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08050148CITY OF CUPERTINO '+*isaq.m+`•a'� > '' ? "•• "' CONTRAC.T(TRINFORMATIf3:' BUILDING DIVISICN PERMIT x �3b:�:gcr . .9e'r` °.�.-eL .>.e-# :'L=�"i3i BURRING ADDBFSS: 10121 JUDY AVE TBD — TO BE DETERMINED PERMIT NO. 08050148 OWNER'S NAME: PERAffr LSSU (DATE JIM CITTA & GAYLE JARVINEN 05/19/2008 ONE: SANrrARY NO. CONTROL NO. ARCHITEC (ENGINEER: BUILDING PERMIT INFO BLDG ELPCr PLUMB MECH LICENSEDCONTRACnOWSderp DEsionof ON Chapter 9 Job Description I hvgeY Nirm wt 1 am Inecomd under provisions of hap (cwnmesming viNSatkn lIXkl)Of Did' a 3 ofw Beumwand Prolecaioacede,andm lice�la RE—RF T/0 3EA LYR COMP INSTL 40YR COMP CLS A 20SQ mann mme.nd eR L 3 tie nucause C- C - Lc.. ANDREW RAIN GUTTERS PD BUS LIC 5/19/8 Do ¢ Conusaer Gam✓ 1,M #k ' ARCHrrECrS DECLAI ATION 6L,rt-5-5 I und.nand my plans dell W used a public records Licomed Professional OWNER -BUILDER DWIARATION 1 Wmhy affirm Nat 1 am exempt from the Contractor's License Law for the i following mason. (Section 1011.5• Business and Pmfeaina Calc: Any city Or county which rtquirts a permit to construct sher. improve, dcmdW, or mPoll any svuaurt prior ut Its Issuance. also m9dms w applicant for Such permit to file a signed statement • that W it licensed pms,nant tow provisions of the COnhmmr's License Law (Chapter 9 Sq. Ft. Floor Area Valuation t (commencing with Section 11100)of Division 3 of the Business and Profeaiw Cak)w - $6919 Nat W u exempt themBom cad w Dais for the allegrd esnmpdon. Any violation of Section 1031.5 by my applicant fora permit subjects w applicant m a civil peaty of ypNber 64 Number CCU O -Type not mom cites five hundred dollav($50[r, 37507052 Pane Y YP 1, an owner of the pmpmy, ar my wployea with wags as their sok cmnpenadon• will do the work. and wsmmnum Is rot intended moRemal for sok (Sec. ]f W. Busimrm and Prnfessions Code: The Cantrsemr's Llttae law dors Out apply to an Owocr a Required Inspections property who builds orimproms themmn, and whodomauch work himselfurthrough his own employees provided that such imprnvgmens art not irearal woRened for vie U. however. the Wilding or improvement Is sold within ons Year of eempktion, w awsm, Wilder will new the Wdm M proving that k did ant Wild es improve for pumwg of ole.). 1, a Owner of than Impart, w exelusawly contracting with acensW mnua.ws to construct the project (Sec. 104/. Business and Professions Conk:) TTe Canu cmr's Li- . Law does not apply to an own. a property wW Wires or waste. Nemon, and who contrmta for such projects wits a mntrmmr(s) Based pursuant to the ContractMs L.iceae law. 0l am aemp moor Sec , B 3 P C fa' dsis mason Das WORKER'S COMPENSATION DECLARATION 1 hareby aBtrm uMgr penalty of p.jury orc of the following 4.1.6. ❑ IMaMw lmainwnac.tif mofeanusntmxlf.immfwww SCmnpm- action. a Provided for by Section 3700 of the labor, Code. for w performance of the wok for whim this permit u issued. ❑ 1 have and will m tion. Worker's CampmsstiOn Insurua, ai raluimd by Section 3100 of the LaWr Code, for Ne performance of w west fw which Nu permit u issued. ' My Workers ComPenseGm I... cam. and Policy, nuumbber cart: Carder. r77DC PVtkM Polity O�/! CEICfIFlCATE OF INN FROM WORKERS' SAnON COMPENSATION INSURANCE Mdsseaion wed nohccanpleted if the permit Is forme hundred nitrates ($100) Or less) I c.tify wt in use pafesmence of IW work for which this Permit is issued. I shall no employ any person In my counter so as m become sobjecl us Ne Work.