08060069 CITY OF CUPERTINO
"COsC.rrvT'wa Fan TONRAG ../._ Mp .CIONBUILDING DIVISION PERMIT
RFS PERMn`NO.
BUI1
�T% TRCHARD /� �"1fSPRING +gCT K.
CASTILLO' S ROOFING 08060069
OWNER'S NAME: ys/IA ( K. PlR ISSUE DATE
SNATnsn Ir
41 EIP AT. 1703 CATHAY DR 06/09/2008
NE:
(408) 251-3565 SANrfARY NO. CONTROL NO.
ARCHrIECT/ENGINEM: BUILDING PERMfr INFO
BLDG ELECT PLUMB MECH
�Op LICENSED CONTRACTOR'S DECLARATION Job Description
4 �W 1 hereby a(fim Wt I m IiCenxO umkr provisions of GhaPW19(rommencing P
wiNSecuon]q10)ofDivl,Ion3oftheBusineaandProfwsiouCede,andmylicenais RE—RF, T/O EXSTNG COMP. INSTL #30LB FLT, INSTL
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CCH Licensed Pmfcssioml -
aw,� OWNER-BUILDER DECLARATION
f 1 hemhy aper Nal 1 am exempt from We Contractors License Law far the
COO following mason.(Section 1031.5.Bauhaus;and Prorossiuu Code:Any city or county
$Iti which uquius a permit W cmumuncL alar.improve,demolish.or repair any strumum
Z'n pearb,its issuance,alw requires die applicant for such permit o Ole a signed statement
0< that he is licensed pursuant to the provisions;of the Conaactor's Limwe law(Chapter9 Sq.F[.Floor Area Valuation
0 (emnour gwithSexian7M(y)ofD;vision3afNeBusinessandPrefmcuouCode)or $9000
k�3 Nat M is exempt therefrom and the hasis for Ne alleged exemption.My violation of
Semon 70315 by any applicant for a permit subjects We applicant to a civil penalty Of e,AN Number Occupancy
tot more than fire hundred dollars ISM 36654032 .`l7V' P Y Type
I,uownerofthepmpmy,amyo.ploycwwithwagesuthehak Co r=don,
wiRde Newark.and Neswct=isnotinmndcdorofferedrusa (Sec.]066.Businm
wall Pmf..ti n,Cade:The Comramm'.License nal apply to an
i •se w does cm.or Required Inspections
property who builds crimpmveathe onand whodocasuch work h;naelforthough his
own employes,provided Natsueh improvements secret intended aroRercW for sale.If,
builder.citeav W onnnimpmf phoauas did 1 uildofimpooma,theoseo-
.it.). will have Ne burden of proving Nal k did not dJW o Impmm far purpose of
tiled.
1,as avner of the property...om u m,ely conaacting with licsosed eonaatu rs m
...thC pr*n(Sec.7066,Business and Pm6catm tit Code:)The Conasmrs U.
cc.Law does not apply W an owner of property who holds or improve,Nemo.;and.
who conaaeu for such pvejeets with a eanaatemr(s)licensed purswnt to the Conu icWh
License Law.
❑1 am exempt under Sec. .B&P C fm Nis uaan
0. Dau
WORKER'S COMPENSATION DECLARATION
40 1 bcreby same under penalty of perjury arc of Ne following deelanuont
❑Ihi,emd will maintain•CeniftcatenfCousen icalf.insumforWorkersCompen-
sall.n.as provided for by Section 31tOo of the labor Cade.for We pmfamacm of Nc
work for which this permit is issued
❑1 have ad will maintain Worker's Compensation Insurance,as twired by secure
3700 of We labor Cade.for the pofamanro of the work for which Nis peer;,is mond - ..
