08090020BUILDING D7 ]ON PERMIT
CONTRA -TORJNFbRMATION A.
_
.
7x m-:�a„ _.. azS��G
BUILD[ NcfA TER ESTATES DR
W
COSMOS ROOFING
PERMIT NO.
08090020
OWNEWSSNAbMI)E:
PERMIT ISSUE DATE
P hESCHER JAMES G ET AL
1901 OLD MIDDLEFIELD WAY
09/04/2008
NE:
cR1L'
(650)969-7663
SANITARY NO. CONTROL NO.
ARCHIECT/ENGINEEK:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O 0 0 O
LICENSED CONTRACTORS DECLARATION
Chapter 9
Job Description
p
1 Mreby arms demand I am nsantler Provisions of (commencing
wiNSeetion 7OlU)ofDiviuon 3afdm Business aM Professions Codc,aM mylzcnscu
RE -RF R/O EXTNG 2 LYRS WDSHK&WDSHNGL RESHTOSB
1'LloIfo aand eReo. Ir.P
3 0LB
ARCHI'IELTSD.CLARATION V "
FLT 40YR CMP CLS A 22.5SQ RADIANT BARRIER
1 undemund my plants still be used u public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am mmmpt from tic Contractors U... Law far too
following moon. (Scotian 7031.5. Business and Professions Cam: Any city a county
which requires a permit ro conswct. Most. improve, demolish, or repair any stmcture
! prior id its issuance, also ruquima theapplieant for such permit to file asignedsuanum
he is licensed to tic of the Canuactora Lcenm Law (Cnaper9
Sq. Ft. Floor Area
Valuation
that pursuant provisions
(commencing r of dm
cu visdon. vi Code) of
cog with Sectiontranscripts
9770
alleged
! ah. he u exempt 1Mserrmo aM Ne buss for the alugcd eaemptfaL AaY viOlaaion of
is and basis f y
Section 7031.5 by any applicant fm a permit subjects tic applicant to a civil penalty or
Number
36922035.WP
Occupancy Type
Y YP
not more Nan five hundred doll.($500).
0 I.0 Owmaof Nepmpmy,amywployaswiLh onium kulccumpenudm.
and use muemm sinal Nmnded Li. doesin ad, Bud^•"•
add Profession.law dos rat apply lf rt uh of
aro apply
Cade: The Canuauors Licenseand
Required Inspections
arty wh W ro
property who builds who
improves Hereon,andwho de souchwork himulrar through his
own employes, PrvWor dal such improvemanu are not ed o mulnfaro
i
wmar,
ofimfarputhe pwmv-
however. Ne We mimproverovinusold withinons completion.
i
etyear
builQcr NB lues mu burdut of proving that he did rot build m improve lm puryom of
ft
.uJ.
(] 1, as owner of Ne propeny am elusively contracting with licensed contractors us
coulmct dm project (Sec. 7044. Business and Profadons Code:) The Contractors U.
.
came law dean not apply an an names of property who bullas of Improves aheman, and.
who cameo for such projects with a eennaemn(s) licensed pursuant to NC Contractors
Lic-am Law.
❑ lefnexamptundm See ,BRPCfmdmureasun
Owns Dau
WORKERS COMPENSATION DECLARATION
1 hereby.Tum under penalty of perjury arc of this fallowing declaration
I have and rill malnufn a Certificate ofConunl in self-uum fa Wedmrs Campion.
.tion, as provided for by Sedan 3700 of tie Labor Cade, for the performance of it.
wank for which this pundit is issued.
ve arM will mumm. Wmkrs Compensation I.. u mtmimd by S.W.
ZZ70pMN ttaor
,
Code, fm tie'it... of the wok for which this permit u issued.
My Workers Compensation Inum�arTs carrier and Policy number art:
Cartier. Cj%QlC.G//Nle Policy No.: It
CERTIFlGTE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
OlTusecdon need not be campkmd I(Ne permit is forcer[ huMaed dollars ($100)
or leas.)
I cemly del in the performance a Ne wart fm which this permit It issued. I shall nm
employ any person in any madauro as N become subject to dm Wasess Compi cation
Laws of California. Data
Applicant
NOTICE TO APPUCANP. IL anor making this Cenifmam of Exemption, you should
become subjtts is than Workers Compensation provisions a the labor Code you muss
forthwith eamply with such provisions or Nu permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 herby arms that Nem us conswcunn lending agency for tic performance a
'
the work for which this permit is issued (Sec. 3(57, Civ. C.)