} L•anpwilla0 Laws of California. Dns Appllaru - NOTICE TO APPLICANT: If, after mLLing NR certificate or Exemption, you should become subject m w Worker's Compensation pmvwons or the later Code, you meet rermwith comply with such provision Or this permit shall W dammed revalued. CONSIRUCDON LENDING AGENCY I tomboy allirre dust vert k a constructiun landing apenry for the perfores. of the work for which the permit is issued (Sec. 31191, Civ, C.) Lender's Name ' fancier's Add. I comfy wt 1 have mad thio application W We wt me above Turn medm is cwmct 1 Agree to comply with all city and county ordinances and sees Ire missing he Wilding cnnetmman, and herby auNoiae mepusmmatives of this city to center upon IW ' above-mentioned property, for inspection purposes (We) agree m save. indemnify and kcep hannlw the Cry of Cupertino against Iiaeilidw.lWgmens.ewu and Of which may k anY war' care axial said City this pa Acunsognence Of ranting SNis Permit APPLICANT 111111jjjjjjND ANDS A{!D WILL COMPLY WITH ALL NON -POINT SOURCE RE 0 S. I\ ml//`•Y\4.� Issued by: Date S �<.m-J 5-- 19-0- Sttnsmus of ApplwntlContracmr Date Re -roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or room building ommpant emus or handle teammates material UVnew by Ila Copeniw Municipal Code. Chapter 9.11. aced the Health and Safety C. o . us3z(.)1 No All roofs shall be inspected prior to any roofing material being installed. W01 the applicant or suture Iadlding asuram o, Nuipmeat w dcviaa which it hvudoo air contaminms defined by w Bay If a roof is ' lled without first obtaining an inspection, I agree to remove a Area Air Quality Management Diurial all new ma ori 5 for' 1 CtiOn. OYo 10th I he - readhaaduurm duhassuc Oaxecondshr rt r mustan lChmund .95 th an Nee Hfor- am,1 (dingda HvlIhe-rea At SX)5, 33 A3an 5534.1 dcus thesir Wilding f Jos rot corm Y have • some. Nat it u my responsibility m IW nosiry ..Wt of nW m9airtr ta nmatW Ipdarmiaa oraC.tificamOrOccupancy. S -- t of -n% Signature of Applicant Date . All roof coverings to be Class'%¢ or better OWOOT Or mthOH7.0d agent Date • 3 ITEMS OF 3 • U CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37507052.00 DATE ISSUED.......: 05/19/2008 RECEIPT #.........: BS000004824 REFERENCE ID # ...: 08050148 SITE ADDRESS .....: 10123 JUDY AVE SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 ,METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 370.70 --------------- 370.70 VOICE ID DESCRIPTION -------- ---------------------------- 601 ROOF TEAR OFF 604 ROOF IN -PROGRESS REFERENCE NUMBER -------------------- #248 VOICE ID DESCRIPTION --- ---------------------------- 602 ROOF PLYWOOD NAIL 605. FINAL REROOF OWNER ............: JIM CITTA & GAYLE JARVINEN ADDRESS ..........: 10123 JUDY AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....:JOHN L ANGELO JR 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 IBSEISMICR VALUATION 6,919.00 ---------- 0.70 ---------- 0.00 ---------- 0.70 ---------- 0.00 1BUSLIC FLAT RATE 1.00 110.00 0.00 110.00 0.00 1REROOFRES SQ FEET 20.00 ' 260.00 0.00 260.00 0.00 TOTAL PERMIT ---------- 370.70 ---------- 0.00 ---------- 370.70 ---------- 0.00 ,METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 370.70 --------------- 370.70 VOICE ID DESCRIPTION -------- ---------------------------- 601 ROOF TEAR OFF 604 ROOF IN -PROGRESS REFERENCE NUMBER -------------------- #248 VOICE ID DESCRIPTION --- ---------------------------- 602 ROOF PLYWOOD NAIL 605. FINAL REROOF OCUPEkTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION APN # & 77� 7 OS � 0 0 v Date:s Building Address: 10,23 JvbY ►4U� , Owner's Name:j i m G i f r A Phone #: �.A d C6 G J 4,e- vi vx eAA 333- IgS