06020047 Sublist Community Development
i t r 10300 Torre Avenue
r Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
SCUPEkTINO
Building Department
JOB A DSS PERMIT#
01l ;� � . 0 6 020CD4
OWNER'S AME: Q v L Z PHONE # 61-QaOO
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/Contra r Signature Date