08080004 CITY OF CUPERTINO
BUILUINe'.DIVISIGN PERMIT '$CONTRACTQRINkO TION'
BUILD N , DRES PERMIT NO.
�5G. II6LLANDERRY PL BAKER ROOFING 08080004
OWNER'S NAME: PERMIT ISSUE DATE
AMANS GARY L AND REBECCA C 2067 LA CON CT 08/01/2008
vNE: SANITARY NO. CONTROL NO.
(408) 559-5105
ARCHITECr/ENGINEER: BUILDING PERMrT INFO
BLDG ELECT PLUMB MECH
X00 LICENSED CONTRACTOR'S DECLARATION Job Description
06 m 1 hereby a(frrrn that 1 w liacmed under provisionsOf Chapter 9(rn rnomming p on
with Section7t%gporDivtian3arua:ensinevanePmr m�aeeywY3e� RE—RF RMV CMP INSTL CMP CLS A 25SQ
in full force and effm L 6
Ll i I;ccom a tic.is
-Fp Dae Conrado, D'!
e££uuuy ARCHnTs7rS DECLARATI r
?W< 1 unMrsunJ my Pluu shall be used as public mxnNs
aG Licensed Pmfcssiana
p 5 OWNER-BUIL)ER DECLARATION
9 i f I hereby affirm that 1 am exempt from the Contractors License Law for Ile
m 0 following mason.(Section]031.3.Business and profession Code:Any city or county
which rcyuires a Permit m.mammet aIle'.Improve,demolish,Or repair any atrucuro
prior to its issuance.also requires the applicant forsuch Permit o file a signed statement
r c mat he is licensed purwam to lase provisions Of the,Contrecwr's Licrosc Law(Chapter 9 Sq.Ft. Floor Area $ Valuation
yFgmnmemcingwidi Sccdon1000)of Division 3 of the Business and professions Code)at
(c 8390
e5 dust W u caempt therefrom and fe basis for the alleged c ompuon.Any violation of
Salon 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of
ss hundred dollars(SM 36226058
ml mom thBw h 'dd'64 Number Occupancy P Y T ype
❑I.ssowna of the propdry,mmY emPlayes wire wise ssdevrOlemmpewdm,
will do 04 wadC and the stint¢¢1e Out intended mORemd for sale(See.7014.BuOKV
and Prefessimes Cade:The CAntrsemrt Liam Law does rot appy to m owmr of Required Inspections
property who Wilds mimpmw memon.and whodoessueh workhimselforthrough his
own employes.provided that such improwments K not inended maRamd forsae If.
however,me Wilding or impmvemant is sold within one year of compledon.the owner-
builder will Iuw the Wrdcs of proving that Ise did Out Wild Or improve for purpose of
sale.).
❑I.as owner of the Property,am exclusively contracting with licensed mnmictme be
construct circ project(Sec.7044.Business and Professions Cade:)TW Coavaemr's U.
cease law does not apply in an own¢of property who Wilda or improv Nemo.,and,
who contracts for stab projects with aeonuamor(s)lieemed pursuant m the ctmommes
L.icena Taw.
❑Iameaemptunder See .B&PCfmthismann
Owns Date
WORKERS COMPENSATION DECLARATION
I Wmby alfa m under penalty of perjury arc of the following declarations:
1 hire and will maintain a Certificates of Common to elf-iosure for Workers Comics.
cation,as provided for by Section 3700 of the Labor Code,for the Performance of the
wart for which this permit is issue&
1 have and will maintain Workers COmpematlon Insumna,as required by Section
3700 M me Labor Code,fm me performance of the work forwhich this Permit is issued. '
My Wt Compensation lnmnaee carrier and policy,num nae ,z�,
Camiee G� Policy NO.;
CERTIFICATE UF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rhe semlm oaE not W cmnplcmd if the permit Is foray hundred do0ars($I00)
Or less)
1 Molly deet in the pmremaae Or the work for which this permit is issued,l Mail rut
croploy any Person in any meearm as In become subject to tie WarknY Compensation
Laws Of Califmcia.Dae
Applicant
NOTICE TD APPLICANT:If after making this Certificate Of Exemption,you should
become sabjcet in the Workers Compensation previsions of the Lahm Code-you mum
.Jz foMwith...Ply with Inch provisions.104 Permit shall W deemed revoked.
z O CONMUCTION LENDING AGENCY
(~ IWO Yaffirm that them is a construction humin,agency for the perform.Of
Ci the work for which this permit Is issued(Sec.3097,Civ.C.)
QLanders Name
Z) z Undoes Address
U O 1 certify wt I have mad this appliatim and some Nu the above iafomusdm is
gL P oufeet I agree to comply withall city and"only aalnanes Rod sue Iaws rohting In
OU Wilding consuiction,and hereby authentic mprossommes Or thus city to rnmr upon the
{Ll •
W.-mrntimed property for oropeNon purposes
F gy (We)agree to save,indemnify and kap hamlets tie City of Capam.against
tIl liabilities,judgments.emu and expenses which may in any way acne against said City
U z in consequence of the granting or this permit
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGU[.ATTONJ/ // O
(Ls �FiEK`B"u[r
bignamort of ApplicmuContracnm Owe Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me appliant Or future Wilding occupant more orhandle hammoos materia
as defined by the Cupenino MucidPal
I Code.Duperme 9.13,and Health d Safety
cafe.Section25s3I(»?