Contractor:�0 1/1�,�r�y Phone#: LApc6-6Z1- OS}�- Fax #: `-1 M - 37-0 — 19212 Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ,a --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 # xr(To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: ..Fq,,4w _ J1=1= -3 e44 . I-" Ll o yK. CU*"/iq Residential Commercial Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the there are any restrictions: ❑ application or if applicable, include in plan set & the sheet index. Valuation: • I Have Signature Understand and Will Comply with Cupertino's Tear -Off Policy: A Sm- OCU PERTINO CITY OF CUPERTINO REROOF FEE SCHEDULE Number of Squares Fee ID Fee Description Fee Group Permit Type 1REROOFCOM Re -roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Commercial B 20 1REROOFRES Re -roof Residential B 1SFDWLR00F I 1BSEISMICRE Seismic Residential B 1REROOFMRES Re -roof Multi -Family B 1MFDWLROOF 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B n 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 $176.18. The re -inspection fee must be paid before another inspection can be scheduled IMPORTANT: 1. Flat roofs must have a minimum of Ya " per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on the job site at the time on inspection. I understand and will comply with the above stated policy on re -roofing. J.1 ". C,rt-✓4- Homeowner's Name: 6 Ryi L- J &-4- V Job Site Address: 10 [T-3 3 J Roofing Company Name: Applicant's Signature: • Greg Casteel Building Official �,,J RW, Revised 11/2/04 Date: 5- J o/ -U$ E Plan Review Process Work Book Page -12-Revised 3/25/08 A 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 4 B. Site 9. Install H.E. Irrigation, (details/spec)' L-1 11. Permeable Pavin Note L -1C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 72points D. Structural 3. Uses Wood 1 -Joist, (See Spec.) S-2 5. Use Truss with heels, (detail) S-2 6. B. OSB Sheathin detail S-2 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 pint P. Other 1. List Green Features on Plans A-1 1 point TOTAL POINTS 40 points E Plan Review Process Work Book Page -12-Revised 3/25/08 A 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. 1. Recycle Job Site Construction & Demolition Waste 3 Resource pts y=yes 65%=.1 point; 75%= 2 points; 60%= 4 points t up to 4 Resource pts . 12. Salvage Reusable Building Materials 4 Resource pts y=yes 3. Remodel for Mixed Use, Adaptive Reuse, and 2 Resource pts y=yes Historic Preservation 4 Resource pts y=yes 4. Protect Native Soil 2 Resource pts y --yes 5. Minimize Disruption of Existing Plants & Trees 1 Resource pt y=yes 6. Implement Construction Site Stormwater Practices 2 Resource pts y=yes 7. Protect Water Quality with Landscape Design 2 Resource pts y=yes 6. Design Resource -Efficient Landscapes and Ga dens � 4 Resource pts y=yes _ 9. Reuse Materials/Use Recycled Content Materials y=yes for Landscape Areas 2 Resource pts y=yes , 10. Install High -Efficiency Irrigation Systems 2 Resource pts y=yes 11. Provide for On -Site Water Catchment / Retention 2 Resource pts y=yes B. Foundation • 1. Incorporate Recycled Fiyash in Concrete 25% Recycled Ryash = 2 points; Add 1 point for every 10% increase of Flyash, up to 5 points up to 5 Resource 2. Use Recycled Content Aggregate 2 Resource pts y= 3. Insulate Foundation/Slab before backfill 3 Energy pts y= C. Structural Frame Ll1. Substitute Solid Sawn Lumber with Engineered Lumber 3 Resource pts y=yes 2. Use FSC Certified Wood for framing 3 Energy pts y=yes (For every 10% of FSC lumber used = 2 points, up to 10) up to 10 Resource pts. 3. Use Wood I -Joists for