08050146 (2) CrfY OF CUPERTINO a� ^ mat +•«i s % : � -6°`s"
BUILDING DIVISION • PERMIT COIrITRACTCTR TNI URMATI Nom'
BUILD NG RESS: - PERMIT NO.
�].'S� ELMSFORD CT PRINCIPLE ROOFING & 08050146
OWNER'SNAME: PERMIT ISSUE DATE
TSU WEI KU 10160 STERN AVE 05/19/2008
N@ SANITARY NO. CONTROL NO.
(408) 898-7298
7A.1CH=/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O LICENSED CON RACIOR'S DECLARATION
I hereby aR es Thu 1 m lkun ad made,provisoes of Chaper 9(commencing Job Description
Setuon'/01tB of Diri on 3ofeu Business and Professore Cade,and my licensee RE-RF RMV EXSTNG WDSHK& INSTL BATTNSYS& STN CTD
a yin
full Tam,, arc �) /3gf
Dg. License Chat Lk.Is 6 MTL RF. CLS A 30SQ
Da¢ jT='-�GOnllacto ARAtO _
DQ�Q ARCHfIECTS DECLARActuds
eZ I urdermanJ my tum shall be mud u public mortls
tiV
yo Licensed Professional
Oat I ma GUILDER DECLARATION
a 0 E 1 hertby.(Rett Thu 1 1. mush farm Ort Canuasafs IJconse law far the
5 O O followwhich me won.(Irmo i ]831.5,c amum, and Rohde oli Cade:Any city m county
$ which rtquirta a permit m e.res the spec,Impmw,demolish.i Fie a sig any structustatement
Zy
Unit
he irecensed prumemmquirospM,pplisam Use uch Connermitwtimeto Lawdautomem
i€detatheencing rdpuewmuothepmvisiamaluuConuazesswicomclaionCoda9 Sq.Ft. Floor Area Valuation
(cmv a is exawidarsdasenand of basis n3 theacired essaption. yvi Code)or $15000
3 Stas o u ewnpt shetcftam and far
bum for ube alleged exemption.Any violauon of
action 7031.5nfive ary red della rar a permit subjects the tapplkam to s dvil pmlty of Number Occupancy Type
act.ort than Ew hundred dolman(SSW). 36208026:°Y�'� P Y YP
ch.
tlnpeasuctor It wptaym aid wgmude'van.70".B .
mal do tad wort sew e: swc or unoe,Livenstended Law de(mule lacy.]Oar,Business
ard Property
who
ions Cade:The ms dare i.Ewes law darn not apply 1f rt owrer of Required Inspections
ma neey who builds orimposeach imps and whowments damsmc tends Mariners,through his
hu nemplayem ldingpronvior impom atempmwmentsmenet esu,of
ar completion.
the mares, .
bawem,dmurne, gerimpmwmmt4cold avidin oneymr or campkum.deawea-
buil4r will Ease th Mullen of provin6 than K did cot bulk or improv for purpoe of ...
nk.).
❑1.as owner of Use property.am mdmiwly mumacting with licensed contractors to .
camwct the poem(Sec.]Oda.Business and Profmsium Code:)The Contractors LF
cense law does not spray in an owner a property who boards or impam thereat.and.
who samtaCta far each pmjew vita it conuacbp(i)licensed purswm in the ConuutaY.
Lkeem Law.
❑I am mempt under See ,B&PC for du neuro
ne Date
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury arc of em following decimations:
❑1 haw and will maintain a CaNficate Ulceration to elf imae far WorteYs Compen.
station,as;i mvided fur by Settle.37100 of the Labor Code,fm the peAarma a of ds
wart for which this Permit is istra d.
❑1 ban,and will maintain W ram's Compemalon Insurance,as mywaed by Scene.
37Wofde Labs Code.(ithe pcRmm,nceofthewmt termites din permitu issued. '
My Worter9mpmua6 Man carrier W�lies number am:
Cartier. pall No.: 6W —;wli
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
('rhe seri.nosed.the compkmd if the permit is farm hundred do8,n(Sly
or kms)
1 ciu*that in the petfo,mance of the work for which this pnmh is issued,l shall Dat
deploy any Persian in any summer so as to become object to the WOM1ars'Compammuse
Laws of Califon.Dam
Applicam
NOTICE TO APPLICANT.If.after making du Certificate of attainder.you should
become subject to the Workers Compensation previsions of the Labor Cad,you mum
.J O faMwith camP1Y with such Proviso.or this permit shall be deemed mv
med okcd.
