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08040201CITY OF CUPERTINO ?e?'+= iaE +'*..•"'< +' BUIMNG DIVISION PERMIT CCSI�ITR:A�TQR INFORMATIti BUILDING ADDRESS: PERMIT NO. 20329 GILLICK WAY ATLAS - TRILLO HVAC 08040201 OWNER'S NAME: PERMIT ISSUE DATE LISA PANG 1965 KYLE PARK CT 04/28/2008 NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO R &R FURNACE & ADD A/C UNIT 'BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONIEd S DECLARATION Job Description Under (commencing 1 Wnby affirm that I under provision of Chapter r HUsimmss WPro(cujon CoM,aad mylkermmu I [the Bu II fSUthon]gXl)ofDividonJOfthe Ire full (one aan e Ucenm Cla Lte.R Dsm Contractor Oz 710 ARCHTIECTS DECIARATI N I undermined my plans Nail W man as public records Licensed Professional OWNER-BUILDER DECLARATION 1 botchy affirm that I am exempt from the Contractors License Law for the following manor. (Section 7031.5, Business and Profession Code: Any city or county which requires a permit to emome4 alter, improve, demolish, m repair my structure prior to its issuance. aloe requires the applicant rormch permit th file &signed catemmt that W U licensed pursuant to tie stormbound of tho Comtracmrs Umremn Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 700) of Division 3 of dC Business Yid Profession Cade) or Nat he m exempt therefrom and Ore basis for Nn alleged emmpthom Any vlolYlon of APN Number Occupancy e P Y GYP Section 7031.5 by any appliam fora Permit mbjecu the applimt to a civil Penally of net mare than five hundred dollars (5300). ❑I,ssowmc of Ilia ptoPerlY•armY wployeu with VngumNe'v ark eampenmthon,- niC dPlafeutloN cnddcc s radon Required Required Inspections M Cnontroxc LLi¢� law se appplyy un an cancer of muptny who buildsoc npnres thermmand wb tdommich wank himmlforduough his awn empioym, provided that such Improvemmuannot I." aroQeran fm We a, however. the building or improvement is mid within ore year otmmpktion. the owner. hulldeo will have the harden of prating that he did not build or improve fm propose of ❑ 1, as awwr m the property am caclmivelY conumYing with licensed contractors th co otmcl the project (See. 7044. Bminem and Profession Code:) The Comment's Li. tens, law does not apply m an owatr orprepeny who Wilds or improve thump. and wW com mum for such projects with a conaacmr(s) Iieenmd p.m an the Contractors License law. ❑lam exempt under see .B&PC for NU wan franc Dam WORKERS COMPENSATION DECLARATION I herby ane under pm ar ulty of perjury e of the following declaratiottY o f have sad will mainWn • CaNOcamaf Canent1. self -Insure for workers Compen- what. as provided for by Section 37M of the Labor Code, for the performance of the wart for which this permit is issued ❑ 1 have and will maintain Wmkars CompenNon I.. as required by SccW. ' 37M of the labor Cade, far der performance of the work for which NU permit u lamed My Webers ompenadon kmnnc unite sad Policy mumbo art: Carder. Policy No.: d A? �J CERTIFlUIE OF XEMPITON FROM WORKERS COMPENSATION INSURANCE ,. (This session wed not eacumplemd If the permit is foram hundred dollar (SIM) or mss) 1 certify, that in the Performance of the work for which this permit is issued. I mall not employ any parent in mY mmwr m m to become mbjut th the Wodreri Cmuparmdm . Laws of c lifered . unto AppBont NOTICE TO APPLICANT. If, after making this Certificate of Exemption. you should become subject th the Wofkers Compensation provisions of the labor Cade, you a" forthwith comply with inch provision or NU permit shall W dccmed revoked. CONSTRUCTION LENDING AGENCY 1 hemby affm that them is