08070200 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACR1IUILM A�7OPT
BUILDING DRESS: PERMIT NO.
22S�S CREEKSIDE CT DIAZ ROOFING 08070200
OWNER'S NAME: PERMIT ISSUE DATE
R.HA, HARRISON 4652 SHETLAND WAY 07/28/2008
NE: SANITARY NO. CONTROL NO.
(925) 565-0960
ARCHIIECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u o p LICENSED CONIItACnder p DECLARATION
1 thereby affirm dust Ii
r 1 ao:wW under provisions of Chapter
er 9(commencing Job Description
4m� wectionT0010ol'Dividon3ofuuBudnessubProfueowGde,aodmyIkenxu RE—RF T/0 EXTNG RF& INSTL 30YR CMP CLS A 25SQ
in In ra er and
pi accrue Clan Lia.e .
F, Dau
ARCHITECTS DETS Dcmr
e C TON
u I underttanJ my pled ahail W stud u puhhc meords
6
t1tn Likened Fofwianal
a 0 5 OWNER-BUILDER DECLARATION
a� E I hereby alarm that 1 am csc ept from the Contractors License law for the
i
00 fallowing RMan.(section 1D313,BLLtimeas and Professions;Cade:Any city or county
13 ff which requires a permit to canswct.also.improve,dormilk L or repair any structure
_iy prioru its issuance.alwnquires be:Applicant forsuch Permit to rile a signed suument
that he is liccused pursuant to the provisions of the Conuame's License law(Chapter 9 Sq.Ft. Floor AreaValuation
omm
y (cemdng with student 7(t)(1)of Division 3 of the Business and Pm $fwionx Code) 9200
f5§ Nat he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant fa a permit sublecu the applicant to a civil penalty ofNumber Occupancy
Ma more tion five hundred dollars ISM 32639038 ..-V Pane Y Type
0 I,uo eller of the property,or my,employees with wages u their sokcompevadem,
will do the work..nit roeawctuu k trot intended or offered for aale(See.rot+,
and Professions cmc The Contractors Liemnae Law does but apply to an Bonn.
owner of Required Inspections
propeny who builds or improves domain.and wh idoeaswh wurkhimselforthrough his
marc mployw,provided that such improvements arc=I intended oroffmad for sale.B.
however,the building or improvement u.mld within one year of mmapletian.the owner-
Wilder will have du border of proven,that he did out build or improve for purpose of
sale.).
. P]1.as arc of the propert,w exdaavely camracting with M.enned conwemn to
mammut the pmjea(Sec.TWa,Business and!Profesdaw Cale)The Convectors Li-
cewe Law dons not apply to an owner of property who Wilds or improves thereon.and
who cramocu for such imoi cu with arnnu,imi.)licensed pmswnt in the communes
Licenm Law.
0 1 oro exce/ps under See B k P C for this reason
a Date I28
owner E' a 7 49
O0.KFR'S COMPENS ON DECLARATION
1 bcteby a =umer penally of pmjM arc of the following drelamtlau:
0 thaveaodwBlmainuina Cm f roof Comntmmlf-insumfaWorkcesComPen-
station,m provided for by Sttdon 3700 of the laWr Code,for the Performance of thc
work for which this Permit is iswd.
0 1 have and will maintain Workers Compewado s Inwuance,as required by Section
31i()(l of the labor Code•for de Performance often were for which this permit Is lived.
My Workers Cp ye Inarrav¢pore W Policy number
Caniv: '-�CERTIFICATE
TELT fl'F lrXE EXEMPTION
.: IZXEFES' a-✓
CERr1Fl CO OF E ATION INSURANCE PROM WORKERS'
COMPENSATION INSURANCE
Cr dermuden rued not W comPleud Bdu permit Is foraw hundred dollar($K0)
or kis)
I certifv dot in the pem
rfonance
or the work for which this Permit u issued,1 dual not
employ any Person in any manrcrmsto become subjar (nmPensuw
U o(Califan�� l .Y
Applipm
NOTICE TO CANT:IL aver making N cninpte of Escmption,you should
become subjc t m the Workers Compensation provisions of the labor Codc,you must
.,O roMwith comply with such provisions or NU Permit shall be decreed revoked.
'z^r%1 CONSTRUCTION LENDING AGENCY
E
1 hereby affirm this dare is a construction lending agency for the urfarmanco of
a ? drewakfor which wpermit ii;i,:wd(S..3097.Civ.C.)
