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13090194CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION 10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255 (408) 777-3228 ^ FAX (408) 777-3333 - buildingacupertino.orcl LUMBING ❑ MECHANICAL ECTRICAL ❑ MISCELLANEOUS PROJECT ADDRESS /�/� /��-APN # OWNER NAME (V `ti' b�PJ� c-�✓l.� PHONE©, STREET ADDRESSd r Y, S, �ATE„Z�P CN 9 V , /nV^ F - -7_ 71 CONTACT NAMn O e� PHO1S��r^ ^ E I�^v "+ A R/ -FAAX STREET ADDRESS CITY, STATE, ZIP ❑ OWNER e< R -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGAIEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME _ , ^ yy LICE f LICENSE TYPE BUS. LIC # COMPANY NAME \ � � , C' FAX V ST ; ET AD RESS �-( CTT TATE, ZIP e 3 PHO l0 ARCHTTECTIENGTNEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WBALAND ❑ YES BUILDING. ❑ COMtv1ERCL4LL URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK V �@COt� 1�2 CJL TOTAL VALUATION:/'I\ c ( 0, r RECEIVED BY' By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating t uilding nstruc on. I authorize representatives of Cupertino to enter the above -identified property fol pection purposes. Signature of Applicant/Agent Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICEusEONLY OVER -THE COUNTER ❑ EXPRESS x STANDARD z , �0`LARGE, ��� MAJOR MEPMiscApp_2011.doc revised 06/21/11 Building (Department City Of Cupertino 10300 Tone Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 R7 ® Fax: 408-777-3333 cC®N7RAMOR / SUBCONMA C70 R Lff,97 JOB ADDRESS: PERM( ,0 . 42 OWNER'S NAME: v PHONE # GENERAL CONTRACTOR: jr BUSINESS LICENSE # ADDRESS: AeAeJ041 *Hour municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FILIAL 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 infformation: (Date c� Owner / Contractor Signature (Date SUBCONTRACTOR BUSHINESS NAME BUSK NESS LICENSE # Cabinets & Millwork Cement Finishing Electrical v� Excavation Fencing Flooring / Carpeting 00X Linoleum / Wood Glass / Glazing Heating IR y Insulation Landscaping Lathing Masonry y� 6 Painting / Wallpaper e Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock r - Tile Owner / Contractor Signature (Date CUI'f f�TINOO CONTRACTOR / SUBCONTRACTOR LRST B uiialing Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 *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 CITE' OF CUPIERTINO BUSINESS LICENSE.'Y��, C���— q - 2-(�--' Is I am not using any subcontractors: Signature Date (lease check appllicahlle subcontractors and compRete the ffaiRowing information: c/ 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 t F� Baa LU WO �z 10-f =O ac I€ E - r f Ir LULL, r _ NO] Pzo56 ou aad a aae suaaa o f'oa ��` :u �'P tS� � iS S- Rai C Mill 4 CL Cn Oh $ ZF� ffi- P �GWOO Ved ouipadn_ s 1/ m� 0 F U os C U ry-�®W 1 lli Q gsa s a. :"� z O.LCC .t. 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