a construction lending spemy for the performance of the work for which One permit Is Wood (Scc. 3097, Ch, G Lembes Name Lenders Add. 1 certify Nat I have read Nis appliaim end sum that tin me" information Is conex% I agme in comply with all city and county adimwm and sum Was, relating in Wilding construction, and hereby suNOdae repreaenuuve of this city m emu upon the above- mentioned property for Inspection purposes (We) agora th save, Indemnify and keep harmless the City of Cupmmo against limilldu, Jug enu.cmuandexpmma which may in my ways. against mid City in cc r� then UngofththsmnnlL APP AI D RSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SO CER U S. Re -roofs Type of Roof Sigmure ofnppliam'Conuauar Dam HAZARDOUS MATERIALS DISCLOSURE will use applicant or future building occummisthn or handle hamdam material as defined by the Cupenino Municipal Code. Chapter 9.11. and the Health and Safety code, Oven 25532(.)7 ❑YU +a 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 IW plicant or future Wilding occupant use equipment or devices which Zr M nlir:ai cmumhunu ss dolman by the Bay Ana Air Quality Managema all new materials for inspection. miu7 l — ❑lb YJfNn . I have mad the hveduus materials requirements undorChmmr6.95 orthe Califon nia HosIO&Safcty Cede,SeNoes 25505,25533 and 2U34, I undewmd thutif the Wilding mete m ly haw a tenant. Nat it my responsibility a notify the occupant of mW ratio n Lan u W ctpdartoissuanceoracmnce/ma a Signature of Applicant Date All roof coverings to be Class'W' or better Owwron � I f Dam' ,gem • 6 ITEMS OF 12 i I L • CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36936014.00 DATE ISSUED.......: 04/28/2008 RECEIPT #.........: BS000004602 REFERENCE ID # ...: 08040201 SITE ADDRESS .....: 20329 GILLICK WAY SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 VOICE ID DESCRIPTION -- - - - - -- -------------------- -- - - - - -- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL a VOICE ID DESCRIPTION - - -- - - -- ---------------------- - - - - -- 507 FINAL PLUMBING OWNER ............: LISA PANG • ADDRESS ..........: 20329 GILLICK WY CITY /STATE /ZIP ...: CUPERTINO CA, 95014 -4412 RECEIVED FROM ....: ATLAS- TR_ILLO CONTRACTOR .......: TRILLO, STEVE LIC # 4269 COMPANY ..........: ATLAS - TRILLO HVAC ADDRESS ..........: 1965 KYLE PARK CT CITY /STATE /ZIP ...: SAN JOSE, CA 95125 TELEPHONE ........: (408)286 -8931 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---- - ----- 1BSEISMICR ---------- - -- -- -- ------ VALUATION 5,300.00 -------- -- --- 0.60 ---- - -- 0.00 ---- ------ 0.60 ---- ------ 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 ---- - - - - -- ---- 224.95 - - - - -- 0.00 ---- - - - - -- 224.95 ---- - - - - -- 0.00 VOICE ID DESCRIPTION -- - - - - -- -------------------- -- - - - - -- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL a VOICE ID DESCRIPTION - - -- - - -- ---------------------- - - - - -- 507 FINAL PLUMBING I %� CITY OF CUPERTINO " FURNACE /AC CITY OF CUPERTINO PERMIT APPLICATION FORM ©YOB o�-D I APN # J tp n 2 `P O i q, Q O J Date:�� /�� / 6 Building Address: Owner'sss� Name: P, hhoo/ne #: Contractor: Phone #: p G X�/ _ 551 O AIM C Fax #: Contractor License #: Cupertino Business License #: 6'S / Contact: Phone #�Sa,5p � �I Vl /r t, 0—A+ ✓I, e " Fax #: Building Permit Info: Elect [y� Plumb E — Mech ET-- Residential Commercial LJ Job Description -�.. 14d6;( For Residential Installations: Attic ❑ 151 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): �5�,b b Strapped On Platform LJ Bonded New Location Replacement 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. F CUPEIt,TINO 1 CITY OF CUPERTINO ► FURNACE /AC FEE SCHEDULE 4 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. 