Landers Name
Lenders Addmas
1 eerdfy that 1 have rod RNs application and sans des tiro above information u
contest- 1 agree m comply with all city and county ordinances and sum laws muting in
Wilding uncipmedon, and hereby authome repraenudves of this city in ami upon dm
ahove-mendoned property for inspection pmpe¢a
(We) agree m... immorally and keep hamless the City or Cup ndro .Same,
limilida, judgmuti, cots and expenses which may In any way ucnm against said City
in consequence of the Yranling of this permit.
APPLICANT UNDERSTANDS AND WILL COMP L ALL NON -POINT
Issued by: 0�( Date
SOUR ULATIO
- Ys
Re -roofs
Type of Roof
Signuurtof APPlinn ntracto
S TTBU sapans posuRE
W10y (value
the Ciipantm
al co utRaro2. umamsiai
u defamed by 0m Cupeniao Mun i al Code. apron 9.11. a Health and Safety
Cods, Sedon 15531()?
❑Yes Na
All-roofs'shall-beinspected prior to any roofing material being installed.
• Will du applicant or future aapanl use equipment or whim
air comaminm fined by the Bay Area Air QuWty Management
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
s�<'ardnus
❑Yrs No
I have mad du huarda i m=Haumquirenmru undcrCNpmr6.95ofthe Califor-
is Hcoidmh SurctyCone. Salons 0505,75533.,115534.1 undcrswd Miltic building
d he uncndy have a mnanL Tut it u my m Mibilily m rodfy dm meeupana fir tic
V p
fits wnianm tee"C"rloWmm:aafa Cmtifmdm OfOccupwuy.
Signature of Applicant 0 Date
All roof coverings to be Class')W' or better
owner ar aatioriaa sen Dow
• 2 ITEMS OF 2
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rog: Sub: Blk: Lot:
APN ........: 36922035.00
DATE ISSUED.......: 09/04/2008
RECEIPT #.........: BS000005993
REFERENCE ID # ...: 08090020
SITE ADDRESS .....: 10760 W ESTATES DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: pdtg
COPY # : 1
METHOD OF PAYMENT
-----------------
CREDIT CARD
'DOTAL RECEIPT
AMOUNT
---------------
293.50
---------------
293.50
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
•
REFERENCE NUMBER
--------------------
MC
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
OWNER ............:
PLESCHER JAMES G ET AL
ADDRESS ..........:
10760 WEST ESTATES DR
CITY/STATE/ZIP ...:
CUPERTINO CA, 95014-4536
RECEIVED FROM ....:
EDWARD A GREGORY
CONTRACTOR .......:
COSMOS, RICHARD LIC #
18844
COMPANY ..........:
COSMOS ROOFING
ADDRESS ..........:
1901 OLD MIDDLEFIELD WAY
STE 2
CITY/STATE/ZIP ...:
MOUNTAIN VIEW, CA 94043
TELEPHONE ........:
(650)969-7663
•
FEE ID
----------
UNIT QUANTITY
-----------------------
AMOUNT PD -TO -DT
THIS REC
NEW BAL
IBSEISMICR
VALUATION 9,770.00
------------------------------
1.00 0.00
1.00
----------
0.00
7.REROOFRES
SQ FEET 22.50
292.50 0.00
----------
292.50
0.00
TOTAL PERMIT
---------- ----------
293.50 0.00
293.50
----------
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
'DOTAL RECEIPT
AMOUNT
---------------
293.50
---------------
293.50
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
•
REFERENCE NUMBER
--------------------
MC
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
Z .0
CITY OF
•CUPERTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION
o 0,;2, o
APN # 9A a ),� 1 , 60
Date: _ Y' -
Building
Building Address:
1�7�a. West �s�4 �s
Owner's Name: �e s C4L`
7r-.
Phone #:
yJd'-- Zs7
Contractor:
C2/�r0S )d 4-',--A,
Phone#:(,��- �yQ- ?663
(5o
Fax #: 6so• 6i'- 9 90 s
Cupertino Business License #:
Contractor License #:
Type
of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt ShinglesAsphalt
Shingles YO
�f Wood Shakes a LcYe S
o Wood Shakes
(.l Wood Shingles
❑ Wood Shingles
a Other (Specify)
❑ Other (Specify)
Number of existing coverings
❑ Provide I.C.B.O. Report #
To be Removed
❑ Provide Mfgr. Installation Specs.