Q Landers Name .
ice. z lenders Addmat ,
iJ Q 1 certify that 1 have mad this application and sou this the abuve information k
{Tn comm I agree 0 comply with all city and county ordinances and state laws relating to
O building construction,and hereby iuthoda representatives of this city Is cmerupnn dm
a Wone
ere-menud PmpenW
Y far Pecuon purypxs
In s
t„s gy (We)agree ere,indemnify and trap harmlCupertinothe City of Cupertino against
On
an liabilities.craticip, menu.casts and pporseswhich mrymNY way acerae agaiestaaid City
V z A APPLICANT
of cite granting of this permit.
^ APPLICANT UNDERSTANDS ANRAMIIL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RE U[ATIONS,A !
Re-roofs
Srgnuu f rpndConuactor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de applicant or future building oecnpMlFaC W tamale camt.mLmrirl
ar defined by the Cupertino Municipal Cmc.CMpur 9.11.and the Health and Safety
Cork.O.25s3u+)'! 0 N All roofs shall be inspected prior to any roofing material being installed.
will the a nkat,err future Wilding occupant us Equipment If a roof is installed without first obtaining an inspection,I agree to remove
Ire e p a prem a devices a mkt g
cD'I�ca�nw air can Wninanu s detected by the Bay Area Air Quality Management all new materials for inspection.
Dy.
I wom mad thehvartlou mamriau re drum on,under Chapter 695 of the Calif.,
.is Health 9 SafctYCade Seemoru 15505.25533 aod 25.534.laderttarb that ifthe Wilding
does rKK emimdy,have a mrWL NN it is my resPandmllry to rmdry the aSnPant of one,
mquimmepu which muttllip j
in aance of
Curticrap Si ure of Appl[cant ' Date
wauNorixcd agentPeau
All roof coverings to be Class'fW"or better
Ow
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32639038 . 00
DATE ISSUED. . . . . . . : 07/28/2008
RECEIPT # . . . . . . . . . : BS000005611
REFERENCE ID # . . . : 08070200
SITE ADDRESS . . . . . : 22015 CREEKSIDECT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO _.
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BILL HARRISON
ADDRESS . . . . . . . . . . : 22015 CREEKSIDE CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1103
RECEIVED FROM . . . . : RODOLFO N DIAZ
CONTRACTOR . . . . . . . : RODOLFO DIAZ LIC # 26457
COMPANY DIAZ ROOFING
ADDRESS . . . . . . . . . . : 4652 SHETLAND WAY
CITY/STATE/ZIP . . . : ANTIOCH, CA 94531
TELEPHONE . . . . . . . . : (925) 565-0960
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
IBSEISMICR VALUATION 9, 200 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1REROOFRES SQ FEET 25 . 00 325 . 00 0 . 00 325 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 326 . 00 0 . 00 326 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 326. 00 #5210 ..
---------------
TOTAL RECEIPT 326 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
vJO7 �Dz v
CITY OF CUPERTINO
'�N REROOF
CITY of
UPEI,TINO PERMIT APPLICATION
APN 11,3 C) J p Date: 0-7�iR/7
Building Address: 0
'Z20t5 0,12E �JbC
Owner's Name: Phone #:
gill Harrison 40e -3q3 -3827
Contractor: Phone #:
UK- C12s-5(ds—dq Cd
Fax #:
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles --)u_. Asphalt Shingles
0- Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report #
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: 7ecxr
I Z5 .S C�
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: 17, 2CD
•I Have Read, Understa d and Will Comply with Cupertino's Tear-Off Policy:
Signa re
Revised 6/16/08
Q CITY OF CUPERTINO
REROOF
C OF
CUPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMIC0 Seismic Commercial B
1RER00FRES Re-roof Residential B 1SFDWLR00F
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 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: _Bl11 h rr k5on
Job Site Address: 22015 Ueek-t)(C-_ CV .
Roofing Company Name: b (a2 O
Applicant's Signature: �• Date: 6 7 OS
•
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 It
a
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. Ener Star Refrigerator, Note/S ec. A-3 1 oint
P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS 40 points
•
Plan Review Process Work Book Page A2-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, Energy 1AD[Healih
A.Site
1.Recycle Job Site Construction&Demolition Waste
65°;=1 point;75°7,= 2 points;BO%=4 points r up to 4 Resource pts 0
2.Salvage Reusable Building Materials _ J 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
S.Implement Construction Site Stormwater Practices 2 Resource pts y=yes 0
7.Protect Water Quality with Landscape Design _ 2 Resource pts y=yes 0
LDesign Effici
Resource- ent Landscapes and Gardens _ 1 4 Resource pts y=yes 0
9.Reuse Matedais/Use Recycled Content Matedals
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 i 1
B.Foundation
1.Incorporate Recycled Flyashin 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/Siab before backfill 3 Energy pts y=yas 0
1 1 !
