08090106 CITY OF CUPERTINO
BUILDING DIV SIGN PERMIT 'CT-0 INFaORMATI N ;
BUILDINWApRE TRA VISTA AVE ASH ROOFING INC 08090106
OWNEEWSS 7NA3MEE: M PERMIT ISSUE DATE
BOB HENDRICKSON 620 ORVIS AVE 09/17/2008
NE: (408) 295-7681 SANITARY NO, CONTROL NO.
ARCHTIEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O j LICENSED CONTRAC OWS DECLARATION Job Description
1 hereby affirm Nal l am licensed under provisions eSCrI of Chapter 9(CommeMinL p
u it Section 70lh0ofDi,W,m3ofineBusiness and PnefctimuCote,and mylicense te RE-RF T/O EXT SHK, SHETHW/OSB RADNT BARRIER
ta N in full fora and e�ect 3C i Z
�qi Licevc Clan LIC.L 30#ASTM UNDRLY W/LNDMRK PREM CLS A DIM SHNGLS NEW
q
Date � Co. 1 1
e 7W ARCHTTECTS DEeuRwn METLFLSHNGS 35SQ
e U 1 understand my plans shall M used a public records
36
o In Licensed Professional
OWNER-BUILDER DECLARATION
ri ex I hereby!firm Na I .exempt from the Contractors Berns Law for to
c e 00 following ouon.(Section 7031.5,Business and PmfC ou Code:My city m county
which requires a pcee t to construct,alter.improv,dcmoltsh,or tepcir my structure
prim m its issuance,also requires to applicant for such pmetil d fik asigned statement
ss< m,the;slkeaedprewan,m theproNriwuerNccaneacdr'slianalaw(Ch.pmr9 Sq.FL Floor Area Valuation
F (commencing with Section 7000)ofDivision 3 of Ne Business and professions Code)or $14210
$
5 F Nat he is eampt therefrom and the buss for 1M alleged exemption.My violation of
Section 7031.5 by my applicant fora Permit subjects mo applicant W.civil penally of
net more man BK Mndred dollars(Scop). 3 5 7 0 5 0 4 0.Aff Number Occupancy Type
I,uo oftieproperty,wmymoployeuwithwagsu1M4wkcompenadon,
w;llda Newadc and do awmam b mtimmn4d wortemd for,ak(See.70 .Business
and Pmresslou Cade:Tbm Canmcmr'r License Law does WE apply m an owner of Required Inspections
pmpmy wM builds or imposes mmcon,and who dour such work himself or through his
own employees,pmvided Nat such improvements tee ret intended"offered forsake,IL
however,the building or improvement uald within one year of mmpletion,the owner.
Milder will haw the burden of proving Nat he did ret Mild or improv for purpose of
sale.).
0 1,u owner of the Property am exclusively Cemeteries with licensed com um;to
Comment me project(Sec.7044.Business and Proressiam Code:)The Coamam's V-
cmm raw does not apply m an owner of property who Milds or improves demon.and
who Contracts ro,such projects it a centrsmKs)licensed pursuant to me
Ire.Law.
laneamnplunderSee ,B&PCfmm;steuon
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby arfim under penalty of perjury,arc of tie following decluodou:
I haw and will maintains Cerifiateof Cavern to selRlvum fa Worker'sCompen-
cation,a provided for by Section 37M of the Labor Code.for me performance of use
work for which this permit is issued.
❑1 ban and will maintain WorkeYr Compensation bm mince,as mu;md by Section
3700.f me labor Codc,for the pedmmance.f to work fowhich Nu Permit is issued '
My Worke'r's.Corippea(a1.Instance carim and Polley
Cartier.�'L]g j j]�Pokey Na.:
ERTIFlCA7E OT EXEMMON FROM WORKERS'
COMPENSATION INSURANCE
("fhisseNm need m1WComPicmd 1f de Permit is forone hundred dollars(SIM)
or lens)
I an;(v Not in me performance of lM work for which this Permit is items.I shN not
employ anyperson in any mmmrw as,m itmomesubject 0 to Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making dk Certificate of Exemption,you should
become Subject to the Worker's Compeosadon provisions of she labor Code,you most
.J Q forthwith comply wit such Providers,or mis permit shall be deemed owkcd.
z y CONSTRUCTION LENDING AGENCY
[—t l hereby affirm tut there its construction lending agency for the performanec of
Ci me work for which Nis permit is issued(See.3097,Civ.C.)
4 A Landers Name
z Lender's Address
C)Q 1 endry mal I lose read this statistical.and sum mu the aMw information u
wrest 1 agree d comply wit all city and county on itunas and sum laws relating te
.O building construction,and hereby mNarine mposenutiva ofNu city to enter upon Use
L57 above-menMned property rte ivpee Ten pmpoxes
F, G (We)ague to ave,indcmeiry and key hamlet the City of Cupenine!jams,
fA I;abilities,judgmcros.costs and exNo.which res,in any way ae cnagdal said City
V Z ;n uengE of the Lasting of thus permit.