Job Description: c{�/
4j A 3 LJd 34.N��L
T`30 �(o L� y0 y r
+�14c�: k �9/l e,
AZ y
Z 2 >7 Is
Residential
Commercial El
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the applicatio i there are any restrictions: El
applicable, include in plan set & the sheet index.
Valuation: 1,'70
I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy:
•;�" . n -.,f
Signature
Revised 6/16/08
6K -
CUPERTINO
CITY OF CUPERTINO
REROOF
FEE SCHEDULE
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
1RER00FCOM
Re -roof Commercial
B
1COMMLROOF
IBSEISMICO
Seismic Commercial
B
1RER00FRES
Re -roof Residential
B
1SFDWLR00F
1BSEISMICRE
Seismic Residential
B
1RER00FMRES
Re -roof Multi -Family
B
1MFDWLROOF
1BSEISMICRE
Seismic Residential
B
1BUSLIC
Business License
B
Revised 6/16/08
0
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 2007 IBC Standards
and manufacturers specifications on re -roofing. All roofs are Class "A" per Cupertino
municipal code 16.04.080.
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.
• 5.
a) Spark arrester installation.
If is installed,
plywood 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 mimmurn of 1/ " per foot slope and demonstrate
that there is no ponding.
2.
An I.C.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.
Homeowner's Name: :::� , " /P J3 GLo,, //.
job Site Address: % D 7 6 0 �Ps �� �4 d e c T.,
Roofing Company
Applicant's Signature:
• Greg Casteel
Building Official
Revised 07/30/08
Date: %% Zcv
r
/v 76a 60e6t 4Cs&4-cs
D -Z
is
Ll
Plan Review Process Work Book Page -12-Revised 3/25/08
Green Building Plan Check
,XD
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
Plans See below
B.
Site
9.
Install H.E. Irrigation, (details/spec)'
L-1
11. Permeable Paving,Note
L-1
C.
Foundation
1.
Use 15 % Flyash Concrete, (note)
S-1
7points
D.
Structural
3.
Uses Wood I -Joist, (See Spec.)
S-2
5.
Use Truss with heels, (detail)
S-2
6.
B. OSB Sheathin detail
S-2
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. A2500 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 oint
P.
Other
1.
List Green Features on Plans
A-1
1point
TOTAL POINTS
40 points
is
Ll
Plan Review Process Work Book Page -12-Revised 3/25/08
Y
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.
I1. Recycle Job Site Construction & Demolition Waste i
65%=1 point; 75%= 2 points; 60%= 4 points
Salvage Reusable Building Materials
up to 4 Resource pt=_
i2,
_
4 Resource pts
y=yes
3. Remodel for Mixed Use, Adaptive Reuse, and
(For every 10% of FSC lumber used = 2 points, up to 10)
up to 10 Resource pts
Historic Preservation
4 Resource pts
y=yes
4. Protect Native Soil
2 Resourceis
P
°
y --yes
5. Minimize Disruption of Existing Plants & Trees
1 Resource pt
y=yes
6. Implement Construction Site Slonnwater Practices
2 Resource pts
y=yes
7. Protect Water Quality with Landscape Design
2 Resource pts
y=yes
IB. Design Resource-Efficiwl Landscapes and Gardens
4 Resource pts
y=yes
9. Reuse Materials/Use Recycled Content Materials
pts
y=yes
for Landscape Areas
2 Resource pts
y=yes
10. Install High -Efficiency Irrigation Systems
2 Resource pts
y=yes
11. Provide for On -Site Water Catchment / Retention
