08080010 CITY OF CUPERTINO ;? + „.r
BUILDnvc DIVISION PERNUT i CONTRiAGTORtINFORNIATION
BUILDING ADDRESS: PERMfr NO.
21.050 RAINBOW DR WESTERN ROOFING SYSTEMS 08080010
OWNER'S NAME: FERUM ISSUE DATE
MOND PING AND YUAN-MING T 1328 WHITE OAKS RD 08/01/2008
NE: (831) 278-1837 SANITARY NO. CONTROL NO.
ARCHMICUENGINEER: BUILDING PERMIT INFO
BLDG ELECT FLUMB MECH
S O LICENSED CONTRACTOR'S DECLARATION
I hocb,affirm dead I sum licensed under proviaioes of Chapter 9(commencing Job Description
with SecdmTOW)of Division 3 of cite Business and Prmfessiom Code.and my license is RE-RF T/O SHKRF FILLSHTR ASNDED 40LBS FLT
I.full force and riff
z License Class �?/`� Lic.d 7Z� INSTL30#MTL TILE PER ICBO 5626 CLS A 30SQ
Date
ARCHr1ELTS GEC
1 untlenunJ my pious ehW he cud u p IIc mcnrdc
J
G Licensed profcssond
OWNER-BUILDER DECLARATION
1 hereby&Rm that I em exempt from the Contrives License Law for the '
0 0 following recon.(Section 7051.5.Business and Rofesduns Cade:Any city or county
$ which requiroM a permit m consam41I1M,improve,dcmnilsh,or repair any aamemro
z�O priortu is issuane.aed mquires thcapplicint forsuch Permit a fibe a signed moment
_ < themheis limned pursuant in me provisions of the Conuecar4 bonus Law(Chapter 9 Sq.Ft. Floor Area Valuation
gs (commencing with Section 7000)of Division 5 of the Business and Prufodons Code)or $20500
— Nat he Is exempt therefrom and the basis for the alleged cumpdon.My dalatfine of
SaBon 7051.5 by any applic+nt for a Permit wbjecu the applicant to s civil penalty of Number Occupancy Type
act em rive more them hundred diction5500), 3 6626024( .
0 Luowno Ofthe property,amyemploycu with wagautheesooemmpewtim,
will do thework.and the sweme,is ret inomded or offered forsaic(Sec.loss.But"
nb Profesdona Cade:The CmmaEMr]Licerue Law does rot apply in an owner of Required Inspections
property who builds or improves thereon.and who does such work himself or through his
awn employees.provided that such impmvemma and not intended dooRcred for We.TL
Wainer.the building or improvement B sold within one year of completion,the owner.
builder will have cite Louden of pmdng that he did rot Mid or rmpom for purpose of
east.).
❑I.as,awns of the property,w Exclusively eomMing with licensed conmamas m
cansrmct the project(Sec.7W,Business and Professions,Coda)The Commism's U.
cone,Law does oat apply m an owner of property who Wild.or ireprovEx therein.and
who comncu for ouch propins with acam esser(a)licensed pmsmut to Me Contract
License Law.
01 son..map,under See ,B&P C for this mown
Ower —Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under perWty of perjury os,of the following declauons:
1ham andwilllfor by •Co40aa of Concerto Cost.
an Wanter'a Cn of the
wren, r pmvidhi for mi SsNon]]00 of the IAba Code,for the penformumce W the
worst for which WM permit is issmad.
O I hue and will maintain Worker's CompemWan bnuan=,u rcgWred by Section
3700 of the Lida Code,for the,peRmmanee ofthe work:for which this permit is ruued. '
My WMIM'.C"ompemaiim t". e_arum and Pull numbs am:
COMMA r+ /cA-�7tA�c/'f!/!/44&mliq No.: '�3f 31rf
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSAMON INSURANCE
(Thu mchm need net he completed If the permit Is formic humEmddolim($100)
or os,)
1 ardfy met In the performance of the woh for which this Permit u issued.I,bail WE
employ anypenon in any marenerso as a became subject m the Worken'Compewdm .
Laws of Ci ifomis.Date
AppUcam
NOTICE TO APPLICANT.IL after making this CcniBum of Esemptian,you should
become subject u the Worker's Compens.dan prodsians of the Mbar Code,you most
,J Q forthwith comply with such proviilPermit nns ser than Peit shall be deemed ked.
