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08050104 CITY OF CUPFRTINO BUILDING DIVISION PERNIIT ,CQNTRACTOR IA}'EQRMATION . ". .. ..`" w€'ir ➢`1iw .tax,@:' PERMIT NO. BUILDINQ ADRRFSSC 08050104 CLELLAN RD TBD - TO BE DETERMINED Rl N.SAMUE:N1 PERMIT ISSUE DATE SOSO DOLORES C AND THOMAS N 05/12/2008 PHONE: SANITARY NO. CONTROL NO. ARCHMCrfENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH C, LICENSED CONTRACTOR'S DECLARATION JOb Description 1 haehy affirm than 1 w 1'rmd nm :der Provisions of ClC nor 9(commencing ni`uj wrlhScCMn]IXp)ofDiviskm3ofdMI1 :eta dProfcmimuCodS nd.ylic m cme4 RE-RF OSB 15/32" OR 1/2" FLT TWO-PLY 40YR HD CLS < n full forand effam >'q_qq Liccvc Us A 20SQ. PRIME CUSTOM CONSTRUCTION PD FOR BUS LIC W Dam ARc)imrrEccros'D�FcL'-sR'—!Alffo—�'—�7"—�"�=C-3"��2/8 - 77u 1 uMcramnd my plans NWI W umd as public records 50�E. Licenmd Professional OWNER-BUILDER DECI.ARATION 92 1 Starchy affirm that I am caempl from dm Conlnaafs License Law rat Ile COO following moon.(Section 7031.5,Business and Professions Code:Any city or County e which as issu a permit ra cpnuracl.aper,improve,d pCmit to :mpair a d UM cm Priortoiu issua:e.alw mquiros the applicant far such permitmfile aligned mumem a nal he rlimmW parmanuo tha provisions of the Contrxwr'a laConm law lChapmr9 Sq.F[. Floor Area $6500 6 Valuation y�$ fast M Tang with Section and the MASS far of dC BYLrlmma pt ou.My ria ladom of y V 5 0 o dol he is 31.5 b lbacfrom antl the aper fm me alleged pplicanon.Any vioruon of .1. than by any applicants all Lon permit Subjects me applicant a Civil pmlty of Number Occupancy Type nst mom than fiw hundmd dollen(SSW). 35903051?`�� P Y YP 0I,uownerofIliapoperty.mmyemployeew0 mgruthe"usolecompanodm, will da the work,and the swclum u not rounded ar nRamd forule(Sec.7041,Bus. and Pmremiae Cadc:The ConuactoYs Lmmm Law does Cat apply In an awfmr of Required Inspections Import,who Nrilda or iro prow dumwn,and who doessuch work hivue If m rhmugh has own cmpluycv.Provided than such improvements an,not inured oroRaed forsak:If. hwever,the building or improvement is and within one Xu of completion.the ownsr- . Witter will have 0u burden of proving that M did an,Wild or improve for purpom of sale.). O 1.u owner m the Property am aclusively contracting with licemed mnuaaon to covtrom the pmjet.(Sec.7044.Business and Profc shoo Code:)T'he Contractor's LL cave Law does ant Wty to an weer of progeny who builds or improves themon.and who cmuacu for bath projcets with s ComramrU)li amsed p rmanl to the Contractor's Lrcmum Isw. ❑lamuemptunder See .BAPCf:thrsroaann - Cala- WORKER'S auWORKERS COMPENSATION DECLARATION I hemby affum under pensty of perjury ons of the following declarations: ❑Ihs+eW imainwnace fi leofcomentwmlf-imumfm Wor SCmnpen- scion,as provided for by Section 37W of the Lab:Code.fm the performanm of the work for which this pc haft is issued. ❑1 have as will maintain Worker's Compatu don Iowan¢,as fryurmd by Section 37M.f me Lsbnr Code,for the puflmuse of the work forwhich thin permit is issued. My Work r Com matin surana Trus and Polity numra� Curicv� Policy No.: t ' b� CERTFICATEOF EMPIONFIROMWORKERS' COMPENSATION INSURANCE Crhrmcllon reed imt ore compumd if the permit is forma hundred dallus($IUa) or Rem) 1 certify that in the performance of the wart for which this permit U issued,l shall not anal-,any pe.a in.1..,an u w bneonu subject to the Wmams Campemllm Lawas of Caliro rna.Data Applicant NOTICE TO APPLICANT:IL after passing this CertrGc tm of Emmpdon,you Should WcC row subjua w the Workers CompMution Provisions of that Lab:Cade you mm wJ O forthpermit with comply with such provisions or this AM)he d: cd invoked .z 'ti y CONSTRUCTION LENDING AGENCY [-r 1 hemby affirm that mem is a Constantino lending agency rat the I o form uncz of L>:> dm work for whim Ar permit is mound(Sec.309'1,Civ.C) 0.A Inch's Norm M z header's Addeo U O 1 certify that 1 have fad this application as etsu the de above Wormadon is 1p.EcmmcL 1 agtm In comply with LI my and county ordinarmv and sum laws mladng w building Comwction.and hemby authotim apmsenuuvu of this city to tour upon the [--\—��-(-/ /j//f� aanvn-mentioned propatr for impaction puryoma 1 F CL (Wc)ague to save.indcranify and keep harmuv Ile City of Cupmino against m in......... .rtia.JWgmenu,camasof,is