2 Resource pts
y=yes
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
2. Use Recycled Content Aggregate 2 Resource pts y-,
3. Insulate Foundation/Slab before backfill 3 Energy pts y
C. Structural Frame
!1. Substitute Solid Saw Lumber with Engineered Lumber -
J 3 Resource pts
2. Use FSC Certified Wood for framing
y --ye,
(For every 10% of FSC lumber used = 2 points, up to 10)
up to 10 Resource pts
3. Use Wood I -Joists for Floors and Ceilings
2 Resource pts
y=ye;
4. Use Web Floor Trusses
2 Resource pts
y=ya<
5. Design Energy Heels on Trusses 6" or more
2 Energy pts
y=ye:
6. Use Finger -Jointed Studs for Vertical Applications
2 Resource pts
y=yes
7. Use Engineered Studs for Vertical Applications
2 Resource pts
y=yes
S. Use Recycled Content Steel Studs for Interior Framing
2 Resource
9. Use Structural Insulated Panels (SIPs)
pts
y=yes
a. Floors
3 Energy pts
y=yes
b. Wall
3 Energy pts
y=yes
c. Roof
3 Energy pts
y=yes
10. Apply Advanced Framing Techniques
4 Resource pts
y=yes
11. Use Reclaimed Lumber for Non Structural Applications
3 Resource
12. Use OSB — -
pts
y=yes
a. Subfloors
b. Sheathing
1 Resource pt
y=yes
_
•
1 Resource pt
y=yes
1. Use Sustainable Decking Materials
a. Recycled content
b. FSC Certified Wood
!2. Use Treated Wood That Does Not Contain ChmmiumlArsenic
13. Install House Wrap under Siding
14. Use Fiber -Cement Siding Matedals
E. Plumbing
1. Install Water Heater Jacket
2. Insulate Hot and Cold Water Pipes
F3. 'Faucets . Retrofit all and Showerheads with Flow Reducers
II a. Faucets (1 point each, up to 2 points)
b. Showerheads (1 point each, up to 2 points)
4. Replace Toilestwth Ultra -Low Flush Toilets
(1 point each, up to 3 points)
5. Install Chlorine Filter on Showerhead
6. Convert Gas to Tankless Water Heater
7. Install Water Filtration Units at Faucets
(2 points each, up to 4 points)
8. Install On -Demand Hot Water Circulation Pump
r. crecmcar
I1. Install Compact Fluorescent Light Bulbs (CFLs)
L bulbs=2 points, 10 bulbs =3 points, 12 bulbs = 4 points)
2. Install IC -AT Recessed Fixtures with CRs (1 point each, up to
5 points)
3. Install Lighting Controls (1 point per fixture, up to 4 points)
4. Install High Efficiency Ceiling Fans with CFLs
(1 point each, up to 4 points)
3 Resource pis
y=yes
3 Resource pts
y=yes
1 IAQ/Health pt
y=yes
1 IAQ/Health pt
y=yes
1 Resource pt
y=yes
1 Energy pt Y_—Yes
2 Energy pts y=yes
Up to 2 Resource pts.
I Up to 2 Resource pts.
Up to 3 Resource pts.
1 IAQ/Health pt y=yes
4 Energy pts Y --yes
G. Appliances
'1. Install Energy Star Dishwasher S
12. Install Washing Machine with Water and Energy
Conservation Features
i3.lnstall Energy Star Refrigerator
14. Install Built -In Recycling Center
H. Insulation
1. Upgrade Insulation to Exceed Title 24 Requirements
a. Walls
b. Ceilinos
2, Install Floor Insulation over Crawl Space
13. Install Recycled -Content, Fiberglass Insulation with
INo Added Formaldehyde _
4. Use Advanced Infiltration Reduction Practices
5. Use Cellulose Insulation
a. Walls
b. Ceilings
6. Alternative Insulation Products (Cotton, spray -foam)
a. Walls
o. Ceilings
Up to 4 IAQ/Health pts.
4 Resource pts y=yeE
Up to 4 Energy pts.
