08080074 CITY OF CUPERTINO �: `^.«'krt «s+ 4r✓'-kmw�" '�"" ' � °4'-`�- '`'
BUILDINC.OIVISiOhb PERMIT COI RAC�TQRINFORMATIgN
_ 2
BUILDING ADDRESS: PERMIT NO.
1.1.625 OAK SPRING CT CASTILLO' S ROOFING 08080074
OWNER'S NAME: PERMST ISSUE DATE
KI_,EIN BFRNARD AND PAULA P 1703 CATHAY DR 08/11/2008
NEA SANITARY NO. CONTROL NO.
(408) 251-3565
ARCHITECT/ENGINEER: BUrIDING PERMMMO
BLDGELECT' PLUMB - MECH
I� t I� I�
�oo LICENSED CONTRACTOR'S DECLARATION Job Description
dr I unrest, a.lou 1 am imuca d under pmridmn of QIupmr 9(commencing P
^_ wilhSectim70p)ofDiNion3oftheBuffueuW nfessbNm
Cn .anlmyraNeis RE—RF T/0 OLD RF& INSTL#30LB FLT, INSTL GAF GRND
n full forme aced eff
. z Linens sec., CNYN CMP 19SQ CLS A
i` Dote r Can
ARCHITECTS DECLARA ON
I undersand my Pros shall be used a public TEconds
Sad Ltccesed PNfeevonel
OWNER-BUILDER DECLARATION
ai 1 hereby affirm tell 11. msmpt from the Conusmrs License Law for the
0 0 following mesa.(Section 703 1.5,et,at and w,de o u Cade:Any city or county
z which its ishs.permit expires c e t e4 elan imgmw,demolW,ere.sig coy umturn
ment
Z> pforbitsrnsedp rson ohe preappliunt far schpermit b Rka Law(Caement
�a lcommie)Ice,vedp,wmntbbepfDi o.. .ftheBuincama.iaamtAw(CepLL,9 Sq.Ft. F1oorArea Valuation
00
2 (commencing with Setmnn and)of India f50(thepurinetempt Prefer sCode)or 9(]
that M u esempt Anmfmm anti er bur for bj alrged csemant to Any rioladon of
Seton dum by eon applicant fora permit subjects We applicant a civil paelry of Number Occupancy Type
not mom men awe hundred amllua(5500). 3 6 6 5 2 0 7 3 .'�(1N
1,u owrcr of the proprty,a mY anplayen with w{os a deo sr cornpewtimn,
add Professions
Code:
ThN[1nmrnntNmadede Law du
rNYr(Sem.to sue BNinW
Nd PN(whoW Cede:The wsmencM1 License LAW dch Out apply lf N owner e( Required Inspections
Own ewho employees.proArimPmwa thereon,endwho daseucmwmk himselfedthmu{h his
own annummiproNded that such Improwmonts in not intended continued fm Ws IL
hmwewn me Wilding orlmpmwmst 4sld within cue you of i mnpktion,the owner-
Wilds MB law the burden of poring that ho did not Wib or impmw for purpose of
ar.).
❑1,u owns of the pmpny,w cod"vely conuacting with licensed contractors in
contract the pmjea(Sec.7W.Business and Profession Cods)The Conmcmes U.
chose Law does not apply in an owner of property who builds or Imprensa thereon,and
who contracts forsuch projects with sconuacmr(s)licensed purust to the Contrectora
License Law.
❑Iemexchum Oda See ,B&PCforthismasnn
Owner Data
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury oro of the following declaauons:
I how and will mainWn a Certificate of Cm can.i m sel(-room for Workdscompen-
tuion,u provided for by Seton 3/00 of the Labor Code,for We perform, of de
work for which this permit is issued
❑I hew and will maintain Worker's Compensation Insurance,as required by Scion
370Dmf the labor Code.for the peRarmance ofthe work for which this Rnnit is issued '
My Workers penscoion lNurmou"'rna Policy numbs K:
tinier. 7W df: - Polley No.: �2300 OC.d9W .
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
OTb section need Out W completed lithe permit Moran hundred dollars($100)
or knJ
I certify mat in the perfmmsem of me work for which mia permit Is Weed.1 shall am
employ
any person in any manners u to become subject in the Workcrr Compeosatbn
Laws of California.Dae
APPliani
NOTICE TO APPLICANT,If,after making this Certificate of Exemption,you should
become subject in the Workers Compensation provision of the Labor Code you mon
wJ ZM
fowith comply with such pes m
rovidor this pelt small he dolled revoked.