0y. role,-,// All roofs shall be inspected prior to any roofing material being installed.
❑Ya
hk
If a roof is installed without first obtainingan inspection,I agree to remove
WIII the applicant or fumes Wilding Occupant tae cquipmrnt or devices which p
it haood..air cmmuninarts ss defined by that Bay Ams Air Quail,Management all new materials for inspection.
aria?
Dyes Qrm�
I have mal the haardommaurials requirements under Chaper6.95ofmc Califor-
iia Hco,r...
Safetyim.Sections MMS,it
3myno,c33334.1uondr, maifmctorme
dist ret corm try how a enma that it us 55 3 and 2553 i.1 m mtiry the occupant Or the
myuimmcnu� tpdormi sedan cartifae raapaary. Signature of Applicant Date
--.I )�
Owner err¢moved'.cast Dau I I All roof coverings to be Class'X'or better
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36226058 . 00
DATE ISSUED. . . . . . . : 08/01/2008
RECEIPT # . . . . . . . . . : BS000005656
REFERENCE ID # . . . : 08080004
SITE ADDRESS . . . . . : 7535 HOLLANDERRY PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : AMANS GARY L AND REBECCA C
ADDRESS . . . . . . . . . . : 7535 HOLLANDERRY
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5039
RECEIVED FROM . . . . : JAMES L BAKER
CONTRACTOR . . . . . . . : JAMES BAKER LIC # 25385
COMPANY . . . . . . . . . . : BAKER ROOFING
ADDRESS . . . . . . . . . . i 2067 LA CON CT
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408) 559-5105
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -- ----- ---------- ---------- ---------- ---------- ----------
IBSEISMICR VALUATION 8, 390 . 00 0 . 90 0 . 00 0 . 90 0 . 00
1REROOFRES SQ FEET 25 . 00 325 . 00 0 . 00 325 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 325 . 90 0 . 00 325 . 90 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----- --------------- --------------------
CHECK 325 . 90 #362
---------------
TOTAL RECEIPT 325 . 90
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----- ------------------------- ----- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
of 0 o
CITY OF CUPERTINO
d` REROOF
.CUPERTINO PERMIT APPLICATION
APN #� / �� � ��� � Date:
Building Address:
�5 6 Il /7 de-K ✓
Owner's Name: ` Phone #:
Contractor: Phone #: S Sg— S' SOS
Fax #:
Cupertino Business License #: Contractor License M
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
a—Asphalt Shingles A--Asphalt Shingles
a-'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:
eon — ¢,nj-vr—Lk
C[��f
Residential Commercial ❑
Green Building: Please complete relevant portion of the • Confirmed with Planning Dept. if
Green Building Checklist & attach it to the applicatior if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation: 3 w
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 6/16/08
�i=va, CITY OF CUPERTINO
REROOF
C1 OF
CUPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
2� 1RER00FRES Re-roof Residential B 1SFDWLR00F
1BSE1SMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
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 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.
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/a "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: L
Job Site Address: 2. 3 T
Roofing Company Name:
Applicant's Signature: � DatnLL Q
. Greg Casteel
Building Official
Revised 07/30/08
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
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 Spec.) S-2 2 points
5. Use 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 oints
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 Refri erator, (Note/Spec. A-3 1 point
P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS1 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
A.Site
Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;80%a=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
6.Design —
Resource-Efficient Landscapes and Gardens 4 Resource
— — — -- — — — Pis )'=Yes 0
9.Reuse Matedals/Use Recycled Content Materials
for Landscape Areas 2 Resource pts y=yas 0
10.Install High-Efficiency Irrigation Systems 2 Resource pts y=yes 0
11.Provide for On-Site Water Catchment/Retention 2 Resource pts as 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 pts 0
2.Use Recycled Content Aggregate 2 Resource pts y=yes D
3. Insulate Foundation/Slab before backfill 3 Energy pts Y_—Yes 0
1 1 !
F;F
C.Structural Frame
1.Substitute Solid Sawn Lumber wrath Engineered Lumber 3 Resource pts y=yes p
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 Ener is
b.Wall 9Y P Y=Yes 0
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
72.Use658 — — —
a.Subfloors 1 Resource pt y=yes 0
It.Sheathing 1 Resource of y=yes 0
_Pc
_ INPUT Resources Energy JADIHealth
error Frmsh
1.Use Sustainable Dacking Materials
a.Recycled content 3 Resource pts 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
13.Install House Wrap under Siding y 1 IAQ/Health pt y=yes 0
�4.Use Fiber-Cement Siding Materials — 1 Resource pt Y=yes D
1 F !
E.Plumbing
1.Install Water Heater Jacket i 1 Enero t
L ----- ---- — --- Yp Y yes D
2.Insulate Hot and Cold Water Pipes 2 Energy pts y=yes 0
I3.Retrofit all Faucets andShowerheads 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 Toilest with Ultra-Low Flush Toilets I
(1 point each,up to 3points) _ — y Up to 3 Resource pts. 0
5.Install Chlorine Filter on Showarhead 1 IAQ/Health pt y=yes 0
6.Convert Gas to Tankless Water Heater 4 Eneroy pts y=yes D
7,Install Water Filtration Units at Faucets gI
(2 points each,up to 4 points) Up to 41AQ/Health pts. 0
8.Install On-Demand Hot Water Circulation Pump 4 Resource pts Y--yes 0
1 1 1
r-.tiecmcai
t.Install Compal Fluorescent Light Bulbs(CFCs) .
