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08090042 CITY OF CUPERTINO ^,.° BU1,1 tNIGJIV}SION PERMIT �s QNTRAGTOReINk`QItM41' ION BUILDING ADDRESS: PERMIT NO. 7633 PROSPECT RD WESTERN ROOFING SYSTEMS 08090042 OWNER'S NAME: PERMIT ISSUE DATE ROSENBAUM DONALD E AND ARLENE 1328 WHITE OAKS RD 09/09/2008 )NE SANITARY NO. CONTROL NO. (831) 278-1837 ARCHITECfIENGINEER: BUILDING PERMIT INFO PLUMB MECH BLDG EIEC?- o p LICENSED CONTRACTOR'S DECLARATION m 1 hereby aBism that I sm Ikcurd under provisions of Chapter 9(commcneing Job Description with Section 7")of Division 3 of to Business and Professions Code,and my li-martin RE—RF T/O WDSHK FILL SHTNG AS NDED, 40LB FLT, infullfonx c 'pyjzo Lleamcclasaad � LJ).• be— INSTL MTL TILE PER ICC5026 CLS A 27SQ ^t7 Dam_lUvy�_COntuamr14*41 e 7W ARCHRECI'S DECI.. O ? U I endervaad my plate shall be ued u pub yard Licensed Pmfrssiond 3 Oat I wo exempt from mDECLARATION I hereby aRrm that 11. uadne from the Camm�COLC.iA C for 0M ' i p O following mason.Permit t ]031.3,Business and Pa.dco0m Code:Any cit or taunt S$ which its in.a permit re ennsuucL alcor.improve,xmolW,or mash primbsliannncpumanto.men to tor etM apions of far xchonewemcense rile a Lnetirtaem)nt �C that ha Section to the of Division of them Buaca WcenselAw(Com)w Sq.Ft. Floor Area Valuation E5 (cot Is,is [ pt Section 7000)ad do,livision 3 of all, dnw tib Proon.Any Code)of $16500 Y 9 Natio k eumpt Fnmfrom and the basis(m the cu th d eumpdm Any violation of .1.. them by wry appllcam for a permit rubjecu the applicant m a civil Anally of y,tgT�t Number Occupancy Type rot mow this five handmd xlisn(5300). 36624039 .'Vt3' P Y YP ❑L oshc work the property,ar my otimeyou mortared wags u Nev(Sec. Business will xthework and Theermeninatmmnxtl oraw doa.1apply in.Business and Professions Cox:mpr Cemeaerors Limner Law data rot appy lf m cough of Required Inspections propertywho bulli orinsprows himr and who dosssocbwork AimselfedJuoughhis own rver.m eca.provided Jur vera improvements in not inmMW m'oRemd fw maso- hvwcver.Ne building an improvement is sold within one year or i m rove l t the awner- builxr NB Raw the WNrm of PrONng Jur K did not hdM or impute for purpose,of ukJ. . ❑1.u owner of the Property.w exclusively mntaedaL with acemed mnhxtms m - t mruuum the project(Sec.7041,Buimas and Professions Code:)The Cmtraemh U. ..- mose Taw does not apply to an owner of property who Wilde or Improves;thereon.and who contracts for uKh pmjcw with a mnuxcmr(s)licensed p0usuant in Ne Cmusan r. Lans"'law. 1 am..apt under Sec .B&P C for this..no Owner Done— WORKER'S reWORKFR'S COMPENSATION DECLARATION I bereby aflhm under penalty of perjury,arc of the fallowing dmlarslions 1 Raw and will maintain a Certificate of Comment in self-insure for Wands Cooper. smon,u provided for by Section 3700 of the Labor Code,for the pcolose enm of the weak for which this permit is iarucd. ❑I haw end will maintain Worke/r Compensation Insurance,as,required by Section 37OOof tha lahm Cox,for ft oformance of the work for which this p.I,u iuuce. ' My Warkees Coope eentim lwru0a carrier and Policy numpv tie: Canier. e/M+w/NM.�(i'o'KVoliey No.: !;->171371— CERTIFICATE ;-7/fgrTCERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This xmim need at he cam plemd if the p)mf t Is fa ane h wWmd doll.(SIM) Or leas) I¢nifty Nu in the performance of the work for which this parn 1,is issued.I shall not employ any person in any matter u at become subject to the Women'Compensation Uwtl of Califomia Data Applicam NOTICE TO APPLICANT:IL after making this Ccnificam of Exemption,yen shoum br2me xbleW in the WOrke's Compensation lennislot,Of the Labot Code,you most ., z forthwith comply with such provision m this permit shall be deemed mokcd. 'Zy CONSTRUCTION LENDING AGENCY [-� 1 hereby affirm that them is a mnsuuctinn lending agency for the prfwmmoc of a the work fur which this permit is earned(Sec 3097,Civ,C.) 0. Q Lenx/s Name . z Lender's Address U O 1 ceNfy that I have read this application and sum that the shoe Infermaoun is cmxCL 1 onsu lion.ad with all qty and county osdinuees and sum lava opea the.� huiw-reconswctiogand hereby auNodrz¢prtscnuurs ofthis city mcnler upon tie gT7 above-mend0ned property for inspectionponsa purposes ... („t y (We)agree to uve,indemnify and keep harmless the City of CM nine against U z incoiwgmn gmenu,eosusn OfLhi$mwhich rorty In any wyaarnmagalmtmid City m APPLICANT of Ne RSTA Lof this permlt. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU REGULATION 0 S � a y'y'C'fase Re-roofs tL�We H a DOus AISDISCL.OSURE Da1t Type of Roof Will the appllcant mfutombu ng accupmlerom or handle harudons material u defined by the Cupertino Mumgpal Cex.Chapmr 9.1;and ds Hcalth and Safety tax, M532(.)