08070159 CITY OF CUPERTINO
BUILDING DIVISIOP7 PERMIT aCONTRAC'I'QR IN' QRMAxTIO
irF:
BUILDING DRESS: - PERMIT NO.
1.4 ASTER LN OMEGA CONSTRUCTION 08070159
OWNER'S NAME: PERMIT ISSUE DATE
TUCHF.M TSAI 451 FENLEY AVE 07/22/2008
lipNE: (408) 243-0404 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
too LICENSED CONfRACnder po ECLes of Ch N
1 bvcpy a(Bm that 1 w limvcd under provitlov of Chapter 9(mmmneing lob Description
. withimtian701MRofDiviaian3offButiastaM fevriomC .&MPyreebacu RE-RF T/0 EX WDSHK INSTL 1/2" OSB&LFTME PRES
_lith mfull foram ander(«,. IO
��? LicenscCl Llo.g ASPHLT SHGLS CLS A 20SQ
F Dam Centrsenor
-ARHTIECPS OECIA
y I understand my plana shall he used an public rmbrda
g Cy0
licmued Professional
.E 5 OWNER-BUILDER m Ce ComraON
Q I hereby,(Sinn that 1 am exempt From the CanbactCo Licence Law for tM
pO following reason.Pemtim 7MIJ.Buaitesand
me.dedan Code:Any city at county
$u` which rtgdme a Permit re eennwq alms,mprow,h Permit t a repair any umetum
_Zap priwmits issuance.dpursu nNuims pro.npRcant for such Permit to Olea Law(natoment
s< that Mlalingm Purmammdmpmrivisionrdm Liceme Sq.Ft. Floor Area Valuation
f F F (carom is exempt
lth therefrom
7000)of,basis f r th al B m!axe exemption.
Myovi ladw of $8000
�`<— Nu K u exempt Ncte(rom and the Mein far the a1mgM edmpvm.MY rialatlm of
section 7071.5 by any applicant for.Permit subjxu the applicant to a civil penalty of Number Occu enc Type
ret more than five hundred dollars WWI, 3 661709 0 .W P Y YP
0 I.u owear of the property,a my employers with wages as their sok mampewWm,
win do the wok and tM mount.is rot inteMed oroffemd for sale(Sec.7044.Business
and PmfaaVana CMe:Th.Convector's License Law does ret apply m an Owner of Required Inspections
property who builds mimpmtes thermn,and whodoessuch worlehimsdfmthmugh hu
awn amployca,provided that such improvements tae not into reoffered Tor ale If. ..
Wilder Ne nve the an i ed o proAnla holdse did m, Wild of improve
for dK propose
of
Wilder will haw the bumett or proving that M did ret build m improve far puryom of
ukJ.
. 0 1.u Omer of rhe epen,,w exclusively convaming with Hammed mmrdton to
mmtrun the project(Sec.7004,Busimm and!Profcs lams Code:)The Cmtracmta U.
come Lew does not apply to an owner of property who builds or improve,thermn,and. -
uImcontacts Tor stele pmjeeu with a cmntracmr(s)livened p.m to the Conumexces
I le—Lew.
O lameampturder Sm ,B&PCf.Nismaann
Owns Dan
WORKERS COMPENSATION DECL.aRAT10N
1 hereby affirm under penalty of perjury ora of the following declarations:
raw next will maintain a Certificate of Covent m self-inure roe Wodtm's com.as provided for by Seci m T?W of tic labor Code,ren as porformm of tM
work for which this permit is issued.
0 I haw and will maintain Worlds Compensation Insurance,as acquired by Section
77M of Ne Labor code.for the performance or Ne were for which this Permit Is issued. .
MYWo,ters Co peasmi nsumex irean Panic"nu 3
Cartier. ^ II No.:
CERTFl OF E) IPTTONFROM WORKERS
COMPENSATION INSUR Cil
(Thin scmlm bond not W mmpletod iter permit is format:hundred dollars,($IW)
or leu)
1 antic.char in the perfomdxe of Na wort for which this Permit is wood.I shall not
employ any Peron 1..1 man.rw an to become subject to the Wortcri Compemmlm
Laws of California.Dam
A,Hcant
NOTICE TO APPLICANT:If,afar mating Nu Ccmftcae of Exemption,you should
become subject to the Workers Campenution provision of the labor Code,you man
.JO forthwith comply with such Provisions or Nu permit shall tan doebed revoked.
'Zy CONSTRUCTION LENDING AGENCY
(—t Ihereby affirm that there u a comtroNnn lending agency for the Performance of
W> the work for which this nevelt is issued(Sec.7097,Civ,C.)