(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 CFCs(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
i i 1
G.Appliances
1.Install Energy Star Dishwasher 1 1 Energy pt y=yes 0
2.Install Washing Machine with Water and Energy
1Conservation Features 1 Energy pt y=yes 0
3.Install Energy Star Refrigerator 1 Energy pt y=yes 0
14.Install Built-In Recycling Center3 Resource pts y=yes 0
I- ----�..-- --------'--- - `—'
1 1 1
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 D
2.Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0
13-Install Racycad-Content,Fiberglass Insulation with
Lo Added Formaldehyde 31AQ/Health pts y=yes 0
4.Use Advanced Infiltration Reduction Practices 2 Eneroy pts Y--yes 0
5.Use Cellulose Insulation
a.Walls 4 Resource pts y=yes C
b.Ceilings 4 Resource pts y=yes C •
S.Altemative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
b.cemngs 4 Resource pts y=yes D
1 1
_PWIT
rndows INPUT Resources Energy 11AWHealth
i1.Install Energy-Efficient Windows
• e.Double-Paned
1 Energy pt y yes p
b.Low-Emissivity(Low-E) 2 Energy pts Y--yes p
� G.Low.ConducrOvit
c_ Y Frames _ _ 2 Energy pts y=yes p
2.Install Low Heat Transmission Glazing 1 Energy pt y=yes p
1 1 1
J.Heating Ventilation and Air Conditioning
F -o Duct Mastic on All Duct Joints J{ 2 Energy pts y=yes p
2.Install Ductwork within Conditioned Space 3 Energy pts y=yes p
3.Vent Range Hood to the Outside 1 IAQ/Health pt y=yes _ p
4.Clean all Ducts Before Occupancy 2 IAO/Health pts y=yes p
5.Install Solar Attic Fan 2 Energy pts Y--yes p
6.Install Attic Ventilation Systems 1 Energy pt Y--yes p
7.Install Whole House Fan 4 Energy pts y=yes p
B.Install Sealed Combustion Units -
a.Furnaces 31AQ/Healthis
P Y=Yes D
b.Water Heaters 3 IAQ/Health pts y=yes p
9.Replace Wall-Mounted Electric and Gas Heaters with
Through-the-Wall Heat Pumps 3 Energy pts y=yes p
10.Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y=yes p
11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yes D
12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes p
13.Retrofit Wood Burning Fireplaces
•• a.Install EPA certified wood stovesf nseds 1 IAQ/Health pt y--yes p
b. Install/Replace Dampers 1 Energy pt Y--yes p
c.Install Airtight Doors 1 Energy pt y=yes p
14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes p
15.Install High Efficiency Filter 41AQ/Hsalth pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes p
17.Install Separate Garage Exhaust Fan 31AQ/Health pts y--yes, p
1
kRenewable Energy and Roofing i 1
1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes p
2.Install Solar Water Heating System 10 Energy pts y=yes p
3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes p
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=1 B points)_ _ Up to 18 Energy pts p
6:Select Safe and Durable Roofing Materials _ _ _ _ 1 Resource pt y=yes p
7 install Radiant Barrier — - 3 Energy pts y=yes p
1
L.Natural Heating and Cooling 1 1
1.Incorporate Passive Solar Heating 5 Energy pts y=yes p
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes p
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes p
1 i 1
•
M. ndoor Air Quality and Finishes INPUT Resources Energy lAO/Haafth
I.Use LowMo VOC Paint 1 IAOlHealth pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 •
i3_Use Low/No VOC Adhesives 3IAQ/Health pts y--yes D
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 6IAQ/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 41AQ/Health pts y=yes 0
6,Use FSC Certified fiiieras for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y--yes 0
10.Install Whole House Vacuum System 3 IAO/Health pts y=yes D
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 Carpet with Low VOCs 4 Resource pts y--yes 0 -
1 i 1
Total Points A 1 1401 130 57
Total Points Project Received: 0 0 0 •
GaaWpmgslgreenbuilrLnoguidelinesrremodslerslgresnpoin5fina1212.�4prMe7ed.rJs
•
an Community Development
10300 Torre Avenue
PJ, Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
qJUPEkTINO
Building Department
JOB ADDRESS:� PERMIT # vi 0,-F
C)o(-) L(
OWNER'S NAME: A t f PHONE # -3 07 9
GENERAL CONTRACTOR; c V2-<a&c,CK FAX #
I am not using any subcontractors: r �9—/ �
Signature Date
Please check applicable subcontractors and complete the following 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