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08090107 CITY OF CUPERTINOr> .a �riE "°�' -BUILDING DIVISION PERMIT CONTRACTQR)TNF,,OT,tMATION BUTWING ADDRESS: PERMIT NO. 11510 WELL SPRING CT TBD — TO BE DETERMINED 08090107 . OW NER'S NAME: PERMIT ISSUE DATE GATLEY CHRISTOPHER J AND 09/17/2008 RE;w moor SANITARY NO. CONTROL NO. ARCHMICT/ENGINEER: BURRING PERMIT INFO BLDG ELECT PLUMB MECH X00 LICENSED CONRACrOWSDECLARATION JpbDesGn Description rd u F 1 hueby affnn oral 1 un HouuN undcr provisions of Clasp.9(mmmcncing P VK withSmdon]0(IB)ofDiHwon3ofNeBusimasand ProrudumCode, mylzamcis RE—RF RMV EXT SHKRF INSTL 1LYR OF 30# in full force and effect. /®7 1 5 2'q_ LieencClya lY.g FLTUNDRLYMNT ,t p Date Y% ComruYr C go/., tine 7W ARCHITECTSDEcuRAnoN �IeTNSTL GAF/ELK SHNGLS CLS A 26SQ EXT PLYWD CLS A < 1 undemund my plan shall W mand v Public mcoNs w Ddu NOTE: OCR SERVICES INC PD FOR BSL 9/17/8 �C t; Licensed Profound ..) OWNER-BUILDER m CLARATION coo W mby alum Nu I am,Bump,from Be Con ms ors Any c Law for the coo showingmmna.(Sauen]1nstr Buadw. andom.dcomi Co de:Any city of county $ which mquirns a permit m corsxiwa.alar,impmw,demo)W,or moor any avunum —Zy prior to its lssusWo.also mquims the applicant rorsach permit W file a sigtmd suumcnt Esc mat W is umnsed purwani to the provisions of the CoUM101-1 Uca.lew(Chaptcr 9 Sq.Ft. Floor Area Valuation y F (commencing with Secdon 7000)of Division 3 of tie Business and Profession Code)or . $9000 e S$— that he is ewmpl IMmfrom and the basis for the alleged exemption.My violation of Section 70315 by any applicant fora permit wb*u de applicant W a civil penally ofNumber Occu ane e .1mmethat fiabuwmdd.11m,(S 36651038 - P YTYP ❑Lasowarofte pmpcoy,w my oroployvor with wage astheuwleeompewdon, will do Be work,and the sanctum is notinunded«offemd forsale(Sec.7014.Bnsimus and Professions Code:The Como cmrs LIceam Law door not apply to an owns of Required Inspections properly who buildiorimpmrestMcmn,and who doessuch work himmlfor through his owncmployca.proHarA mal web improwmmu ore rot inrerded oroRerrr)f«sale R, bowevm,me Wilding ar impmwmdu u old within arc Wild of complmthe awrer- builder will havethe barons of proving mat W did Out build Or impmfor far purywe of ale.). ❑1,as owner of the propurty,w aclusively,corm d.g wins IiaruW mnbaemrs to construct IW pmjcm(Sec.7014.Business aM Professions Cade:)Tho Caooscmrs U. across Law dao not appy an an owmr of property who Wads or improves memon.and. who contracts for such projects with a co ncubor(s)licenced pmwam to the Contractors Licmac Law. I am aempt under See ,B h PC for this mason Owner Data WORKERS COMPENSATION DECLARATION 1 Wreby affirm under penalty of pedury,arc of de fallowing declarations: I haw and will mainuin•Cerdfiou of Consent W self-insure for Workers Camper, satim,as provided for by Section 3700 of the ISWr Code,for the perfoWatee of de work for which this i mnit is issued. ❑I haw and will maintain Workers Cumpeasstion I...as mquirtd by Socamn 37M of the lsbw Code.for the performance ofthe ooh for which this permit Is isad. ' My Worker+Campewdap Ins rtmw Gamier and Policy number are: cad o,l/�•rfi'v>^-/ r/rx �✓ Policy No.: We. 199 Y773� CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE Eruct oration mad not W compkud if IW Escort,is two=hundred dollars($10(f) or less) 1 ardfy dot in the performance of the work for which this purmh is issued.l Purl rant employ any person in any mamer an as W baomewbjci W the Workms'Compensation Laws of California-Dau Applicam NOTICE TO APPLICANT:If.afar making this Oenificeu of Exemption,you should bmome subject to the Workera Compcwtion provisions of arc Lmmr Code,you mud .J O E forthwith comply with such provision w this yemrit dull W deemere d wind. _. Z" CONSTRUCTION LENDING AGENCY ti 4 li muchy aRthi and than isconsuucti lending agency for tie performance of the work wh fur which this permit is Issas(Sec.700 9'i,Or.C.) Qlender's Namc .7. z Ierwera Adams V O 1 candfy,that 1 have rad this application and sou that the am,irdo mau s is U. const I si m,to comply with all city and county on ina ort and suss laws aiding W .O Wilding conswcuon,and hemby authpdm repmsenutivet of this city in catty upon the shove.memimcd properly far inspection puryoses H cL (We)agme W an,indemnify and Fecp hamlets the City of Cupertino against rn liabilities,judgmenss,cosu and apcusor which may Warty way accrue against said City in conacgaree of th,granting of this Ewmh. _ r. SOP C tpUINDDERSTAN/DS AN WIL COMPLY WITH ALL NON-POINT Issued by: Date �>��� z� / /)s--.7y9—/7—u Re-roofs Signature of pplianUCanuamor Due HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the vitlianl or future Wilding occopratsom or handle bruraons maudal U defined by the Cupertino Municipal Code.Chapur 9.12,and the Horlth and Safety cane,semen 25532(.)