08050088 PERMIT
BUILDING ADDRESS: PERMIT NO.
11572 MORNING SPRING CT YORKSHIRE ROOFING OF 08050088
OWNER'S NAME: IN]U K'F h t 11j"I MRM7 ISSUE DATE
GILL JAMES B 7275 NATIONAL DR 05/09/2008
NE: SANITARY NO. CONTROL NO.
(925) 606-6700
ARCHITIECrIENGINEEt: BUILDING PERMIT INFO
BLDG ELECT PLUMB MIRCH
�0' LICENSED CONTRACTORS DECLARATION
I hereby affirm dist I am licensed under provisions of Chapter 9(commencingJob Description
�U5 with�gon7O(X))orDM � �=
�on3ofBnftfcssium�-Amm-11",xis RE-RF;T/O 1LYR& APPLYCOMP,CLS A 21 SQ
;�E Intel I tj kLk jiiiiti_
3nZ COO I YORKSHIRE ROOFING RENWD BUS LIC 5/9/8
L ide Co.
D
oric
ARCHITECTS DECLARATION V
Imultramand my plane shall W used.Public nexems,
3�u
l'tu.H
Licensed Prufassi...I
OWNER-BUILDER DECLARATION
I thereby affirm that I am exempt from the Contractors License Low for the
j:M0 following reason.Scietitat 7031.5,Business and PMF.i..Code:Any city.1 County
which medres.permit to....west.allocs,invinamt,demenlim,Or repair any structure
prim to its isma..0so requires de.appli.are,fmatech permit to file ai,.d statement Sq.Ft. Floor Area Valuation
that he is licensed purmart to the provisionsa the C.numatue.Lie..U.(chapter 9
Yo-Z-$
or
(commencing with Section 7.00)of Division 3 ofthe Busummund Professions Cade)or
$10985
Nat W is exempt therefrom and the basis for the alleged exemption.Any violation of -
Section 701.5 by any applicant for a Permit SubicCla the APPIWOUL to A Civil Penalty Of
.I..that five hundred defers,(SM 3 6 6 5 2 0 3 7 AFF Number Occupancy Type
0 I."ownerOfftpmp",Mmy=ploymwithwgesud kmiecompemaUon,
wad dathework
dforme(Sec.70 a4.
and Proession"Code:The Comusector's Licermse,Law Met OOL apply to an owncr of Required Inspections
proptery who Wildistaintroves,thement,and he docasueh weak himencifirtionxiSh his
inancumployeeds.provided that such Improvements are mainumicil mroffered for salm It.
however,the Wileding or improvermeriL is told within one yea,ofccomplation.she manexr-
builifer will have this burden of proving that he did not Wild or improve for purpose of
cile.).
[-]1.as owner of the property.me exclusively Contracting with licassiod commuctorat W
construct the project(Sec.7044.Busionext;and prolexisions Code:)TM Cormuelor's Li-
cense Law does..,apply to a...Or a property who Wild..1 inverm.ft...and.
who contracts for such projects with a contractur(s)licensed pursuant In ithe Contractors
License Law.
0 1 mo.erupt under Sec. B&P C for this..a
Owner Date
WORKER'S COMPENSATION—DECLARATION
I hereby tiffirre under gauntly of perjury WC of ft following dexhanalmons,
I ham and will maintain a Certificate of Consent to self-insum W Workers Compact.
sattion,as pmvi&d for by Section 3700 of the Labor Code.for this pOrforrmom of the
work:far which this permit is issued.
0 1 have and will onsimme Woultier's Compensation I.ce,as reffired by Section
3700 cifthe Labor Cade,fix ft performantc ofthe work for which this permit is issued.
My Worker.Composition I.. and Policy muckoars.
Carrier. A- ,'_7ciOr Poll,No.;b N O\A 0 tO
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mus section weed noWcompleted if the Permit is forone hundred dollars(SIM)
or Lem)
I.miry Not I.Ofe enforma.e of the works for which this permit is issued.I"I not
employ any person in my mormerm m to become subject to ft Woftn'Conopmeation
Lem of Calillmna.Date
Applicant
NOTICE TO APPLICANT.If,after making this Cediflem,of Exemption,you should
become Subject to the Worker's Compensation provisions of the Labor Code.you in=
Z ficallwith Comply with such gunitiomms Or this Permit shall C decreed revoked.
z 0
CONSTRUCTION LENDING AGENCY
I thereby affirm that,there is a construcliont lending agency for the performance of
W work for which this permit's issued(5..3097,Civ.C.)
