08060058 FOWNERSNAME:
TY OF CUPERTINO
BUILeINGDIVISION PERMIT in'-c0 RACTORINEORMATION ,;.
I�TAVE M & S ROOFING CO. 0883058
PERMIT ISSUE DATE
LIU RUE—YING AND LI—CHU 208 COPCO LN 06/09/2008
NE:
(408) 314-0870 SANITARY NO. CONTROL NO.
ARCHITECTPENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u00 LICENSED CONTRACTOR'S DECLARATION Job Description
u I thereby affirm Nal I am lumnsed under Pmviaion a(Chapwr 9(commencing P
wish Seetion 711011" Division 3a(dm Buuncu anO PrafeuWm Code.and my license is RE—RF RMV EXSTRF &INSTL CLS A OSB SHTNG 50YR
_txN in full tome awe ett va tel .
52Z License Clara �-- Lle.g Lt CMPRF
9 F, DOW Contractor
CTS DECLARATION 3 0 S Q
I e 1 understand my Plam'hall be used as public reeoNa
Dyd
9G� Licensed Professional
5OWNER-BUILDER DECLARATION
a�,sf 1 Wmhy affirm that 1 am exempt from the Contractor's License Law for tic
i O O following mown.(Section 7031.5.Business and Professions Code:Any city or county
which rcquims a permit to construct,alter,improve,demolish,Or repair any swcture
°z< primrb its isma.c.alto requims the applicant res"mh permit w ftleaaignwatsmmcm
that he Islicc^sed pursuant W Nc provisions of Nc Contractor's lJuvc law(CNpm 9 Sq.F[. Floor Area Valuation
g (commencing with Section7(a)(1iDivuion3oftheBusinessandProfeai^mCati $10000
y that he u exempt therefrom and the basis for the alleged exemption.Any violation of
Section7031.5 by artyapplicvnfora permit mbj=the applicant war civil penalty of A.p7��Number Occupancy
mm roam Nan ftw hundred dollva($300). 35719087 .rVUr` P Y Type
❑I.uawdea of dm pmpmry,mmy ervplaycn with wagnas the'v sek mmpewtion,
will Pr tiro stunk and the he u wt Gmmdwe Law
does
mi apply in an,B neer of
,rote Roreaaian Inde:The Contrxwh Licence law don dem apply in an'toner ar ,__ Required Inspections
Own crtyww wlldsdimprowathimoawwW intended
gh
his
ownemployed,pmNdadthat such impmwmeruaase notimewW m leered for soler,
holds, Ne Wildingoriers of mwg told within mm year of completion,the ole
Wilder WB Itsw the burden of pmHng dist k did rot toric m improv for Purpose of
sad.).
❑1.as owner of the property,am exchru cly contracting with fcenad connotations to
construct the project(Sec.7064,Busineu and Profesuon Cede:)Tea Comracwr's Li-
cede law don not apply man..of property he Wilds or ireprowu dmmon,and.
who contracts for such prejeets with aeonuacmr(s)licenced pursuant in the Contractors
License law.
❑1 am exempt under Sec ,B&P C for Nu reason
Owner Due
WORKER'S COMPENSATION DECLARATION
I hereby aRnn under penalty of perjury rn of the following declarations:
❑1 ham and will maintain'Cutifnm ofComoem to self-asum for Worker's Compen-
mion,as provided for by Section 3700 of dm labor Code,far the i mformammce of the
work for which this permit is issued.
❑1 hast and will maintain Workers Compemauon h ommum.as mquimd by section
3700 of the,Labor Codc,fix the performwec of the work for which this permit u issued.
My Worker',Compeasatim loorm.drib and Policy number am: 6i
Cartier. r.7.�eF� .�'f
Policy Noi 4 7/ —> ,L
CERfIFlCA OF EKEMPION FROM WORKERS'
COMPENSATION INSURANCE
(iM,section deed trot W cemnpkmd if th permit as foram'hundred dollar,($100)
Mleei)
1 coati tict in the performance of the work for which this Permit Is humid.1041 not
employ any Main in any mamderm as in become subject in Ore Workeri CempevaGon
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
Glome subject m Ne Woheh Comou
pctian pron m
visioof Ne Labor Cade,you use
.J O forthwith comply with such Pmviumru or Nu permit shall be docmed k,d.
CONSTRUCTION LENDING AGENCY
[-+ 1amity-from that them is a construction lendingageo.),for dm pinformanse.f
r'1 ti the work for which this Permit b issued(See.3097,Civ.C.) -
o Lender's Name
z Lmckrx Add.