mwhichmryln anY myamue agsim mid Ciy U z in eonsegmace of the graining of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE RF,cf+LATIONS. C� L,-0-08 Re-roofs Signawrc of ApplicanVCuntracwr Data NA2A Nauru MATERIALS DISCLOSURE Type of Roof WIII them Cuptn im Nauru Wilding mcuPantuo.1 m handle hamNoos mammal Road io dm Cupertino Municipal Cade.Chapmr 9.11,and the Hmlm and Safety .Section 15531(a)?41F ❑Yes All roofs shall be inspected prior to any roofing material being installed. �No Will the Applicant or fuwm building occupant cyuipmcnt or dcvias which If a roof is installed without first obtaining an inspection,I agree to remove cafl,W ardnm air cunuminanu as defies by the Bay A.Air Quality ManagContra all new materials for inspection. oYv pl No . I have mud the hamafdoua maurisiamquinsco nts umler Cluplarb.95 of the CAllor. nu Hmal"SafaYOAC.SCimu]5505.25533 as 35534.1uscmuld thoifmc Wilding dors ox cul Indy haw a ours,the it r my mspana lily to Mary the occupant of um myui nts whleh most be mat pier to isamma or.ca,tifimm ora prnry. Signature of Applicant Date now 'l' -0 0wnsr or amhoaacd agent All roof coverings to be Class'�V'or better CITY OF CUPERTINO • 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk': tot': APN . . . . . . . . : 35903051 . 00 DATE ISSUED. . . . . . . : 05/12/2008 RECEIPT # . . . . . . . . . : BS000004749 REFERENCE ID # . : 08050104 SITE ADDRESS . . . . . : 7830 MC CLELLAN RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . : . . . . : SOSO DOLORES C AND THOMAS N ADDRESS . . . . . . . . . . : 7830 MCCLELLAN RD CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4221 RECEIVED FROM . . . . : AZ CUSTOM CONSTRC CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , • TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 6, 500 . 00 0 . 70 0 . 00 0 . 70 0 . 00 1BUSLIC FLAT RATE 1 . 00 110 . 00 0 . 00 110 . 00 0 . 00 1REROOFRES SQ FEET 20 . 00 260 . 00 0 . 00 260 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 370 . 70 0 . 00 370 . 70 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 370 . 70 #1019 --------------- TOTAL RECEIPT 370. 70 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 0OF CUPERTINO PERMIT APPLICATION APN 4259 0 3 (95-1. 6.c) Das_ BuildiAddress: I � SO mc clella Pj rco,_ ,e (2 c1q- g3_015- Owner's Name: Phone #: TQC S0S (D Contractor: / Phone #: 'Fe-7 p 3 1 cI ryk- e ©w� C�Vi S�k��6 ! 0✓� Fax #: Cupertino Business License #: Contractor License #: "�?J Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles )( Asphalt Shingles ft 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: p ('� �S 3a c^¢ Yg 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: 6, _2� • I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature CITY OF CUPERTINO iam REROOF •CUPEkTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF IBSEISMICO Seismic Commercial B 2U 1REROOFRES Re-roof Residential B 1SFDWLROOF / IBSEISMICRE Seismic Residential B IREROOFMRES Re-roof Multi-Family B 1MFDWLROOF IBSEISMICRE 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. ea) 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 Y4" 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: qTD 1,.,L`_nS /0 I%0 Job Site Address: C �(� 1 V `Cly le 11 A n � Roofing Company Name: /JQ 2 t V"._2 Applicant's Signature: "lig Date: • 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 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 oint P. Other 1. List Green Features on Plans A-1 1 point TOTAL POINTS1 40 points • �3 6 � La-llC, P_'�A 14AY 121008 OY 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. A.Site 1.Recycle Job Site Construction&Demolition Waste s 65%=1 point;75%= 2 points;80%=4 points up to 4 Resource pts 0 12.Salvage Reusable Building Materials_ J 4 Resource pts y=yes D _ _ 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 B. aapes and G Design Resource-Efficient Lndscardens 4 Resource y=yes p ---- — - pts 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 1 1 • 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 C.Structural Frame 1 1 1 I1.Subsmute 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. 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 S.Use Finger-Jointed Studs for Vertical Applications 0 PP 2 Resource pts y=yes 0 7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes p 8.