - —
8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y--yes 0
10.Install Whole House Vacuum System 3 IAQ/Heeth pts y=yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring B Resource pts y--yes D
�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 D
5.Use Exposed Concrete as Finished Floor 4 Resource pts y yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
{ 1 1
Total Points A I 14DI 130 57
Total Points Project Received: 1 01 0 0 •
G:data/progsrgreenbuildmgguidelineshemodelersrgreenpointsfinal272.04protxctedxls
•
Community Development
10300 Torre Avenue
!4jl
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: PERMIT # 7
/0e�27 �Y-6
OWNER'S NAME: PHONE # gjtj 97,1
GENERAL CONTRACTOR: FAX # I(pZ7 y
5 ex�i.ceS
I am not using any subcontractors: Y117 /,�J e
Signature Date
Please check applicable subcontractors and complete the followin 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
Owner/Contractor Signature Date