08090138 CITY OF CUPERTINO �� ,> t s %� ^':
BUILDING DIVISION PERMIT CON`TR: CTORINFURMA,TION
n,zs>a-xti,.•,> �.�tc.-Bio# -"'a.wK{.�.� -#x3y n
BUILDING ADDRESS: PERMIT NO.
11066 LINDA VISTA DR _ WESTSHORE ROOFING INC 08090138
OWNER'S NAME: PERMIT ISSUE DATE
COLLIER BERNICE B TRUSTEE 2814 AIELLO DR C 09/22/2008
NE SANITARY NO. CONTROL NO,
ARCHITECDENGINEER: BUILDING PERMIT INFO
RE—RF RMV EXT WDSHK INSTL BLDG ELECT PLUMB MECH
SHK O O O O
wap LICENSED CONTRACTOR'S DECLARATION
I hmeby,affirm that l am licensed under Provisions of Chapter 9(commeMing JQDesicri0on
mm with S,ction7")of Division3ofthc Busiwssat ofessima Cadc.an mylittnt is
n<a in full forte and of ct. '] 7 7
roi Lieenm--( �ls.lt7
F Dam O T,DEC
RCHTIECI'S DECLARATION
-r 1 uMemand my plans shed be used as public manody
JyV
I O Licensed Professional -
OWNER-BUILDER DECLARATION
f 1 berth,affirm that I am uempt from ted Contractors License law for the
C O o following...a.(Section TW L5.Business and Prolamines Cache:Any city or county
$ which me qulra Permit to conandes,alter.Improve,demolish,nr mpoir any structure
_zy pear to is issuance.also,rtquims to applicant for such Permit an file a signed statement
< Wss W is deceased pursuant to the provisions of the Contaclar'a License Law(Chapter 9 Sq.Ft.Floor Area Valuation
x�s (commencing with Section 7000)of Division 3 of the B unease and Professions Code)tar
that he in eamd,a themfrom and the basis far the alleged exemption.My vhdwdon of
Section 70313 by any applicant for a permit subjects the applicam to a civil penalty of APN Number Occupancy Type
not mase Baan Bus hundred dollars ISMP Y YP
I,as owner of the property.or my employee wish wages as Jack wa Compensation.
will do the work.add the atmctum in any intended or offered far sale(Sec.TD44,Business
and Profusions Cade:The Contractors License Law dao We apply by an owner of Required Inspections
property who Wilds orimprove thereon.and who ducsswhwork himselfordarough his
awn employ=.provided that such improvements art not intended araQered forsale If.
however,the Wilding ar improvement is sold within one yens of completion.We owtri-
Wilder witi have the WNen of proving that M did no,MW or improve for puryo¢of
.I.J.
. ❑1.u owner of de property wo walwively ewaacting with Ilceeed ttnaamms he
coustmet Use prefect(Sec.7044.Business and Poets sl,ns Cade:)The Coavaemr s U.
cense Law dors not apply to an owner of property who Wilds or improves theman,and
who contracts for such pmjeca with acunaactor(s)licensed pursuant an We Convectors
License Law.
❑IarnotemptunderSee ,B&PCfarthismwan
Owner Dat
WORKERS COMPENSATION DECLARATION
I hereby afrum under Penalty of perjury m of the following decimations:
1 ba.c atW will maintain•Cmtifiwteof Cement m self-insure far Workers Campus.
tiw,ss provided fm by Seca.n 3M of the labor Code,far the perfmmance of the
work for which this permit is issued.
❑1 have and will maintain Workers Compenution I...u required by Sermon
3700.(me labra Codc,for the pedarmance.fee work for which this permit I,issued. '
My Workers
tCompuations lyoma=erricr and Policy number ere: -> q
Cartier.�")(i1fP Fe1n�Policy No.:Z 607—l00I
CERTIFlCA'I�ThTOFLFf10N FROM WORKERS
COMPENSATION INSURANCE
(Thu succi.deed not W complete Bane permit is forme,hundred dollars(SIM)
or less.)
1 certify tent in the performance of the work for which this Permit is issued.I shall not
employ any person in any summer se as m become subject to the Workers'Compewdan
laws of California.Data
Applicant
NOTICE TO APPLICANT:IL afar making this Certificate of Eaempdon.you should
bwome subject in the Workers CmnNanation provisions of the Labor Code.you owe
.J O foMwith comply with such provisions or this Permit shall be deemed hooded.
z c CONSTRUCTION LENDING AGENCY
[-� IWnby,frum that them It a connnctint lerWing apps,ray the pMormaam of
Ile the wool,far which this Permit is usuad(Sec.](197,Civ.C.)
W A Lenders Name
z Lenders Add.
