08080014 CITY OF CUPERTINO
Ac
BUILDING 151vi31ON • PERMIT .C�L'ITRACTORI1�1F,OItMATI,(7!V
BUIL I G RESS: PERMIT NO.
��T�� IMPERIAL AVE M & S ROOFING CO. 08080014
OWNER'S NAME: PERMIT ISSUE DATE
WU YUH—FEN HAND SITYUE B 208 COPCO LN 08/04/2008
NE: SANITARY NO. CONTROL NO.
(408) 314-0870
ARCHTIERYENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECN
vOp LICENSED CONTRACTOR'S DECLARATION
Job Description
U 1 hereby affirm deal I am licensed under provisions or Chapb r 9 buncen sing p
with Section 7000)ofDivison 3 ofthe Businev Pmfessiom me,and my license is RE—RF RMV EXT WDSHK INSTL 1/2"OSB PRES TL CLSA
^ H in full forte and grfal
C�Z license Chis ('—Z� Lic.N r 28SQ
t„ Dames—1�c s,7 Canitaemr�RA•7
q ARCHIIECI-S Ds public recon
5 i< - 1 understand my Pk^a MW he used u public records
is C Licensed Professional
r'0OWNER-BUILDER DECLARATION
jq I hereby affirm that I am exempt from the Contnnofa License law for be
p o following mason.(Section 703 1.5,Busincor and Prefcalons Code:Any city or county
$ which requires a Permit to cmarueL alw,impmvx,demolled.Or repair any structure
prior in its issuance.,Iw requites the applicant forsuch permit to file a signed comment
<
than heit;lieemedpnNamtodoe provisions oflhecommeta;sucemeLaw(chapter 9 Sq.Ft. Floor Area Valuation
� (commencing withmm
Sd7000)ofDiwmBusiness $15000
y R E thin he Is exempt therefrom and do basis for the alleged exemption.Any violation of
Section 7031.5 by my applicant fora permit subjects the applicant to a civil pendly of
mmolNumber Occupancy
ml come than BK hundred dollars,(5500), 3 5 71910 3 . Pane Y Type
Lo awns,of Jc potrumm m1, uoployna with wgesa th.(Sce.co 4.Buri on,
will dothcwores and the he CoreismlinLnded eraw do far sale(See.ION, weer of
aM Rlywho ns Crean The canflumera ondw o Law des,Out apply lf rd awm4 err Required Inspections
propertyrhobu0damimprowachimrove who daasueh work himasaforWaugh his
awnemployees, ei pr sushi tis oldwitatenot intended oroQcred for axle If.
however.the have
tWilding or improvement u sold withinierr, Weld or completion.Nip=Owner.
of
buldtt w10 have W burden of provin6 that he did col build err Improve for puryom of
sok.).
❑1,as owuer of the PropenY-am reclusively convening with licensed a9nuanma in
construct the project(See.7044,Bnsimu and Prefinni Code:)The Cmvactals Li-
eeme law does not apply In an owner of property who builds or improve,Wmm,and,
who contracts for such pvjmta with amnwctor(s)lWood pontoon m the Contracmr'a
Lie me law.
❑lameacmplummcr Bee .BAPCforthuwon
Owner Onto-
WORKERS COMPENSATION DECLARATION
40 L hereby alliin under penalty of perjury Ones of that fallowing deciaruiom:
Thawand will maintain a Cenifinaem m re of CO .114.m.fer Wof e.Compen-
shad.,ns provided for by Section 3700 of the labor Code.for W performance of the
work for which this permit is issued.
❑I have and will maintain Warkses Coreprnsadon Insurance,as required by Section
370(1of the labor Code,for the pcdomence close work forwhich this permit is issued.
My Worws Compensation Ins rams carrier and policy num ram:
C.. Policy Polley Na.��_
FlCA F COMPENSATION
RA WORKERS'
COMPENSATION INSURANCE .
mus seNm need rot be completed if the permit is foram hundred dolhn(5100)
or leu)
I certify Nan in the perform.of the work for which this Permit u issued,l shall not
employ any person in any mannerse u to become subject to do WorkersCompletion.
laws of Caifomis Dam
Applianl
NOTICE TO APPLICANT:If,afar making this Cconfirem of Exemption,you should
become subject in the Work s Compensation provisions of the latter Cede.you muss
.J O forthwith comply with such provisions or Nurmsh
peit all be dueed mrevoked.
'z'••" CONSTRUCTION LENDING AGENCY
IlctebY&IT=Na them is a mmwctinn lending agency for the pcdomance of '
6i
One work for which this permit 4 issued(Sec.3097,Civ.C.)
