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CITY OF CUPERTINO
DIVISION PERMIT
"CTPAINFOItMA'CIOI
BUILDING
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PERMIT08050124
SAN JUAN RD
TBD - TO BE DETERMINED
NER'S NAME:
PERMIT ISSUE DATE
GARY QUEEN
05/14/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDGEfECI PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
ime,
Job Description
I hereby affirm that 1 am li¢n¢d ander pori or Gap. 9 (commencing
with Secd.n7")ofDividon3ofthe Bumness dP.fLqS (aLy Aanderylfeeuei+
CI
.....
RE -RF T/0 EXSTNG RF& INSTL 80MIL PVC RF SYS CLS A
In III( (ora and J7 3
License Clua Li Lb. g Z::)25
SQ .
Dam Canucwr -
y p ARCHITECTS DECLA 20"`SI e
1 uMmunJ m ------ band u public records 'r// ??0 fl ,G`n
Licensed Pmfa tsumod
OWNER -BUILDER DECLARATION
1 berehy affirm Nat I am exempt from Ne COmtraelofs License Law for the
following moon. (Sadao 7U31.S. Business aM Pmfeui.a Cade: Any city ar county
which requires •permit b cot-uaeL slot, impmvs, dcmnlish. m repair any suacloc
prior tons issuatce. also requites da, ... It., far such pumil to file aligned summa,
W is licensed to Nc of the Communes Lanz Law(Gapmr 9
Sq. Ft. Floor Area
Valuation
that pursuant provisions
(commencing with Section 7000) of Division S of the Business and Professions Cade) Or
$20000
that he is exuap themfmm and the basis In, the Online[ eammptioa My violaue , of
Section 7031.5 by my applksnl for a permit subjects the sIlic.L on. evil penally of
umer
Occupancy Type
nm more than fe handled dollars(1504
34221030)
0 I, u owner althe property, m my omployco with wage a dmbmo compeasadon,
will do the worle and the auuuure is not intended oaffered for sale (Sce.'f0&a, Budmas
Required Inspections
and Profession, Crew The ConuacmYs Liee•a Law does an, apply the an owner Of
Property WOds or improes drvcon,std whodaoluchwok himselfm Wrough his
own emple,n es, provided that such impro ememu an, not imeMed oroffered forule If,
howevo. Ne building Or improcanenl Is sold within one yea of cmepletion. the owner -
Wader, NB haw the huhu, of Proving that be did mm build or impmw: for purpose of
sale.).
0 I, as owner of IM property, am aclusively contracting with licensed rontmuors to
'
constrict the Dolens (Sec. TOsd, Business and Professions Cade:) The Couucmts L.
.
ante Law does not &PPly to an owner 0f property who Wilds or impows damcm. and,
who contracts for such projects with a contrae0r(s) licensed posam in the Contractor's
Isms taw.
O lamaemplunder Sens .B&PCfo dds mason
o Date
WORKERS COMPENSATION DECLARATION
I hereby rants under penally of PeOmY arc of the following declarations:
0 l ham and will maintain • Cerdficam.f Consent to self-iasusu for Wertels Comps-
-
auion, as provided for by Section 3700 of the Isbo Cade. for the Performance of the
...
wok for which this pcmdt is bound
0 I Itave and will maintain Workre, Compensation lumina, at Feel by Schon
'
3700.17 Ne labor Cade, Ica thep?armance attic wort for which Nu Permit a Wood.
'
My Wartne.cro1atp-emfado0 vier and Polity numbvam:
Grtier. JfL�- lam Polioy No.: � 3CI ocxi
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This session nand mteerompleod If the Farah H foachundrW cleanest (SIDE)
Or lata)
1 certify that in the peformece of the wok for which this permit It issued. I snail no
employ any Person in any maMerm a to We. subject in the Workers' Conpevadon
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you Amid
baoome subject in dm Whorl Composition provisions of the Isom Code you mus,
forthwith comply with such pron dons or this Permit Nall be deeme! revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affam Nat there is a construction lending agency for the performance of
the wart for which this Permit is Wood (See 3097. Civ. C.)
lenders Nurse
Lenders Md.