1 MCREPALT 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. 1 PGASCOM Commerical for ea gas piping System P 1 -4 outlets 1 BPGAS For each gas piping system of 5 or P more per outlet. 1 MCAPPVNT Commercial for the install /relocate/ or M replacement of ea appliance vent installed & not incl in an appliance permit. 113SEISMICO Commercial Seismic B 1 MRRAA 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 InstalI/Relocate ea M suspended heater,recessed.wall htr, or floor mounted unit heater. 1 MRAPPVNT Residential for the install /relocate/ or M replacement of ea appliance vent install & not incl in an appl pen-nit. I] • ;Cry MY OF *CU CITPEI,TINO E CITY OF CUPERTINO FURNACE/AC FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type FURNACE FURN/AC 1 PGASRES 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 1 MFR = <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> I 00 BTU install or relocate ea forced - air /gravity type furnace/burner, incl ducts /vents attached to such appliance over 100,000 Btu/h M I EPERMITFEE Electric Permit Fee E / 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit P 1TRAVDOC Travel Documentation B 1BUSLIC Business License B E cmo CUPERTINO CITY OF CUPERTINO FURNACE /AC FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type AIR CONDITIONING FURN /AC 1 BCAIRHAN Commercial A/C Units <= l Ok CFM B IMCRAA Commercial Mech Repair /alt/add M IBSEISMICO Seismic Commercial B 1PGASCOM Commerical for ea gas piping System 1 -4 outlets P IPGASRES Residential for ea gas piping system of 1 -4 Outlets P 1 BPGAS For each gas piping system of 5 or more per outlet. Comm/Resid P 1 BREMAIRHAN Residential A/C units <= 1 Ok CFM B 1MRRAA Residential Mech Repair / alt/add M IBSEISMICR Seismic Residential B IEPERMITFEE Electric Permit E IMPERMITFEE Mechanical Permit M 1PPERMITFEE Plumbing Permit P 1TRAVD0C Travel Documentation B 1BUSLIC Business License B 0 U 0 0 ,2D32oj 6 r Plan Review Process Work Book Page -12- Revised 3/25/08 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 Plans See below ,,��55ee..{{��>>����� y B. Site 9. Install H.E. Irrigation, (details /spec)' L -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 Spei S -2 2 points 5. w Use Truss with heels, (detail) S -2 2 points 6. B. OSB Sheathing, detail I S -2 2 points E. Ext. Finish 1. Composite Decking, (Note /Spec:,- I 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 IWIMMERM TOTAL POINTS 40 points 0 0 ,2D32oj 6 r 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. rte 1. Recycle Job Site Construction & Demolition Waste i 65 % =1 point; 75 %= 2 points; 80 %= 4 points { up to 4 Resource pts 0 2. Salvage Reusable Building Materials j 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 5. Minimize Disruption of Existing Plants & Trees 1 Resource pt y =yes 0 6. Implement Construction Site Stonnwater Practices 2 Resource pts y =yes 0 7. Protect Water Quality with Landscape Design 2 Resource pts y =yes 0 8. Design Resou ce•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 ots v =ves 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 2. Use Recycled Content Aggregate 3. Insulate Foundation/Slab before backfill C. Structural Frame �1. Substitute Solid Sawn Lumber with Engineered Lumber 2. Use FSC Certified Wood for framing (For every 10% of FSC lumber used = 2 points, up to 10) 3. Use Wood I- Joists for Floors and Ceilings 4. Use Web Floor Trusses 5. Design Energy Heels on Trusses 