08080110 CITY OF CUPERTINO �.r.) '" xs °3•f.- ( *�� � "
BUILDING DIVISION PERIVIIT .'CONTRA TCIRANFORMr1.TION
,�::: �,..
BUILDING PERMIT NO.
/.) /I DUMAS DR TBD — TO BE DETERMINED 08080110
OWNER'S NAME: PERMIT ISSUE DATE
POON DAVID S AND MAUREEN Y 08/15/2008
NF SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
RE—RF T/0 SHKS INSTL 1/20SB BLDG ELECT PLUMB MECH
O O O O
moo
LICENSED CONTRACTOR'SDECLARATION 1bDescri tion
4 C 1 hereby a«m Nn
r 1 am Returned under provisions of Clupur 9(commencing ^•^•^- ^• - ^^^ op
t� riN Sccuon]pMBDiviaon of du BusircssaM Pmfcuioru Cade.,nd mYliccnuu
d ins ren roree caedeflect.L
epi i"IF s Lic.Is
a;
fa Dau Cdnmacor
erep ARCHITECTS DECLA 0
W U I understand my plans BIW I W used.pub records
g6
ii^ LiccmcJ Professional
rE3 OWNER-exempt fr m the Con ION
M O 1 berry.(stns that I L exempt from the Canons Co :My c Law for the
i❑O following mason.(Semite ID3 L5,Business and Profuddns Code:Any oily structure county
3$
which requiresissuance.
,permit re conswcL slur.Improve.h Permit t nr repair any comment_Z< tatheiits iasuded parbumquires the applicant for such Permit tilt asigaJ suumem
g metluuOe.medpmruammNcproraionsnrNecenpa,wr'auee��w(chap.m9 Sq. F[.Floor Area Valuation
yO (commcaing with Secuon]OW)of Div¢ion 3df Ne Buunmand Profcasiom Cdde)m
$
that M I.exempt therefrom and the basis for the alleged exemption.Any violaJon of
Section 7031.5 by any applicant for a pumit subjects Ne applicant o a civil pcoalty of APN Number Occas ant T e
not mom Nafiven .e hundred damns($50 y, p y yp
❑L,sow eat abepropu oncis .mployee wlN wageas Ne'u isle cdmpcovden,
will dothewodL and the an Communes LMedorawdo tarsale(Sec.in A.ownimv
pro ertywh to Code:oIbe cnmaeewra License Law oda not apply o rt owner is Required Inspections
propertywhobuilds i improve Heron,and w u aressuintwent himselfelthroughh.
own employee,provided this suer improvements are not intended
ar to uoroe red for ale B,
Wilmur a the building or improvement i,sold within alas yens of completion,the,owner-
sak.), will have Use buNco of proving Nu Its did rot basal Or improve for purpose of
ale.l.
❑1.as owner or the propen,,are uclumely communing with Hummed conow"ohs b
construct the project(Sec.7044,Business and Pmfessiam Code:)The Conmuoe,Li-
came Law docs not apply in an owner of protan who builds or improve thereon.and.
who contracts for such projects with a cmnuanor(s)licensed pursuant m one Commander
License law.
❑1 em uempt under Sec .B 0 P C for this reason
Owner Dam
WORKERS COMPENSATION DECLARATION
1 uereby aRrm under pcmlty o(petim,nM of dm following declanumm:
I lu+eatWwill]onuin aCertif mor Camaro eco elf-ivumlmWorkcesCempcn-
eul as provided for by Section 3700 of the Labor Code,for the performance of one
work for which Nu permit is issued
❑1 have and will maintain Wormer Compensation Imuran¢,n acquired by Sccuon
3700 of ane txr Code,for the Pcrfurnanee Of the work for which this permit is issued.
My Wor Cm tion urea carie and Policy number atm::G,�/.
Grtier. Policy No.�l I-I\ N'f
CERTIFICATE OF EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE .
(Tris section need rot re completed i(the permit is(moa hunNW dollars($IOD)
or less.)
1 zrufy Net in she performance of Ne work for which this permit is issued.l stall not
employ any penin in any manor an as u become subject to the Workcrs'Compcmadon
Laws of California.Dam
Applianl
NOTICE TO APPLICANT:1f,e0cr making this C.miBcau of Esemttimn,you should
Wer n e subject to the Worker's Compensation provisions of she labor Code,you most
.J O forthwith comply wish each provisions or Nu Permit shall be domed mokcd.