1 casify that I have read this application and sum that can shove information is
cumene. l agree to comply with all city and county omimences and awe laws misting to
Wilding construction. tad hereby suthadm reprexaadvet of Nu city as aor upon the
above-mamdaned propertyds.cme far Inspection puryOsea
(We) &goes 10 rove. indemnify sod trop harmless use, City of Cupertino agairw
and6.g expnsu whim may in my �+'sY &roue agaimsmid Cly
Incoidalu c..1 thec.s
in cansequcnce of the drandng of this Pennll
'
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURPGUlyrj'IppiF�\
Issued by: Date I—/ ^��-
��of (t/1/a. /�—�`� J S_�
Re -roofs .
S,gnu rtof AppliaHAZARDO Ons.
to
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Willy se future Wilding oevpant slam orhandle haardou material
t e Cunni
Cupenin0 Municipal Cade. Gapta 9.12 and the Health and Safety
u deESee
.. 25
. pvu zss3x(a)T Aa
All roofs shall be inspected prior to any roofing material being installed.
Will thea scant or future building Osu ani am o della. whim
po g p
If a roof is installed without first obtainingan inspection, I agree to remove
co Air Qu
'i7�mo tar conuminanu u deEnN by the Bay Arta Air Quality Managcmenl
all new materials for inspection.
Dlami
DYes 16NO
1 ham mal the haamusseraeriais mWiremenu under Llap,od.95 of do Glifor.
nu Ha1N&SO Cade, am-25505.25533and Z5534.1understsnd NuifNe building
dna Tal cwrtndy M1am i c Nu it u my mapoalY b ratify Nc oaupanl of Nc
re,iPam h be i morbid" ma°r ° y g
� / YDow
Signature of Applicant Date
All roof coverings to be Class 'n" or better
Gmeerorauthori rdagent
• 3 ITEMS OF 3
•
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 34221030.00
DATE ISSUED.......: 05/14/2008
RECEIPT #.........: BS000004777
REFERENCE ID # ...: 08050124
SITE ADDRESS .....: 22830 SAN JUAN RD
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER .:..........: CARY QUEEN
ADDRESS ..........: 22830 SAN JUAN RD
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
OPERATOR: patg
COPY # : 1
RECEIVED FROM ....: BRETT SHELTON ROOFN
CONTRACTOR .......: TBD' -.TO BE DETERMINED LIC # 00096
COMPANY ..........: TBD - TO BE DETERMINED
ADDRESS
CITY/STATE/ZIP ....
TELEPHONE ........:
FEE ID UNIT
-----------------------
QUANTITY
----------
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
1BSEISMICR VALUATION
20,000.00
----------
2.00
----------
0.00
----------
2.00
----------
0.00
IBUSLIC FLAT RATE
1.00
110.00
0.00
110.00
0.00
1REROOFRES SQ FEET
25.00
325.00
0.00
325.00
0.00
TOTAL PERMIT
----------
437.00
----------
0.00
---------- ----------
437.00
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT
AMOUNT
---------------
437.00
---------------
437.00
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
REFERENCE NUMBER
--------------------
#43944
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
•
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CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION
APN # �, 4aa l � 3 � • � �
Date:
Building Address: �G. 9,501(49,501(4ag3D San Joan!2C@
C�pe�tinc�, C
.
Owner's Name:
Card Noeen
Phone #:
qa- yy(0-al0g1
Contractor: SHELTON ROOFING
-Phone #:
1245 Thompson Ave. L
Santa Cruz, CA 95062-3229
Fax #: 931- 00- 19 39
Cupertino Business License #: (831) 464-4120
Contractor License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built -Up Roof ❑ Built -Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
�{ Other (Specify) fjrW X Other (Specify) SD M� 1 1:1�,
Number of existing coverings ❑ Provide I.C.B.O. Report #
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:PVC
--rear Of P 2>< I S�1(lOJ M%, 1 o S $D M i -�6 ndo
scarf o•. SyS+e.m
Residential k17V 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:
`FOD 000
I Have R5#, Understand and Will Comply with Cupertino's Tear -Off Policy:
t�
CITY OF
CUPEkTINO
CITY OF CUPERTINO
REROOF
FEE SCHEDULE
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
1REROOFCOM
Re -roof Commercial
B
1COMMLROOF
1BSEISMICO
Seismic Commercial
B
cL�
1REROOFRES
Re -roof Residential
B
1SFDWLR00F
1BSEISMICRE
Seismic Residential
B
1RER00FMRES
Re -roof Multi -Family
B
1MFDWLROOF
1BSEISMICRE
Seismic Residential
B
I
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: - C -!CA 0, ck e-eVl
Job Site Address: 2 Z t �d &vt Rk
Roofing Company Name: ``-r� C-e��� F oo�Ll�
Applicant's Signature:
•
Greg Casteel
Building Official
Revised 11/2/04
a
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0
0
Plan Review Process Work Book Page -I rReised 3/25/08
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
11. Permeable Paving,Note
L-1
C.