O
Z 51 CONSTRUCTION LENDING AGENCY '
��+ 1 homb sRm that them B a consuucMn lending
[—, y {agency fur the performance of
�i ework for which this Permit io issued(Sm.3I97,Civ.C.)
QLenders Name
Z) ,
�Z Cabers Address
fJ Q 1 certify that I haw mW this application and state that the show information Is
Iy ;'•! roma 1 agree to comply with all city and county ondimmcu and sum laws misting to
SL-J:
Wilding construction.and hereby aumon.mpmsenunmsm'd is city to cram"Imn the
W above-mentioned property for Impeton purposes
LL (We)agree to saw,indemnify and kap hamlea the City of Cuperuno aµist
.,rue liabilities.judgemou,coN and eapeam which may in any way amue s{ant said City
L) in chnegnnce of the granting of this Pennell. (
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /k. ` Z'
SOUR LATIO ,./
'0 Re-roofs
this ppbma mnusemr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will use applicant or future Wilding azomweLs me orhande Murdoch material
eadefinedby the Cupertino bf iaps ods,Chapter 9.13,cod tis Health and Sa(ctY
Code,Seton 25532(a)Y All roofs shall be inspected prior to any roofing material being installed.
❑YN e
Will ren apple=[or fuu m mding Occupant use equipment or dcamN which If a roof is installed without first obtaining an inspection,I agree to remove
i,hvxmu air eonlaminents ONd by the Bay Amo Air Quality Mutual;ement all new materials for inspection.
WaT
❑Yrs ❑No
I haw mad me hundonmau.Malsmwimmenu under Chapmrd95 of OatCalifmr-
nrHulth&Safsty Code Sriau25505.25533w2S534.1.W wWth Uft Wilding
dor Out cumn y ha teaann that it is my responsibility to Wily the morgan,of the,
mgmimmen hk �etpior nancmmracenilk.mO a�cyD Signature of Applicant Date _
e r.umo a gen /Dam All roof coverings to be Class'W'or better
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN 36652073 . 00
DATE ISSUED. . . . . . . : 08/11/2008
RECEIPT #. . . . . . . . . : BS000005747
REFERENCE ID # . . . : 08080074
SITE ADDRESS . . . . . : 11625 OAK SPRING CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER KLEIN BERNARD AND PAULA P TRUS
ADDRESS . . . . . . . . . . : 11625 PAL S [ROMG CT
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5140
RECEIVED FROM . . . . : CASTILLO'S ROOFING
CONTRACTOR . . . . . . . : JOSE CASTILLO LIC # 25850
COMPANY . . . . . . . . . . : CASTILLO' S ROOFING
ADDRESS . . . . . . . . . . : 1703 CATHAY DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95122
TELEPHONE . . . . . . . . : (408) 251-3565
® FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- -------- ------------- ---------- ---------- ---------- ---------- -
IBSEISMICR VALUATION 91000 . 00 0 . 90 0 . 00 0 . 90 0 . 00
IREROOFRES SQ FEET 19 . 00 247 . 00 0 . 00 247 . 00 0 . 00
---------- ---------- ---------- ----
TOTAL PERMIT 247 . 90 0 . 00 247 . 90 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 247 . 90 #15258
---------------
TOTAL RECEIPT 247 . 90
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
OP 6D v o-7q
CITY OF CUPERTINO
REROOF
•CUPEkTINO PERMIT APPLICATION
APN # 2 0 , A D 73 • 0 C) Date:
Building Address: / b2s O a l
Owner's Name: Phone #: S 7_ 7
Bernard /</iez 7 7
Contractor: Phone #:
aS/- 3S4
C4S7/ [.1.� S Re GG�<J Fax #:
Cupertino Business License #: Contractor i e sse#-
Type of Roof Covering: vl [O
Existing: Proposed:
❑ Built-Up Roof ❑ ilt-Up roof
❑ Asphalt Shingles ;/Asphalt Shingles
ood 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: eox 0 -36
Gkv)k 1cCvi k1rA ccm . �q 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: 7\
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
C!
Sign ture
Revised 6/16/08
I '
CITY OF CUPERTINO
REROOF
CUPEkTiNO ' FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
/ p 1REROOFRES Re-roof Residential B 1SFDWLR00F
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC 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/a "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:
Job Site Address:
Roofing Company Name: 0, 10
e*,og�,-Au
t r�s�f� _ te
Applicant's Signata¢ — Date:
• 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 as 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 point
P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS1 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.
