06090078 ' .. .. -
Community Development
10300 Torre Avenue
� Cupertino CA 95014
Telephone(408)777-3228
CITY m Fax(408)777-3333
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Building Department
JOB ADDRESS: PERMIT # n
C CLC-L N aO 60 �6D7
OWNERS NAME: N L t-LOSS PHONE # Vo8 —26-S-wq4 7
GENERAL CONTRACTORS AvVgf 4 ars FAX # j
I am not using any subcontractors:
Signa a 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
�—/Z 64
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Owner/Contracto' r Signature Date