08080088 CITY OF CUPERTINO �k AY >x
BUILDING DIVISION PERNIIT C�NTRACTORINFO MATIt),N
YM1 Sah',^,xtv.�'.. .�it� -F.c� e�tm:4�W '� Tom^• s$sld
BUILDING ADDRESS: PERMIT NO.
5 1,1 LY AVE; C & C ROOFING 08080088
OWNER'S NAME: PERMIT ISSUE DATE
C;!11 NG' YOUNG 89 S 21 ST 08/13/2008
NE
(408) 298-1868 SANITARY NO. CONTROL NO.
ARCHIT 111NIGINEER: BURRING PERMIT INFO
BLDO ELECT O O PLUMB MECH
O O
3 C p LICENSED CONTRACTOR'S DECLARATION
1 beroby aRrm its 1 am li¢rvN under provkiom oI Chapter 9(commcrcing Job Description
with Section 7")or Division 3afthe Business and Pmresdum Code,and my license is RE-RF RMV SHKS 1/2" CDX 40YR CMP CLS A 25SQ
full forte and e,R a
j'/' Liceve Clan L
Commuter _ nn r fYVG
Q7W ARCHITECT'S DECLARATION
2 I undcrsund my plans shall W used v public meet&
JyU
b G
Licensed Professional
5 OWNER-BUILDER DECLARATION
ai<f 1 hcmby alio that 1 am exempt from the Contractors License Law for the
y O O following mason.(Section 7011.5.Becomes and Profadam Cads:Any city or county
I3 V which requires a Permit to construct alter.)mpmve,demolmh.or repair any structure
-�< pdormits Wuawc.alsonequimtMapplicmtformch PennittofileasignWatammenn
£�0 Sq.Ft.Floor Area Valuation
that he is lkcwed pursuant to the provisom of the Con=W'l Li¢wc law(Chapter9
y (commencing with Section 70D0)of Division 3 of the Busmen;and Profeskm Cods)or $9900
e eS g that k I,nsempt iernfrom aW the W is for the a,,d exemption.Any violation of
Section 7031.5 by any applicant foes permit subjects the applicant m a civil penalty a( Number Occupancy
Wt mom than five huelmd dollars(0001 35903020 . P Y Type
❑I.vowrcs of the property,are mY ernPinYees w'dh wgnv ie'v sok compewtim. ..
and dothework,and the structure Contractors
I.I dor aRe dosWta(Sec.7014,emerof
and enyw bis Code:The mthermrs cid who law does tet apply i an nwnu of Required Inspections _
propertywbabisipu aimprovthereon,andwho dao suchwokh roffeemiromle bis
owacm the,Wiprovidedtetsuch cit is and
arc Wt intended mofkred forme sale If,
however,ie building or Improvement ir amd within one year of comm.for
pas owns.
buiku wiB Mve the burden of proving that he did tet build or improve(o purpose of
sok.).
1,u owner or the property,am esGu w,cly casomma ng with licensed rnntractan to
convect the project(Sec.7044.Business and Professiom Cede:)The CoaOacbr's Li.
cense law does not apply to an owner of property who builds or improves thereal and
who contracts for such projects with a exammcmr(s)Iicemed punuam to the Contractors'
Llceve law.
❑Ion uempt under See .B&PCfmrtmsumW
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby under under penalty of perjury ane of the following declarations:
1 ha.e and"I maintain a Certificate ofComcm to self.imam for Wodots Commem.
suint,v provided for by Section 3700 of the labor Code,for the performance are the
wok for which this permit is immune.
❑1 have rud will maintak Workers Compeoul Insuma.as expound by Section
3700 of ie labor Code,for ie pcAormana of the weak fro which this Permit is Issued.