QLendeYs Name
z Lerdefa Address
J Q 1 certify Jur I have red this application W sum more the above infomutim is
conmL I,grin to comply with all city and county ordinances and sole Was relating res
building concoction,and hemby mthodrz representatives of this city in inner upon the,
W ,hove-mentioned property for inspection purposes
gy (we)agree to saw,indemnify and Incept hatmkns use city of Cope
no
(n Iiabilitia.jWgmuenLL.cmtsandrepenses which maYle mY w,Y,mue a{ainstseid City
U z in consequence of lie granting Of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RE uLA 0Pl6.
r-
Sikboum fApphcau onvanew Orion
so— _ 8 Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type ofRoof -
Will the applicant or future building occupsousnom or handle hamtlons material
an defined by the Cupertino Municipal Code.Chapter 9.12,anti the Health and Safely
cede.Smtim 255324)7
❑Ya ONO All roofs shall be inspected prior to any roofing material being installed.
OWill the applicant or future building Occupant can equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
lt haaNnm air cmumiana as,derrued by the Bay Arra Air Quality Management all new materials for inspection.
Disorel7
❑Yes 0N
I have read she hvatdms materials requimmenu under Chapter 695 of the Califor.
sena HcalthA Safety Cade,Setimu 75505,25533 and 25534.I mdcraab that if Ne building
dors rot currently haw,a mens,UW Ila my mapmnibilily m ratify the occupant of the
mquimme whkhmunktin It poor musuan.of.Cc;caaafOcwaey. Signature of Applicant Date
Owner or authanmda int VI oak All roof coverings to be Class'Ines,Or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY '# 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35719103 . 00
DATE ISSUED. . . . . . . : 08/04/2008
RECEIPT # . . . . . . . . . : BS000005669
REFERENCE ID # . . . : 08080014
SITE ADDRESS . . . . . : 10445 IMPERIAL AVE
SUBDIVISION . . . . . . .
CITY . . . . . . ... . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WU YUH-FEN H AND SITYUE B
ADDRESS . . . . . . . . . . : 10445 IMPERIAL AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5931
RECEIVED FROM . . . . : M & S ROOFING CO.
CONTRACTOR . . . . . . . : MIRSAD KRAJWIC LIC # 28360
COMPANY . . . . . . . . . . : M & S ROOFING CO.
ADDRESS . . . . . . . . . . : 208 COPCO LN
CITY/STATE/ZIP . . . : SAN JOSE, CA 95123
TELEPHONE . . . . . . . . : (408) 314-0870
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--------- --------- ---------- ---------- ---------- ---------- ----------
IBSEISMICR VALUATION 15, 000 . 00 1 . 50 0 . 00 1 . 50 0 . 00
1REROOFRES SQ FEET 28 . 00 364 . 00 0 . 00 364 . 00 0 . 00
---- ---------- ---------- ----------
TOTAL PERMIT 365 . 50 0 . 00 365 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 365 . 50 #2090
---------------
TOTAL RECEIPT 365 . 50
VOICE ID DESCRIPTION . VOICE ID DESCRIPTION
--- - .------ ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
CITY OF CUPERTINO
egg` REROOF
•CUPERTINO PERMIT APPLICATION
APN # Date:
X57/ / 03 ' 0() B- y- Da'
Building Address:
Owner's Name: Phone #:
'TEV E" w cn 110R- -0 8l6
Contractor: Phone #:
(� S TZfIO�)I(�Ej Fax #:
Cupertino Business License #: Contractor License #:
So -2 1P
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles U Asphalt Shingles
tx 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: peMJV1
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:
applicable, include in plan set & the sheet index.
Valuation:
I Have Read,, Understand and Will Comply with Cupertino's Tear-Off Policy:
• �arn�� C
Signature
Revised 6/16/08
CITY OF CUPERTINO
REROOF
C1 0
CUPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1RER00FRES . Re-roof Residential B 1SFDWLROOF
V 1BSEISMICRE Seismic Residential. . B
lRER00FMRES 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 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: Sll_t Y iE7 \kA1\
Job Site Address: 10.440 i LMEPCA& W-P
Roofing Company Name: I� qZO E)F:_1A 0-0,
Applicant's Signature: Z,.dun 11C— Date:
• Greg Casteel
Building Official
Revised 07/30/08
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 1 point
P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS1 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.
