08070222 (2) CITY OF CUPERTINO
BUILDING DIVISION
PERMIT ' COi TRACTOR�INFORMATIgN
BUILDING ADDRESS: PERMIT NO.
.1.0561 JOHNSON AVE STONERIDGE ROOFING 08070222
OWNER'S NAME: PERM)T ISSUE DATE
EMMY WONG & WM GRUENHOLC 2798 GLENFIRTH DR 07/30/2008
ONE: (408) 729-5101 SANITARY NO. CONTROL NO.
ARCHr ECf1ENGINEER: BUILDING PERMM INFO
BLDGELECT PLUMB MECH
t� 0 0 0
�Oa LICENSED CONTRACTOR'S DECLARATION
b 1 both,affirm door 1 Am Boosted under provisions of Chapter 9(commencing Job Description
E
with Section 70100)of Division 3 of ft Business And Prefiessionct Code.and my Ike=6 RE—RF T/O TR&GRVL INSTL 2—PLY 30LB FLT W/30YR CMP
w, in full fora am effect
ip? Licenseadsli.R CLS A 19SQ
=q Dau: Contsacbr iF -
7W7W ARCHDECI-S DECLARATIl7 i
1 undersand my Plana shall he used As public recwN
D-u
Licensed Pmfessianal
OWNER-BUILDER DECLARATION
E 1 hereby a1Brm that 1M exempt from Be,Contnnms License law for the
COO following mason.(Section 7(1)13,Business and Pmfeasions Cade:Any city or county
$ which requires o permit to conaran alar.improve.demullN,m repair any aronum
prier to is noun..than mquircs tleapplicant for such permit in fileasignm statement
that he islicensed pursuant bthe provisions ofbcContractors License Law(Chapter 9 'Sq.Ft. Floor Area Valuation
y� (commencing with Section 7000)of Division of the Business and Professions Cadet)or $9300
f 5 g_ mal h
e is exempt therefrom and the basis for the alleged exemption.Any violation of
Scotiom 7031.5 by any applicant for a permit sobjcca the applicator to a civil Penalty of Number Occupancy
Am roam than fie hundred dollarsC15M. 37527008 . Penc Y Type
I,aowrcroftk pmperry.amy moPloym with wagnsddu'v role compcmuon,
will do the work and the sticture a But intended or oncmd for sale(Sm.'IIW,Buuxss
And Professions Cmc:The Con4Kafs IJah[e law does net apply an an owner of Required Inspections
property who Wihdhimienproma thereon,ond who dassuehworkhimeelfor through his
awnemployees,pmvided Natuchimpmsemmaarenetintendedoroffe n for We.If.
however,Ne building or improvement is sold within one year of compleuan,the owner.
builder will have the bunion of proving that he did net Wild or improve for purpose of
ale.).
❑1.As owner of the property.Am esmutively,contracting with licensed contsxsas An
comnul the project(See 7W.Brained am Professions Cade:)The Contra[mes U.
censn Law does not apply b an owner of property who builds or imprown domem.and
who contracts for such Projects with a contractor(s)licensed pursuant b the Contractors
Lim.law.
❑I Am exempt under Sea .B B P C for this mason
Owner Dow
WORKER'S COMPENSATION DECLARATION
1 hereby,a0irm under pevhy of perjury ons,of Ne fallowing doclaa0am:
1 haw am will maimate a CmiEau of Corsem In self-iodre forWorkers Coupon-
'on,As provided for by Section 3700 of the Labor Code,for But performance of the
work for which this permit is issued.
❑1 ham and will maintain Woram's Compensation Insurance,As Ieyu red by Section
3700 of Ne Labor Code,for On performance of the were for which to,permit is leaned.
My Workeea Compensation insurance carnia and Polity number M:
Carrier. Policy JWR&MpO / IIN FROM
111aS
COMPENSArION INSURANCE
flTis section sued not ho completed if the permit is forane hummd doll=(5100)
or leu)
I certify Not in to performance of Nn work for which this permit is issued.I shall not
employ any person in any manrlerso As or Income subject to rho Wmkeri Cwnpomadon .