My Workers Cnsadoni Irsunna carom nod policy number am:
Caner S�i//E Fri w D Policy Nn./�pLff
CERTIFICATE OF EXEMPTTON FROM WORKERS'
COMPENSATION INSURANCE
from aecdm need tet M completed if the permit Is for.hundred dngars(5100)
onus)
I c.rufy that in ie performance of the work for which this Permit is issued,l shall m1
employ any person in any manner an as b become,subject to the Woe¢ 'Compo m
Laws of Calif mnia.Das
AppBcent
NOTICE TO APPISCANT:IL after making Nis Ccnificam of Exemption,you should
became subject to the Workers Compensation provisions of the labor Code you mon
.,O foMrowith comply with such Pnidom or its permit shall W deemed masked,
Z� IR
CONSUCnON LENDING AGENCY
[-�t 1hereby&frmt iatiers sea comtructim lendingagercy fordoierfomm of
Ct: the work rear which its Who u Wood(Sec.3097,Civ.C.)
fi)Q Lenders Name
G
Z lenders Address
w7
U O 1 enemy most 1 love read its mastication aW auta its the move imamatiun k
{7. cornea I agree b comply with all City and county odinatcv and soon laws miming to
O Wilding construction,and hereby authorise rep ommativn of this city to cnmr upon the
r[7a shove-mentioned property for impaction pugmses
F gy (We)gems to ave.indemnify and keep hamlemm the City of Cupertino specal
fn Ibmili0ea,judgmenu.costs sold expcmv which may in any way accme agalmissid City
(„)Z to conagwmc of the gusting of iia pemit
ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE�'iULAT10NS. _ _
Re-roofs
HAZARDOU
Sigu
nurc a(ApplscaDam
HAZARDOUS MATERIALSDISCLOSURE Type of Roof
WiII y t applicant a four Wilding e.Chapter
2.hawk h eadaw macris
C de.Sed io 25 Cupertino Municipal Cede.Chapter 9.13,and the Health and Safety
Code.section zss32(a)7cjlr All roofs shall be inspected prior to any roofing material being installed.
Cl yes
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicant or future building occupant sex .Air(bis or Moa which P g
_mom ivat'Minw air canuminans v dc0ncd by ie Bay Asea Air Quality Management all new materials for inspection.
Dyes
1 have read On hamhws mamriamsquimmcntsunder CletW6.95 ofti a Califer.
nu Health&Safety Cade,Sexxi.2551)5,25533 and 25534.IuWcnmW nhuifie Wilding
does tet currently los a tenant this in is my mpoem bility m notify the ecupent of the
mqm I�gs which muse be sectpeontui are are,colftuacordec.pmry. Signature of Applicant Date
owmrormmmixadage., Dam All roof coverings to be Class'%}"or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . ... . . . : 35903020 . 00
DATE ISSUED. . . . . . . : 08/13/2008
RECEIPT # . . . . . . . . . : BS000005771
REFERENCE ID # . . . : 08080088
SITE ADDRESS . . . . . : 875 LILY AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CHING YOUNG
ADDRESS . . . . . . . . . . : 875 LILY AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4261
RECEIVED FROM . . . . : OZZIE CAMARA
CONTRACTOR . . . . . . . : OSVALDO CAMARA LIC # 22982
COMPANY . . . . . . . . . . : C & C ROOFING
ADDRESS . . . . . . . . . . : 89 S 21 ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95116
TELEPHONE . . . . . . . . : (408) 298-1868
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- - -- ---------- ---------- -- ---------- ----------
1BSEISMICR VALUATION 9, 900 . 00 1 . 00 0 . 00 1 . 00 0. 00
IREROOFRES SQ FEET 25 . 00 325 . 00 0 . 00 325 . 00 0 . 00
--- --------- ----- ----------
TOTAL PERMIT 326 . 00 0 . 00 326 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
------- --------------- --- — --
CREDIT CARD 326 . 00 VISA
---------------
TOTAL RECEIPT 326. 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
I OF
•CUPERTINO PERMIT APPLICATION
APN # Date:
Building Address:
L �GI G
Owner's Name: Phone #:
tl 6-
Contractor: Phone N: yob 29&'-/&t�F
(f /zoo r/C r✓ G- Fax #: �dg� -29� -
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )i( Asphalt Shingles
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:
a 571,4 /mac r �IZ c Q X Ya �1E,4✓1 �G P
C'L ass �4-
Residential Commercial
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation:
2 � S
•I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 6/16/08
CITY OF CUPERTINO
«�" REROOF
CUPERTINO FEE SCHEDULE
Number of Fee ID. Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1REROOFRES 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
•
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 1/4 " 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: r'747 1 iy C.- ///I ,/ ei
Job Site Address:
Roofing Company Name: e 1� �'//FIGO i/(/ G
Applicant's Signature: t�iti��C'��s �y-� Date: fit- /3 Off'
• 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 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. Energy Star Refrigerator, (Note/Spec. A-3 1 point
P. Other 1. List Green Features on Plans A-1 1 point
MONAMMIMMI TOTAL POINTS1 40 points
•
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.