?3z(.)] 0y. / All roofs shall be inspected prior to any roofing material being installed. ❑Yns No kWill the applicant ar fumm building aauPam me,e9vipment or irises which If a roof is installed without first obtaining an inspection,I agree to remove .t b.oko s air contaminants u defined by tie Bay Are.Air Qualiy M...Somcm all new materials for inspection. �isu ct] ❑Yca 'Fm Thave road NehuSNmrmamdalsrtquitcmmu unJerC norand 95 ofthe Caldi —� rtes Hmlthksaadthe to.secdau3amialS 553inomeM534.under Ocmund thisoffs building does rot.mmody have•amanl Jul' xsponsibiIlly m notify the occupant rf the aqui m)nuwhichmusbe at ' rani mofaCcnifmaeoflkmpamy. SIg lure 'App is Date O athadr1d.'Ortlp Dam II roof verings to be Class r%?."or better i CITY OF CUPERTINO • 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: pdtg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36624039 . 00 DATE ISSUED. . . . . . . : 09/09/2008 RECEIPT # . . . . . . . . . : BS000006031 REFERENCE ID # . . . : 08090042 SITE ADDRESS . . . . . : 7633 PROSPECT RD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER ROSENBAUM DONALD E AND ARLENE ADDRESS . . . . . . . . . . : 7633 PROPSECT RD CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5242 RECEIVED FROM . . . . : MICHAEL D LUNNEBORG CONTRACTOR . . . . . . . : MICHAEL. LUNNEBORG LIC # 25896 COMPANY WESTERN ROOFING SYSTEMS ADDRESS 1328 WHITE OAKS RD CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE (831) 278-1837 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 16, 500 . 00 1 . 70 0 . 00 1 . 70 . 0 . 00 1REROOFRES SQ FEET 27 . 00 351 . 00 0 . 00 351 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 352 .70 0 . 00. 352 . 70 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 352 . 70 VISA ------ TOTAL RECEIPT 352 . 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 CUPERTINO PERMIT APPLICATION APN #2 G W,-� / i 0 .3 3 � Date: `-1 _p Building Address: 7G33 (?nx ec�l1 ' �LL Owner's Name: Phone #: Contractor: Phone #: Fax #: 'r o v Sri I }S Cupertino Business License #: Contractor License #: 4 � 9� zr Type of Roof Covering: Existing: Proposed: o Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ?W: Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ?ir- Other (Specify) t,•cj�6[ Number of existing coverings ❑ Provide I.C.B.O. Report # C-(,-Lr. . ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: 1 T`ex V � ' (.,JJc� f kOjCC% -Fkk 5kt4,7T j 'A6 wearl -C/ AW N, 7C(+ ) %Ntj^ls r, C-144l 4- (-r Pei icc dArs �_ f7c�tr. 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: ed, I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: • S a re c Revised 6/16/08 Rif CITY OF CUPERTINO REROOF aITYOF' CUPERTINO FEE SCHEDULE Number of Fee ID ' Fee Description Fee Permit Type Squares Group IREROOFCOM Re-roof Commercial B 1COMMLROOF IBSEISMICO Seismic Commercial B' , ' 2�1 1RER00FRES Re-roof Residential B 1SFDWLROOF ' 1BSEISMICRE Seismic Residential B 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF IBSEISMICRE 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. 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 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 wroth the above stated policy on re-roofing. Homeowner's Name: W Oi R4 Job Site Address: 733 1QCa�Q,r� Roofing Company Name: LJ -a-J Q a J�r3a�y S.�pg f Applicant's Signature: 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 See below Mew 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 1 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.Sde 1.Recycle Job Site Constriction&Demolition Waste 65%=1 point;75%= 2 points;60%=4 points up to 4 Resource pts 0 2.Salvage Reusable Building Materials _ _ i 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 5.Implement Construction Site Stonmwaler Practices 2 Resource pts y=yes 0 7. Protect Water Quality with Landscape Design 2 Resource pts y_=yes 0 16.Design Resource-Efficient Landscapes and Gardens - 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 1 Retention 2 Resource pts y=yes p 1 1 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 ptsTO 2.Use Recycled Content Aggregate 2 Resource pts y=yes 3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes p 1 1 1 C.Structural Frame f1.Substitute Solid sawn Lumber bntti Engineered Lumber J 3 Resource pts y=yes p 2.Use FSC Certified Wood for framing (For every 1000 of FSC lumber used=2 points,up to 10) up to 10 Resource pts. p 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 p 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 p 7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes p B.