Z y CONSTRUCTION LENDING AGENCY
Iherby M.that f.isaeomsuetinm lending ageay(or Ne perfoamanre of
�i Ne work for which Nu permit is Wood(Sec.3097,Civ.C.)
W� Q landess Name .
z Lcndus Address;
V C) I certify Nat I hale rad this application and sum Net the above information is
U.E torted I agree o comply with all city and county ordineaee and sum laws muting to
C) building construction,and hereby mtrmtiae repteonMfie of this city to Omer upon Ne (eQ'/gI[ ,�/t►y�(aa/t, //
,Hili-..nudgme progeny for inspection purposes
F a (We)agree to„K,indemnify and mcp harmh a the City of Cupcnino against
h incoiJa,judgmenhe'urfindor this ca which may in any coy scare agunstseid City
f,J z A APPLICANT
of the UNDERSTANDS
of NuPe WILL
�••' APPLICANT UNDERSTANDS AND WILL COMPLY WITHyAL//L NON-POINT Issued by: Date -rjg-
SOUR�C !!ON$- A 0 lf,f/g2
_ Re-roofs 2
Sign rAPPlia"HAZARDOUS MATERIALS DISCLOSURE Dau Type of Roof
Will the applicant orfuture building reapaptsorcor
IaMleh rommamrial
u dMd by de ) d Municipal Code.Chapter 9.12,aM Ile Hearth and Safetycode.Section 25s32(x)7
Cup
Cl Y. syNar All roofs shall be inspected prior to any roofing material being installed.
Will rhes applicant or future building=open[use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit harardnm airconwnimnts as seed by the Bay Area Air Quality Management all new materials for inspection.
Dlsmict]
❑Yon No
I haw mad the harardoes Materials rtquirearems under Clutter 6.95 of she Califor- ^ /
riaHcslin k Safety Cddc,$cutins 25305,25533and 23534.1urvacrstand Nal if Ne bulling Ir v
does not ct A mean.the it u my retponilNliry he aufl de meupant of Ne
reqs nts b m primes da dracnare,edreSign re of Applicant Date
Owneror authorondagcm Gum All roof coverings to be Class erne.or better
CITY OF CUPERTINO
2 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35925037 . 00
DATE ISSUED. . . . . . . : 08/15/2008
RECEIPT # . . . . . . . . . : BS000005801
REFERENCE ID # . . . : 08080110
SITE ADDRESS . . . . . : 7573 DUMAS DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . . -
OWNER . . . . . . . . . . . . : POON DAVID S AND MAUREEN Y
ADDRESS . . . . . . . . . . : 7573 DUMAS DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4310
RECEIVED FROM . . . . : ANTHONY RAINIERI
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------ - -- -- ---------- ---------- ---------- - ---
].BSEISMICR VALUATION 17, 000 . 00 1 . 70 0 . 00 1 . 70 0 . 00
IREROOFRES SQ FEET 39 . 00 507 . 00 0 . 00 507 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 508 . 70 0 . 00 508 . 70 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CASH 1, 000. 00
CREDIT CARD 375 . 20 MC ,
---------------
TO`L'AL RECEIPT 1, 375 . 20
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ----- ---------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS - 605 FINAL REROOF
•
oioko/ io
CITY OF CUPERTINO
REROOF
• CUPEkTINO PERMIT APPLICATION
APN#tiJ6 W 5 6 • 60
Date:
Building Addr ss:
s�3 D., ,a
Owner's Name: Phone#:
'Oj .v ilD ?&'Don �1 - 2 ci
Contracto'r:II-- o Phone #: 7,,(,q jz/d
Fax #: -Z& c/TZ-Iv
Cupertino Business License#: Contractor License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles JjAsphalt Shingles
• -0� Wood Shakes a 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: �/� �e5 1, S U0 S a 30 r (, 7—L
Residentia 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:
/7D191)
1 Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signa e
Revised 6/16/08
Q flal, CITY OF CUPERTINO
REROOF
CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
IREROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Residential B 1SFDWLROOF
/ 1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
• 1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08
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
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 1oint
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.Site
11,Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;80%=4 points up to 4 Resource pts 0
�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 0
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 Resource-Efficient Landscapes and Gardens 4 Resource pts y=yes 0
9.Reuse Materials se 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 D
2.Use Recycled Content Aggregate 2 Resource pts y=yes 0
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes 0
1 1
C.Structural Frame 1
r---- � - — ---- -�
1_Substitute Solid Sawn Lumber with Engineered Lumber 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 pis y--yes 0
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
6.Use Finger-Jointed Studs for Vertical Applications 2 Resource pts y=yes 0
7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes 0
S.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
'f2.Use bSB - -
a.Subfloors 1 Resource pt y=yes 0
• b.Sheathing 1 Resource pt y=yes 0
1 ! 1
D.Exterior Finish ,
1.Use Sustainable Decking Materials
a.Recycled content 3.Resource pts y=yes D .