Foundation
1.
Use 15 % Flyash Concrete, (note)
S-1
72points
D.
Structural
3.
Uses Wood I -Joist, (See Spec.)
S-2
5.
Use Truss with heels, (detail)
S-2
6.
B. OSB Sheathin detail
S-2
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 paints
5.
Tankless W.H., (Note/Spec.)
A-2
2 paints
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 POINTS
2
40 points
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Plan Review Process Work Book Page -I rReised 3/25/08
Green Points Rating System for Remodeling Projects
• Due to the diversify 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.
1. Recycle Job Site Construction & Demolition Waste
j
65%=1 point; 75°%= 2 points; BDA° = 4 points
I( up to 4 Resource pts
2. Salvage Reusable Building Materials_ _
M 4 Resource pts
y=yes
3. Remodel for Mixed Use, Adaptive Reuse, and
(For every 10% of FSC lumber used = 2 points, up to 10)
up to 10Resourcepts.
Historic Preservation
4 Resource pts
y=yes
4. Protect Native Soil
2 Resource pts
y=yes
5. Minimize Disruption of Existing Plants & Trees
1 Resource pt
y=yes
6. Implement Construction Site Stormwater Practices
2 Resource pis
y=yes
7. Protect Water Quality with Landscape Design
2 Resource pts
y=yes
6. DesignResou ce Efficient Landscapes and Gardens
4 Resource pts
y=yes
9. Reuse Materials/Use Recycled Content Materials
_
y=yes
for Landscape Areas
2 Resource pts
y=yes
10. Install High -Efficiency Irrigation Systems
2 Resource pts
y=yes
11. Provide for On -Sita Water Catchment / Retention
2 Resource pts
y=yes
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
2, Use Recycled Content Aggregate 2 Resource pts y=yes
3. Insulate Foundation/Slab before backfill , �,, _,
C. Structural Frame
1. Substitute Solid Sawn Lumber with Engineered Lumber
-11 3 Resource pts
2. Use FSC Certified Wood for framing
y=yes
(For every 10% of FSC lumber used = 2 points, up to 10)
up to 10Resourcepts.
3. Use Wood I -Joists for Floors and Ceilings
2 Resource pts
y=yes
4. Use Web Floor Trusses
2 Resource pts
y=yes
5. Design Energy Heels on Trusses 6° or more
2 Energy pts
y=yes
6. Use Finger -Jointed Studs for Vertical Applications
2 Resource pts
y=yes
7. Use Engineered Studs for Vertical Applications
2 Resource pts
6. Use Recycled Content Steel Studs for Interior Framing
2 Resource pts
y=yes
9. Use Structural Insulated Panels (SIPS)
y=yes
a. Floors
3 Energy pts
y=yes
b. Wall
3 Energy pts
y=yes
c. Roof
3 Energy pts
y=yes
10. Apply Advanced Framing Techniques
4 Resource pts
y=yes
11. Use Reclaimed Lumber for Non Structural Applications
3 Resource pts
y=yes
a. Subfloors
• L
{j 1 Resource pt
y=yes
b. Sheathing
`_
i 1 Resource of
v=ves
!1. Use Sustainable Decking Materials 1
Q
1. Install Compact Fluorescent Light Bulbs (CFLs)
a. Recycled content
3 Resource pts
y --yes
j b. FSC Certified Wood
3 Resource pts
y --yes
12. Use Treated Wood That Does Not Contain Chromium/Arsenic 1(
1 IAQ/Health pt
y=yes
3. Install House Wrap under Siding (
1 IAQ/Health pt
y=yes
4. Use Fiber -Cement Siding Materials _ _ +
1 Resource pt
y=yes
E. Plumbing
1. Install Water Heater Jacket — „_
.1. Energy pt
Y --yes
2. Insulate Hot and Cold Water Pipes
2 Energy pis
Y --yes
3. Retrofit all Faucets and Showerheadswith Flow Reducers
2 Energy pts
y=yes
a. Faucets (1 point each, up to 2 points) ' ,
. Up to 2 Resource pts,
b. Showerheads (1 point each, up to 2 points) {
Up to 2 Resource pts,
4. Replace Toilest with Ultra -Low Flush Toilets
No Added Formaldehyde
(1 point each, up to 3 points) J
Up to 3 Resource pts.