C.Structural Frame
11.Substitute Solid Sawn Lumber with Engineered Lumber —7 3 Resource pts y=yes 0
2.Use FSC Certified Wood for framing J
(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
S.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0
9.Use Structural Insulated Panels(SIPS)
a.Floors 3 Ener is
9Y P 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 pis y=yes 0
j
a.Subfloors 1 Resource pt y=yes 0
• b.Sheathing
L J 1 Resource pt y=yes p
1 1
INPUT ReSDurces Energy �IAQ,`Heafth
D, Door Finish -
1.Use Sustainable Decking Materials •
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 IAO Health of y--yes 0
13.Install House Wrap under Siding ! 1 IAQ/Health pt y--yes 0
14.Use Fiber-Cement Siding Materials 1 Resource pt y=yes D
I 1 1
E.Plumbing
1.Install WaterHeater Jacket — —, 1 Energy pt Y--yes D
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.Shdwerheads(1 point each,up to 2 points) Up to 2 Resource pts. D
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 y 1 IAQ/Hsalth 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 IAWealth pts. 0
6.Install On-Demand Hol Water Circulation Pump 4 Resource pts y--yes 0
1 1 1
r,.erecmcar
II1.Install Compal 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 f 1
G.Appliances
�1.Install Energy Star Dishwa'she( - -1 1 Energy of y=yes 0
i2.Install Washing Machine with Water and Energy '
lConservation Features 1 Energy pt y=yes 0
3.lnstall Energy Star Refrigerator 1 Energy pt y=yes D
4.Install Built-In Recycling Center 3 Resource pts y=yes 0
1 1 1
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
I3.Install-Recycled-Content,Fiberglass Insulation with.-
INo Added Formaldehyde _ _ ; 3 IAQ/Hsalth pts y=yes 0
Z Use Advanced Infiltration 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 0
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
o.Ceoings 4 Resource pts y=yes 0
1 1
I.Windows
'1.Install Energy-Efficient Windows -
• a.Double-Paned 1 Energy pt Y--yes 0
b.Low-Emissivity(Low-E) 2 Ener is
Energy y--yes 0
c.Low.Conductivity Frames 2
L ._. _ Energy Pts Y--yes D
2.Install Low Heat Transmission Glaiin'g 1 Energy pt y=yes D
1 ! 1
J.Heating Ventilation and Air Conditioning
1.Use buct Mastic on All Dud Joints 2 Energy pts yryes 0
2.Install Ductwork within Conditioned Space 3 Energy pts yryes 0
3.Vent Range Hood to the Outside 1 IAO/Health pt y=yes 0
4.Clean all Ducts Before Occupancy 2 IAOMealth pts y=yes 0
5,Install Solar Attic Fan 2 Energy pts Y--yes 0
B.Install Attic Ventilation Systems 1 Energy pt y=yes 0
7.Install Whole House Fan 4 Energy pts y=yes 0 B.Install Sealed Combustion Units -
a.Furnaces 31AQ/Health pis 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 XV 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 stoveslnserts 1 IAQ/Health pt 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 p
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 D
1 1
K.Renewable Energy and Roofing 1
1.Pre-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 0
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=18 points)_ _ Up to IS Energy pts 0
.6.selad Safe and burable Rooting Materials - _ __ _ __ 1 Resource pt y=yes p
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 pts y=yes p
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pis y=yes 0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0
• 1 1 I
INPUT Resources Energy IAQIHmlth
M.In oor Air Quality and Frnrshes ••
'1.Use LowND-VOC Paint 1 IAQ/Health pts y=yes 0 •
2.Use Low VOC,Water-Based Wood Finishes 2 IAO/Health pts y=yes D
13.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 61A0/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 41AQ/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 Trim 1 Resource pts y--yes D
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=yes0
�2 Use Rapidly Renewable Flooring Materials _ 1 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 IAQMealth 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
1 i 1
Total Points A 1 1401 130 57 •
Total Points Project R 1 0 0 0
G:daarpro��/�rxenhuildnp�uidsiivyrenodel=Ngreenpdmsfina1212.04prme7e�.z!s
•
.,,,. Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
SUPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
22(b1 &V-ksde CA. DEQ 0200
OWNER'S NAME: 6//1 rrj�-Or) PHONE # Z411?'— 3443-3` 2-Z
GENERAL CONTRACTOR: l7r/12 Qoc tklC-t FAX #
I am not using any subcontractors: 41 v7 /2,VA
ell 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
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date