6" or more 6. Use Finger - Jointed Studs for Vertical Applications 7. Use Engineered Studs for Vertical Applications B. Use Recycled Content Steel Studs for Interior Framing 9. Use Structural Insulated Panels (SIPS) a. Floors b. Wall c. Roof 10. Apply Advanced Framing Techniques 111. Use Reclaimed Lumber for Non Structural Applications a. Subfloors • b. Sheathing up to 5 Resource 2 Resource pts y= 3 Energy pts y= 3 Resource pis y =yes up to 10 Resource pts, 2 Resource pts y =yes 2 Resource pts y =yes 2 Energy pts y =yes 2 Resource pis y =yes 2 Resource pis y =yes 2 Resource pis y =yes 3 Energy pis y =yes 3 Energy pis y =yes 3 Energy pis y =yes 4 Resource pts y =yes 3 Resource pts y =yes 1 Resource pt y =yes 1 Resource pt y =yes r r r r r r r r 0 r r r r 0 0 1. Use Sustainable Docking Materials a. Recycled content 3 Resource pis b. FSC Certified Wood 3 Resource pis 2. Use Treated Wood That Does Not Contain Chromium/Arsenic 1 IAO/Hsalth pt 3. Install House Wrap under Siding 1 IAO/Hsalth pt 4. Use Fiber- Cement Siding Materials 1 Resource pt E. Plumbing 1, Install Water Heater Jacket 1 Energy pt y--yes 2. Insulate Hot and Cold Water Pipes 2 Energy pis y=ye: 3. Retrofit all Faucets and Showerheads with Flow Reducers Up to 5 Energy pis a. Faucets (1 point each, up to 2 points) Up to 2 Resource pis b. Showerheads It point each, up to 2 points) Up to 2 Resource pis 4. Replace Toilest with Ultra -Low Flush Toilets Up to 4 Energy pis (1 point each, up to 3 points) Up to 3 Resource pis 5. Install Chlorine Filter on Showerhead 1 IAO/Health pt y =ye: 6. Coned Gas to Tankless Water Heater 4 Energy pis y =ye: 7. Install Water Filtration Units at Faucets (2 points each, up to 4 points) Up to 4 IAO/Heallh pis 8. Install On- Demand Hot Water Circulation Pump 4 Resource pis y =ye: r. tiecunctu 1. Install Compact Fluorescent Light Bulbs (CFLs) (6 bulbs =2 points, 10 bulbs =3 points, 12 bulbs = 4 points) Up to 4 Energy p 2. Install IC -AT Recessed Fixtures with CFLs (1 point each, up to 2. Install Washing Machine with Water and Energy 5 points) Up to 5 Energy pis 3. Install Lighting Controls (1 point per fixture, up to 4 points) Up to 4 Energy pis 4. Install High Efficiency Ceiling Fans with CFLs 3.Install Energy Star ReMgerator It point each, up to 4 points) Up to 4 Energy pis G. Appliances 1. Install Energy Star Dishwasher 1 Energy pt y =yes 2. Install Washing Machine with Water and Energy 2. Install Floor Insulation over Crawl Space 4 Energy pis Conservation Features 1 Energy pt y =yes 3.Install Energy Star ReMgerator 1 Energy pt y =yes 4. Install Built -In Recycling Center 3 Resource pis y =yes H. Insulation 1. Upgrade Insulation to Exceed Title 24 Requirements a. Walls 2 Energy pis b. Ceilings 2 Energy pis 2. Install Floor Insulation over Crawl Space 4 Energy pis 3. Install Recycled- Content, Fiberglass Insulation with No Added Formaldehyde 3 IAO/Healih pis 4. Use Advanced Infiltration Reduction Practices 2 Energy pis 5. Use Cellulose Insulation a. Walls 4 Resource pis b. Ceilings 4 Resource pis 6. Alternative Insulation Products (Cotton, spray -foam) a. Walls 4 Resource pis o. Cenings 4 Resource pis • 0 C, J r r r r U r r r U r r U • 0 C, J r r r r • 0 C, J J. Heating Ventilation and Air Conditioning 1 Install Energy - Efficient Windows 2. Install Solar Water Heating System 1. Use Duct Mastic on All Duct Joints a. Double -Paned 1 Energy pt • b. Low - Emissivity (Low -E) 2 Energy s 9Y P 3. Vent Range Hood to the Outside c. Low. Conductivity Frames y =yes 2 Energy pts 2. Install Low Rest Transmission Glazing 1 Energy pt J. Heating Ventilation and