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0 9.Use Structural Insulated Panels(SI Ps) a.Floors 3 Energy pts y=yes 0 b.Wall c.Root 3 Energy pts y=yes 0 3 Energy pts y=yes 0 10.Apply Advanced Framing Techniques 4 Resource pts y=yes 11.Use Reclaimed Lumber for Non Structural Applications 0 _ pp 3 Resource pts y=yes p • i a.Subfloors 1 Resource pt y=yes b.Sheathing 0 -- -- - - --- — - -- - 1 Resource pt Y=YeS 0 1 1 f D.Exterior Fimsh 1.Use Sustainable Decking Materials • a.Recycled content 3 Resource pts y--yes D b.FSC Certified Wood 3 Resource pts y--yes 0 112,Use Treated Wood That Does Not Contain Chromium/Arsenic i 1 IAO/Health 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 Hot and Cold Water Pipes 2 Energy pts y--yes 0 [3.Retrofit all Faucet's and ShowerheYdswth Flow Reducers a.Faucets(1 point each,up to 2 points) I 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 0 7.Install Water Filtration Units at Faucets (2 points each,up to 4 points) Up to 4IAQ/Health pts. 0 6.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0 r.riecmcar 1 ff1.Install Compact Fluorescent Light Bulbs(CFCs) — -' (6 bulbs=2 points,t0 bulbs=3 points,12 bulbs=4 points) Up to 4 Energy pis. D • 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 I G.Appliances 1.Install Energy Star Dishwasher — 1 Energy pt y=yes 0 2.Install Washing Machine with Water and Energy Conservation Features 1 Energy pt y=yes 0 3.Install Energy Star Refrigerator { 1 Energy pt y=yes 0 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=yes 0 b.Ceilings 2 Energy pts y=yes 0 2.Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0 [3.Install Recyoled-Content,Fiberglass Insulation with No Added Formaldehyde — ` 31AQJHealth 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 D.Uenings 4 Resource pts y=yes D flo inws !1.Install Energy-Efficient Windows a.Double-Paned 1 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 Transnission Glavng 1 Energy pt y=yes p 1 1 1 J.Heating Ventilation and Air Conditioning ,1.-Use bunt Mastic on Alt Duct Joints - _y 2 Energy pts y=yes 0 2 Install Ductwork within Conditioned Space 3 Energy pts 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 S.Install Sealed Combustion Units a.Furnaces 3 IAQ/Health pts y=yes p 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 p 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 9D%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes p 13.Retrofit Wood Burning Fireplaces a.Install EPA certified wood stovesrnserts 1 IAQ/Health pt y=yes 0 b. Install/Replace 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 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 IAQMea th pts y=yes 0 1 1 1 K.Renewable Energy and Roofing 1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes p 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 p 4.Install Photovoltaic(PV)System (1.2 kw=6 points,2.4 kw=12 points,3.6 kw=1 B points) _ Up to 16 Energy pts 0 6.Select Safe and Durable Roofing Materials 1 Resource pt y=yes 0 7.lnstall RadianfBamer -- — J 3 Energy pts Y--yes 0 1 1 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 p • 0 1 1 M.Indoor Air Qua dy and Finishes Vit.Use Low tJo VOC Paint _ 1 IAO/Haalth is es 0 _ _ _ P Y=Y 2.Use Low VOC,Water-Based Wood Finishes 2 IAO/Health pts y--yes 0 f3:Use LowMo VOC Adhesnves 3 IAQMealth 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 61A0/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 t7.Seal allFxposacfi arlicleboard or MDF _ _ 4 IAQ/Health. pts y=yes D 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 t 1 1 N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 C.Use Rapidly Renewable Flooring Materialsals _ _ _ —1 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 51A0/Health ptsy=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 4. 1 1 Total Points Aval able: 1 1401 1301 57 1* Total Points Project R 0 0 0 G:datarprogslgmenbuildngguidelines4emodelers/greenpointsfna1212.Nproladed.tls • Community Development 10300 Torre Avenue !a Cupertino CA 95014 Telephone(408)777-3228 CITY Fax(408)777-3333 �U Building De artment JOB ADDRESS: PERMIT # 7F30 OWNER'S NAME: PHONE # 41G �S GENERAL CONTRACTOR: FAX # I am not using any subcontractors: �— ��—4�D, 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 eLinoleum/ 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