' y CONSTRUCTION LENDING AGENCY
F+ 1 hereby affirm Nat them is•conmtmmifm lending agency r.rdic perfopmvree of
C' > dm wart far which this gmot Is Issued(Sete.309),Civ.C.)
Leadnra Name
Dz panders Add.
U O 1 nobly that I hose feed this mitcana.ard.tate that the,how kfom Ulan u
LL E as rt 1 grte to comply will all city and county aNimncn,nd ark laws missing in
0 building construction.and hereby,udome¢Prtsenuum of this city to enter upon use
r W ahovnmenuane r Property car impceon whichPurpose,
I„,4 (We)agree to aw,indemnify and trap harmless ere City of CM,,,no against
ar7 incoiuesjWgmensecam and ofpis chniich may in any w'aYamue against said City
U a7 m APPLICANT
ofdepanting or the permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR EGULATIONS.
GS I W e,) Re-roofs
Spgmum fAppmipnVCam,xtar FData
HAZARDOUS MATERIALS DISCLOSURE Type of Roof �---
WIII the applicant or fuumo building ampantmoro or birdie harallom muerial
u defined by the CUP=.do Muni 1 Cock.Chapter 9.12 and de Hcahh and Safety
cane' Deedes zss3z(a)] All roofs shall be inspected prior to any roofing material being installed.
❑Tar Na
If a roof is installed without first obtaining an inspection,I agree to remove
Will em applicant or fumrt building aavpant tau equipment or devices which g P
ps�harardnm air canuminanta
rodcIfired by the Bay Ama Air Quality Management all new materials for inspection.
0Yes Me
I
oHcahawrecalyCOdhh Srdouuw.m2a3to3Bri3a.umgoimgadmc2n5534.1 Chaperb.9m3aiffthdcebCwalldifonnjdem coivurranY haw•unanL tautt u myroomibility -
m pacify tie oceupant of Je
mquimmenhiehmuuhemeixi.,wissa.m.LSCcNBaam.focmpacy. Signature of Applicant Date
own..,anamri d.gem All roof coverings to be Class'%¢"or better
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36208026 . 00
DATE ISSUED. . . . . . . : 05/19/2008
RECEIPT # . . . . . . . . . : BS000004817
REFERENCE ID # . . . : 08050146
SITE ADDRESS . . . . . : 1177 ELMSFORD CT
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : TSU WEI KU
ADDRESS 1177 ELMSFORD CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : DERECK LOI
CONTRACTOR . . . . . . . : DERECK LOI LIC # 27564
COMPANY PRINCIPLE ROOFING &
ADDRESS 10160 STERN AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (408) 898-7298
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- --------- ---------- ---------- ----------
1BSEISMICR VALUATION 15, 000 . 00 1 . 50 0 . 00 1 . 50 0 . 00
1REROOFRES SQ FEET 30 . 00 390 . 00 0 . 00 390 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 391 . 50 0. 00 391 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD - 391. 50 MC
---------------
TOTAL RECEIPT 391. 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----- ----------------------------- - _ _
-- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
-� CITY OF CUPERTINO D 0
REROOF
19CUPEkTINO PERMIT APPLICATION
APN # Date:
Building Address:
117-7
�r�^isF�r�v
Owner's Name: Phone #:
Ts u Wc-�' e-14 (¢og)
Contractor: Phone #:
Fax #:
Cupertino Business License #: C�-7 Contractor License #:
�3
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ sphalt Shingles ❑ Asphalt Shingles
Ff Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify) �Qi prgf�
Number of existing coverings ❑ Provide I.C.B.O. Report# E7s2-/4�
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: Qt~,,r_,F S>`ir✓� ly�z�0 JyaC� n f/�►�G /'1���`P�c Sdy�e,��
S�iN crior Ye�Gr�rte dz+Q� i� aeA4S/X 3ei/0 G
Residential a Commercial
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: �
. I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
1;;?L�
Signature
CITY OF CUPERTINO
affla- REROOF
,CUPEkTwO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Residential B 1SFDWLROOF
�6
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
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: 7314 t-r-1 K-1
job Site Address: /77 �lMSyl'O �j
Roofing Company Name:
Applicant's Signature:_.— Date:
• 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
Y
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 paints
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 I A-1 1 point
TOTAL POINTS1 40 points
CE Cop,
MAY 19?OD@
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
1.Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;60%=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 Resource-Efficient Landscapes and Gardens 4 Resource pts y--yes 0
9,Reuse Material"e 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 !