?❑Ye �rva All roofs shall be inspected prior to any roofing material being installed. Will the.Mliaatarfutumbuildingwxuwni=cquipmmtM&� whiCh If a roof is installed without first obtaining an inspection,I agree to remove 1 rt harudna air commuct rts as dofrod by doe Bay Ara Air Quality Managcmcm all new materials for inspection. am ❑Yca 1 I ban mad arc hauNau maerials rtquimmcnss under CTupurh.9sofde Wilding rata HA althhSafnyCaae,Sav us0s.sssn awus3e.l mrdvwM mnirme Wilding dor Tot curmndY warrnan11 tithrpy msponfibility m Wary de occupant of the coq nen;�whie maxi «Wihuncar,c are,uarOmpuey. Signature of Applicant Date h� All roof coverings to be Class'"or better Ower w authomsd ager Data CITY OF CUPERTINO • 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36651038 . 00 DATE ISSUED. . . . . . . : 09/17/2008 RECEIPT #. . . . . . . . . : BS000006110 REFERENCE ID # . . . : 08090107 SITE ADDRESS . . . . . : 11510 WELL SPRING CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : GATLEY CHRISTOPHER J AND CATHA ADDRESS . . . . . . . . . . : 11510 WELL SPRING CT CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5136 RECEIVED FROM . . . . : OCR SERVICES INC 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 91000 . 00 0 . 90 0 . 00 0 . 90 0 . 00 1REROOFRES SQ FEET 26 . 00 338.. 00 0 . 00 338 . 00 0 . 00 ---------- ---------- --------- ------ TOTAL PERMIT 338 . 90 0 . 00 338. 90 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 338. 90 #1056 --------------- TOTAL RECEIPT 338 . 90 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 CITI�OF CUPEkTINO PERMIT APPLICATION APN# Date: �bb5iv3� Ou qq7 -o Building Address: //6/0 Well S Y,'n c t Owner's Name: Phone#: W) SIoz9- /V chr,s &�f/�y cc) (4.N) 690- (/70 Contractor: O G R S U/a✓ and oo f r Phone #: -ro7 // 6q- 7L}7 O -7o Aldy-rte! e P-cLl s�te5-44 d V XC U� Fax#: 03- 6 - &Zyd Cupertino Business License #: Contractor License #: 9o7/s� Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles '* Asphalt Shingles --/i. Wood Shakes ❑ Wood Shakes . ❑ Wood Shingles L3Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings / ❑ Provide I.C.B.O. Report# )8 To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: emeue eXjS /7t s oK� Yo ins one Gc' eY of30 {'elf//unclPvlaym �nf i Sns /I (27- 4f%LK sh,'1)91z-5� a(o s9s , P�f h eA1'31VV)00d a&ss 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: 90 v v AHReadQUnd�er`sta an Wi Compwith Cupertino's Tear-Off Policy: ✓ V ! u � Signature Revised 6/16/08 CITY OF CUPERTINO �(a REROOF CITY& • CUPEkTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group IREROOFCOM Re-roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Commercial B 1REROOFRES Re-roof Residential B 1SFDWLR00F 1 1BSEISMICRE Seismic Residential B 1REROOFMRES 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 fora 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: (f L1Y) S6?cc / Ito ! Job Site Address: // 510 Well Roofing Company Name: 0C 2 S O L //L ay-) Applicant's Signature: 4_� Date: q /�L/0,3/ • 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 p6ints 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-3 120- nt P. Other 1. List Green Features on Plans A-1 1ntTOTAL POINTS 40nts • • 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. A.Site F ycle Job Site Construction&Demoli on Waste=1 point;75%= 2 points;BD%=4 pointsup to 4 Resource pts 0 vage 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 Stonmwater Practices 2 Resource pts y=yes 0 7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0 B.Design Resource EfficientLandscapes and Gardens_ _ _ 4 Resource pts y=yes D 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 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 D 1 1 1 C.Structural Frame 1.Substitute Solid Sawn Lumberwith Engineered Lumber _� 3 Resource pts y--yes 0 2.Use FSC Certified Wood for framing (For every 10%of FSC lumber used=2 paints,up to 10) up to 10 Resource pts. D 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 D 5.Design Energy Heels on Trusses 6'or more 2 Energy pts y=yes D 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 Interior Framing 2 Resource pts y=yes 0 9.Use Structural Insulated Panels(Sips) a.Floors 3 Energy pts y=yesD 