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14060075J1 ,i I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 7977 PUMPKIN CT OWNER'S NAME: CHEN XIAO AND PAN JUNMIN OWNER'S PHONE: 4086279720 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lie. # Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self - insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will com with all non -point source regulations per the Cupertino Municipal Code, Sec ion 9 18. Signature Date OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self - insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulat s per the Cupertino Municipal Code, Section 918. 'f1 Signature Date CONTRACTOR: CHEN XIAO AND PAN I PERMIT NO: 14060075 7977 PUMPKIN CT ] DATE ISSUED: 06/12/2014 CUPERTINO, CA 95014 ! PHONE NO: JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL INSTALL (N) A/C UNIT IN SIDE YARD AREA & REPLACE (E) FURNACE, SAME LOCATION Sq. Ft Floor Area: I Valuation: $6000 APN Number: 36202040 00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 D IT ISSUANCE OR 180 D OM L ALLED INSPECTION. L� RE- ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 2 3, and 25534. _1 612/ Owner or authorized agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional s GENERAL PERMIT APPLICATION Q MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (403) 777 -3333 • buildina(5cuoerino.ora m I S ❑ PT 7 AA-Q l�TG MECH? IQIC AL ❑ ELECTRICAL ❑ MIS CELLANTTEOUS PROTPLT ADDRESS q -71 ,/tN; Imo\' V 'C. V P � K'0 I AP]T :746 z- " O v l C) OWI�ERNaME xl,ali l/� ►Q/✓1 � 1 V Y�y� I PHONE z(nG_ ENd� Jul% dal � _ZIP STREJ- -7 ADDRESS ! q 7 j pVt *n' k K & . I CITY, STATE, '' fwtl vw c A q f- O f I FAX ` �E.]JAII CO'NTACr NAhM I PHONE �r _ / z ' ^�/� J►; ►1. avv a �j Lv , tKa k wl-, STREET 4DDRFSS CITY, STATE, ZIP FAX OV7N-M ❑ OWA -BUIID t ❑ 01AW .RAGENT ❑ CONTR4CTOR ❑ C01MUICTORAGENT ❑ ARMUMCT ❑ ENGAic.2 ❑ DE\,E OPER ❑ TEN.4a'Tr COl'TP.ACTORNAME -^ I LICENSE NUMBER I LICENSETYPE I BUS.LIC,°. C01v21-.NY NAME I E -MA L I FAX STREET ADDRESS I . CITY, STATE, ZIP PHONE ARCMTECT/ENGIINEER NAME LICENSE NUNMER. I BUS. LIC n COMPANYNAJ M E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PRONE USE OF FD or DUPLEX ❑ MULTI - FAMILY PROJECT LN WrLDLAND ❑ YES PROJECT M, ❑ YES BL=11.'G: ❑ COMWERCIAL I URBAN IN EMFACE AREA NO I FLOOD ZONE o IS THE BLDG AN ❑ YES BICH.LER Hot ,M? NO DESCRIPTION 0'r WORK z � �n5-�"G� Ltd ��• = TOTAI, VALUATION: _ By my signature below, I certify to each of the following: I am u`1e prope ty o;;mer zed ages ac e--pro o;; ehalf. I have read this application and the information I have provided is c I have read the Descrip�lon of Work and verify it is accurate. I a comply A ith all applicable local ordinances and state la;vs relating to buildin co c . I authorize representatives of Cupertino to enter the abo;�i 21ed property for inspection pu�eses. S i g11attare. of AppticantlAgent: Date: SUPPLEMENTAL ORMATION RE TJ=D m ,sue m 0� -. WN .V,EPAlisa4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units ( < =10K cfm) 1BREMAIR 1 # $70 Furnace, Forced -Air 1MFR = <100 1 # $139 TOTALS: $209.00 x a 0.Y Mech. Plan Check 0.0 hrs $0.00 .11hu rh. Pion (hez.k FT Mech. Permit Fee: IMPERMIT 11111mb. Pefm t Jere: VA, Other Mech. Insp. 0.0 hrs $47.00 Other Plumb True. E�IIa��I� Lslec 1`ns1�. flhwib. Insp. Fce: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Tl:ctrint ntn 1 Th.— fond nro 6ncod nn A. railahlo and nro nnhi nn octimatn Cnntart tha Aunt fnr addn'l infa. FEE ITEMS (&e Resolution 11 -053 Ef . 711113) 7977 PUMPKIN CT DATE: 06/12/2014 REVIEWED BY: MELISSA IlaADDRESS: APN: 362 02 040 BP #: *VALUATION: 1$6,000 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD or Duplex PME Plan Check: PENTAMATION PERMIT TYPE: FURN /A WORK INSTALL N A/C UNIT IN SIDE YARD AREA & REPLACE E FURNACE SAME LOCATION SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units ( < =10K cfm) 1BREMAIR 1 # $70 Furnace, Forced -Air 1MFR = <100 1 # $139 TOTALS: $209.00 x a 0.Y Mech. Plan Check 0.0 hrs $0.00 .11hu rh. Pion (hez.k FT Mech. Permit Fee: IMPERMIT 11111mb. Pefm t Jere: VA, Other Mech. Insp. 0.0 hrs $47.00 Other Plumb True. E�IIa��I� Lslec 1`ns1�. flhwib. Insp. Fce: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Tl:ctrint ntn 1 Th.— fond nro 6ncod nn A. railahlo and nro nnhi nn octimatn Cnntart tha Aunt fnr addn'l infa. FEE ITEMS (&e Resolution 11 -053 Ef . 