Floors and Ceilings 2 Resource pts y=yes 4. Use Web Floor Trusses 2 Resource pts y=yes 5. Design Energy Heels on Trusses 6' or more 2 Energy pts y=yes 6. Use Finger -Jointed Studs for Vertical Applications 2 Resource pts y=yes 7. Use Engineered Studs for Vertical Applications 2 Resource pts y=yes S. Use Recycled Content Steel Studs for Interior Framing 2 Resource pts 9. Use Structural Insulated Panels (SIPS) y=yes a. Floors 3 Energy pts y=yes b. Wall 3 Energy pts y=yes c. Roof 3 Energy pts y=yes 10. Apply Advanced Framing Techniques 4 Resource pts y=yes 11. Use Reclaimed Lumber for Non Structural Applications 3 Resource pts h2. Use OSB y=yes I a. Subfloors b. Sheathing {I 1 Resource pt y=yes -- _ 1Resource pt y=yes F1. Use Sustainable Decking-Mitarials Up to 2 Resource b. Showerheads (1 point each, up to 2 points) Up to 2 Resource 4. Replace To0est with Ultra -Low Flush Toilets «' (1 point each, up to 3 points) a. Recycled content 3. Resource pts y--yesF 0 4 Energy pts y= 7. Install Water Filtration Units at Faucets 0 b. FSC Certified Wood f 3 Resource pts y=yes 0 2. Use Treated Wood That Does Not Contain Chromium/Arsenic i 1 IAQ/Health pt y --yes 0 3, Install House Wrap under Sidling 1 IAQ/Health pt y --yes 0 4. Use Fiber -Cement Siding Materials 1 Resource pt Y --yes 0 E. Plumbing 1. Install Water Heater Jacket 1 Energy pt y= 2. Insulate of and Cold Water Pipes 2 Energy pts y= 3. Retrofl all Faucets and Showerheads with Flow Reduce s - i a. Faucets (1 point each, up to 2 points) Up to 2 Resource b. Showerheads (1 point each, up to 2 points) Up to 2 Resource 4. Replace To0est with Ultra -Low Flush Toilets «' (1 point each, up to 3 points) Up to 3 Resource 5: Install Chlorine Filter on Showerhead 1 IAQ/Health pt y= 6. Convert Gas to Tankless Water Heater 4 Energy pts y= 7. Install Water Filtration Units at Faucets 0 (2 points each, up to 4 points) Up to 41AQ/Health B. Install On -Demand Hot Water Circulation Pump 4 Resource ots v= r, tiecmcar [,—.[Install Compact Fluorescent Light Bulbs (CFLs) (6 s=22 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 Energy pt (1 point each, up to 4 points) Up to 4 Energy pts. 0 G. Appliances Install Energy Star Dishwasher 1 Energy pt Install Washing Machine with Water and Energy «' mservation Features 0 0 0 0 1 Energy pt nstall Energy Star Refrigerator 1 Energy pt Install Built -In Recycling Center ._ 3 Resource pts H. Insulation 1. Upgrade Insulation to Exceed Title 24 Requirements a. Walls 2 Energy pts y=yes b. Ceilings 2 Energy pts y --yes 2, Install Floor Insulation over Crawl Space 4 Energy pts y=yes 3. InstallRecycled-Conten[, FiberglassInsulation with IjNo Added Formaldehyde 3 IAQ/Health pts y=yes 4. Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes S. Use Cellulose Insulation e Walls 4 Resource pts y=yes %b. Ceilings 4 Resource pts y=yes 6. Alternative Insulation Products (Cotton, spray -foam) a. Walls 4 Resource pts y=yes 0. Ceilings 4 Resource pts y=yes «' 0 0 0 0 0 0 0 0 0 1. Install Energy-Efficiant Windows a. Double Paned 1 Energy of b. Low -Emissivity (Low -E) 2 Energy pts c. tow. Conductivity Frames -------- 2 Ener is ,i Energy 2. Install Low Heat Transmission Glazing _ 1 Energy pt J. Heating Ventilation and Air Conditioning (1. Use Duct Mastic on All Duct Joints-� 2 Energy pts y--ye,, 2. Install Ductwork within Conditioned Space 3 Energy pts y=yes 3. Vent Range Hood to the Outside 1 IAQ/Health pt yqe<. 