08040009 CITY OF CUPHRTIPIO � � • I���s,»�t
BUILDING DIVISIONy` PERAUT C4Cog\3:TxRAC�TQRIlVFORMATI TIO I:
Buap��2"FhOMESTEAD RD APT 206 DRAEGER CONSTRUCTION INC 08040009
OWNER'S NAME: - PERMIT ISSUE DATE
HOMEOWNER' S ASSOCIATION 605 COMMERCIAL ST 04/03/2008
ONE: SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG EIECr PLUMB MECH
3G p LICENSED CONTRACTOR'S DECLARATION Ib Description
�n T Mreby&from Nn O0SCT1 1 am licensed under pwvisou Of Chapter 9(commencing P
M Satioe 7M)arDi Tina.3 cruse Businev and P10I.Amw Code.aed my license is R/R LIKEFORLIKE SIDNG&TRM&SPPRT BEAM, INSTL
in full forte,and effect
L..Cl L'c.• /,,/7-Z (N) FLSHNG/COATNG
Dae, —�_�Conuacmr
ty ARCHITECTS DECLARATION
q I undersand my plans.hell W used u Imhlic mane
Ssed Licensed professional
^ 03pNEm BUILDER DECLARATION
i cE I hereby a(Rm onn I em aurone Gum We Cessions Co License law for We
D o fallowing maw..(Section 703 L3,BusnrsS and Professions Code:Any city or county
$ which uquseSe.permit aim rernnwuaalso.Improve,heermitt Or pan anytmnum
S° prior W its l cense ce,tlw ni to We the applicant of We
m permit Licenseo rile a Law Chemet
3<
that ISO is licensed purssion7 c provisions of WeComtwtofa License law(Chapter Code)
Sq.Ft. Floor Area Valuation
WASImencingw BannermanandW Beed,frnftheeSeinwendort.My vi Cade)or $6300
Q $ Nal he r 31.5 b Wemfrom and tun bur far the alleged aeicant t.Any l penalty
of
Seton tit. by arty reddontror•petit wbjeeta the applicant to,civil pewlty of umber Occupancy e
tmtmnmW,nGwnunamedrlam(s5ao). � 32659999 ! 3N P Y�'P
❑I,u Owner of We property,or my employee with might as Web sole eomperenrn,
will do We.,it.and the smulhm is not i.kiWed or offered for age(Sm.7044.BusinessRaired Inspections
and Prow
reow Caen The Conuwmro e nss License Law danot apply m an owner of 9 P
property who Wilda orimproastunreon,and who does suchwmk6imulror through his
ownemPloyee,provided Was Such lmprowmau me not intended moffead raruln if.
however.We Wilding or improvement is to within one year of oompleuon,We owna-
W ilder will hew We Wren or proving that he did set Wild or improve for purpose of
YIe.).
0 1.as owtur of We property am eclwively contracting with licensed mmrwton to
wuwct We project(Sec.7044.Business and Professions Coda:)The Comactw's U.
ecwe law does not apply to an owner of property who Wilda Or bnpro u Women,and.
who commma far Such pe jeets vied a eanlracmr(s)licensed pureunl to de ConusWs
Licesm Law.
[:]I am exempt uncle Sec ,B R P C for this meson
Owner Dam
WORKER'S COMPENSTnON GECI.6RATLON
I bemby amen under penalty of peymy now or We Wnowiag deaboad'"A
baa and will meinuin a Certificate ofCouenl w self-iuum for Workces Compere
n,as provided forby Section 370(1 of We Labor Cade,for We perform.ntt of We
h
for which this permit is issued.
0 1 have and will maintain Wo ton's Compensation Insamnce,as required by Section
3700 of We Labor Code.Ise the perfannana ofthe work for which Wis permit is Issued. '
My Workee Campewdon)serails amu and Polity m:
Cartier. �Gf/G 1211MLIPoliry Na.:AMC;/r t
CERTIFlCATE OF P.XEMP ION FROM WORKERS'
COMPENSATION INSURANCE
Clbrsecom need set uncompleted lite permit Is forme hundred dollar(SIM)
or les)
I cvufy that in We performance of the work for which this permit is issued,19WI am
employ any pawn in any mwncrw as m become subject to the WorYee'Compenstan
Laws of California.DM
Applicant
NOTICE TO APPLICANT.If,.ror making this Certificate of Exemption,you Should
become subject he We Worker's Corepew4tiun provisions of We labor Code,you most
.,z fonbwuh comply with Such p emse.A this Permit Nall un acemed mated.