0 Landers Name
0. z Lenders Addresa
U O 1 certify Nn 1 have rend this application not slam that Ne show information is
Iy torten.I agree m comply with all dry and ex mly a minimax aM sale Pan relating to
10 Wilding construction,and harebY antherire representatives of this city to etWupon Ne
LV salve-menuamd property for impaction purposes
(We)agree to save,indemnify and keep harmless the City of Cupertino against
rn liabilities,jMgmcnu,costa and,aresmacs which may In any way.cdue against said City
U Z in consequence or the granting either permit. !�
SOURICANT UNDCU ERS7 NDS AND WILL COMPLY w�glmL NhN-PORI Issued by: Date
(/ Re-roofs
Signature of AppncanVConuactor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupamsmre or luadle humans material
u dcflm l by the Cupertino Mut Ri Cade.Chapter 9.12 and Ne Health and Safety
Conn.station 1357I4)?
[Dy. P01e All roofs shall be inspected prior to any roofing material being installed.
Will the, lice,,or furem Wilding occupant um a ori If a roof is installed without first obtainingan inspection,I agree to remove
PP g P q pment a deHm Mich
hwardbus air cmumirunu u dcrira 'Ne Bay Are.Air Qadity Management all new materials for inspection.
Oyer
I have mad Ne he»mmsmmerialsmqu muncou underChap erd.97 of the Califor-
nia beat"Saretycode.Section 27703,29577 and 25774.I undersnd atelftle Wading
does ret cumendW haw a mnanl that it u my responsibility to boufy the mceupanr of da,
rtgaimmcuew missueee tor,Cavrrae Of OccuseencY
4 Signature of Applicant Date
Ower or aNmiec Dam 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 . . . . . . . . : 36617090 . 00
DATE ISSUED. . . . . . . : 07/22/2008
RECEIPT #. . . . . . . . . : BS000005544
REFERENCE ID # . . . : 08070159
SITE ADDRESS . . . . . : 1435 ASTER LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : TUCHIM TSAI
ADDRESS 1435 ASTER LN
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5216
RECEIVED FROM . . . . : OMEGA CONSTRUCTION
CONTRACTOR . . . . . . . : JUNG HUH LIC # 22317
COMPANY . . . . . . . . . . : OMEGA CONSTRUCTION
ADDRESS 451 FENLEY AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95117
TELEPHONE . . . . . . . . : . (408) 243-0404
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- - --------- ----------
1BSEISMICR VALUATION 8, 000 . 00 0 . 80 0 . 00 0 . 80 0 . 00
IREROOFRES SQ FEET 20 . 00 260 . 00 0 . 00 260 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 260 . 80 0 . 00 260 . 80 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
-------- --------------- --------------------
CHECK 260 . 80 #5354
---------------
TOTAL RECEIPT 260 . 80
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----- ---------------------------- --- --------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF CUPERTINO
' REROOF
•CUPERTINO PERMIT APPLICATION
APN # /–7 O Date: 71 22_ Q(?
Building
^ AA0nn ` �o
Owner's Name:. ` Phone #. `U
Contractor: F� ,[[, \ Phone #: ��4` �–' /ps -�IU
`�A C r* � �\ � 1 Fax #: `` ztq 6—(o
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: f �^
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:
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 6/16/08
CITY OF CUPERTINO
REROOF
CITY OF
CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
2 1RER00FRES Re-roof Residential B 1SFDWLR00F
/ 1BSEISMICRE Seismic Residential B
1RER00FMRES 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 1997 UBC Standards
and manufacturers specifications on re-roofing.
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 1/4 " 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:(' l\
IM T5Q
Job Site Address: �S-
Roofing Company Name: _ C
Applicant's Signa e:
• Greg Casteel
Building Official
Revised 11/2/04
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
--i-points
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 __?_points
E. Ext. Finish 1. Composite Decking, (Note/Spec.) A-3 2 points
4. B. Fiber Cement Siding, (Note/Spec, A-4 2 cints
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. AJ 1 point
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.
