14120071-FCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21030 GREENLEAF DR CONTRACTOR: TITAN GENERAL PERMIT NO: 14120071
CONSTRUCTION
OWNER'S NAME: LEAVITT CAROLYN S TRUSTEE 46509 MISSION BLVD STE.1 18 DATE ISSUED: 03/25/2015
O R'S PHONE: 4088938007 FREMONT, CA 94539 PHONE NO. (408) 883 -8668
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E]
CONSTRUCT 2 STORY SFDWL TO INCLUDE 1ST FLOOR;
License Class Lic. #_ 2170
r-r, SQ FT, 2ND FL. 1568 SQ FT; ATTACHED GARAGE 439 SQ
Contractor (� a +id Date , FT; 1497 SQ FT TO FRONT PORCH, OVERHANG, DECK
I hereby affirm that I am licensed under the provisions of Chapter 9 REV # 1- ENCLOSE SOUTH WALL OF CARPORT, RELOCATE & CHANGE
(commencing with Section 7000) of Division 3 of the Business & Professions AMP ON PANEL TO 400 AMPS - ISSUED 4/20/15
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. Sq.,Ft Floor Area: Valuation: $600000
A,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 inconsequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
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 regulations per the Cupertino Municipal Code, Section
9.18.
Date
APN Number: 32628084.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 18 RMIT ISSUANCE OR
Date:
RE- ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roo f 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 Cuper ' unicipal Code, Chapter 9.12 and
the Health & Safety Code,, Sections 2550 , 255 and 25534.
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
im]ADDRESS:
21030 GREENLEAF DR
DATE: 04/20/2015
REVIEWED BY: MELISSA
rblech. Permit Fee:
APN: 326 28 084
BP #: 14120071
*VALUATION: Iso
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE: p
Phemh, bup. Fee:
PENTAMATION
PERMIT TYPE: 1GENRE i
WORK
REV # 1 - ENCLOSE SOUTH WALL OF CARPORT RELOCATE & CHANGE AMP ON PANEL TO
SCOPE
400 AMPS - ISSUED 4/20/15
v .v
Mech. Plan Check
Plumh. Plan C herb.
I Aec. Plan ("heck
rblech. Permit Fee:
Plumb. Pe=rmit Fee:
Eke. Permit Fee:
Other ;llech. Insp.
other Plumb Insp.
Other Elec. Insp,
;:Lfe& Insp. tee:
Phemh, bup. Fee:
Elec. Insp, Fee:
NOTE: This estimate does not includefees due to other Departments (i,a Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept-for addn'l info.
FEE ITEMS (Fee Resolution I1 -053 Eff 7111131
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (j) No
$0.00
hours
$143.00
Plan Check, Hourly
ISTPLNCx
Suppl. PC Fee: (j) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes (j) No
$0.00
Suppl. Insp. Fee:' Reg. ® OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tczv:
�1.clrninisbative Fee:
G
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee.
$0.00
Select a Non - Residential G
Building or Structure
i
Travel Documentation Fees:
Strong Motion Fee:
$0.00
1.0 hrs
$143.00
Inspections
ISTINSP Inspection, Hourly
Bldg Stds Commission Fee:
$0.00
SUBTOTALS.'.
$0.00
$286.00
TOTAL FEE:
$286.00
Revised: 04/01/2015
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
' cD
1 (408) 777 -3228 • FAX (408) 777 -3333 • building cupertino.org
CUPERTIN
❑ NEW CONSTRUCTION ❑ ADDITION . ❑ ALTERATION / TI REVISIO / DEFERRED
PROJECT ADDRESS O—� ^ T
APN # 32L 06 O�
v S V
OWNER NAME -
1
PHONE \ _ gD�
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EMAIL
STREET ADDRESS 2 p v --,o -
CITY, STATE, ZIP
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FAX
CONTACT NAME G �N
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E -MAIL
STREET ADDRESS
CITY, STATE, ZIP %
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FAX
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El OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT MCONTRACTOR ❑ CONIRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CCT�ORijA � '�
LICE NSER
LICENSETYPE
BUS. LIC# �7
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COMPANY,&'. ME
E -MAIL
FAX
STREETD S
CITY, STATE, ZIPS _ n
PHONE
v ,
6
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK �� ! �` Sw ,
EXISTING USE
PROPOSED USE CONSTR.
TYPE
#STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXLSTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
-
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑YES
BEING ADDED? ❑NO
ADDITION? ❑NO
"
PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
15 1448tIV. ED BY '`r
..-�- "- _.
VALUATION:
PLANNING APPL � ❑ NO PLANNING APPROVAL LETTER
EICHLER -HOME? [-]No
-�
-I
4
By my signature below, I certify to each of the following: I am the property owner or auth agent to rope s behalf. I have ma s_
application and the information I haV�r4A s correct. I have read the Description o Drk and verify It is accuurr t . agree to- comply with all applicable local
ordinances and state laws relating to con ruction. I authorize representatives of Cupertino to enter tl a o - identified property for inspection purposes.