Air Conditioning 4 Energy pts y= 2. Install Solar Water Heating System 1. Use Duct Mastic on All Duct Joints 2 Energy pts y--yes 2. Install Ductwork within Conditioned Space 3 Energy pts y =yes 3. Vent Range Hood to the Outside 1 IAO/Health pt y =yes 4. Clean all Ducts Before Occupancy - 2 IAO/Health pts y =yes 5. Install Solar Attic Fan 2 Energy pts y =yes 6. Install Attic Ventilation Systems 1 Energy pt y =yes 7. Install Whole House Fan 4 Energy pts y =yes S. Install Sealed Combustion Units a. Furnaces 3 IAO/Health pts y =yes b. Water Heaters 3 IAO/Health pts y =yes 9. Replace Wall- Mounted Electric and Gas Heaters with Through - the -Wall Heal Pumps 3 Energy pts y =yes 10. Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y =yes 11. Install AC with Non -HCFC Refrigerants. 2 Resource pts y =yes 12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace 2 Energy pts y =yes 13. Retrofit Wood Burning Fireplaces • a. Install EPA certified wood stovesrnserts 1 IAQ/Health pt y =yes b. Install /Replace Dampers 1 Energy pt y =yes c. Install Airtight Doors 1 Energy pt y =yes 14. Install Zoned, Hydronic Radiant Heating 3 Energy pts y =yes 15. Install High Efficiency Filter 4IA0/Health pts y =yes 16. Install Heat Recovery Ventilation Unit (HRV) 5 IAO/Health pts y =yes 17. Install Separate Garage Exhaust Fan 3IA0/Health ots v =ves K. Renewable Energy and Roofing 1. Pre -Plumb for Solar Water Heating 4 Energy pts y= 2. Install Solar Water Heating System 10 Energy pts y= 3. Pre -Wire for Future Photovoltaic (PV) Installation 4 Energy pts y= 4. Install Photovoltaic (PV) System (12 kw = 6 points, 2.4 kw =12 points, 3.6 kw = 16 points) Up to 16 Energy 6. Select'Safe and Durable Roofing Materials �__. � _ 1 Resource pt y= 7. Install Radiant Barder 3 Energy pts y= 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 pis 11 1. Use Low /No -VOC Paint 1 IAQ/Health pts y =yes 2. Use Low VOC, Water -Based Wood Finishes 2 IAQ/Health pts y =yes 3. Use Low /No VOC Adhesives 3 IAQ /Health pis y =yes 4. Use Salvaged Materials for Interior Finishes 3 Resource pts y =yes 5. Use Engineered Sheet Goods with no added Urea 4 Resource pts y =yes Formaldehyde 61AQ/Health pts y =yes 6, Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y =yes 7. Seal all Exposed Particleboard or MDF 4 IAO/Health pts yryes 8. Use FSC Certified Materials for Interior Finish 4 Resource pis y--yes 9. Use Finger- Jointed or Recycled-Content Trim 1 Resource pis y =yes 10. Install Whole House Vacuum System 3 IAQ /Health pis y--yes N. Flooring 1. Select FSC Certified Wood Flooring 8 Resource pts y =yes 2. Use Rapidly Renewable Flooring Materials 4 Resource pts y =yes 3. Use Recycled Content Ceramic Tiles 4 Resource pts y =yes 4. Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pis y =yes 5. Use Exposed Concrete as Finished Floor 4 Resource pts y =yes 6. Install Recycled Content Carpet with Low VOCs 4 Resource pis y =yes Total Points A val a e: Total Points Project Received- 1 1401 130 57 01 0 0 G; datal pmgsl greenbuildingguidelineslremodelersl greenpoints (inal2.12.g4protectedads • S 0 CITY OF *CUPERTINO • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777 -3228 Fax(408)777 -3333 Building Department JOB ADDRESS: . 1))iG) PERMIT # OW Lk Lol OWNER'S NAME: PHONE # GENERAL CONTRACTOR: S — D FAX # I am not using any subcontractors: X , Signature - Date Please check applicable subcontractors and complete the following information: Owneractor_Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing IIectrical 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 Owneractor_Signature Date