U Q I emdfy that 1 have and this application and lam that the aWw information is
tL F cortex 1 agree in comply with all city and county iNinatmes and sum laws relating in
.OU building commuction,aro hereby author=reproenuuvrs of this city to enmr op .the
r LU shove-menuudedpmpcny for""prem purpowhich may
(•+W (Wm)agree to sale,indemnify and keep hasmless the City of Cupcnino against
VS in'aramil gmenW costs aro oxpe^suwhieh maY in any way acmue aguwsaid City
U Z in eorucquedec of the granting or this permih / q
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEEGULATIONS. s J1
stgmmR O( UCa macwr Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appit.,or future wilding oecupam.mom a,handle bavmon motorial
at defou d by time Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Code.Section 255320)7
❑Yu (11416 All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
Will tic air Co am a n. Wing o"gall use"amount Qu it devices which P g
Cummer�nua air contaminants dcfrmd by the Bay Ara Air Quality Management all new materials for inspection.
0Ym Nu
I have mw the hvaNsmsmucrlalsmquimmcnu under Chapwr6.95 of the Calilm-
niaHcalthh SafctyCwc,Berner 25505,25533 and 25534.1 uwcrsmod Oaifthe Wilding � G+
dm'nonmtswhkhmust t currently haw•mnan4 Net It u my mspmedibility m oddly de occupant of Ne --� top
mquimmerwiuummofaccmrnm^lacuMm .. Signature of Applicant Date
6—g —0
Owner or mummord,gem D,mI I All roof coverings to be Class'%¢!'or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . I . . . . : 35719087 . 00
DATE ISSUED. . . . . . . : 06/09/2008
RECEIPT #. . . . . . . . . : BS000005038
REFERENCE ID # . . . : 08060058
SITE ADDRESS . . . . . : 10470 IMPERIAL AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LIU RUE-YING AND LI-CHU
ADDRESS . . . . . . . . . . : 10470 IMPERIAL AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5930
RECEIVED FROM . . . . : M & S ROOFING CO
CONTRACTOR . . . . . . . : MIRSAD KRAJWIC LIC # 28360
COMPANY . . . . . . . . . . : M & S ROOFING CO.
ADDRESS . . . . . . . . . . : 208 COPCO LN
CITY/STATE/ZIP . . . : SAN JOSE, CA 95123
TELEPHONE . . . . . . . . : (408) 314-0870
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1REROOFRES SQ FEET 30 . 00 390 . 00 0 . 00 390 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 391 . 00 0 . 00 391 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 391 . 00 #2061
---------------
TOTAL RECEIPT 391 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- --------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
CITY OF CUPERTINO
REROOF
CITY of
CUPEkTINO PERMIT APPLICATION
APN # 35 / ?U4 C� Date:
Building Address:
/04 -70 / M C-,#Z i v
Owner's Name: Phone #:
L I LA Q L4 E >/ / Cr (doff/ 2S 3 — ZGg
Contractor: Phone #:
/-1 — S /Zov/ 1/-/ Fax #:(�7.0
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles A Asphalt Shingles
K Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings 1 ❑ Provide I.C.B.O. Report#
pa To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: /Z 6
Ff/-T '/,A 11 /N 57-/f C S°o l7rz C .0 iK P AZ it
Residential Commercial
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the there are any restrictions: ❑
application or if applicable, include in plan
set & the sheet index. �--
Valuation:
/40
•I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
�7Z�/ ter•
Signature
CITY OF CUPERTINO
it..'.. REROOF
OCITY OF
CU
PEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
3 O 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
•
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 1997 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 r/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 1 .4 2%6F y / /,< -
Job Site Address: _ /w L-! 7 --; I r•c a c7tcr� r% - /t L.,-
Roofing
Roofing Company Name: r-1 -5 r i le
Applicant's SignatureDate: 20 —o
• Greg Casteel
Building Official
Revised 11/2/04
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
x d..
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 points
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. 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. Ener Star Refrigerator, Note/S pec.) A-3 1 oint
P. Other 1. List Green Features on Plans A-1 1 point
s TOTAL POINTS 40 points
JON 0 91008
Plan Review Process Work Book Page-l2-Revised 3/25/08
Green Points Rating System for Remodeling Protects
• 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 Resources Enerpy Aollhmith
A.Site
1.Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;B0%=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
B.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 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 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 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=yes 0
1 1 1
C.Structural Frame
1.Substitute Solid Sawn Lumber with Engineered Lumber l 3 Resource pts y=yes 0
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 y=yes 0
b.Wall 3 Energy pts y=yes
0
c.Root
3 Energy pts y=yes p
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
�f2' so OSB
-- — -- -- —`
a.Subfloors — _-- --' Resource pt y=yes 0
J.Sheathing 1 Resource pt y=yes p
1 1
INPUT ReSDUnres Energy 1ADIHealth
D. xtenor inis
11.Use Sustainable Decking Materials j
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 ChromiunJArsenic 1 IAO/Hsaith pt y--yes 0
3.Install House Wrap under Siding 1 IAQ/Health pt y=yes 0
4.Use Fiber-Cement Siding Materials 1 Resource pt y=yes 0
E.Plumbing
1.Install Water Heater Jacket _—� ' 1 Energy pt y=yes 0
2.Insulate Hol and Cold Water Pipes 2 Energy pts y=yes 0
3.Retrofit all Faucets and Showerheads with Flow Rsducare
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
(1 point each,up to 3 points) _ Up to 3 Resource pts. 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 D
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 pis y=yes 0
1 1 !