4. Clean all Ducts Before Occupancy 2 IAQ/Health pts yges 5. Install Solar Attic Fan 2 Energy pts y=yes 6. Install Attic Ventilation Systems 1 Energy pt y=yes 7. Install Whole House Fan 4 Energy pts yges 8. Install Sealed Combustion Units a. Furnaces 3 IAQ/Health pts y=yes b. Water Heaters 3 IAQ/Health pts y=yes 9. Replace Wall -Mounted Electric and Gas Heaters with Through -the -Wall Heat Pumps 3 Energy pts y=yes 10. Install 13 SEEW11 EER or higher AC with a TXV 3 Energy pts y=yes 11. Install AC with Non -HCFC Refrigerants 2 Resource pts y=ye=- 12. Install 90 Annual Fuel Utilization Efficiency (AFUE) Furnace 2 Energy pts y=ye. 13. Retrofit Wood Burning Fireplaces a. Install EPA certified wood stovesrnserts 1 IAQ/Health pt y=yes b. Install/Replace Dampers 1 Energy pt y=yes c. Install Airtight Doors 1 Energy pt y=yes 14. Install Zoned, Hydronic Radiant Heating 3 Energy pts y=yes 15. Install High Efficiency Filter 4 IAQ/Health pts y=yes 16. Install Heat Recovery Ventilation Unit (HRV) S IAQ/Health pts y=yes 17. Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes K. Renewable Energy and Roofing 1. Pre -Plumb for Solar (Nater Heating 4 Energy pts y=ye- 2. Install Solar Water Heating System 10 Energy pts y=yes 3. Pre -Wire for Future Photovoltaic (PV) Installation 4 Energy pts y=yes 4. Install Photovoltaic (PV) System (1.2 kw = 6 points, 2.4 kw =12 points, 3.6 kw =18 points) Up to 16 Energy pts I6. Select Safe and Durable Roofing Materials 1 1 Resource pt y=yes 7. Install Rarrieradiant B ~ - 3 Enerov ols v=ves L. Natural Heating and Cooling 1. Incorporate Passive Solar Heating 5 Energy pts y=yes 2. Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes 3. Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0 r. Use LowMo-VOC Paint V 1 IAO/Health pts y=yes 2. Use Low VOC, Water -Based Wood Finishes 2 IAQ/Health pis y=yes tt-3. Use LowMo VOC Adhesivas 31AQ/Health pts y=yes 4. Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes S. Use Engineered Sheet Goods with no added Urea Formaldehyde 61AOMealth pts y=yes 6. Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes t7. Seal alCEzposed Parti& board6 MDF _� 41AQfHealth, pts y=yes B. Use FSC Certified Materials for Interior Finish 4 Resource pts y--yas 9. Use Finger -Jointed or Recycled -Content Tim 1 Resource pts y=yes 10, Install Whole House Vacuum System 3 IAQ/Health Dts v=ves 8 Resource pts 0 D D 2. Use Rapidly Renewable Flooing Materials —Recycled 0 .0 0 D D y=yes 3.—Use Content Ceramic Tiles 4 Resource pts y=yes 4. Install Natural Linoleum in Place of Vinyl 5 IAQfHealth pts y=yes 5. Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 6. Install Recycled Content Carpel with Low VOCs 4 Resource pts 0 N. Flooring 1. Select FSC Certified Wood Flooring 8 Resource pts y=yes 2. Use Rapidly Renewable Flooing Materials —Recycled 4 Resource pts y=yes 3.—Use Content Ceramic Tiles 4 Resource pts y=yes 4. Install Natural Linoleum in Place of Vinyl 5 IAQfHealth pts y=yes 5. Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 6. Install Recycled Content Carpel with Low VOCs 4 Resource pts y=yes Total Points Av 1 1401 1301 57 • Total Points Project R 1 01 0 0 G:daiarprog-dgreenbuildingguidelineshemodeleNgreenpointsfna121204pm1scted.sls CIN OF *UPEkTINO • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: /012-3 v PERMIT # 6FOS-o/.K<4--- OWNER'S NAME: c mA G a.« -3rw i v e,,, PHONE # y 09-373— IS -5 GENERAL CONTRACTOR: A*,t,4,� FAX # fl - 37o- 92Z I am not using any subcontractors: 3t-,� a�-6 Signature Date Please check applicable subcontractors and complete the following information: J"V, �' • J Owner/ Contractor Signature S— i� —C'A Date 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 J"V, �' • J Owner/ Contractor Signature S— i� —C'A Date