U O 1 maty dust 1 have read by,applieatiw arced state due de.Were information is
It. Comes,1 agres as comply with all city and County ordinances and sate laws relating to
building convection.and hemby authorise mpuswutive of Nu city to coney upon the,
LL7 aWve-mentioweproperst far dex,suion purypta
W (We)agree m save,indemnify and kcep hanalcm the City of Cupertino against
rn in Consequence
ities.juagractus,sequeneofthe grand,es this ermil, may in any wayattme against said City
U'z in corucgucuce of the Lnnting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �i Z !^c.�
SOURCE REGULATIONS. q
�-- � `f Re-roofs
3agn ar pphnn o d.ctay Do �=
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum Wilding accuyantatore orhandle hacsrdow notarial
at deWtd by the Cupw1w Municipal Cad,,chapter 9.12.and the Health and Safety
code, 0y.
w usnx(,)+ 11 All roofs shall be inspected prior to any roofing material being installed.
YwNo
Will the a tient y rotate Wilding mcca rat at If a roof is installed without first obtaining an inspection,I agree to remove
Pp 6 e equipmentor M.O.which g Pe
W>aoanw air can ane u defraud by use Bay Area Air Quality Managemcns all new materials for inspection.
admT
Ye
I have read the matariaurtquimmcnu under Chapmr6.95 ofthe Cairn,
niceHealth&Safety Cade,Sections x5505,15573 and255M.l understand doodae Wilding -� J/ r�
Da
does not currently have a teens Wt It h my responsibility W notify the oc,upam of de _[
onda.mms which must W met prior te' ofd Ikota ora
gnature of Applicant e
oy athari>teagen D.!e All roof coverings to be Class'W'or better
CITY OF CUPERTINO
• 2 ITEMS OF 4 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35616024 . 00
DATE ISSUED. . . . . . . : 09/22/2008
RECEIPT #. . . . . . . . . : BS000006145
REFERENCE ID # . . . : 08090138
SITE ADDRESS . . . . . : 11066 LINDA VISTA DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : COLLIER BERNICE B TRUSTEE
ADDRESS . . . . . . . . . . : 11066 LINDA VISTA DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4752
RECEIVED FROM . . . . : BEN FOWLER
CONTRACTOR . . . . . . . : PAUL FOWLER LIC # 21417
COMPANY WESTSHORE ROOFING INC
ADDRESS . . . . . . . . . . : 2814 AIELLO DR C
CITY/STATE/ZIP . . . : SAN JOSE, CA 95111
TELEPHONE . . . . . . . . : (408) 694-0060
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 17, 300. 00 1. 80 0 . 00 1 . 80 0 . 00
1REROOFRES SQ FEET 28 .50 370 . 50 0 . 00 370 . 50 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 372 . 30 0 . 00 372 .30 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 719 . 10 MC
---------------
TOTAL RECEIPT 719 . 10
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
CITY OF CUPERTINO
•\" 11g` REROOF'
:CUPEkTINO PERMIT APPLICATION
APN # Date:
d �
Building Address: 11016 ,✓ldA v 5 fcl dy,.
Owner's Name: Dr f n Ge_ C o n l e y' Phone #:
Dr L53 — '133Z
Contractor: v,_/es f5h o r e )?Oa f)nc) Phone #: y5 6 -O ZOd
Fax #: 956 - OZ57
Cupertino Business License #: Contractor License #:
L/ / -7 �a zzI
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
a Asphalt Shingles a Asphalt Shingles.
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) 1%, Other(Specify) 5/" coa1�'�l See
Number of existing coverings 1 ❑ Provide I.C.B.O. Report # ESR
To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: +Z e mwe V-004 5)qq 1e-Q � H
5-eMrd Cavi on 5HgI�e oar FeFfex bv)def1a1~-rtu �Zg I
u
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: I L ZOO
I Have Read, Understand Will Comply with Cupertino's Tear-Off Policy:
•
ignature
Revised 6/16/08
CITY OF CUPERTINO •
' REROOF
ITY O
CUPEkTINO FEE SCHEDULE •
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
2-1 1REROOFRES Re-roof Residential B 1SFDWLROOF
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B IMFDWLROOF
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/ "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: I2f'✓V1 I c-e 60 )Ve r
Job Site Address: I I. n rn i {/� �� Vis Y-
Roofing Company Name: P d✓e vD
Applicant's Signature: Date:
• 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
TOTAL POINTS1 40 points
•
•
Plan Review Process Work Book Page-12-Revised 3/25/08
J -
1 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.