711113) FEE QTY/FEE MISC ITEMS Plan Check ['ee: .Sulupl. P {: PME Plan Check: $0.00 �r'Ytili jrz?P: PME Unit Fee: $209.00 PME Permit Fee: $47.00 Administrative Fee: 1ADMIN $44.00 Work Without Permit? 0 Yes (F) No $0.00 'I(Iv a72C<.'L', PJcit'7 #ling fees: Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.60 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $348.60 $0.00zTOTAL FEET $348.60 Revised: 10/01/2013 CUPERTI NO HVAC ALTERATIONS ENERGY COMPLIANCE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building a mpertino.oro WHEN IS A PERWF REQUIRED A construction permit shall be obtained from the enforcement agency prior to the erection, construction, reconstruction, installation, relocation, or alteration of any mechanical system, except as permitted in Chapter 1, Section 112.2 of the 2010 California Mechanical Code. Projects requiring permits include, but are not limited to: • New HVAC installation • HVAC Changeout • Replacement of furnace, coil, FAU or condenser h • Relocation of an existing HVAC unit • Adding or replacing more than 40ft ducting in unconditioned space BUSINESS AND PROFESSIONS CODE, SECTION 7110 Willful or deliberate disregard and violation of the building laws, including the California Building Code, and local permit requirements constitutes a cause for disciplinary action from the Contractors State License Board working in conjunction with the local building department. This action may consist of fines up to $5,000 per violation or suspension/revocation of a contractor's license. 2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24, Part 6) REQUIREMENTS INCLUDE: 1. Heating equipment must have a minimum 78% AFUE (Exception: Wall & floor furnaces; room heaters). 2. Central air conditioners & heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER. 3. Newly installed or replaced ducts must have a minimum insulation value of R -4.2. 4. A setback type thermostat (24 hr clock with four set points) is required for all alterations. 5. New or replacement ducts must meet the mandatory requirement of Section 150(m). • All joints and openings in the HVAC system must be sealed. • OnIy UL 181, UL 181A, or UL 181B approved tapes or mastic shall be used to seal duct openings. • Connections of metal ducts and the inner core of flex ducts shall. be mechanically fastened. Flex ducts must be connected using a metal sleeve /coupling. • Flex ducts that are suspended must be supported every 4 ft. max for horizontal runs with no more than 2" of sag between supports and 6 ft. max for vertical runs. 6. The CF- 6R- MECH -04 must be completed and signed by the installing contractor. The Inspector will collect this form and verify that the model numbers are the same as the installed equipment. 2008 Residential Compliance Forms.doc revised 04110112 s Efooeen4gecy :b m ,, +�m- CA Z Conditioned Duct insulation Cnt'1 %iSt'IYfIIlIRlliilll:t�iCieIir 06Zlitea re 1 Thermostat'` ^� Package d : -U Pomace COP ®HSPF y f; , Served by system Dve� 40 8 of ducts' added orrepiaced Setback Indoor Coil SEER _ �, 6-11 sf .m unconditioned space, - Trot oir-- ,*Presat4 must be . Condensing Unit EER E3 Resistance Other 1. Equipment Type: Choose the equipment being instai1 ; if more than one system, use another CF -1R ALT- h1VAC. for each system. 2.11Tnimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. Contractor (Doctrraentation Author's /Responsible Designer's Dexhration Statement) • I edify that this Certificate of Compliance documentation is accurate and comDlete: f` + I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for,the design identified. on this Certificate of Compliance. • I caitify that the energy features and perfannanw specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts I and 5 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for appr(w4.,Aitb the permit application. _ Name: y1 m h a*L SignaGire: Company n''Pii� ate:. Addr�: License: City /Stalcizip: 2008 Residential Compliance Forms.doc revised 04110112 CUPERTINO OWNER- BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 FAX (408) 777 -3333 • building okupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS m �i,� '* PN BP# pip O ;I- OWNER NAME ias atw, Jukimvh OWNER ADDRESS q wrn ''o- fit, "' DESCRIPTION OF WORK: C LAt-L We are providing you with an Owner - Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner - Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) 5"T 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner - Builder, may held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner - Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 7�_3. 