Signature Applicant/Agent: Date: Z
of ,
SUPPLEMENTAL INFORMATION REQUIRED
'''
.:::
❑ '
x Y
��BUILD7NG � y
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
OVER THE - COUNTER � �
PLAN REVIEW
x
permit for new building.
EXPRESS
�
s z
��`pLANnuvcr�LA�tIEVIEw�,.
as � ��
4<"
��
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
Cl' sTANnARD 5
PuBticwoRxsk,
form if any Hazardous Materials are being used as part of this project.
"
s
� pr LARGER *t.-' ,a � � � =- �'`"��
� sF>� AF•PTw �, �s. ,4,.
Copy of Planning Approval Letter or Meeting withPlanning prior to'fr
�
submittal of Building Permit application.
CI MA`7OR '' s �{
+ "BAISTTAFtY ,SEg'ERDISTRIGT B� +
n,.
�'r,'�u 4 m
h ENVIROIVMEIVTAI�HEAliTiir�s �
B1dgApp_2011.doc revised 06121111
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21030 GREENLEAF DR CONTRACTOR: TITAN GENERAL PERMIT NO: 14120071
CONSTRUCTION
I OWNER'S NAME: LEAVITT CAROLYN S TRUSTEE 146509 MISSION BLVD STE 118 1 DATE ISSUED: 03/25/2015 1
PHONE: 4088938007
up LICENSED CONTRACTOR'S DECL %ARATION
License Class Lic. #
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 comply
with all non -point sou c ulations per the Cupertino Municipal Code, Section
9.18.
FREMONT, CA 94539 1 PHONE NO: (408) 883 -8668
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
CONSTRUCT 2 STORY SFDWL TO INCLUDE 1ST FLOOR;
2170
SQ FT, 2ND FL. 1568 SQ FT; ATTACHED GARAGE 439 SQ
FT; 1497 SQ FT TO FRONT PORCH, OVERHANG, DECK
Sq. Ft Floor Area: I Valuation: $600000
APN Number: 32628084.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Date:
3 /� RE- ROOFS:
ii; , e�� Date 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.
❑ 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 regulations per the Cupertino Municipal Code, Section
9.18.
Date
Signature of Appli
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 equi p m or devices which emit hazardous
air contaminants as defined by the B rea Air uality Management District I
will maintain compliance with the upertino M icipal Code, Chapter 9.12 and
the Health & Safety Code, Sec on 505, 255 , and 25534.
Owner o uthoriz�e: fr 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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building Qcupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 1030 GTL F _ t �-
AlP$
N #
^ 0 9
OWNERNAME
PHON("id&) ,g9$_p661' E-MAIL Cl 0 -(16 e
1�Cn
STREET ADDRESS f ® 2- 1� c, kv p CITY, STATE Z^ FAX
�
CONTACT NAME G\J is -0 PHONE `S�ZG
E -MAIL IF "0 1::Z. L�Vo &\e1A�i
STREET ADDRESS
CITY, STATE, ZIP f,Agl0�_,A. �Ap q „ -7o
17I`ARCHITECT I� _0
FAX
❑ OWNER ❑ OWNERR-- BUB-DER ❑ OWNER AGENT ❑V CONTRACTOR ❑ CONTRACTOR AGENT ENGINEER C3 DEVELOPER 11 TENANT
CONTRACTOR NAME LICENSE NUMBER
LICENSE TYPE
BUS. LIC k
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECTIENGINEER NAME
LICENSE NUMBER
BUS. LIC d
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK —1 ® ST0 (Az Ill � i
"�
1ST u I I Kn - �I -10 , O 41- s�C<S� fl- L I V S 6 F57
AW
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
5` _�
T
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG NEW FLOOR DEMO
AREA AREA \°7P AREA 1�
l
NET ARE 41-17
TOTAL �iACH
L
/
BATHROOM
REMODEL AREA
KITCHEN
REMODEL AREA
OTHER
REMODEL AREA
PORCa
DECK AREA
TOTAL DECKTORCH AREA
GARAGE AREA: DET
.HA�REA
V
L ,D
[]AT
j_
6Lj1°T f
/�
(J
DWELLING UNITS:
IS A SECOND UNIT ❑YES
O
SECONDSTORV YES
ADDITION?
IBEING
ADDED?
C]NO
/W;7
PRE - APPLICATION YES IF YES, P O� OPY OF
PLANNING APPL9 ❑NO PLAN P 0 'PL
IS THE BLDG AN El YES
EICHLER HOME?