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 0
,3.Install House Wrap under Siding 1 IAQ/Health pt y=yes 0
I4.Use Fiber-Cement Siding Materials 1 Resource pt y=yes 0
E.Plumbing
r1.Install Water Heater Jacket _ _ _ 1 Energy pt y--yes 0
2.Insulate Hot and Cold Water Pipes 2 Energy pts y=yes 0
F3,Retrofit all Faucets and Showerheads with 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. D
4.Replace Toiled with Ultra-Low Flush Toilets
t(1 point each,up to.3 points) __ - J Up to 3 Resource pts. D
5:Install Chlorine Filter on Showerhead 1 IAQ/Health pt y=yas 0
S.Convert Gas to Tankless Water Heater 4 Energy pts y=yes D
7.Install Water Filtration Units at Faucets
(2 points each,up to 4 points) Up to 4 IAQ/Health pts. 0
B.install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes D
i 1 1
r.eiecmcar
(i 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. D
4.Install High Efficiency Ceiling Fans with CFLs
(1 point each,up to 4 points) Up to 4 Energy pts. 0
! 1 !
G.Appliances
�1.Install Energy—Star Dishwasher - 1 Energy pt y=yes 0
12.Install Washing Machine with Water and Energy
IConservation Features 1 Energy pt y=yes 0
I3.Install Energy Star Refrigerator 1 Energy pt y=yes 0
.4.Install Built-In Recycling Center ' 3 Resource pts y=yes 0
1 1 !
H.Insulation
1.Upgrade Insulation to Exceed Title 24 Requirements
a.Walls 2 Energy pts y=yes D
b.Ceilings 2 Energy pts y=yes D
2.Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0
13.Install Recycled-Corifent,Fiberglass Insulation with
+No Added Formaldehyde 31AQ/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 C •
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
o.ceilings 4 Resource pts y=yes 0
1 1
. I.Windows
1.Install Energy-Efficient Windows
• ; a.Double-Paned 1 Energy pt y--
yes b.Low-Emissivity(Low-E) 2 Energypts y=c.Low.Conductivity Frames 2 Energy pts y=2.InstaGLow HeatTransmissionGlazing 1 Energy pt yf
J.Heating Ventilation and Air Conditioning
11.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--yes 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
8.Install Sealed Combustion Units
a.Furnaces 3 IAQ/Health pts y=yes D
b.Water Heaters 31A0/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 Enercy pts y=yes D
11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yes 0
12.Install 9D%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes D
13.Retrofit Wood Burning Fireplaces
• a.Install EPA certified wood stovesfinserts . 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 D
15.Install High Efficiency Filler 41ADMealth pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 51AQ/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes D
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 D
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
8.Select Safe and Durable Roofing Materials _ _ 1 Resource of y=yes D
7.Install Radiant Berner 3 Energy pts y=yes 0
1 1 1
L.Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy pts y=yes 0
2. Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes 0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y yes 0
1 1 1
•
.In oor Air Qua y,and rroshes INPUT Resources Energy M14eafth
1.Use Low/No-VOC Pairit 1 IAQ/Health pts y--yes D
2.Use Law VOC,Water-Based Wood Finishes 2 AQ/Health pts y--yes 0
'3:Use Low/No VOC Adhesives 3 IAQ/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
5.Use Fxtedor Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
,7.Seal all Exposed Particleboard or MDF 4 AQ/Health. pts y=yas D
8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes D
10.Install Whole House Vacuum System 3 AQ/Health pts y=yes D
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
12.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 IAO/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 Available: 1 1401 130 57 •
Total Points Project R 1 0 0 0
G:datarprogsrgreenbuildngguidelineshemodelersrgreenpointsLnal2.1204protectedxls
•
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 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/a "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: ?00 /1
Job Site Address: S 4.
Roofing Company Name:
• Applicant's Signature: Dater
Greg Casteel
Building Official
Revised 07/30/08
ad
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
jjjf,UPEI�TINO
Building Department
JOB ADDRESS: ,; T J PERMIT #
OWNER'S NAME: o.v, DO/✓ PHONE # (,, 2-77
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: 1 \ / C
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