1 understand as an "Owner- Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk. by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. j4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 7P 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. 76. 1 understand if I am considered an "employer' under state and federal law, I must register with the state and al government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. �7. 1 understand under California Contractors' State License. Law, an Owner - Builder who builds single - family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. �T)8. I understand as an Owner - Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwneYBuildeYFonn 2010. doe revised 04114110 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB).at 1- 800 - 321 -CSLB (2752) or www.cslb.ca.gov for more information. about licensed contractors. 7?-10. 1 am aware of and consent to an Owner - Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. ]�p 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner - Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the inf rmation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner - Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verifv the orooerty owner's signature. — Property Owner's Signature: ,6A]I li Date: n/ I V/ (k I --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner- Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner - Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized. Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwneYBuilde7Form 2010.doc revised 04114110 CUPERTINO Address SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE -� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION�=,l�t,`� 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building(@- cupertino.org Permit No. 14-0 6Ja 7 PURPOSE This affidavit is a self- certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single- family and multi- family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X On ever level of a dwelling unit including basements X X Within each slee in room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel- burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CSC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above - referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. W, fhe forme nnrl rnnrlifinn.c of thi.¢ Rtatement I IIdVU ICdU G11U ay1UU 1v 11111Y .n... ... .. .� ...... .... ... __.. _... _.._ _. _ - - -- Owner (or Owner Agent's) Name: h [0 M I ^ PAVI Si nature ................ ..::,... ............................................. ............................... Date:................ Contractor Name: Signature......................................... ..........................Lic.# ....... ............................... Date: ................... Smoke and CO form.doc revised 03118114 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408- 777 -3333 JOB ADDRESS: PERMIT # /'y 06 0 ' OWNER'S NAME: PHONE # 4oS- &'i -,1 GENERAL CONTRACTOR: T Pd BUSINESS LICENSE # ADDRESS: CITY /ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Owner / Conilractor Signature bfjz /14 Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Conilractor Signature bfjz /14 Date CUPERTINO Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408 - 777 -3333 CONTRACTOR / SUBCONTRACTOR UST JOB ADDRESS: Nn1 (1G1 Ct rf %'p,4 PERMIT OWNER'S NAME: 11,4 PHONE # 4:01—W LO GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: CITY /ZIPCODE.: *Our municipal code requires all businesses working in the city to have a City of Cupertino:- business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRA0 TORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: >� _ ' Sign ure Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date AAA" Putvi F K;vu CcApe�+,'Ko CA 9 0 Owhe,f Nxrne, 4 Jcx` 4 - ✓t- PA,n- WDI� NttAtJ2 fLAr-V\0(W- iAe,,/j a(,-, Uo CUPERTINO Building Departrnent j Or. COMMUNFTY DEVEL,91PMEW DEPARTMDrr BUILONG DNISION - CUPERTIP40 APPROVED This set Of plans and Specifications MUST be kept at the job site during construction. It is unlawful to make any changes or alterations on same, or to deviate th 0r9fr0m, without approval from the Building Official. The Stamping Of this plan and specifications SHALL NOT be h�el y r �an �ns of �a� ce o State Law. DATE " PERMIT NO.