INPUT Resources Energy A011-lealth
A.Site
1.Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;80%=4 points i 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
F8—Design Resource-Efficient Landscapes and Gardens_ -� 4 Resource pts y=yes 0
9,Reuse MatehalsNse 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 I
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 pis 0
2.Use Recycled Content Aggregate 2 Resource pts y=yes 0
3.Insulate Foundation/Slab before backfill 3 Energy pis y=yes 0
1 1 1
C.Structural Frame
.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 pts 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
8.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0
9.Use Structural Insulated Panels(SIPS)
a.Floors 3 Energy pts y=yes 0
b.Wall 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
a.Subtloors 1 Resource pt y=yes D
• b.Sheathing 1 ResourceY
P t =Yes
L -------- — 0
INPUT Resources Energy IAG/Health
D. xlenor ims
hi Use Sustainable Decking Materials
I a.Recycled content i 3 Resource pts y=yes 0
' b.FSC Certified Wood 3 Resource pts y=yes 0
i
2.Use Treated Wood That Does Not Contain Chromium/Arsenic 1 IAQ/Health pt y--yes 0
13.Install House Wrap under Siding 1 IAQ/Health pt y=yes 0
i4.Use Fiber-Cement Siding Materials 1 Resource pt y=yes 0
1 1 1
E.Plumbing
1.Install Water Heater Jacket 1 Energy pt y--yes 0
2.Insulate Hot and Cold Water Pipes 2 Energy pts y=yes 0
3.Retrofit all Faucets and Showerheads with Flow Reducers
a.Faucets(1 point each,up to 2 points) I 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
L(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 D
6.Convert Gas to Tankless Water Heater 4 Energy pts y=yes 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.treancar
I1.Install Compact Fluorescent Light Bulbs(CFLs) j
(6 bulbs=2 points,10 bulbs=3 points,12 bulbs=4 points) i 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
1.Install Energy Star Dishwasher 1 Energy pt y=yes 0
2.Install Washing Machine with Water and Energy !
I
Conservation Features I 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 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
`VF—stall Fiberglass lnsulation with
No Added Formaldehyde _ _ ` 3 IAO/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 D
b.Ceilings 4 Resource pts y=yes 0 •
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
n.Ueilings 4 Resource pts y=yes 0
1 1
INPUT ResDurces Energy lAO/Health
Wln ows
It.Install Energy-Efficient Windows f
a.Double-Paned 1 Energy pt y=yes 0
b.Low-Emissivity(Low-E) 2 Energy pts y=yes D
c.Low.Conductivity Frames 2 Energy pts y--yes 0
2.Install Low H eat Transmission GlazingI Energy pt y=yes 0
1 1 1
J.Heating Ventilation and Air Conditioning
LUse Duct Mastic on All Duct Joints 2 Energy pts ' y--yes D
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 7
0
5.Install Solar Attic 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 pts y=yes 0
B.Install Sealed Combustion Units
a.Furnaces 31AQ/Health pts y--yes 0
b.Water Heaters 31AQ/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 Energy pts y=yes 0
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 stoves(nserts 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 4 IAQ/Health pts y=yes 0
16,Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes 0
17,Install Separate Garage Exhaust Fan 3IAO/Health pts y=yes 0
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
i8.Select Sate and Durable Roofing Materials 1 Resource t es
s1 a — —--- - -- -- - P y=y D
7.Install Radiant Barrier 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 yryes 0
1 1 1
•
NPUT Resources Energy MONealth
In oor ❑Qualdyan Fmis es
It.Use LowMo-VOC Paint _ ____ _ _ _ 1 IAQ/Health pts y=yes 0
P.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use Low%No VOC Adhesives 3 IAQ/Health pis 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 6IAQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
�7.Seal all Exposed Particleboard or MDF _ __ _-, 4 IAO/Health pts y=yes 0
8.Use FSC Certified Materials 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 31AQ/Health pts y=yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
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 Carpel with Low VOCs 4 Resource pts y=yes 0
1 1
Total Points Avails le: 1401 1301 57
Total Points Project Received: ZT 01 0 0 •
G:datalprogsrgreenbuildngguidelinestremodelersigreenpoimfinal2.12.04prolected.ds
•
.w., Community Development
* 10300 Torre Avenue
(N / Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
WUPEI�TINO
j
Building De artment
JOB ADDRESS: PERMIT #
/(90,r h-VQ- D S op
OWNER'S NAME:,('t r— u f PHONE V0 G
GENERAL CONTRACTOR: /d-1 4,f fo o/ FAX #ye8
I am not using any subcontractors: rl i 84-0
Signatu4e 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