CONSTILUCTION LENDING AGENCY
I hemhyafllim that them Is.consauNnn lending agency for the Perftermanw of
lYi> the work(or which this permit Is issued(Sec.5197,Civ.C.)
Q Lender's Name ,
,7 z Lender's Address
U Q 1 comfy that I low mead!this application aed Must that the show information is
(y comm"'I agree m comply rith all city and county odinanmas and state,laws reading in
-C) Wilding consuuctron,and homeyauthadn reprmaades nof this city rep meso upon the
W above-mendomed proper,fa inspection Puryeses
Is. (We)attic'in ow,indemnify and keep humless the Or,of Cupertino alainst
m,cA IlabilWesjudgmcns,.cas,andexpaues whichmaylnuywaya gLimlmdChy /
(3 z in consegmnce of dm grading of this Permit.
^, APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO EREG TIONS.
Re-roofs
Ilnu ApplianUCmn err Dau
HAZARDO TERIAIS DISCLOSURE Type of Roof
Will BeapPliontafu no asupantmoe or handle huscdoes materia
u donned by the CupeNno 1. mast Code.Chapter 9.13.and the Health and Safety
Code,Section 255324)7
❑Yes ONO All roofs shall be inspected prior to any roofing material being installed.
Will cite applicant or fume building Occupant me equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t harardoa ter contaminants u denmzd by the Bay Area Air Quality Management all new materials for inspection.
OYes 0 N
I hew real the hendmusmatedsis repuimmenuunder Chepler6.95 ofthe Canon
ni.Hulmh&S.fety Cade,&.d.253M,M533a M5M.lundeuund Nuifdx building
does not currently haw a u ran,Out it It my rupomibility u notify the occupant of the
ulmmcuuwhichmusi met Pd Mo.=of.Certificate nfaaPatey, ignaureof Applic Date
p med.sent Dare. II r of coverings to be Class'J�."or better
CITY OF CUPERTINO
• 2 ITEMS. OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Seo : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36626024 . 00
DATE ISSUED. . . . . . . : 08/01/2008
RECEIPT # . . . . . . . . . : BS000005664
REFERENCE ID # . . . : 08080010
SITE ADDRESS . . . . . : 21050 RAINBOW DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MONG PING AND YUAN-MING T
ADDRESS . . . . . . . . . . : 21050 RAINBOW
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5210
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
P'EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ----—------- ---------- ------ ---------- ---------- ----------
1BSEISMICR VALUATION 20, 500 . 00 2 . 10 0 . 00 2 . 10 0 . 00
1REROOFRES SQ FEET 30 . 00 390 . 00 0 . 00 390 . 00 0 . 00
------'---- ---------- ---------- ----------
TOTAL PERMIT 392 . 10 0 . 00 392 . 10 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 392 .10 MC
---------------
TOTAL RECEIPT 392 .10
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------------- -------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
4o 0 / C)
CITY OF CUPERTINO
REROOF
UPERTINO PERMIT APPLICATION
APN #2(,, Cp0 / 6f� Date:
Building Address:
Owner's Name: Phone #:
IfOf-- cJrf (, �iiCD�
Contractor: Phone #:
Fax#: Y,96- M 17-13
Cupertino Business License #: a , p Contractor License #:
b 7r9 7-i-
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
�F Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) Other (Specify) e4�a ( f le
Number of existing coverings ;r Provide I.C.B.O. Report # t&z C..