My W.rkers CCoyrype nahashare"' i and Policy numberam: or.�
Cartier. �Poliry
CERTIFICATE OF UlIMP ION FROM WORKERS'
COMPENSATION INSURANCE
(1-hlaamlpt need not be Completed if the permit Is frena hundred dullam(3100)
or less)
1 Certify that in We performance of We work for which Nis permit is issued.I shall not
employ anypcnon in ay manners as W become abject on We Worsen'Compenaaua
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,oRer making this certificate of Exemption,you should
become subtim W the Worker's Compensation ymvWms of Nc labor Cade.you most
wJ O forthwith comply with such Provisions o this permit shall be doomed!revoked.
z uj CONMUC ION LENDING AGENCY
[—i 1 hereby alRm that there is a construction lending agency for the pMomarxx of
rG
We work To,which this permit Is tamed(San.3M.Civ.C.)
GQ Lenders Name .
z lenders Address
U C) 1 certify Nu 1 have mad this application and skW Nal cite shave iteromatiun is
fL^. C mCCL 1 agree W Comply with all City and County ordinance,and mace laws missing W
_C) building construction.and hereby authods ropreunuuvu of Nis city W Cnurupnn the
r fsl in Connmcnn or to San.We
inspection end npuryous
rt^i r6'/I IiaMlitieWe)a agree
t.cwt and eapcwc,wh�eh himmicaus
City of
Cupertino
against
City
U,Z m cewegwrue ser Nc gnnung of this permit. /�
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO -POINT Issued by: Date
SOUR REGU T10
Re-roofs
Si u (AppliaHAZAR cOr pate
HAZARDOUS
DOUS MATERIALS DISCLOSURE Type of Roof
W t e Cupertino
no Mom building C de.Chapter
r 9. or lundh Heamaw material
as definer by the 32(a)?na Mum' 1 Code.�upter 9.11,and au Health and Safety
Cade.semen zss3z(,)?
Yee No All roofs shall be inspected prior to any roofing material being installed.
❑
Will We applicant or future buildin occupant are If a roof is installed without first obtainingan inspection,I agree to remove
pp e p equipmentorUMana which P
emit a. mew air eonum;n,nts ,u d by We Bay Arca Air Quality Management all new materials for inspection.
District? '
❑Ya u
I hats mel Ne huamswmmdals mquimmats underChapmr6.95ofduCalifor-
nuHWNkSafcty Cede&suots25505,25533and]5534.I.ndc.UW aifWe Wilding
onto t c mly have a totem-Nu;t is my mpom;bility W moury the occupant of the
requi to wh tbemet Pd.,Wissuanceor.cemiruateor roe Signature of Applicant Date
owner t
amh 'ed agcm n Dow 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 . . . . . . . . : 36654032 . 00
DATE ISSUED. . . . . . . : 06/09/2008
RECEIPT # . . . . . . . . . : BS000005050
REFERENCE ID # . . . : 08060069
SITE ADDRESS . . . . . : 11600 ORCHARD SPRING CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SHEN YI-MING ET AL
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014
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
--- ------ - ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 9, 000 . 00 0 . 90 0 . 00 0. 90 0 . 00
1REROOFRES 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 #15133
---------------
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
•
oho oo (D 9
CITY OF CUPERTINO
CGS`' - REROOF
OCUOF
PEkTINO PERMIT APPLICATION
APN # Date:
3(05 y03 ,2 , oo LP
Building Address:
I I (pn0 0 rchar-d C i1_ C+ .
Owner's Name: one#:
P60 C�1-5 I - ,:� S�(�
Contractor: Phone #: a Si _ 3 Sin -
..S 7-1 L,t,6 Fax #: fit. E
Cupertino Business License #: Contractor License #:
o �S
Type of Roof Covering:
Existing: Proposed:
Wilt-Up Roof ❑ Bu' -Up roof
Asphalt Shingles ❑ sphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
N�afnber of existing coverings ❑ Provide I.C.B.O. Report#
S To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: ;rar o t- r- mac; C,Om p.
11 ct
(�� F gr n& Ceripi ehai Lq S . Iq SQ
Residential M 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:
• I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Sig 6
ICITY OF CUPERTINO
;r._,G
REROOF
ICUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
I 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
•
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 com ly with the above stated policy on re-roofing.