r.oecmcar
1.Install Compact 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 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. D
4.install High Efficiency Ceiling Fans with CFCs
(1 point each,up to 4 points) Up to 4 Energy pts.11 D
1 1 1
G.Appliances
1.Install Energy Star Dishwasher 1 Energy pt y=yes 0
2.Install Washing Machine with Water and Energy
nservation Features i 1 Energy pt y=yes D
I3.Install Energy Star Refrigerator 1 Energy pt y=yes D
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=yas 0
b.Ceilings 2 Energy pis Y--yes 0
2.Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0
�3^.I^Install Recycled-Content,Fiberglass Insulation with -�
L Added Formaldehyde _— , 3IAQ/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=yes0
b.Ceilings 4 Resource pts y=yes 0
6.Alternative Insulation Products(Colton,spray-foam)
a.Walls - 4 Resource pts y=yes D
o.uemngs - 4 Resource pts y=yes 0
1 1
INPUT _ Energy IAO..Nealth
i.Windows
•
[isii7ll—Ener�gy.:Effieierit�Windows J
a.Double-Paned 1 Energy pt y=yes 0
b.Low-Emissivity(Low-E) 2 Energy pts Y--yesD
c.Low.Conductivity Frames J 2 Energy pts y=yes 0
2.Install Low Heat Transmission Glazing 1 Energy pt y=yes D
1 1 1
J.Heating Ventilation and Air Conditioning
�1 UUse Dud Mastic on All Duct Joints 2 Energy pis y=yes 0
2.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0
3.Vent Range Hood to the Outside 1 IAC/Health pt y--yes 0
4.Clean all Duds Before Occupancy 2 IAO/Health pts y--yes 0
5.Install Solar Attic Fan 2 Energy pts y=yes 0
6.Install Attic Ventilation Systems 1 Energy pt y=yes 0
7.Install Whole House Fan 4 Energy pts y=yes 0
B.Install Sealed Combustion Units
a.Furnaces 3 IAQ/Health pis y=yes 0
b.Water Heaters 31AD/Health pts y=yes 0
9.Replace Wall-Mounted Electric and Gas Heaters with
Through-the-Wall Heat Pumps 3 Energy pts y=yas D
10.Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts Y--yes 0
11.Install AC with Non-HCFC Rafrigerants 2
j--yes Resource is 0
_ P _
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 stoveslinserts 1 IAQ/Hsalth pt y=yes D
b. InstaIVReplace 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 41AQ/Hsan pis y--yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Haalth pts y=yas 0
17.Install Separate Garage Exhaust Fan 3 IAQlHealth pts y--yes p
1 1 1
enewable 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=16 points)_ __ Up to 16 Energy pts 0
'�6.Select Safe and Durable Roofing Matewals - _ 1 1 Resource pt y=yes D
7.Install Radiant Barrier 3 Energy pts y=yes 0
1 1 1
L.Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy pts y=yas p
2.Install Overhangs or Awnings over South Facing Vrindows 3 Energy pts y=yes p
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0
UP LYT Resources Energy IAD/Health
M.In oor Air Qu rty an Finishes
r1_.Use LOWiN6 VOC Paint 1 IAQ/Health pts y=yes 0 •
2.Use Low VOC .Water-Based Wood Finishes _ 21AQ/Health pts y=yes 0
P.I Low(No VO'C Adhesives _, 3 IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes . D
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AO/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
V.Seal all Exposed Particleboard.or MbF- -`, 41AQ/Health pts yges D
8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pis Y--yes D
10.Install Whole House Vacuum System 3 IAQ/Health pts y--yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2.Use Rapidly Renewable Floonng Matenals 4 Resource pts y=yas 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts ygas 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 Availablel 1 1401 1301 57 •
Total Points Project Received: 01 0 0
G:datarprogsrgmanbuildmoguidefineshemodslersrgreenpointsUnalZ 12.04protau1edx1s
•
Community Development
r Q?', 10300 Torre Avenue
N F Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
WUPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
/�4i7c� /�"r .a t",
�� � OU>a
OWNER'S NAME: PHONE # "
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
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