Lenders Name
D z
CL. Lcrxdcrrs Adders
U C I cerlify that I haw read this application and some that ft above information It
I, Correct.I agree to Comply with all city and county ceardineraccumd sum laws missing On
0build!......utac�..and Inoclymilmarim city ut.mc,.pOm ft
U above-mentioned pire,xity,for inspection purposes
Wc)agree to save,indemnify and lamp harmless Lhc City of Cupertino against
to liabilities.judgments,costs mid expenses which may in any my we=Mium,mid City
Z in Consequence Of the grounfiAg Of tins permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIOtiS.
Signature Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the VpiicwL or future buildinge, Or handle hasurdous material
ext defined by ft Cupertino Municipal Code,Chapter 9.12.and ft Health and Safety
Code,
Section 25532(4)? All roofs shall be inspected prior to any roofing material being installed.
Y. XNo
Will ft applicant
t air r If a roof is installed without first obtaining an inspection,I agree to remove
rout
. future building accurrant use equipment or Ekxcn which
Dorso
ha'�' muz air Contaminants a defined by the Bay Area Air Quality Management all new materials for inspection.
District?
0yes )(No
I have mail the hatozoloas municialsoutunamens undicrChapterli.95 oftim Califte,
nu[Icalen&Sx(CuyCOdC,Soxicaus 25505,25533 and 25534.1 undustasol ftifft Wilding
does set currently haw...nLNal itlamympmibilityWmdryNeoccupant ofthe
"quiroments which most W uncypnorto ismarm ore Certificate,OfOccupwxyi92 5-9-0 8- Signature of Applicant Date
L0.oOmmb.1`1ied.&CnL Date All roof coverings to be Class or better_
CITY OF CUPERTINO
• 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36652037 . 00
DATE ISSUED. . . . . . . : 05/09/2008
RECEIPT # . . . . . . . . . : BS000004721
REFERENCE ID # . . . : 08050088
SITE ADDRESS . . . . . : 11572 MORNING SPRING CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER GILL JAMES B
ADDRESS . . . . . . . . . . : 11572 MORNING SPRING CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5121
RECEIVED FROM . . . . : YORKSHIRE ROOFING
CONTRACTOR . . . . . . . : KENNETH E FALCONS LIC # 28212
COMPANY . . . . . . . . . . : YORKSHIRE ROOFING OF NORTHERN
ADDRESS . . . . . . . . . . : 7275 NATIONAL DR
CITY/STATE/ZIP . . . : LIVERMORE, CA 94550
TELEPHONE . . . . . . . . : (925) 606-6700
eFEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 10, 985 . 00 1 . 10 0 . 00 1 .10 0 . 00
1BUSLIC FLAT RATE 1. 00 110 . 00 0 . 00 110 . 00 0 . 00
1REROOFRES SQ FEET 21 . 00 273 . 00 0 . 00 273 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 384 .10 0 . 00 384 . 10 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 384 . 10 #22671
---------------
TOTAL RECEIPT 384 . 10 . :. -
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
o�vs oo SW
CITY OF CUPERTINO
1y�O- REROOF
CITY Of
•CUPERTINO PERMIT APPLICATION
APN # _3 to/ 6, 57 J 3 7-
Date:
5-5 og
Building Address:
M-I'L MA o-�\
Owner's Name: Phone #:
�wc - 'LS )_-6 $H-.s
Contractor: Phone#: ctzs- 6o(,- &7-o o
0 Cr ,s 0 0Fax #:
Cupertino Business License : Contractor License #:
/ q'LZ
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles y1 Asphalt Shingles
XWood Shakes /❑V 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: T:«, -o FF LRS„ r -PP Ij SVA' 2\ SI .
Ctari r4
Residential Commercial El
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:
10 S
•I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
CITY OF CUPERTINO
Satin
REROOF
•CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
2- 11REROOFRES Re-roof Residential B 1SFDWLR00F
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE 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.