Laws of California Date
Applicant
NOTICE TO APPLICANT:If,aMr making NW Certificate of Esemptian,you should
became subpt b the Wor s Compensation provisions of the labor Cera you most
.,O forthwith o
comply with such provirus Ar Nu vok
Permil shall W doomed reed.
z CONSTRUCTION LENDING AGENCY
[—r I hereby affirm that there is a construction lending agency for the Performance of
lYi
the wurk fur which dds permit is issued(Sec.3097,Civ.C.) -
QLenders Nene
= z tenders Address
U O l aNfy Wil I have read this application And sue dent the show information a
!L ^. corrin 1 agree b comply with all city am county oNinarces avd sou laws mlaung b
rV' building conswction,and hereby aumonot,numesenuuws of Nu city b enter upon lh
show-menudgm property for inspection pmpwhich my
H G (We)Agra loam,indemnify and poop harmless the City of Cupertino against
fry incoursesjudgmcnae grow am expenses which may In any way ocenre against said City
V z ineanscquenee Iof NDERSrANDS the permit ^'
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b j
SOURCE REGULATIONS. Y• Dale Q�'f
�
—'?C)'7) Re-roofs
Dote
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant awe or handle haandem material
As defined by tie Cupertino Municipal Conte,Chapter 9.h3,and the Health and Safety
Code,Ovns tionus)z(a>+ All roofs shall be inspected prior to any roofing material being installed.
o
Will the,Applicator or future building nen nt c If a roof is installed without first obtaining an inspection,I agree to remove
Pp B W equipment or device,which g P
t
P.moons air canuminanu u defined by Ne Bay Ma Air Quality Managcmcnt all new materials for inspection.
❑Yea EK.
I hawrowtheea Omer 50aamquiremems 4.1ua purd.95of Ne Califon- I
nits not
tenant. 23E it
MYrumu7l53a.l hmcrsunde eVio Wilding
Jens rant currently haw•tenant.Net it u MY maponsihility b nrotifY den e[upanl of the
roquiremenu which mute Ec roes prior b issuane of o Certifcau of Occopxecy.
o Signature Of Applicant Date
g�c' �e 11 �J sf4 l 4 A
�ne(�auNuriv<d.1en11 Date 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 . . . . . . 1 . : 37527008 . 01
DATE ISSUED. . . . . . . : 07/30/2008
RECEIPT # . . . . . . . . . : BS000005634
REFERENCE ID # . . . : 08070222
SITE ADDRESS . . . . . : 10561 JOHNSON AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : EMM WONG & WM GRUENHOLC
ADDRESS 10561 JOHNSON AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : SERGIO GONZALEZ
CONTRACTOR . . . . . . . : SERGIO GONZALEZ LIC # 25625
COMPANY . . . . . . . . . . : STONERIDGE ROOFING
ADDRESS . . . . . . . . . . : 2798 GLENFIRTH DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95133
TELEPHONE . . . . . . . . : (408) 729-5101
. FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------ --- ----- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 9, 300 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1REROOFRES SQ FEET 19 . 00 247 . 00 0 . 00 247 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 248 . 00 0 . 00 248 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 248 . 00 VISA
---------------
TOTAL RECEIPT 248. 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
vk 010,a
CITY OF CUPERTINO
REROOF
CIT*CUPERTINO PERMIT APPLICATION
APN # -75 oZ-1 O O 0 Date:
�- Q-
Building Address: 5 0Id
Owner's Name: Phone
� V
Contractor: Phone #: yoS Z�f - S 1 bl
5jolad fe, 2 0 ti Fax #:
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
e "'Built-Up Roof wilt-Up roof
❑ Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings jh� ❑ Provide I.C.B.O. Report #
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
1 l./� two ter
/ p S l✓i o e /S Ovd1 .0 �GSJ
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: El
applicable, include in plan set & the sheet index. _
Valuation:
60
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
4440
Signature
Revised 6/16/08
CITY OF CUPERTINO
REROOF
cl Of
CUPER,TiNO 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 1SFDWLROOF
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 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: AAIC i % kN QC
Job Site Address: /_Q,5 4 �, A�0,b -IV-
Roofing
VRoofing Company Name: ��"nn ,//,f
Applicant's Signature: i�_Itn 24-/±, Date: 30_O 8
• 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 oints
C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 __Lpoints
D. Structural 3. Uses Wood ]-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 oints
E. Ext. Finish 1. Composite Decking, (Note/Spec.) A-3 2 points
4. B. Fiber Cement Siding, (Note/Spec. A-4 2 oints
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 cints
G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 4 points
H. Appliances 1. Energy Star Dishwasher, (Note/Spec.) A3 1 paint
3. EnergyStar Refrigerator, (Note/Spec. 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-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.