INPUT Resoutces Energy IAO/Healtio—
A.Site
I,.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&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
(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 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 0
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes 0
1 1 I
C.Structural Frame
LSubstitute Solid Sawn Lumber with Engineered Lumber 3 Resource pts y=yes 0
2.Use FSC Certified Wood for framing J
(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
8.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.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
2 Use OSB i
a.Subtloors
1 Resource pt y=yes 0
• b.Sheathing _ 1 Resource pt y=yes 0
L.
1 1
INPUT Resources Energy IAQ/H,.Ith
D. xtenor Finish
1.Use Sustainable becking Materials
a.Recycled content 3 Resource pts y=yes 0 •
b.FSC Certified Wood 3 Resource pts y=yes 0
12.Use Treated Wood That Does Not Contain Chromium/Arsenic 1 IAQ/Health pt y=yes 0
13.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
r1.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 Showerheads 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
14.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 0
7.Install Water Filtration Units at Faucets
(2 points each,up to 4 points) Up to 4 IAQ/Health pts. 0
8.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
1 1 1
I%tiecmcai
I1.Install Compact Fluorescent Light Bulbs(CFLs)
f(i 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. 0
4.Install High Efficiency Ceiling Fans with CFLs
(1 point each,up to 4 points) Up to 4 Energy pts. C.
1 1 1
G.Appliances
1.Install Energy Star Dishwasher 1 Energy pt y=yes 0
12.Install Washing Machine with Water and Energy
Conservation Features 1 Energy pt y=yes 0
3.1nstall Energy Star Refrigerator 1 Energy of y=yes 0
14.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=yes 0
b.Ceilings 2 Energy pts y=yes 0
2.Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0
i3.Install Recycled-Content,Fiberglass Insulation with -
INo Added Formaldehyde - 3lAa 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=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
o.t;emngs 4 Resource pts y=yes 0
INPUT Resources Energy IAQ/Health
I.Windows
1.Install Energy-Efficient Windows
a.Double-Paned 1 Energy pt y yes 0
b.Low-Emissivity(Low-E) 2 Energy pts y=yes 0
c.Low.Conductivity Frames 2 Energy pts y=yes 0
— -- --- —
2.Install Low Heat Transmission Glazing 1 Energy of 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 0
2.Install Ductwork within Conditioned Space 3 Energy pfs y=yes 0
3.Vent Range Hood to the Outside 1 IAO/Health pt y=yes 0
4.Clean all Ducts Before Occupancy 2 IAQ/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
8.Install Sealed Combustion Units
a.Furnaces 31AQ/Health 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 SEER/11 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 0
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 stoveslinseds 1 IAQ/Health pt y=yes 0
b. InstalVReplace 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 41AO/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 IAQ/Health pts y=yes 0
I 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 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=18 points) _ Up to 18 Energy pts 0
6.Select Safe and Durable Roofing Materials __ __ , 1 Resource pt y=yes 0
7.Install Radiant Berner 3 Energy pts y=yes 0
1 1 1
L.Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy pts y=yes 0
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts . y=yes 0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0
• 1 1 1
•-r-
M.Indoor Av Ouality andFlnls es
'1.Use Low/No-VOC Paint _ 1 IAO/Heaith 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 _ _ __ 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 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
i7.Sea aExposed Particleboard or MDF - ___ 4 IAQ/Health pts y=yes 0
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 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 1
Total Points Aval able: 1401 1301 57
Total Points Project Received: -e— 0j 01 0 •
G:dalarprogsrgreenbuildingguidelineslremodelerslgreenpointslinal2.12.04prolecied.xis
•
Community Development
�f 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
Z- (z vC- U o� a o
OWNER'S NAME: h 'N PHONE # og'-2 - 6 F
GENERAL CONTRACTOR: <f FAX # p - 3
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