08090015 (2) CITY OF CUPERTINOBUILDING DIVISION PERMITCOL�TRACTEIRINFQRMATI�IV
BUILDING ADDRESS: PERMTf N0.
/`--)24 SHADOWHILL LN STONERIDGE ROOFING 08090015
OWNER'S NAME: PERMIT ISSUE DATE
'-PIU T.MG–SHUN AND TZUWEI L 2798 -GLIINFIRTH DR 09/04/2008
ONE: (408) 729-5101 SANITARY NO, CONTROL NO.
ARCHITECTtENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECN
DOp LICENSED CONTRACTOR'S DECLARATION
w l hereby IMM that I m lien red under Powisiaa s of Chalmr 9(commencing .Job Description
with5ectim]B(IU)UfDiHaionJordwEuuneaaaMProfcatiamCode.andmylkelaau RE–RF T/0 WKSHK& INSTL 30LB FLT PRES TL CLS A
DLI– mmRrarceudertece ?FR4// 28SQ
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20 Date 4__ Co DSCL
ARCHRECTS DECLARATION
< 1 understand anJ my plans Nall useu d Public records
6U
k LLa Licensed Professional
OWNER-BUILDER mDECLARATION
ECOI hereby M.Nat 1am 1. .Savin from Ne cutins r3 License Law for Ne
ECO O following umes a (Section BO1.5.Business and Ptnfaatinn Code:A.yity m m county
which regvlas issuance,panel w or=t e altar.improve,h Permitdemolish.u m e pair any structure
_I< poor miueprsuainquire theapplicantof for such Permit Lu on,Lncdsawmcnt
x
that heencingwdpSectio 7to Use")ofDivionofoftheBft uxccautanecrselaw(Clupwr9 Sq.F[. Floor Area Valuation
yl-g
(commencing Section 7") basiiofrofthceedexe pton.MynCodc)o $11650
Nal o is exempt ttrsefmn and the buts for the cts de, ewnptiat Any Holahan or
Semon]0313 by arty em elent Ire a 0y,nfl subjects the applicant w a ciHl penally of Number Occupancy Type
ncn mine Jtanfw hattdred dollars(SN1P), 36230093 . P Y YP
❑I.ss owe ar the polavay.cemy wPloyw with w,geeJeer win eampetmdnn.
adPrleeswork.andtti<mtanmeisncULicen Lawclamrnampplytooa4.nsheron
and ertywi an Wilds
r The Covuvcwr,Learn are dam oat apply w,n owner is Required Inspections
Owns Yloyem,proorimpmwlhimpmoe wM douoochamkhimnelred forsgh his -
ownemPloyebuiproHded provenimprowmenuarencl mended aided..thema.lr,
builw the buildingorimpmwmentbmidwithin on year or cprow for purpose will have Jc reran of proving dist w did nct wild or improve for puryose of
oak.).
0 1,a own,of the property,am exclusively earthed,with reamed comoscm to
contact the project(Sec.7044,Business and Professore Cade:)The ContecwYs U. .
cense law does not apply to an owner of property who builds or improve thereon,arW, ..
who cattuacts for such projects with a cemotcum(s)licensed pursuant to tae Contrxctor's
Liam.Law.
❑Imrawpundc See ,Ba PCrmthiammn
Ower Dae
WORKERS COMPENSATION DECLARATION
I hereby afrm under Penalty of perjury,one or the fallowing declarations:
1 ham and will maintain•C rtifaw of Co..,be self-roam for WortedsCamPen-
much.at provided for by Section 3700 of the labor Code,for the performance of Jc
work for which thin Permit is Wood.
❑I haw and will maintain Werke's Compensation Insurance,an required by Section
3700.(the labor Code.for the pedom use or the wort for which this permit is issued.
My Workces Campaautlon Immossuc carrier and Policy number am:
Cartier: 4,)1/ policy No.: I6Cl4I.S/�
CERTIFICATE OF EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(r ds sectln need not be considered if We permit in for.hundred dollars 1$100)
or Ins)
I cerdfy that in the performance of the work for which this Permit u issued.l Nall ncl
employ any person in any mane erso as,as become subject rode Worked Compensation
Laws of Califomia Date
Applicant
NOTICE TO APPLICANT:it.after making this Ccnineac of Exemption,you should
become subject to On Worker's Compensation previsions of tie labor Cade.you most
.,O forthwith comply with such proviso.m this peanut shall k deemed wwkcd.
'Zy CONSTRUCTION LENDING AGENCY
[-� I hembYdrtm that there isa construction mndingagcrcy for the perfomtarxeor
C >
the rem for whim than Permit in Wood(Sec.Som,Ci,C.)