INPUT ResDuices Energy IA011-lealth
A761te
1.Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;BO%=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
B.Design Resource-Efficient Landscapes and Gardens__ 4 Resource pts y=yes 0
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
1 1 1
S.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 pis 0
2.Use Recycled Content Aggregate 2 Resource pts y=yes 0
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes 0
1 1 1
C.Structural Frame
Fl
Substitule Solid Sawn Lumber wth 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 pis 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 pis y=yes 0
7.Use Engineered Studs for Vertical Applications 2 Resource pis y=yes 0
8.Use Recycled Content Steel Studs for Interior Framing 2 Resource pis y=yes 0
9.Use Structural Insulated Panels(Sips)
a.Floors 3 Energy pts y=yes 0
b.Wall 3 Energy pts y=yes 0
c.Roof 3 Energy pts y=yes 0
10.Apply Advanced Framing Techniques 4 Resource pis y=yes 0
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes 0
12.Use 0SB
a.Subfloors 1 Resource pt y=yes 0
• Lb.Sheathing _ —_ i 1 Resource pt y=yes 0
1 MEMM
INPUT Resources Energy AD/Heafth
rror n sfi
1.Use Sustainable Decking Materials
a.Recycled content 3 Resource pts y=yes 0
b.FSC Certified Wood 3 Resource pts y=yes 0
2.Use Treated Wood That Does Not Contain ChromiumlArsenic 1 IAO/Health pt y--yes 0
3,Install House Wrap under Siding 1 IAO/Health pt y--yes 0
4.Use Fiber-Cement Siding Materials 1 Resource pt y=yes 0
1 1 1
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 Faucets and Showerheads with Flow Reducers
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 3 points) Up to 3 Resource pts. 0
5.Install Chlorine Filter on Showerhead 1 IAO/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 IAO/Health pts. 0
8.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
r.ruacmcar
1.Install Compact Fluorescent Light Bulbs(CFLs)
(6 bulbs=2 points,10 bulbs=3 points, 12 bulbs=4 points) Up to 4 Energy pts. 0
2.Install IC-AT Recessed Fixtures with CFLs(i 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 pl 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 Recycled-Content,Fiberglass Insulation with
No Added Formaldehyde 3 IAO/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 e
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
I).Cewngs 4 Resource pts y=yes 0
INPUT ReSDurces Energy IAO/Health
mows
Fl.InstallEnergy-EfficienlWindows�
. Ia.Double-Paned i 1 Energy pt y=yes 0
b.Low-Emissivi y(Low-E) ` 2 Energy pts y=yes 0
L c_Low.Conductivity Frames 2 Energy pts y=yes 0
2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 0
1 1 1
J.Heating Ventilation and Air Conditioning
F1.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 0
7.Install Whole House Fan 4 Energy pts y=yes 0
B.Install Sealed Combustion Units
a.Furnaces 31AQ/Health pts y=yes 0
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 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 y=yes 0
12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Fumace 2 Energy pts y=yes 0
13.Retrofit Wood Burning Fireplaces
a.Install EPA certified wood stovestinserts 1 IAQ/Health pt y=yes 0
b. Install/Replace Dampers 1 Energy of 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 Filler 41AQ/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 IAQ/Health pts y=yes 0
1 1 1
K.Renewable 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 0
3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0
4,Install Photovoltaic(PV)System
(12 kw=6 points,2.4 kw=12 points,3.6 kw=1 B points) Up to 18 Energy pts 0
T§-elect Safe and Durable Roofing Matedals —E 1 Resource pt y=yes 0
7.Install Radiant Barrier 3 Energy pts y=yes 0
1 1 1
L.Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy pts y=yes 0
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
INPUT Resources Energy A0111oallh
. n oor r ue Ity en rn s es �'
1.Use Low/No-VOC Paint 1 IAQ/Health pts y--yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Heallh pts y--yes 0
3.Use Low/No VOC Adhesives 3 IAQ/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
7.Seal all Exposed Particleboard or MDF 4 IAQ/Health pts y=yes 0
8.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/Heallh pts y--yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring B Resource pis 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 1
Total Points AFE]e: 1 1401 1133001 57
Total Points Project Received: 0� �I
e:datalprogstgreenbulldingguidelineslremodelerslgreenpointsfinal2.12A4pmtaded.ds
Community Development
' 10300 Torre Avenue
YJ- Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
6UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT # (?O p O v 7�
1 1(100 25 O cLk a r t s C- . O 6 O
OWNER'S NAME: I r \ PHONE # .:) S—(
GENERAL CONTRACTOR FAX # a S 1 Q fj�
I am not using any s contract oz / O "
Signature Date
Please check applicable subcontracto d com lete 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