A.Site INPUT- Resources Energy AD/Heafth
11.Recy�ite Construcdon&Demolition Waste I
165%=1 point;75%= 2 points;60%=4 points I
4 up to 4 Resource pts 0
'I2.Salvage Reusable Building Materials _ J _ 4 Resource pts y=yes 0
3.Remodel for Mixed Use,Adaptive Reuse,and
Histodc 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
18.Design Resource-Efficient Landscapes and Gardens _ 4 Resource pts y=yes - 0
9.Reuse Materials Use Recycled Content Matedals
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
I 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 p
2.Use Recycled Content Aggregate 2 Resource pts y=yes 0
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes p
C.Structural Frame
1 1 1
,1 Substitute Solid Sawn Lumber with 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. p
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 Yertical Applications 2 Resource pts y=yesC
7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes 0
6.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
12,Use OSB -
a.Subfloors 1 Resource pt y=yes 0
• b.Sheathing 1 Resource pt y=yes p
1 1 1
xter rens
1.Use Sustainable Decking Materials
a.Recycled content 3.Resource pts Y--yes D •
b.FSC Certified Wood 3 Resource pts y--yes D
12.Use Treated Wood That Does Not Contain Chromium/Arsenic 1 IAQ/Health pt y--yes 0
I3.Install House Wrap under Siding 1 IAQ/Health pt y=yes D
14.Use Rber-Cement Siding Materials 1 Resource of y=yes D
E.Plumbing
�L I utall Water Heater Jacket J 1 Energy pt y=yes D
2.Insulate Hot and Cold Water Pipes 2 Eneroy pts y=yes 0
3.Retrofit all Faucets and Showerheade with Flow Reducers
F
a.Faucets(1 point each,up to 2 points) Up to 2 Resource pts. 0
b.Showerheads(1 point each,up to 2 points) I Up to 2 Resource pts. 0
I4.Replace Toilest with Ultra-Low Flush Toilets t
(1 point each,up to 3 points) _ _ l Up to 3 Resource pts. D
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
il
7.Install Water Filtration Units at Faucets
(2 points each,up to 4 points) Up to 4 IAO/Health pts. 0
B.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
1 1 1
r.tiecmcai
I1.1nstall Compact Fluorescent Light Bulbs(CFLs)
1(6 bulbs=2 points,10 bulbs=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. 0
1 1 1
G.Appliances
!1.Install Energy Star-Dish w-a—shir 1 Energy pt y=yes D
2.Install Washing Machine with Water and Energy
Conservation Features 1 Energy pt y--yes 0
!3.lnstall Energy Star Refrigerator 1 Energy pt y=yes 0
i4.Install Built-In Recycling Center 3 Resource pts y=yes 0
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 0
2.Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0
f3.Install Recycled-Content,Fiberglass Insulation with
'No Added Formaldehyde 31AQ/Health pts y--yes D
4.Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes D
5.Use Cellulose Insulation
a.Walls 4 Resource pts y=yes 0
b.Ceilings 4 Resource pts y=yes D •
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
o.uenings 4 Resource pts y=yes 0
I.Windows
1.Install Energy-Efficient Windows
• a.Double-Paned 1 Energy pt y=yes D
b.Low-Emissivity(Low-E) 2 Energy pts y=yes D
c.Low.Conductivity Frames 2 Energy pts y=yes D
D
2.Install Low Heat Transmission Glazin9 1 Energy pt y=yes.
1 1 f
J.Heating Ventilation and Air Conditioning
-1.Use Duct Mastic on All Duct Joinfs _� 2 Energy pts y--yes 0
2.Install Ductwork within Conditioned Space u 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=yes7 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 D
3.Install Sealed Combustion Units
a.Furnaces 3 IAQ/Health pts y=yes 0
b.Water Heater 3 IAQ/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 D
13.Retrofit Wood Burning Fireplaces
• a.Install EPA certified wood stoves411se115 1 IAQ/Health pt y=yes 0
b. Install/Replace Damper 1 Energy pt y=yes 0
c.Install Airtight Door 1 Energy pt y=yes 0
14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0
15.Install High Efficiency Filter 4 IAQ/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
1 1 1
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar(Nater 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 pis y=yes 0
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=1 B points) Up to 15 Energy pts 0
8.Select Safe andDurable Robfing Materials _ _ 1 Resource pty=yes D
7,Install Radiant Barrier 3 Energy pts y=yes p
1 i 1
L.Natural Heating and Cooling
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 0
1 1 1
•
INPUT Resources Energy 1AQ1Hm1th�'
M. n oc,r Air Quality an Finishes
1.Use LowRJo-VOC Paint - _ 1 IAQ/Health pts y=yes 0 '
2.Use LowVOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 •
�3.Use LowMo VOb Adhesives _ 3 IAQ/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/Hsalth pts y=yes 0
.7.Seal all Exposed Particleboard or MDF - _ _ _ 4 IAQ/Health pts y=yes 0
8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D
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 3 Resource pts y--yes 0
j2.Use Rapidly Renewable Flooririg Ma'tedals 4 Resource pts y=yes 0
3.Use Recycled 6onfent 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 Avallab e: 1 1401 1301 57
Total Points Project Received: 0 0 0 /•
'L q/z Z`d
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•
Community Development
Q 10300 Torre Avenue
!rv� l Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
#UPEI�TINO
Building Department
JOB ADDRESS: i j 0 6 6 b,'n d j WO, alb- PERMIT #
OWNER'S NAME: Y �ce C0111 2 ✓ PHONE # 252
GENERAL CONTRACTOR: W e5 hoyr, Rjb1 FAX #
I am not using any subcontractors iz� 2 21109>
Signature Y Date
Please check applicable subcontractors and complete the following information:
ba 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