WM GJ Lemice,Name
z lender's Address
U O I certify the I lure rem this a,dicuion and num this tw show bdmmation is
k
econeseL 1 agree to comply with all city and county ordinances and Stata lam minting to
.0 building conmetion,and hereby authorise reprenetaJws of this city to new upon Je
shove-mentioncd property for inspection puryosea
(We)agree w saw,indemnify and keep homeless Wr City or Cupertino against
to in
isequeneof ftcramand eapeueich may in any myaceme againlsvd City
U Z A APPLICANT
of thegrantingof this Permit.
WIIssued by: Date
t-^ APPWCANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT �j
SOURCE REGULATIONS.
J lrri f2Mi" Re-roofs
Sognsua a(ApplienJCant Dare
FIAZARDOUDOUS MATERIALS DISCLOSURE Type of Roof
WIIIdC CullomafUlm Iipal ng IXTUPNIYamof sonharHeaddaand Safety
u
defined io de Cuanino Municipal Calc.Chapter 9.12,aM Je Health and Safety
Code.pix,us32(a)7 CJ No All roofs shall be inspected prior to any roofing material being installed.
ren the applies or fmmr wilding orcupam tax equipment or dcHma which If a roof is installed without first obtaining an inspection,I agree to remove
h bv.= n air contaminants to defincd by the Bay Am Air Quality Management all new materials for inspection.
❑Ye 'y NYU
I have read the hoatdcus mammals requirements underchapter6.95 of the Califor.
nia Hcaltha SafciyCodc,Section 25505.25533 ao125534.I understood thmiftic wilding / 4r
d=trot currently haw a termL dust itis my mrponlbllity to notify Nc occupaut or the
requirements which most be met poor w issuance of•CeNfwate of Occepancy. '�
�d/rvn Signature of Applicant Date
On., r auNomcd agent Date All roof coverings to be Class'pW'or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Elk: Lot :
APN . . . . . . . . : 36230093 . 00
DATE ISSUED. . . . . . . : 09/04/2008
RECEIPT # . . . . . . . . . : BS000005986
REFERENCE ID # . . . : 08090015
SITE ADDRESS . . . . . : 7524 SHADOWHILL LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WU TING-SHUN AND TZUWEI L
ADDRESS . . . . . . . . . . : 7524 SHADOWHILL LN
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5052
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
• EEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-- - ------ ---------- -- -- ----
IBSEISMICR VALUATION 11, 650 . 00 1 . 20 0 . 00 1 . 20 0 . 00
11REROOFRES SQ FEET 28 . 00 364 . 00 0 . 00 364 . 00 0 . 00
TOTAL PERMIT 365 . 20 0 . 00 365 . 20 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----- --------------- -------------
CHECK 365 . 20 #0955
---------------
T0'C'AL RECEIPT 365 .20
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-- -------- -------- ----------- -----------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
� vCl oO , S
CITY OF CUPERTINO
IN, le RREROOF
�CUPEkTINO PERMIT APPLICATION
APN # Date:3 0 � 9 3 . oo
Building Address:
"Zy ,&zkll 1h
Owner's Name: Phone #: (yng)628 2,3)1
/e
Contractor: Phone #: CSI o L) 7 Z y- S l o l
e 1 i' Fax#:
Cupertino Business License #: Contractor License #: 766,yi1
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof a Built-Up roof
❑ Asphalt Shingles VAsphalt Shingles
V�Wood Shakes o Wood Shakes
❑ Wood Shingles o Wood Shingles
❑ Other (Specify) a Other (Specify)
Number of existing coverings Q ❑ Provide I.C.B.O. Report #
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
o - ,
o WoodShr cC ;njrx
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:
li 6s o
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 6/16/08
CITY OF CUPERTINO
' REROOF
CITY OF
CUPERTINO FEE SCHEDULE
i
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
2 1REROOFRES Re-roof Residential B 1SFDWLR00F
f 1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
IBUSLIC 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 aroofing any roong installation.
final 4. To receive a nal 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 V4 " 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: rile, L✓u
Job Site Address:
Roofing Company Name: 1 tom-ii
• v
Applicant's Signature: Date:
• 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
z v
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. Energy Star Refrigerator, (Note/Spec. A-3 1 point
P. Other 1 1. List Green Features on Plans A-1 1 point
TOTAL POINTS1 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
Energy IAD/Heafth
A.Site
141.Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;B0%=4 points ! up to 4 Resource pts D
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 D
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
-Design -6 Gardens Landscapes and Gardens_ 4 Resource pts y=yes 0
l.-e-- iS Ul — —
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 D
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes D
1 1 1
C.Structural Frame
f1.Substitute Solid Sawn Lumber 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 D
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 D
6,Use Finger-Jointed Studs for Vertical Applications 2 Resource pts y=yes D
7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes D
6.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes D
9.Use Structural Insulated Panels(SIPs)
a.Floors 3 Ener is
9Y P Y=Yes 0
b.Wall
3 Energy pts y=yes D
c.Roof 3 Energy pts y=yes D
10.Apply Advanced Framing Techniques 4 Resource pts y=yes 0
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes D
12.Use CFS-8-
a.