5. Install Chlorine Filter on Showerhead
1 IAQ/Health pt
y=yas
6. Convert Gas to Tankless Water Heater
4 Energy pts
y=yes
7. Install Water Filtration Units at Faucets
4 Resource pts
y=ya!
(2 points each, up to 4 points)
Up to 41AQ/Heallh pts
8. Install On -Demand Hot Water Circulation Pump
4 Resource pts
y=ye:
r. tiecmcar
Q
1. Install Compact Fluorescent Light Bulbs (CFLs)
1. Install Energy Star N-shwashwr
(6 bulbs=2 points, 10 bulbs � points, 12 bulbs = 4 points)
Up to 4 Energy
2, Install IC -AT Recessed Fixtures with CFLs (1 point each, up to
5 points)
Up to 5 Energy
3. Install Lighting Controls (1 point per fixture, up to 4 points)
Up to 4 Energy
4. Install High Efficiency Ceiling Fans with CFLs
1 Energy pt
(1 point each, up to 4 points)
Up to 4 Energy
G. Appliances
Q
0
1. Install Energy Star N-shwashwr
1 Energy pt
Y --yes
2. Install Washing Machine with Water and Energy
Conservation Features
1 Energy pt
Y --yes
3.Install Energy Star Refrigerator
1 Energy pt
y=yes
4. Install Built -In Recycling Center
3 Resource pts
y=yes
H. Insulation
1. Upgrade Insulation to Exceed Title 24 Requirements
a. Walls
2 Energy pts
y=yes
b. Ceilings
2 Energy pts
y=yes
2. Install Floor Insulation over Crawl Space
4 Energy pts
y=yes
fK Install Recycletl-Content, Fiberglass Insulation with _
'
i
No Added Formaldehyde
31AQ/Health pts
y=yes
4. Use Advanced Infiltration Reduction Practices
2 Energy pts
y=yes
5. Use Cellulose Insulation
a. Walls
4 Resource pts
y=ya!
b. Ceilings
4 Resource pts
y --ye!