Z^ CONSTRUCTION LENDING AGENCY
[-i.�. I hereby Stem that Nem r•construction lending agency for We performance of
ai ti the work for which this permit r Issued(Sec.3097,Civ.C.)
Q l.ende9Name ,
z Lancer,Add.
U0 1 miry that I haw reed this application SM Stale dw We Sbow information r
l3. rorreseL I agree in comply with all city and county ordnance and awe lawn relating In ,
0 Wilding construction.and hereby wWarine mponuwtivea of this city to enter upon the
l3l above-mentioned property for inspection purposes
(We)agree to sew,indemnify sed keep barmlwa the City of Cupcnino againrt
i-n N liabilities,Jedgmonu.cam and espnues which may In soy way Seethe agsuwsdCity
U,Z in eowequence of the granting of this ptrmiL ^2 p
^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH All NON-POINT Issued by: Date 7Y7
SOURCE REGULATIONS. ,In� /^ �j /-
//f/ 1 Re-roofs
Signnuro of Applien✓CrA ror Oe¢
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will
We applicnt or future Wilding ocepwtsrom or handle haurdow maeris
as de0ncd by We Cupertino lihmucip.1 S*.Chapter 9.1;and We Helue and Safety
Cade,Seton 25533(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ye o
Will We applicwt or fuwm building aceupant sew equipment ar devlou which If a roof is installed without first obtaining an inspection,I agree to remove
It har.m.us sr contaminants u defined by the Bay Ams Air Quality Management all new materials for inspection.
OctT
❑Ye I']nvO
I hove mad We hawrnmouted.bmqui...0 undo Chaper6.95 ofthe Califor-
run Health kSafctyCode,Section25505,25533 at25534.1 undemund Anifthe Wilding
docs not currently have a Tem eL that it is y responsibility to nary We occupont or We
rofornewnuw hmtwarGa
he icer :s ar, crureeea� SignatureofApplicant Date
Owner armed age m /� 6 Dae- All roof coverings to be Class'}W'or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32659999 .206
DATE ISSUED. . . . . . . : 04/03/2008
RECEIPT # . . . . . . . . . : BS000004337
REFERENCE ID # . . . : 08040009
SITE ADDRESS . . . . . : .22330 HOMESTEAD RD APT 206
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HOMEOWNER'S ASSOCIATION
ADDRESS . . . . . . . . . . : 22330 HOMESTEAD RD APT 206
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : DRAEGER CONSTRUCTN
CONTRACTOR . . . . . . . : DRAEGER, JOHN EDWARD LIC # 21895
COMPANY DRAEGER CONSTRUCTION INC
ADDRESS . . . . . . . . . . : 605 COMMERCIAL ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 536-0420
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 6, 300. 00 0.70 0. 00 0.70 0. 00
1DECKWOOD EACH 1. 00 • 428 . 00 0. 00 428 . 00 0. 00
-T-------- ---------- ---------- ----------
TOTAL PERMIT 428 .70 0. 00 428.70 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 428 .70 #135464
---------------
TOTAL RECEIPT 428 .70
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 enviropment 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 RESDUTCOS Energy [ADIHealth
. ate ,L.�7a b„mss f2d
1.Recycle Job Site Construction 8 Demolition Waste
65%=1 point;75%= 2 points;80%=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 8 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
L-
8.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 10
1 I 1
B.Foundation
1.Incorporate Recycled Flyash in Concrete 9l
a�
'25°/Recycled Flyash=2 points;Add 1 point for every 10%
increase of flyash,up to 5 points up to 5 Resource ptsF 0
2.Use Recycled Content Aggregate 2 Resource pts y=yes 0 �U ,
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes /0 1
1 I t
C.Structural Frame �L�J
[1.Substitute Solid Sawn Lumber w th Engineered_Lumber_ 3 Resource pts y=yes 0 c:--
2.