SBa.Subfloors 1 Resource pt y=yes D
• b.Sheathing 1 Resource pt y=yes p
1 1 1
114PUT Resources Energy 0
xtenor Fims
1.Use Sustainable Decking Materials
a.Recycled content 3.Resource pts y=yes 0 •
b.FSC Certified Wood 3 Resource pts y--yes D
'2.Use Treated Wood That Does Not Contain Chromiu"ksenic ' 1 IAQ/Health pt y=yas 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 0
E.Plumbing
C.Install Water Heater Jacket _ 1 1 Energy pt y=yes 0
2.Insulate Hot and Cold Water Pipes 2 Eneroy pts y=yes 0
r3.Retrofit all Faucets and Showerheads*with Flow Reducers
1 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
6 point each,up to 3 points) S Up to 3 Resource pts. 0
5.Install Chlorine Filter on Showerhead 1 IAQ/Health pt y=yes 0
6.Convert Gas to Tankless Water Heater 4 Eneroy 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
8,Install On-Demand Hol Water Circulation Pump 4 Resource pts y--yes 0
1 1 1
r.trecnicai
I1 Install Compact 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 Eneroy pts. 0
1 1 1
G.Appliances
(t.Install Energy Star Dishwasher _ 1 Energy pt y=yes D
2.Install Washing Machine with Water and Energy
Conservation Features 1 Energy pt y=yes 0
:3.lnstall Energy Star Refrigerator. I 1 Energy pt y=yes D
4.Install Built-In Recycling Center 3 Resource pts y--yes 0
1 i 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
13.Install Recycled-Content,Fiberglass 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
b.Ceilings 4 Resource pts y=yes 0 •
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walis 4 Resource pts y=yes 0
c.Uemngs 4 Resource pts y=yes D
1 1
INPUT ReSDUMBS Energy 1ADtHeafth
I. rndows
•1.Install Energy-Efficient-Windows
. I a.Double-Paned _ 1 Energy of es 0
Y=Y
It.Low-Emissivity(Low-E) 2 Energy pts Y--yes 0
c.Low.Conductivity Frames 2 Energy pts Y--yes 0
2.Install Low Heat Transmission Glazing 1 Energy of Y--yes 0
1 1 f
J.Heating Ventilation and Air Conditioning
r1.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--),es 0
5.Install Solar Attic Fan 2 Energy pts Y--yes 0
6.Install Attic Ventilation Systems 1 Energy of Y=yes 0
7.Install Whole House Fan 4 Energy pts y=yes 0
B.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 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 stovesrinseris 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 Aa/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 AQ/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=16 points) Up to 18 Energy pts 0
,6.Select Safe and Durable Roofing Materials _ 1 Resource of y=yes 0
7.Install Radiant Barrier - 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 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
j1.Use LowRJo-VOC Paint- 1 IAO/Health pts y=yes •0
2.Use Low VOC,Water-sasedWood Finishes 2 IAO/Health pts y=yes 0 •
'3.Use LowMo VOC Adhesives _ 3[AD/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 v !Y 4 IAQ/Health pis y--yes 0
S.Use FSC Certified Materiels 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 6 Resource pts y--yes 0
12.Use Baplcly Renewable Flooring Materials 4 Resource pts y--yes 0
3.Use Reced Content Ceramic Tiles 4 Resource pts y yes 0
ycl
4.Instal 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
1 1 !
Total Points Availablel 1 1401 1301 57
Total Points Project Received: cSZ 0 0 D
G:daiarprogs/greenbulidingguidelineslremodelersrgreenpoinisfinal212.04prolecled.xls
•
. Community Development
ylira
, 10300 Torre Avenue
1 - Cupertino CA 95014
Telephone(408)777-3228
CIN OF Fax(408)777-3333
*UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
4�09 0 1 �
OWNER'S NAME: /G L✓ PHONE # • c1 -S 1 Q 1
GENERAL CONTRACTOR p FAX #
I am not using any subcontractors: S ce;w�/1 6Grl tle J O
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