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 D 11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes p ------ I a.Subfloors 1 Resource of y=yes p • b.Sheathing I 1 Resource pt y=yes 0 1 1 1 INPUT ResDurres Energy IADII­le�lltr av xterior Finish ;1.Use Sustainable Decking Materials ia.Recycled content 3 Resource pts y--yes 0 • b.FSC Certified ed Wood 3 Resource pts y--yes 0 12.Use Treated Wood That Does Not Contain ChromiumlArsenic j 1 IAO/Health pt y=yes 0 13.Install House Wrap under Siding f 1 AQ/Health pt y=yes 0 !4.Use Fiber-Cement Siding Materials 1 Resource pt y--yes 0 E.Plumbing 1.Install Water Heater Jackst ~__ _J 1 Energy pt y=yes 0 2.Insulate Hot and Cold Water Pipes 2 Energy pts yryes 0 3.Retrofit all Faucets and Showerheads with Flow Reducers i a.Faucets(1 point each,up to 2 points) I Up to 2 Resource pts. 0 b.Showerheads(i 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 yryes0 6.Convert Gas to Tankless Water Heater 4 Energy pts Y_-yes0 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 Hol Water Circulation Pump 4 Resource pts y=yes 0 1 1 1 r-.riecmcai 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 G.Appliances 1.Install Energy Star Dishwasher J 1 Energy pt y=yes 0 2.Install Washing Machine with Water and Energy 1 Conservation Features f 1 Energy pt y=yes 0 3.Install Energy Star Refdgerator ` 1 Energy pt y=yes o 4.Install Built-In Recycling Center 3 Resource pts y=yes 0 ------ --r 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 rInstall Rec bk:1--Content,Fiberglass Insulation with - o Added Formaldehyde 3 IAQ/Health pts y=yes 0 4.Use Advanced Infltration 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 C • 6.Alternative Insulation Products(Cotton,spray-foam) a.Walls 4 Resource pts y=yes D o.ueilings 4 Resource pts y=yes 0 1 1 1 ' I.Windows INPUT ResDurces Energy 1ADIHealth i1.-Insiall ElergyEfficWit Windows • a.Double-Paned 1 Energy of y=yes 0 b.low-Emissivity(Low-E) 2 Energy pts y=yes 0 c.Low.Conductivity Frames _ _ i 2 Ener is e L-- -- at --- -- Energy Y--yes s 0 2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 0 1 f 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 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 pis y=yes 0 12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pis y=yes 0 13.Retrofit Wood Burning Fireplaces • a.Install EPA certified wood stoves/inserts 1 IAQ/Health of y=yes 0 J. 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 4 IAQ/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/Haalth pts y=yes 0 . I 1 I 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 pis y=yes 0 3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pis y=yes p 4.Install Photovoltaic(PV)System (1.2 kw=6 points,2A kw=12 points,3.6 kw=18 points) Up to 18 Eneray pts p 6.Select Safe and durable Roofing Walerials - 1 Resource --- - - - - ---- pt y=)e5 0 7.Install Radiant Barrer 3 Energy pts y=yes p 1 1 1 L.Natural Heating and Cooling 1.Incorporate Passive Solar Heating 5 Energy pis y=yes p 2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts . y=yes p 3.Plant Deciduous Trees on the West and South Sides 3 Energy pis y=yes p 1 1 1 iX.Tnoor Alr Quality an Finishes �.Uso LowMo VOC Paint u 1 IAQ/Health pts y--yes 0 2.Use Low VOC,Water-Based Wood Finishes _ 2 IAQ/Health pts y=yes 0 • i3.Use Low/No VOC Adhesives 3IAQMealth pts y=yes 0 4.Use Salvaged Materials for Interior Knishes 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/Health pts y=yes 0 if.Seal all Exposed Particleboard or MDF . __ 4 IAQ/Health pts y--yes D B.Use FSC Certified Materials for Interior Finish 4 Resource pts y--yes 0 9.Use Finger.-Jointed or Recycled-Content Tim 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 B Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials J J 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 IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpel with Low VOCs 4 Resource pts yyYes 0 1 1 Total Points A 1 140 130 57 Total Points Project R 1 01 OT-701 • G:data/progsrgreenbuildngguidelineshemodelersrgmenpdntsUnal2.72.04protected.xk • ..�., Community Development p 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 * UMkJINO Building De artment i JOB ADDRESS: PERMIT # 10535 PAI (A *c>M Ne- I OWNER'S NAME: j f I Lf 1 --f7 PHONE # 4Z4Y -44gq , GENERAL CONTRA OR: P6ff FAX # GIS-115 I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following 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 A66PIN6 I NL U 21 2,'1 Septic Tank Sheet Metal Sheet Rock T" e y i7 -0 Owner/Contractor Signature Date