INPUT Resources Ener9ly IA011-leafth
to
51.Recycle Job Site Construction&Demolition Waste ,I
65%=1 point;75%= 2 points;80%=4 points up to 4 Resource pts 0
12.Salvage Reusable Building Materials J 4 Resource pts y--yes 0
3.Remodel for Mixed Use,Adaptive Reuse,and V
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
(8.Design Resource-Efficient 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 y=yes 0
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
1 1 1
C.Structural Frame
r ---- — — --- -- —
1.Substitute Solid Sawn Lurnber with 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
8.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=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 pts y=yes 0
I12.Use OSB
a.Subfloors 1 Resource pt y=yes 0
• i b.Sheathing 1 Resource pt y=yes 0
0 0 1
INPUT ReSDUTCeS Energy IA011-feaA
xlanor mrs
11.Use Sustainable Decking Materials
a.Recycled content 3 Resource pts y=yes 0 •
1 b.FSC Certified Wood 3 Resource pts y=yes 0
12.Use Treated Wood That Does Not Contain Chromium/Arsenic 11 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 pty=yes 0
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
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 IAO/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 41AQ/Heallh pts. 0
B.Install On-Demand Hol Water Circulation Pump 4 Resource pts y--yes 0
1 1 1
r.tiecmcai
1.Install Fluorescent Light Bulbs(CFLs) j
(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.I 0
G.Appliances
IT.Install Energy Star Dishwasher v 1 Energy pt y=yes 0
12.Install Washing Machine with Water and Energy
Lonservation Features 1 1 Energy pt y=yes 0
3.lnstall 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
13.ihifell Recycled-Corileni,Fiberglis-s Insulation with -'
iNo Added Formaldehyde ; 31AQ/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=yes0
b.Ceilings 4 Resource pts y=yes 0
6,Alternative Insulation Products(Cotton,spray-foam) •
a.Walls 4 Resource pts y=yes 0
o.Cemngs 4 Resource pts y=yes 0
1 1wow
INPUT ReSDurces Energy IAO/Heafth
I.Windows
1.Install Energy-Efficient Windows
. a.Double-Paned 1 Energy pt y=yes 0
b.Low-Emissivity(Low-E) 2 Energy pts y=yes 0
c.Low.Conductivity Frames __ 1 2 Energy pts y=yes 0
2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 0
1 1 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 IAO/Health pt y=yes 0
4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 7
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
B.Install Sealed Combustion Units
a.Furnaces 3 IAQ/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)Fumace 2 Energy pts y=yes 0
13.Retrofit Wood Burning Fireplaces
• a.Install EPA certified wood stovesrinseas 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 IAQ/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAQ/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.Select Safe and Durable Roofing Materials — � 1 Resource pt y=yes 0
7.Install Radiant Barrier - - 3 Energy pts 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
•
INPUT Resources Energy IAD/Health
. ndoor Air Qua ny an Flnrs es -
rUse Low%Noo-VOC Paint - - _ _ {J 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
19.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 61AQ/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 _ _ 4 IAQ/Health pts y=yes 0
8.Use FSC Ce tified Materia s 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 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes0
L.Use Rapidly Renewable Floo vg Mate aly — _ __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 Carpet with Low VOCs 4 Resource pts y=yes 0
Total Points AEE le: 140F 1301 57
Total Points Project Received: 0 0 0 .
G:daWprogslgreenbuildingguidellneshemodelersrgreenpoinlsfmal2.12.04proladed.xls
•
Community Development
r 10300 Torre Avenue
F Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
,CUPEI�TINO
Building De artment
JOB ADDRESS: PERMIT #
/OSo22'L
OWNER'S NAME: Uo PHONE # t )
GENERAL CONTRACTOR: 'r FAX #
I am not using any subcontractors: /G;/,ya�z 30 'Ott
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