6. Alternative Insulation Products (Cotton, spray -foam)
a. Walls
4 Resource pts
y=ye
D. Cemngs
4 Resource pts
y=ye,
0
Ll
E
Q
0
0
0
Ll
E
1. Install Energy -Efficient Windows
a. Double -Paned
1 Energy pt
It. Low -Emissivity (Low -E)
1 2 Energy pts
c Low. Conductivity Frames
2 Energy pts
_
2. Install Low Heat Transmission Glazing
- 1 EnergV of
J. Heating Ventilation and Air Conditioning
2 Energy pts
y=
Fl. Use Duct Mastic on All DuCt Joints
2 Energy pts
Y --Yes
2. Install Ductwork within Conditioned Space
3 Energy pts
Y --yes
3. Vent Range Hood to the Outside
1 IAQ/Health pt
y=yes
4. Clean all Ducts Before Occupancy
2 IAQ/Health pts
y=yes
5. Install Solar Attic Fan
2 Energy pts
y=yes
6. Install Attic Ventilation Systems
1 Energy pt
y=yes
7. Install Whole House Fan
4 Energy pts
Y --yes
S. Install Sealed Combustion Units
3 IAQ/Health pts
y -
a. Furnaces
3 IAQ/Health pts
y=yes
b. Water Heaters
3 IAQ/Health pts
y --yes
9. Replace Wall -Mounted Electric and Gas Heaters with
4 Energy pts
y=
Through -the -Wall Heat Pumps
3 Energy pts
y=yes
10. Install 13 SEER/11 EER or higher AC with a TXV
3 Energy pts
y=yes
11. Install AC with Non -HCFC Refrigerants
2 Resource pts
y=yes
12. Install 90%, Annual Fuel Utilization Efficiency (AFUE) Furnace
2 Energy pts
y=
•. 13. Retrofit Wood Burning Fireplaces
a. Install EPA certified wood stoves/inserts
1 IAO/Health pt
y=
b. Install/Replace Dampers
1 Energy pt
y=
c. Install Airtight Doors
1 Energy pt
y=
14. Install Zoned, Hydronic Radiant Heating
3 Energy pts
y=
15. Install High Efficiency Filter
41AQ/Health pts
y=
16. Install Heat Recovery Ventilation Unit (HRV)
51AQ/Health pts
y=
17. Install Separate Garage Exhaust Fan
3 IAQ/Health pts
y -
K.
K. Renewable Energy and Roofing
1. Pre -Plumb o tern a ing
4 Energy pts
y=
2. Install Solar Water Heating System
10 Energy pts
y=
3. Pre -Wire for Future Photovoltaic (PV) Installation
4 Energy pts
y=
4. Install Photovoltaic (PV) System
(1.2 kw = 6 points, 2.4 kw =12 points, 3.6 kw = 18 points)
Up to 18 Energy
' �6. SSelect Safe andDurable Rotfing Matelots` —i
1 Resource pt
y=
7. Install Radiant Barrer «—
3 Energy pts
y�
L. Natural Heating and Cooling
1. Incorporate Passive Solar Healing 5 Energy pts
2. Install Overhangs or Awnings over South Facing Windows 3 Energy pts
3. Plant Deciduous Trees on the West and South Sides 3 Energy pts
0
1. lJie' LowMo-VOC 1 IAQ/Health pts y --yes
2. Use Low VOC, Water -Based Wood Finishes_ 2 IAQ/Health pts y=yes
3: Use Low/No VOC Adhesives _ __ i 3 IAQ/Health pts y=yes
4. Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes
5. Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes
6. Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes
LT Seal all Exposed Particleboard or MDF 4 IAQMealth pts y=yes
B. Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes
9. Use Finger -Jointed or Recycled -Content Trim 1 Resource pts y --yes
10. Install Whole House Vacuum System 3 IAQ/Health pts y=yes
0
D
0
B Resource pts
D
0
0
0
0
0
0
4 Resource pts
3. Use Recycled Content Ceramic Tiles
4 Resource pts
4. Install Natural Linoleum in Place of Vinyl
5 IAQ/Health pts
5. Use Exposed Concrete as Finished Floor
4 Resource pts
6. Install Recycled Content Carpet with Low VOCs
4 Resource pts
N. Flooring
1. Select FSC Certified Wood Flooring
B Resource pts
Use Papidly Renewable Flooring Materials - __�
4 Resource pts
3. Use Recycled Content Ceramic Tiles
4 Resource pts
4. Install Natural Linoleum in Place of Vinyl
5 IAQ/Health pts
5. Use Exposed Concrete as Finished Floor
4 Resource pts
6. Install Recycled Content Carpet with Low VOCs
4 Resource pts
Total Points Available: 1 1401 1301 57 •
Total Points Project R 1 01 01 0
3:datalpmgsrgreenbuild'mgguidellnes4emodelerslgreenpointsfinal212.D4pmlected.tls
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CITY OF
stUPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS: PERMIT #
22830 SaL1 J ttc�h
06050 I
OWNER'S NAME: e- r Glu c eL t� PHONE #
GENERAL CONTRACTOR: c , Koo FAX #
I am not using any subcontractors: / "&''^^t' V�v g-lv-5
Signature Date
Please check applicable
Owner/ Contractor Signature
Date
SUBCONTRACTOR
uuvaii �QLlVlI.
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