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: 1 ° r-e.l i— I)�M 6� I
Job Site Address: (�-
v
Roofing Company Name: o-r K S ti re ao (
App ' sSignature: Date:
• Greg steel
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
4 Y,
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 paint
TOTAL POINTS 40 points
•
•
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
65%=1 point;75%= 2 points;80%=4 points up to 4 Resource pts 0
2.Salvage Reusable Building Materials _ 4 Resource pts - y=yes 0
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
C6.Design Resou:rc Efficient Landscapes and Gardens
_.____- ^_ _, j 4 Resource pts y=yes p
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 p
B.Foundation
! 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=yesF;F 0
C.Structural Frame
1 1 I
1.Substitute Solid Sawn Lumber with Engineered Lumber 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 10Resource 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=yas
6.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 0
S.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes p
9.Use Structural Insulated Panels(SIPS)
a.Floors 3 Energy pts y=yes 0
b.Wall 3 Energy pts y=yes
c.Roof 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
r._.. _ _ 3 Resource pts y=yes p
,12.UseOSB -- "—_--
a.Subfloors 0
I Resource pt y=yes
• b.Sheathing ` _— —_— --
( . 1 Resource pt y=yes p
Qi 01
D. xtenor ims1] INPUT Resources Enetgy IA071-leafth
1-1.Use Sustainablebecking Materials
i a.Recycled content 3.Resource pts e=yes 0 •
b.FSC Certified Wood 3 Resource pts y=yes 0
l2.Use Treated Wood That Does Not Contain Chromium/Arsenic 1 IAQ/Heaith pt y--yes 0
13.Install House Wrap under Siding 1 IAQ/Health pt y=yes 0
j4.Use Fiber-Cement Siding Materials 1 Resource pt e=yes 0 _
1 ! 1
E.Plumbing
1.Install Water Heater Jacket 1 Energy pt y=yes 0
2.Insulate Hol and Cold Water Pipes 2 Energy pts y=yes 0
F
Retrofit all Faucets and Showerheads with Flow with I a.Faucets(1 point each,up to 2 points) 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 9'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 41AQ/Health pts. D
8.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
r,.trecmcar
1 Install Compact Fluorescent Light Bulbs(CFLs)
L(l bulbs=2 points,.10 bulbs=3 points,l2 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 pis. 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 !
G.Appliances
1.Install Energy Star Dishwasher — – 1 1 Energy pt y=yes 0
2.Install Washing Machine with Water and Energy
Conservation Features 1 Energy pt y=yes 0
3.Inslall Energy Star Refrigerator 1 Energy pt y=yes 0
4.Install Built-In Recycling Center l 3 Resource pts y=yes 0
H.Insulation
1,Upgrade Insulation to Exceed Title 24 Requirements
a.Wails 2 Energy pts y=yes 0
b.Ceilings 2 Energy pts e=yes 0
2,Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0
3.Install Recycletl-Content,Fiberglass Insulation with i
No Added Formaldehyde _ 3 IAQ/Health 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
o.Callings 4 Resource pts y=yes 0
mows -
1.Install Energy-Efficient Windows
• I a.Double-Paned 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 D
�2.Install Low✓Heat Transmission Glazing 1 Energy pt y=yes 0
1 1 !
J.Heating Ventilation and Air Conditioning
1.Use Duct Mastic on All Duct Joints - _J 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 IAQ/Health pt y--yes 0
4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y--yes 7
0
5.Install Solar Attic Fan 2 Energy pts y=yes 0
6.Install Attic Ventilation Systems 1 Energy pt y=yes o
7.Install Whole House Fan 4 Enercy pts Y--yes 0
8.Install Sealed Combustion Units
a.Furnaces 31AQ/Health pts y--yes 0
b.Water Heaters 31AO/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 yryes 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 stoves/inserts 1 IAQ/Health of 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 41AQ/Health pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Heallh pts y=yes 0
17,Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes 0
1 1 1
01newable Energy and Roofing
1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes 0
2.Install Solar Water Heating System 10 Energy pts y=yes p
3.Pre-Wre for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=18 points) Up to 18 Energy pis 0
6.
Set act Safe andDurable Roofing Materiels _ _ --� 1 Resource pt y=yes 0
7.Install Radiant Barrier - - - - 3 Energy pts y=yes 1 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 0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0
1 1 1
•
M.In oor Alr Qua rty and Frnlshes
rt.Use Low1No-VOC Paint 1 IAOMealth pts y--yes D
2.Use Low VOC,Water-Based Wood Finishes _ 2 IAO/Health pts y--yes 0 •
3:Use LowMo VOC Adhesives 3 IAO 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/Heallh pts y=yes 0
�.Seal all Exposed Particleboard or MDF _ _ J 4 IAQ/Health. pts y=yes D
6.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts yges 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 IAO/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 Available: 1 1401 1301 57
Total Points Project Received: �- 1 01 O=
G:da,arprDgslgreenbuildngguidelineshemodeleygreenpmmsfinal2.1204protededyJs
•
Community Development
r 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OUPEkTINO
Building Department
JOB ADDRESS: PERMIT#
11S11 r C6F-os-oodf—
OWNER'S NAME: qre r ' j01 01111 PHONE #
GENERAL CONTRACTOR:4orksWrcE oo Fi'n FAX #
I am not using any subcontractors:
V Signature Date
Please check applicable subcontractors and complete the following ' ormation:
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
Roofi=ng Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date