A.Ske
1.Recycle Job Site Construction&Demolition Waste 1
65°/G=1 point;75%= 2 points;BD%=4 points up to 4 Resource pts 0
2.Salvage Reusable Building Materials _ 4 Resource pts y=yes D
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 0
5.Minimize Disruption of Existing Plants&Trees 1 Resource pt y=yes 0
6.Implement Construction Site Slormwater Practices 2 Resource pts y=yes 0
7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0
B.Design Resource-Efficient Landscapes and Gardens - 4 Resource
- - - -- - — - - Pis y--yes D
9.Reuse Materials/Use Recycled Content Materials
for Landscape Areas 2 Resource pts yl-,es 0
10. Install High-Efficiency Irrigation Systems 2 Resource pts y=yes D
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 ptsFOO
2.Use Recycled Content Aggregate 2 Resource pts y=yes
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes 0
1 1 1
C.Structural Frame
1.Substitute SolidSawn 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 1-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 0
S.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 0
B.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0
9.Use Structural Insulated Panels(SIPS)
a.Floors 3 Ener
b.Wall 9Y Pts Y=Yes 0
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
12. Use OSB - - - -- - - - '-
a.Subfloors 1 Resource of y=yes 0
• b.Sheathing _
1 Resource pt y=yes p
1 1 1
INPUT Resources Energy ADMeafth
.Exterior Finish
.1.Use Sustainable backing Materials
a.Recycled content 3.Resource pts Mes 0 •
b.FSC Certified Wood 3 Resource pts y=yes 0
`2.Use Treated Wood That Does Not Contain Chromium/Arsenic 1 IAQ/Health pt y--yes p
13.Install House Wrap under Siding 1 IAQ/Health pt y=yes 0
14.Use Fiber-Cement Siding Materials 1 Resource pt Mes; 0
1 1 1
E.Plumbing
1.Install Water Heater Jacket J 1 Energy pt y=yes 0
---- — _ _Pi_ – •--- – —
2.Insulate Hot and Cold 1Nater Pipes 2 Energy pts y--yes 0
3.Retrofit all Faucets and Showerheadswith 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 s
�1 point each,up to 3 points) _ ! 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 Energy pts Mes 0
7.Install Water Filtration Units at Faucets
(2 points each,up to 4 points) Up to 4 IAQ/Health pts. 0
6.Install On-Demand Hot Water Circulation Pump 4 Resource pts y--yes 0
1 1 1
r,tiecmcai
1.Install Compact Fluorescent Light Bulbs(CFLs) )
(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. 0
1 1 1
G.Appliances
Irl.Install Energy Star Dishwasher } 1 Energy pt y=yes 0 .
2.Install Washing Machine with Water and Energy. i
1Conservation Features i 1 Energy pt y--yes 0
Wnstall Energy Star Refr gerator 1 Enargy pt y=yes 0
4.Install Built-In Recycling Center 3 Resource pts y=yes 0
1 1 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 wifli
Lo Added Formaldehyde ! 31AQ/Hea1th 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.Walls 4 Resource pts y--yes 0
D.l;eilinos 4 Resource pts y=yes 0
1 1 1
INPUT Resources Energy 1ADIHealth
F. endows
it.Install Energy-Efficient Windows _
• , a.Double-Paned 1 Energy pt y=yes 0
b.Low-Emissivity(Low-E) 2 Energy pts y=yes p
L c.Low.ConductivityFrames
_ __ _ _ 2 Energy pts y-yes D
2.Install Low Heat Transmission Glavng J 1 Energy of y=yes 0
1 ! 1
J.Heating Ventilation and Air Conditioning
11.Use Duct Mastic on All Ducl Joints -_ 2 Energy pts y_yles 0
2.
Install Duchvork within Conditioned Space 3 Energy pts y=yes 0
sta
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 0
5.Install SDIarAttic 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 pis y=yes 0
8.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
f0.Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts Y--yes p
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 stoves6nserts 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=yas 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes D
17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes
D
1
K.Renewable Energy and Roofing 1 1
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
i6.Select Safe and Durable Roofing Materials - _ 1 Resource pt y=yes p
7.Inslall Radiant Barrier . — -�� - 3 Energy pts y=vas 0
L.Natural Heating and Cooling 1 1 1
1.Incorporate Passive Solar Heating 5 Energypts y=yes p
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes D
3.Plant Deciduous Trees on the West and South Sides 3 Eneroy pts y=yes
0
• 1 1 1
M.In oor Air Quality and Finishes INPUT Resources Energy �AQ/Health
'I.Use LowMo-VOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low Vb Water-Based Wood Finishes 2 IAOMealth pts y=yes 0
3 Use Low/No VOC Adhesives_ 3 AQ/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
i7 Seal all Exposed Particleboard or MDF 4 IAQ/Health pts y=yes D
6.Use FSC Certified Matedals 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 B Resource pts y=yes0
2.Use Rapidly Renewable Flooring Materials 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
1 f 1
Total Points Available: 1401 130 57
Total Points Project Received: 0 0 0 •
G.datalprooslgreen6uildinoguidelines/remodelerslgreanpointsfinal2.12.D4prolecled.gs
•
Community Development
{ 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
#UPER,TINO
Building Department
JOB ADDRESS / , , 1�"���t�6, PERMIT # �O
OWNER'S NAME: C �ro �^� � I PHONE # --k
tLj-
GENERAL CONTRACTOR: pVjlCtaaAx # _ !-97-5 am not using any subcontractors: C� 2X
St a Date
Please check applicable subcontractors and complete the followin 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
Ti
Owner/ actor Signature Date