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 0
C.Structural Frame
1 I 1
1.Substitute Solid Sawn Lumber with Engineered Lumber — 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 Interior Framing 2 Resource pts y=yes p
9.Use Structural Insulated Panels(SIPS)
a.Floors 3 Energy pts y=yes 0
b.Watt
c.Roof 3 Energy pts y=yes 0
3 Energy pts y=yes 0
10.Apply Advanced Framing Techniques 4 Resource pts y=yes p
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes 0
• I a.Subfloors _ 1 Resource pt y=yes 0
b.Sheathing 1 Resourcet
--- ----- --- -- P Y=Yes 0
0 Of 1
D. xtenor mish
1.Use Sustainable becldng Materials
a.Recycled content 3 Resource pts y--yes 0
1 b.FSC Certified Wood I 3 Resource pts y=yes 0
12.Use Treated Wood That Does Not Contain ChromiurTArsenic i 1 IAQ/Health pt y=yes 0
13.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 t !
E.Plumbing
1.Install Water Heater Jacket — 1.Enemy pt y yes 0
2,Insulate Hot and Cold Water Pipes 2 Energy pts y--yes 0
3.Retrofit all Faucets and Showerheads wi$ Flow Reducers
a.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 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=yas 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 Hot Water Circulation Pump 4 Resource pts y=yes 0
1 1
v.tiecmcai
�1.Install Compact Fluorescent Light Bulbs(CFLs)
(6 bulbs2 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 �— 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 Y--yes 0
b.Ceilings 2 Energy pts y=yes 0
2.Install Floor Insulation over Crawl Space 4 Energy pts Y_-Yes 0
f3.Install Recycled-Conlent,Fiierglass Insulation with
No Added Formaldehyde ! 3 IAQ/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 0 O
b.Ceilings 4 Resource pts Y--yes 0
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
o.uenings 4 Resource pis y=yes 0
1
' .Win ows
I1.Install Energy-Efficient Windows i
a.Double-Paned 1 Energy pt y=yes D
b.Low-Emissivity(Low-E) 2 Energy pts y=yes 0
c_Low.Conductivity Frames _ _ 2 Energy pts Y--yes0
2.Insta l Low Heal Transmission Glazing 1 Energy pt y=yes 0
1 1 1
J.Heating Ventilation and Air Conditioning
1.Use Duct Masfic on Als Duct Joints _ 2 Energy pts es 0
2.Install Ductwork within Conditioned—Space 3 Energy pts y=yes 0
3.Vent Range Hood to the Outside 1 IAO/Health of y--yes p
4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y--yes 0
5.Install Solar Attic Fan 2 Energy pts y=yes 7 0
6. Install Attic Ventilation Systems 1 Energy pt y=yes 0
7. Install Whole House Fan 4 Energy pts Y--yes 0
S.Install Sealed Combustion Units
a.Fumaces 3 IAQ/Health pts y=yes 0
b.Water Heaters 3 IAQfHealth pts y--yes p
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 stovesfinserts 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 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAO/Heallh pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAO/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 p
6:Select Safe and Durable Roofing Materials 1 Resource pt y=yes p
7.Install Radiant Barrier 3 Energy pts y=yes p
L.Natural Heating and Cooling I 1 1
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 p
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes p
• 1 1 1
M.Indoor Air Quality and Finishes
11.Use_LowAo-VOC Paint_ _ _^I 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes_ 2 IAQ/Health pts y--yes 0
�3.Use LowMo V0C Adhesives J_ 1 3 IAQ/HealthY
- is =Y es 0 P
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y--yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AO/Heallh 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 0
8.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 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
1 ! 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2.Use Rapidly Renewable F&nng Materials _ — f 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 pis y=yes 0
S.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpel with Low VOCs 4 Resource pts y=yes 0
1 ! 1
Total Points Available: 1 1401 1301 57 •
Total Points Project R 01 0 0
G:daWprogsrgreenbuiidngguidelines4emodeleNgreenpointsfina 2-l2.04pmle,.fedads
•
Community Development
10300 Torre Avenue
'� Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
'WUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
I 17q i;LM!;fery 69or-Gj/' i ! °-c 6
OWNER'S NAME: -Tgt4 w ic-Lt PHONE # 4" ) 26fi — 1I' b
GENERAL CONTRACTOR FAX #
I am not using any subcontractors: �/ 9P/o T?
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
M
Owner/Contractor Signature Date