AP co (CANT UNDERSTAND AND LL COMPLY WITH ALL NON-POINT Issued by: Dale
SO RCE � TIONS.
C" Re-roofs
S;Lnuurto Apple amu DOU Date
AZARDOUS MATERIALS DISCLOSURE Type of Roof �'✓
fiIr' y ft Clamor fMurtip-ICgoCu PM,9.]Z.dN lieu chaus OmdSmriJ
u ❑n by th Cupertino Municipd Code.CWpmr 9.1;and IM HeJN and Safety
c don 25532(,)7 All roofs shall be inspected prior to any roofing material being installed.
Yes �No
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicator few¢building occupant tax cqulpmcnt or dcviea which (�
4 huvMu umiv
air conn s u @fined by to Bay Arta Air Quality Management all new materials for inspection.
T
❑Yes �pNo
1 hew read me hmardms materiah requ un
umencrder Cbap Cr6.95 ofine odiro-
ia Health&SafctyCede,Section 25509.25533 vu125530.I underamd Mff ft building
rmt,lfincrudy hew a tevnt dui I, my responsibility m notify to occupant of No
sec u-Wh'hen vee tpinaaammnr.CrrdreaerOmpancy. Signature of Applicant Date
e��✓/�Ja� t �i 77eDY All roof coverings to be Class'%{"or better
O!� mtricid.2cm Date
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35705040 . 00
DATE ISSUED. . . . . . . : 09/17/2008
RECEIPT # . . . . . . . . . : BS000006109 .
REFERENCE ID # . . . : 08090106
SITE ADDRESS . . . . . : 10535 MIRA VISTA AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . . .
OWNER . . . . . . . . . . . . : BOB HENDRICKSON
ADDRESS 10535 MIRA VISTA AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : ASH ROOFING INC
CONTRACTOR ASH, BOB LIC # 18553
COMPANY ASH ROOFING INC
ADDRESS . . . . . . . . . . : 620 ORVIS AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112-2322
. TELEPHONE (408) 295-7681
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 14, 210 . 00 1 . 50 0 . 00 1 . 50 0 . 00
1REROOFRES SQ FEET 35 . 00 455 . 00 0 . 00 455 . 00 0 . 00
----------
TOTAL PERMIT 456 . 50 0 . 00 456 . 50 0 . 00
METHOD OF PAYMENT AMOUNT . REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 456. 50 #23039
---------------
TOTAL RECEIPT 456. 50
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
CITY OF
CUPERTINO PERMIT APPLICATION
APN # �� —2 O O L/O Q Date:
Building Address:
I 3t5- MII'
V, Ave-
Owner's Name: Phone #:
Contractor: Phone #: ?44�
Fax #: 2(®1 S I7S�f
Cupertino Business License #: Contractor License #:
3021 z_-7Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles �tk 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 Mfg. Installation Specs.
Job Description: .( CXl S F1' S c�_ U1� h
��Ivl ��v v�Gi� I�) l.Glj'i'Y��l�— P/c \ e,QA_(S D(�11 S'i'lt S
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:
3D O
I Have R d, U derstand and Will Comply with Cupertino's Tear-Off Policy:
,L
Signature ��/
Revised 6/16/08
CITY OF CUPERTINO
REROOF
CUPEkT1NO FEE SCHEDULE .