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 b.Wall p c.Roof 3 Energy pts y=yes p 3 Energy pts y=yes p 10.Apply Advanced Framing Techniques 4 Resource pts y=yes p 11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes p 12.Use OSB - — --'-- - a.Subfloors 1 Resource pt y=yzs p b.Sheathing • _. 1 Resource of y=yes p 1 1 i ztenor mis INPUT ResDomes Energy [ADIHealth 1.Use Sustainable Decking Materials a.Recycled content 3 Resource pts y=yes 0 • b.FSC Certified Wood 3 Resource pts y--yes 0 j2.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 V _ 1 Energy pt y=yes 0 2.Insulate Hol and Cold Water Pipes 2 Energy pis y=yes 0 Rotrofii 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) 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 4 IAQ/Health pts. 0 S.Install On-Demand Hol Water Circulation Pump 4 Resource pts y=yes 0 1 1 1 r.tiecrncai 11.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 —'l 1 Energy pt y=yes 0 2.Install Washing Machine with Water and Energy Conservation Features 1 Energy pt Y--yes 0 13.Install Energy Star Refrigerator 1 Energy pt y=yes 0 4.install Built-In Recycling Center I 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 13.Install Recycled-Content, Fiberglass Insulation with - Lo Added Formaldehyde 31AQ/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 D b.Ceilings 4 Resource pts y=yes 0 • 6.Alternative Insulation Products(Cotton,spray-foam) a.Walls 4 Resource pts y=yes D o.Ceilings 4 Resource pts y=yes 0 1 1 1 INPUT Resources Energy 1ADIHeafth I.Windows 1.Install Energy-Efficient Windows a.Double Paned 1 Energy pt y=yes D b.Low-Emissivity(Low-E) 2 Energy pts Y--yesD c.Low.Conductivity Frames 2 Energy pts y=yes 0 2.Install Low Heat 1 Energy pt y=yes 0 1 ! f 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 D 4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 7 0 5.Install Solar Attic Fan 2 Energy pts Y--yes D 6.Install Attic Ventilation Systems 1 Energy pt y=yes 0 7.Install Whole House Fan 4 Energy pts y=yes D S.Install Sealed Combustion Units a.Furnaces 31AOJHealth pts y=yes 0 b.Water Heaters 3 IAQ/Health pts y=yes 0 9.Replace Wall-Mounted Electric and Gas Heaters with Through-the-Wall Heat Pumps 3 Energy pis y=yes 0 10.Install 13 SEEM 1 EER or higher AC with a TXV 3 Energy pts y=yes D 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 D 13.Retrofit Wood Burning Fireplaces • a.Install EPA certified wood stovesTinseds 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 D 16.Install Heat Recovery Ventilation Unit(HRV) - - 5 IAQ/Health pts y=yes D 17,Install Separate Garage Exhaust Fan 3 IAQ/Health pts y_-yes D 1 1 t K.Renewable Energy and Roofing 1.Pro-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-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes D 4.Install Photovoltaic(PV)System (1.2 kw=6 points,2,4 kw=12 points,3.6 kw=18 points)_ Up to 1 S Eneroy pts 0 6.Select Safe and Durable Roofing Materials _ 1 Resource pt y=yes D 7.Install Radiant Barner - 3 Energy pts y=yes p 1 i L.Natural Heating and Cooling 1 1.Incorporate Passive Solar Heating 5 Energy pts y=yes D 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 — INPUT Resources Energy IAD/Hmith M, n oor rr Qua,rty and Finishes 5.Use LowMo-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y--yes 0 • ;3.Use Low&VOC Adhesives _ 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials far Interior Finishes 3 Resource pts y=yes D 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/Health pts y=yes 0 7.Seal all Exposed Particleboard or MDF _ 4 IAQ/Health pts y=yes D 6.Use FSC Certified Mate als 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 31AQ/Health pts y=yes 0 7si N.Flooring 1.Select FSC Certiiled Wood Flooring 6 Resource pts y--y2.UseRapid y Renewable Floc ng Mate els 4 Resou ce pts y yL3.Use Recycled Content Ceramic Tiles 4 Resource pts y=y4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=y0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=y6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=y 1 i ! Total Points Available: 140 130 57 Total Points Proiect Received: 1 01 01 0 • 3:daa�pmgslgreenbuildmgguideme remodelersigreenpoinlsfinaIL12.04proteclad.zls • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 WUPEkTINO Building De artment JOB ADDRES : n PERMIT # o 9 D 6 � / 76-3 n s ex, R 7 OWNER'S NAME: ?, PHONE # ,�cvr 3&9 9/ GENERAL CONTRACTOR: pf s FAX # I am not using any subcontractors: tgnatu Date Please check applicable subcontractors and com Tete the fo4wing information: 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 Own Co actor Signature Date