2.Use FSC Certified Wood for framing
(For every 10%of FSC lumber used=2 points,u to 10 G
P P ) 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
8.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yesJ�,� _ 0
9.Use Structural Insulated Panels(SIPs) L
a.Floors 3 Ener is
Energy y=yes ,_ 0
b.Wall 3 Energy pts =yes "r/f p , ad 0
c.Roof 3 Energy pts -�yM.Il es ra 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
112.Use OSB --
a.Subfloors 1 Resource pt y=yes 0
b.Sheathing
I 1 Resource pt y=yes 0
1 1 1
r
i
ADIHeafth
e orn s
1.Use Sustainable Decking Materiels
a.Recycled content 3 Resource pts yryes 0 A
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
1 Install House Wrap under Siding 1 IAQ/Health pt y=yes 0
4.Use Fiber-Cement Siding Materials 1 Resource pt 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 Showerbeads with Flow Reducers
a.Faucets(1 point each,up to 2 points) Up to 2 Resource pts. 0
b.Showarheads(1 point each,up to 2 points) Up to 2 Resource pts. 0
4.Replace Tollest with Ultra-Low Flush Toilets
(1 point each,up to 3 points) Up to 3 Resource pts. 0
5.Install Chlorine Filter on Showerhead 1 IAQfHealth 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
6.install On-Demand Hot Water Circulation Pump 4 Resource pts y--yes 0
r.eiec[ncar
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 10 4 points) Up to 4 Energy pts. 0
4.Install High Efficiency Ceiling Fans with CFLs
It point each,up to 4 points) Up to 4 Energy pis. 0
1 1 1
G.Appliances
1,Install Ensrgy Star Dishwasher 1 Energy pt y=yes 0
.2.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 yeses 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.Wells 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.uailings 4 Resource pts y--yes 0
1 1 1
I �
INPUT Resources Ener
rn ows
1`.Installl'Energy-Effibient Windows
'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 pts y=yes .0
2.Install Low HeafTransmission Glaiing 1 Energy pt Y--yes 0
1 1 1
J.Heating Ventilation and Air Conditioning
1.Use Duct Mastic on All Duct Joints _ 2 Energy pts Y--yes D
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
S.Install Solar Attic Fan 2 Energy pts y=yes 0
6.Install Attic Ventilation Systems 1 Energy pt y=yes D
7.Install Whole House Fan 4 Energy pts y=yes D
8.Install Sealed Combustion Units
a.Furnaces 31A0/Hea1th pts 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 SEER111 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 D
12.Install 90%Annual Fuel Utilization Ef iciency(AFUE)Furnace 2 Energy pts y=yes 0
13.Retrofit Wood Burning Fireplaces
a.Install EPA certified wood stovesrnserts 1 IAQ/Health pt y--yes 0
• b. Install/Replace Dampers 1 Energy pt Y--yesD
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 Ef dency Filter 41AQ/Health pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAO/Health pts y--yesD
1 1 1
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar Water Heating 4 Energy pts Y--yes 0
2.Install Solar Water Heating System 10 Energy pts Y--yes D
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.Seledt Safe and Durable Roofing Materials, 1 Resource pt y=yes 0
7.Install Radiant ffir-69F 3 Energy pts y=yes 0
1 1 I
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=ygS D
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts Y----yes 0
1 1 1
. n oor r ua ry an n s es i
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 3 IAO/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 D
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Seal all Exposed Particleboard or MDF 4 IAQMealth pts y=yes D
B.Use FSC Certified Materials 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 IAQ/Health pts y=yes 0
1 I 1
N.Flooring
1.Select FSC Certified Wood Flooring B 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 IAO/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 1 1
Total Points Available:1 1 1401 130 57
Total Points Project Received: 1 01 31777777571
•
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CITY OF CUPERTINO
ADDITION/REMODEL
CUPEIIaTINO PERMIT APPLICATION FORM
APN# ��/ 1 n n I ZOO Date: 4'-3/D(%
Building Address: l0 1 Vl I
Z"3 0 40 0 UAJIT Zfl (0
Mailing Address (if different from building address):
Owner's Name: Phone# : Wro - A l'!- cl q 1 01
M oWXJE24 pOvlldfu Fteetnr_
Contractor: Phone#: cJ O$ - ST b- u q Zfl
DRa�e -� t,ods 2utTo.l I+�L Fax #: 413b —ci3b- 04Z,5
Contractor License#: to(7 7.k p
Cupertino Business License#:
Contact: Phone#: &+iD S- 2 0 q_ y (l`f 4
w14 -1i0CZ. Fax#: O3b -0t{Z5'
Building Permit Info:
Bldg. X Elect. ❑ Plumb. ❑ Mech. ❑ Hillside ❑
Job Description:
Addition (adding sq footage):
(D5CA 1610'a S5)
What is being remodeled? Vo t LI L-r-- S 1014Jk
'1-1Z1-1 ' Ado 5%3f1f0CT' Sr64 '1 . 14JST-4Lt.- (&J) (��Ai*i��t�f�t�Ti�► y •
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 Other
Type of Construction (Usage Class): Occupancy Type:
1 FR, 11FR ❑ 11, 111, V-IHR ❑ 11, 111, 1V V-N ❑
Valuation: _ Please check this box if the project is a
O second-story addition ❑
Green Building Check list must be completed and Green Building Points Achieved:
attached to the plans.