Up to 5 Energy
Up to 4 Energy
Up to 4 Enemy
1 Energy pt y=yes
1 Energy pt
1 Energy pt
3 Resource pts
2 Energy pts
Y_—Yes
2 Energy pts
Y --yes
4 Energy pts
y=yes
31AQIHealth pts
y=yes
2 Energy pts
y=yes
4 Resource pts
y=yes
4 Resource pts
y--yas
4 Resource pts
y=yeE
4 Resource pts
y=yes
•
•
LJ
' 1. Install Energy -Efficient Windows -
• a. Double -Paned 1 Energy pt
b. Low -Emissivity (Low -E) 2 Energy pts
c. Low. Conductivity Frames 2 Energy pts
2. Install Low Heat Transmission Glazing - 1 Enerov of
J. Heating Ventilation and Air Conditioning
�. Use Duct Mastic on All Ducl-Joints
2 Energy pts
2. Install Ductwork within Conditioned Space v J
3 Energy pts
3. Vent Range Hood to the Outside
1 IAQ/Health pt
4. Clean all Ducts Before Occupancy
2 IAO/Health pts
5. Install Solar Attic Fan
2 Energy pts
6. Install Attic Ventilation Systems
1 Energy pt
7. Install Whole House Fan
4 Energy pts
B. Install Sealed Combustion Units
(1.2 kw = 6 points, 2.4 kw =12 points, 3.6 kw = 1 B points)
a. Furnaces
3 IAO/Health pts
b. Water Heaters
3 IAQ/Health pts
9. Replace Wall -Mounted Electric and Gas Heaters with
-
7. Install Radiant Barrer
Through -the -Wall Heat Pumps
3 Energy pts
10. Install 13 SEER/11 EER or higher AC with a TXV
3 Energy pts
11. Install AC with Non -HCFC Refrigerants
2 Resource pts
12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace
2 Energy pis
13. Retrofit Wood Burning Fireplaces
. a, Install EPA certified wood stoves4nserts
1 IAQ/Health pt
J. Install/Replace Dampers
1 Energy pt
c. Install Airtight Doors
1 Energy pt
14. Install Zoned, Hydronic Radiant Heating
3 Energy pts
15. Install High Efficiency Filter
4 IAQ/Health pts
16. Install Heat Recovery Ventilation Unit (H RV)
5 IAO/Health pts
17. Install Separate Garage Exhaust Fan
3 IAQ/Health ots
K. Renewable Energy and Roofing
1. Pre -Plumb for Solar Water Heating
4 Energy pts
y=yes
2, install Solar Water Heating System
10 Energy pts
y --yes
3. Pre -Wire for Future Photovoltaic (PV) Installation
4 Energy pts
y=yes
4. Install Photovoltaic (PV) System
(1.2 kw = 6 points, 2.4 kw =12 points, 3.6 kw = 1 B points)
Up to 16 Energy
pts
6. Select Safe and Durable Roofing Materials_
-
1 Resource pt
y=yes
-
7. Install Radiant Barrer
3 Energy pts
y=yes
L. Natural Heating and Cooling
1. Incorporate Passive Solar Heating 5 Energy pts
2. Install Overhangs or Awnings over South Facing Windows 3 Energy pts
3. Plant Deciduous Trees on the West and South Sides 3 Energy pts
Y. �
;'1. Use LowANo-VOC Paint--
1 IAOMealth pts
2. Use Low VOC, Water -Based Wood Finishes
2 IAQ/Health pts
13. Use Low/No VOC Adhesives -
3 IAQ/Health pts
_
4. Use Salvaged Materials for Interior Finishes
3 Resource pts
5. Use Engineered Sheet Goods with no added Urea
Use. Recycled Content caram-ic-T-les
Formaldehyde
61AQ/Health pts
6. Use Exterior Grade Plywood for Interior Uses
1 IAQ/Health pts
•7. Seal all Exposed Pa ticleboa d or MDF
4 IAQ/Health pts
B. Use FSC Certified Materials for Intenor Finish
4 Resource pts
9. Use Finger -Jointed or Recycled -Content Trim
1 Resource pts
10. Install Whole House Vacuum System
31AQ/Health pts
N. Flooring
1. Select FSC Certified Wood Flooring
6 Resource pts
y --yes
i2. Use Rapidly Renewable Flooring Materials - -
13.
_ 4 Resource pts
y=yes
Use. Recycled Content caram-ic-T-les
4 Resource pts
y=yes
4. Install Natural Linoleum in Place of Vinyl
5 IAQ/Health pts
y=yes
5. Use Exposed Concrete as Finished Floor
4 Resource pts
y=ye=.
6. Install Recycled Content Carpel with Low VOCs
4 Resource pts
y --yes
Total Points Available:
Total Points Project Received:
t
•
1401 1301 57
01 0 0 •
avaollc
G:daarprogslgreenbulldinpguidelinesl2modeleNgreenpmnlsfina1212Mprrnecled.rJs
0
0
10
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:lp76PERMIT
#
U? D O a c,
OWNER'S NAME: S'r
PHONE # Yp _yf7 ,( yja —
GENERAL CONTRACTOR:
C�-Au
FAX # &S`v- 76,9
-- 9so-r
� v
I am not using any subcontractors. %- Y a a)7
ignature Date
Please check applicable subcontractors and complete the following information:
•100111tagia
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
s /17 s J ti
Septic Tank
Sheet Metal
Sheet Rock
Tile
•100111tagia
Date