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
?� IREROOFRES Re-roof Residential B ISFDWLROOF
113SEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
113SEISMICRE Seismic Residential B
IBUSLIC 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: ''V�`Iiv� �d)b'V` 14P (VjCk&
Job Site Address: 5315 ��/�
IV Vji) 1 / lV
Roofing Company N 6: r t>
Applicant's Signature: i Dateq�- T
• 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
s
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. Appliances1. Energy Star Dishwasher, (Note/Spec.) A-3 1 point
3. Enerav Star Refrigerator, (Note/Spec. A-3 1 point
P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS1 40 points
• I
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 ResDulces Energy IAO[Heafth
A.Site
1.Recycle Job Site Construction&Demolition Waste
165%=1 point;75%= 2 points;a0%=4 points up to 4 Resource pts 0
2.Salvagz Reusable Building Materials 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.Design Resource-Effcient LLandscapes
--- — — ------and Gardens 4 Resource pts Y=Yes D
9.Reuse MatenaWUse 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 i 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=yesFJ 0
1 1 1
C.Structural Frame
1.Substitute Solid Sawn Lumberwth Engineered Lumber J 3 Resource pts y=yes 0
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 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
B.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0
9.Use Structural Insulated Panels(SIPS)
a.Floors 3 Energy pis y=yes D
b.Wall
c.Roof 3 Energy pts y=yes 0
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
_— -- — — -- — j
r.a.Subfloors 1 Resource pt y=yes 0
•
It.Sheathing — — -- — — --- —
1 Resource pt y=yes p
1 1
INPUT Resources Energy 1AGIllealth
D.Exterior Finish
.1.Use Sustainable Decking 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
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 �_ Ji 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. D
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) J Up to 3 Resource pts. D
5.Install Chlorine Filler on Showerhead 1 AQ/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
6.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
1 1 1
r,rrecmcar
1.Install Compact Fluorescent Light Bulbs(CFLs)
(6 bulbs=2 points,10 bulbs=3 points,12 bulbs=4 points) i 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 i 1
G.Appliances
1.Install Energy StarDishwasher 1 Energy pt y=yes 0
2.Install Washing Machine with Water and Energy
Conservation Features 1 Energy of y=yes 0
3.Install Energy Star Refrigerator 1 Energy pt y=yes 0
4.Install Built-In Recycling Center 3 Resource pis 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
EInstall Recycled-Content,Fiberglass Insulation with
Added Formaldehyde ,__ - j 3 IAD/Health pts y=yes 0
4.Use Advanced Infiltration Reduction Practices tices 2 Energy pts y=yes D
5.Use Cellulose Insulation
a.Walls 4 Resource pts y=yesD
b.Ceilings 4 Resource pis y=yes 0 •
6.Alternative Insulation Products(Colton,spray-loam)
a.Walls 4 Resource pis y=yes D
o.ceilings 4 Resource pts y=yes D
1 i 1 •
INPUT Resources Energy IAQ]Hmlth
I.Windows
5.Install Energy-Efficient Windows
• I a.Double-Paned
i Energy Pl Y=Yes D
b.Low-Emissivity(Low-E) 2 Energy pts Y--yes p
L
C.Low.Conductivity Frames _ 2 Energy._------ - -- } ypts y=yeS D
2.Install Low Haat Transmission Glazing - 1 Energy pt y=yes p
1 f 1
J.Heating Ventilation and Air Conditioning -
�.Use Duct Mastic on All Duct Joints _ 2 Energy pts y=yes p
2.Install Ductwork within Conditioned Space 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 IACMealth pis y=yes 7
D
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 IADMealth pts y=yes 0
b.Water Heaters 3IAQ/Hea1th pts y=yes 0
9.Replace Wall-Mounted Electric and Gas Heaters with
Through-the-Wall Heal Pumps 3 Energy pis 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 pis 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 stoveslnseris 1 IAQ/Health pt y=yas ID b. Install/Replace Damper 1 Energy pt y=yes c.Install Airtight Doors 1 Energy pt y=yes 14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 15.Install High Efficiency Filter 4 IAO Health pts y=yes 16.Install Heat Recovery Ventilation Unit(HRV) 51AQ/Health pts y=yes 17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes
1
K.Renewable Energy and Roofing t 1
1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes D
2.Install Solar Water Heating System 10 Energy pts y=yes 0
3.Pre-Wre for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2A kw=12 points,3.6 kw=18 points) _ Up to 18 Energy pts p
6.Select Safe and Durable Roofing Materials
`----___- _._.___ _ _ __ _ ___ 1 Resource pt y=yes p
7.Install Radiant Barrier 3 Energy pis y=yes p
L.Natural Heating and Cooling i 1 1
1.Incorporate Passive Solar Heating 5 Energy pis y=yes p
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts IM
y=yes 0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes
0
1 1 I
•
P
INPUT ResDurces Energy IAQ?Hmlth
M.Indoor Air Quality and Finishes
rl.Use LowFN6--VOC Paint _ 1 IAQ/Health is es 0
__ _ P Y=Y
2.Use Low VOC,Water-Based Wood Finishes 2 IAO/Health pts y=yes 0 •
3.Use Low/No VOC Adhesives _ ._ _ _ 31AQ/Health pts y--yes 0
4.Usa 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 IAQNealth pts y=yes 0
7.Seal all Exposed Particleboard or MDF _ _J 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: 1 1401 1301 57
Total Points Pro'ect Received: Zr 01 OF-01
•
r
G:datarprogslUri, ingguidelineshemodelersrgmenpointsfinal212.04prolecled.Kls
•
Community Development
10300 Torre Avenue
Y Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPE(�TINO
Building Department
JOB ADDRESS: PERMIT #
/1,5/ 0 1,Uell S y-i C% 0O
OWNER'S NAME: C ' a PHONE # -10-;t96 /
GENERAL CONTRACTOR: OCR— Lfl2 nd foo FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation:
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
i