**For Office Use Only***
Over-the-Counter ❑
CITY OF CUPERTINO
ADDITION/REMODEL
fi,
CUPETINO FEE SCHEDULE
s
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
ADDITIONS 1R3SFDADD
PLLONGRNGR Long Range PL
Planning/Residential
1R3INSP Dwellings Inspections B
1R3PLNCK Dwellings plan check B
IR3REPINSP Dwellings Repeat B
Inspection
IR3REPPLNC Dwellings Repeat Plan B
Check
1R3HINSP Dwellings Hillside B
inspection
1R3HPLNCK Dwellings Hillside B
Ian check
1R3HREINSP Dwellings Hillside B
Repeat Inspection
IR3HREPLNC Dwellings Hillside B
Repeat Plan Check
1R3ALTINSP Dwellings Alternate B
Materials Inspection
1R3ALTPLNC Dwellings Alternate B
Materials Plan Check
1PCESS Cesspool P
1PPRSEWG Ea. Private Sewage P
Disposal System
1PRSEWER Sewers P
1BPSPRINK Lawn P
Sprinkler/Backflow
1BPWSVCS Main Water Service P
1BSEISMICRE SeismicResidential B
DECKS 1R3SFDADD OR
1R3SFDREM
IDECKWOOD Deck (Wood)-Each B
Each
1DECKRAIL Deck Railing-Each B
Each
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
uantity Fee ID Fee Description Fee Group Permit Type
S Sq Ft
GARAGES 1R3SFDADD OR
1R3SFDREM
1GARDTW<=1K Wood Frame up to B
1,000 SF
1 GARDTM<=1K Masonry up to 1,000 B
SF
BCONSTAXR Construction.Tax Res
new detachedgarage)
PATIO'S OPEN 1R3SFDADD OR
1R3SFDREM
1PATIOWOOD Wood Frame up to.300 B
SF
1PATIOMETAL Metal Frame up to 300 B
SF
1PATIOOTHER Other Frame up to 300 B
SF
PATIO'S CLOSED 1R3SFDADD OR
1R3SFDREM
IPATI0ENCLW Enclosed Wood up to B
300 SF
1PATIOENCLM Enclosed Metal up to B
300 SF
1PATIOENCLO Other Enclosed Patio B
up to 300 SF
1COVPORCH Porch Covered-Each B
Each
1REROOFRES Residential Re-roof B
Each 100 SF
REMODELS 1R3SFDREM
1REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan
300 SF check
1REMRESBAT Bath Remodel up to B
300 SF
1REMREOTH Other Remodel up to B
300 SF
REMODEL PLNCK
1 STPLNCK 0-3 for Standard Plan Check B NOT FOR OVER THE
remodel) COUNTER PLAN CKS.
3 of
CITY OF CUPERTINO
ADDITON/REMODEL
FEESCHEDULE
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 B
(Structural Shear
Wall/Masonry)
1 WINBAYSTR Bay Window B
Structural
SKYLIGHTS 1R3SFDREM
1 SKYL<10 SF Skylight less than 10 s£ B
1 SKYL>1 OSF Skylight greater than B.
10 sf or structural
1STAIRS Stairs-first flight/ea B
addt'l Alk
1BUSLIC Business License . B
4 of 3
„ Community Development
10300 Torre Avenue
to
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�CUPEkTINO
Building Department
JOB ADDRESS: PERMIT#
0 p eo L( 00v
OWNER'S NAME: W J*tj 4CS o t'.t1T0 PHONE # tf a'� - 5;b-O Lf-zo
GENERAL CONTRACTOR Ve.4 C6 -rt, t,041I- W ti FAX # y-o b - G;6 -o+%q
I am not using any subcontractors: �AJ µ 4 1 3 (v x
Si a Date
Please check applicable subcontractors and complete the followinginformation:
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
' e
Owner C tractor Signature Date