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: ,pr Woo Z 5-k ake _ —F� 1 SL N
�Qo.r � 1 � fK t..lFeeja Z � 4,v rSs'FEf�
Residentia 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:
ZC-) �vJ
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
•
ignature
Revised 6/16/08
CITY OF CUPERTINO
REROOF
CUPER,TINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
6 1RER00FRES Re-roof Residential B 1SFDWLROOF
1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08
e
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/ "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: t n1 C (�
Job Site Address: �R"-P, ' J J00 u
r ..J
Roofing Company Na W`P S 1'e r J PLOA Z s.4�
Applicant's Signatur . Date: L��k
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
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 oint
P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS1 40 points
i
I
Plan Review Process Work Book Page A 2-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 Resnuices l ]AD/Health
rte
1.Recycle Job Site Construction&Demolition Waste 7
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
6.Design Resou ce Eff tient 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 yryes 0
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 pts 0
2.Use Recycled Content Aggregate 2 Resource pts y=yes 0
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yesl;;F 0
1 1 I
C.Structural Frame
1.Substitute 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 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 Intedor Framing 2 Resource pts y=yes 0
9.Use Structural Insulated Panels(SIPS)
a.Floors 3 Energy pts y=yes p
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
a.Subfloors 1 Resource pt y=yes D
b.Sheathing 1 Resource of y=yes 0
xter or n s
1.Use Sustainable Decking Materiels
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 ChromiurnfArsenic 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
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
Ft.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 Toiled with Ultra-Low Flush Toilets
(1 point each,up to 3 points) 'Up l0 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 IAO/Health pts. 0
B.Install On-Demand Hot Water Circulation Pump 4 Resource pts y--yes 0
r.eiecmcai
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 I 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 pts y--yes 0
H.Insulation
1.Upgrade Insulation to Exceed Title 24 Requirements
a.Walls 2 Energy pts yryes 0
b.Ceilings 2 Energy pts Y--yes 0
2.Install Floor Insulation over Crawl Space 4 Energy pts y--yes 0
1 Install Recycled-Content,Fiberglass Insulation with
No Added Formaldehyde 3 IAQ/Health pts y=yes 0
4.Use Advanced Infiltration Reduction Practices 2 Enargy 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.Allemative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y--yes 0
c,t;emngs 4 Resource pts y=yes 0
1 1 1
• , ., m owa ITAPLIT Resources Energy ADMealth
1.Install Energy-Efficient Windows
a.Double-Paned }
• r._e____—_,�__._ 1Energypt yeses 0
I .b.Low-Emissivity(Low-E) 2 Energy pts y=yes 0
( c.Low.Conductivity Frames _ 2 Ener is
----- Energy Y yes 0
2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 0
1 1 1
J.Heating Ventilation and Air Conditioning
r`Use Duct Mastic On Alc Dud 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 21AQ/Health pts y=yes D
5,Install Solar Attic Fan 2 Energy pts y=yes 0
S.Install Attic Ventilation Systems 1 Energy of Y--yes 0
7.Install Whole House Fan 4 Energy pts y=yes 0
8.Install Sealed Combustion Units -
a.Furnaces 31AQ/Health 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 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 slovestiinserts 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 D
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) 51AQ/Health pts y=yes 0
17,Install Separate Garage Exhaust Fan 31AQ/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_6etiii Safe—an d Durable Roofing Matarials 1 Resource pty=yes 0
T Install Radiant Barer 3 Ener is
9Y P 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 1
•
1
ADIHeafth
. n oor r ue ty an n s es - '
1.Use Low%No-VOC Paint 1 IAO/Health pts y--yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAO/Health pts y--yes 0 •
3.Use Low/No VOC Adhesives 31AOMealth 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 61A0/Hsalth pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAO/Health pts y--yes 0
7.Seal all Exposed Particleboard or MDF 4 IAO/Health pts y--yes 0
8.Use FSC Certified Materials for Interior Finish 4 Resource pts y--yes 0
9.Use Fingsr-Jointed or Recycled-Content Trim 1 Resource pts y--yes 0
10.Install Whole House Vacuum System 3 IAO/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 0
4.Install Natural Linoleum in Place of Vinyl 51A0/Health pts y--yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y--yes 0
S.Install Recycled Content Carpet with Low VOCs 4 Resource pts y--yes 0
1 i 1
Total Points AM15671 1 1401 1301 57
Total Points Project Received: 1 01 1-51
G:daWpmgsrgreenbulldmgguidelinesrremodelerslgmmpolntsfinel212.e4prote.ted.xts
•
e Community Development
10300 Torre Avenue
JCupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
*UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT #
O�a�ao �0
OWNER'S NAME: N PHONE # mor qq&Q16oF--
GENERAL CONTRACTOR: , S FAX # �Trj r77,7
I am not using any subcontractors
Signa Date
Please check applicable subcontractors and com let the ollowing information:
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
O r/Contractor Signature Date