Homeowner's Name: / a n I ) h /� /��/�
Job Site Address: I I l/�}n! 0 r
Roofing Company Name:
Applica '� p . 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 oints
7
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 oints
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-31 oint
P. Other 1. List Green Features on Plans A-1 1 point
.�.
TOTAL POINTS 40 paints
.//GOd
•
✓Uy x
�9?SOB
•
Plan Review Process Work Book Page-12-Revised 3/25/08
} 4Green 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 Resources Energy lAOlHeaith
site
1.Recycle Job Site Construction&Demolition Waste 1
65%=1 point;75%= 2 points;80%=4 points I 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-Eff cient 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
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 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
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 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
8.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts 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 pts y=yes 0
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes 0
12.Use OSB —l
a.Subfloors I 1 Resource pt y=yes 0
• I b.Sheathing I 1 Resource pt y=yes 0
1 1 1
xtenor Finish INPUT ReSOUTCeS Energy IAD/Health
1.Use Sustainable Decking Materials
JIj a.Recycled content 3 Resource pis y=yes 0 •
b.FSC Certified Wood 3 Resource pts y=yes 0
2.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 _ _ i 1 Resource pt y=yes 0
1 1 1
E.Plumbing
i.Install Water Heater Jacket J 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 UHra-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=yes0
6.Convert Gas to Tankless Water Heater 4 Energy pis y=yes 0
7,Install Water Filtration Units at Faucets
(2 points each,up to 4 points) Up to 4 IAQ/Health pts. 0
B.Install On-Demand Hot Water Circulation Pump 4 Resource pis y=yes 0
1 1 1
t.Clectrlcal
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(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 1
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 pis 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 31AQ/Health pis y=yes 0
4.Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes
5.Use Cellulose Insulation
a.Walls 4 Resource pis y=yes 0
b.Ceilings 4 Resource pis y=yes 0 •
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
o.t;eilings 4 Resource pts y=yes 0
1 1 1
INPUT ReSDurces Energy IA01Health
I.Windows,
11.Install Energy-Efficient Windows
a.Double-Paned 1 Energy pt y=yes 0
b.Low-Emissivity(Low-E) 2 Energy pts y=yes 0
c.Low.Conductivity Frames I 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
1.Use Duct Mastic on All Duct Joints 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 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
8,Install Sealed Combustion Units
a.Furnaces 3 IAQ/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)Furnace 2 Energy pts y=yes 0
• 13.Retrofit Wood Burning Fireplaces
a.Install EPA certified wood stovesfmserts 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 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
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=18 points) Up to 18 Energy pts 0
6.Select Safe and Durable Roofing Materials 1 Resource pt Y=Yes 0
7.Install Radiant Barrier 3 Energy pts y=yes 0
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
• I 1 1
I
INPUT Resources Energy tAQ/Health
M. ndoor Air Qua Ity annisifils
r—--— ---- — — -- — P y=y
1.Use Low/No-VOC Paint _ _ _ 1 IAOMealth is es 0 •
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health 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/Heaith pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Seal all Exposed Particleboard or MDF _ __ 41AQ/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/Health pts y=yes 0
1 1 1
.N.Flooring
1.Select FSC Certified Wood Flooring 8 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 D
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
Total Points Aval able: 1401 1301 57 •
Total Points Project Received: 1 01 01 0
G:daialprops/greenbuildinggt idelineshemodelersrgreenpantsfinal2.12.04protecled.xls
w Community Development
10300 Torre Avenue
. y- Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
W,UPEt�TINO
Building De artment
JOB ADDRESS: PERMIT # QO6
(' 1^
OWNER'S NAME: j PHONE # 2-6 I"3 S(05
GENERAL CONTRACTOR: 0 pM7t L,Lc3S FAX # S .2
I am not using any subcoM Iq 0)�
Signature bate
Please check applicable subcontractors and complete the following ' ormation:
60 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 G
Owner/Contractor Signature Date