RECEI
TOTAL IQ
By my signature below, I certify to each of the following: I am the property owner or authori agent to t on the property owner's behalf. I have read this
application and the information 1 have provided is correct. I have read the Description of W &k-and yerify it is curate. I agree to comply with all applicable local
ordinances and state laws relating to building construction thorize representatives of Cupertino to enter the above- idpentified property for inspection purposes.
Signature of Applicant/Agent: Date: �ZJ { S y f
SUPPLEMENTA INFOP- MATION REQUIRED
h ._ PLA1�CIiECKT1TE,
ROUTTI�G SliIPr„ s ,
New SFD or Multifamily dwvellings: Apply for demolition permit for
OVER TH7rCOtTIVTER
existing building(s). Demolition permit is required prior to issuance of building
ING PLAIT ItE� iEly $'
permit for new building.
❑4ExnRESS I' -
❑ r 6PLANREVLEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
TAN'DnRD w
,
4
❑ �P o t.
_ c
form if any Hazardous Materials are being used as part of this project.
�
"'
❑ zGE T� r
J
❑ `FI' z s4
_ Copy of Planning Approval Letter or Meeting with Planning prior to
" +
�,
❑
submittal of Building Permit application.
MA70R -,
ARX SEIi'ER DISTRICT _ y
❑-
. i>ENVIR6 IYHIENTAI.7IEALTA i�.t "_ .,,.<
BldgApp_2011.doc revised 06121111
A
CITY OF CUPERTINO
S . FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 21030 greenleaf dr
DATE: 12/15 /2014
REVIEWED BY: Mendez
MISC ITEMS
APN:
BP #:
*VALUATION: 1$600,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE:
New Construction
PREVIARY SFD or Duplex
USE:
!' --- 2nd Unit? Yes • No
PENTAMATION 1 R3SFD
PERMIT TYPE:
WORK
construct 2 story sfdwl to include 1 st floor; 2170 sq ft 2nd fl. 1568 sq
ft; attached garage 439 sq ft;
SCOPE
1497 sq ft to front porch, overhang, deck
hrs
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. (s.f.
R -3 (Custom) . II- B,111- B,IV,V -B 5,674 $3,404.41 IR3PLNCK $4,524.81 IR31NSP
fi.'d`Pfti..l)ePdd2!i ee,
Other rtir.'s',r'?.. Ina q).
,44ech, hiq). 1,* ee:
TOTALS: I 5,674 I $3,404.41
Plan"!), Pr'i'i1tfY Flet':
Plumb, InT.. Fee:
$4,524.81
€. >Ie.. I'lrrri C�rcx�
iec, Pe vif Fee:
0 -..her EI e r. Its;p,
E!"c. MSP. Fee:
NOTE. This estimate does not include fees due to other Departments (tie. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). I liese fees are Dasea on the preliminary information available and are only an estimate. Contact the Dept for aaan -t uilo.
FEE ITEMS (Fee Resolution 11 -053 E f 7/1/133
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$3,404.41
Select a Misc Bldg /Structure
or Element of a Building
Suppl. PC Fee: Q) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$4,524.81
Suppl. Insp. Fee-(F) Reg. Q OTT-0,01
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXR
1
#new
units
$667.73
Aehninisirauive Fee
0
G
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Fee: IPLLONGR
$794.36
Select a Non - Residential
Building or Structure 0
i
F aa- elDocumentation I°'rses
Strong Motion Fee: IBSEISMICR
$78.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$24.00
* 'kP arS UBT (1TALS
�.N
$9,493 31
TO TAL FEET
$0 00. ,
$9,493.31
Revised: 10/01/2014
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: .:Z- O O aO-A
PIV Y-.
PERMIT # L+Imoog
OWNER'S NAME: Can Ui
PH NE # O 3 —
GENERAL CONTRACTOR: r - }-
BUS SS LICENSE #
ADDRESS: Lm 8
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
Please check applicable subcontractors and complete the following information:
Date
V0
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
�l�"GLYL- �nL� rGC I S-�' -�
?j!� -�
Cement Finishing
-i � ,����,�
Electrical
Excavation
(2 en &1-o,-L
3 4- 2 v
Fencing
�N
, 3 ' Z
Flooring / Carpeting
� rL,-
Linoleum / Wood
E
3"t-q8 Z
Glass / Glazing
P-- e-ki
i 2' Z
Heating
Insulation,
Sj`jC,
y e
Landscaping
3
Lathing
�-
Masonry
-�- ^�
8 Z—
Painting / Wallpaper
_ _
Paving
��
Plastering
Q/l,s �C,
Z 3
Plumbing
z'
Roofing
5
360
Septic Tank
N �}
Sheet Metal
Sheet Rock
Lk.
Tile
�'- �'Gtn� C' n e/)-Gk-L
t 2 Q
ner / Contractor Signature Date
;Oc'l
1
-