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08080115 CITY OF CUPERTINO ?^>; r :3,+s�"�" �° "_' - - BUILD DIVISION PERNII'j' kC01V RAC, TOyR I1 'I+'ORMATIQN BUILDING ADDRESS: PERMIT NO. 10.470 MADERA DR TBD — TO BE DETERMINED 08080115 OWNER'S NAME: PERMIT ISSUE DATE MUL2�1N ALBINO 08/15/2008 NE: SANITARY NO. CONTROL NO. ARCHREC(ENGINEER: BUILDING PERMIT INFO . , BLDG ELECT PLUMB MECH 0 0 30Z' LICENSED CONTRACTOR'S DECLARATION lob Description rd 1^j I hereby affirm that 1 am licensed under provision,of Cbapter 9(commencing zzIN Section 7000)ol'Divislon 3a dm Eusimenand Profeuimu Cremand mylironub RE—RF T/0 SHKS INSTL OSB SHTHNG INSTL 15# FLT ^.<j se in full fo¢c roti effaL �gz uanm claimsLic.a Z INSTL NEW 30YR COMP CHNG ALL MTRL CLS A 28SQ ^t• Dem =SC e A�ITECsCanDECu Anon aD yNb y I underwnJ my plans mail be used as public records JyU tiLicensed Prufeuianal ' OWNE0.-BUILDER DECLARATION M1 bemhy.lila than 11. exempt from Ne fe nlras Cc :Any c Law for the 00 followwhich d reason.(Section t 7031.5.L5. t,aineu and w.demolish. Calc:Any city s county $Pi which mqulre,permit m conaa4 tlmr.improve.demnluh.err repair any suumure ' _ii, prior to its issuance.alm inquire dte applicant forsuch rurmiuo file,signed suumem s thanWis licensed pursuant toNcprovislovofduConsumersLicense Law(Chapter 9 Sq.Ft. Floor Area Valuation rFr� mmornming with Section7000)of Division 3 of the Businua and Professimu Cade)or $10945 real be Is escmpl Nuc(rom W de buil for 1W alleged uempdon.Any violation of Sada 7031.54 applicant for a permit subjeau the applicant m arnil penalty of 32635049 :VU V(p Number Occupancy Type not more Nu Om hundred doll.(SM. Q I,v owner of W Napemy.err my employeer wIN wepa u Nov sole compevetien, will do Newara.and Nesuumnc Is not intended or offered fonaW(Sm.7014,Business Required Inspections and Indicated.Cada:Te Commerce,License Law drum not apply m in owner of q P property who builds Or improves thencon,and who does ouc h work himself v Nmugh his awn employee,provided dw such improvenwro arc not Intended aroffered for We If. however.the building orimprommcnt Is sold within ane year of comptedon,the owner, Wilder will have the Writes of proving that M did net WIW or imprme far purgsu of uleJ. ❑I,u owner of ted Property,am exclusively cmuuning with licensed enbulma to . consunad the project(Sec.7044.Bust.and Pruferalms Code:)Max Ceouumh U- cove Law docs not apply an an owner of property who Wilds or improves demand,and who contracts for such pmjcmm with a conuactor(s)Reeved pursuant to ted Conuuctor's License law. I me exempt under Sec .B&P C for the won Owner Dam WORKERS COMPENSATION DECL RATION I hereby air.under Ismaili,of perjury and of the following declautions ' I have and will mainuu aCWOcate of Covent u self-loam for W~3 Compen- urian,u provided for by Section 3700 of the Labor Cade.for the pert....of the work for which this small la issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the labor Code,For the Performance of the work for which this pewit u load. ' My workee.Comparison..louurua tamer and Paling num : Cartier. Policy No.:�Oar18S- Z �th WFEMPf10N FROM WORKERS' COMPENSATION INSURANCE (fhbsMim sed not be compleud if the pewit Is fora..hundred dollen(5100) or lead) I cenify that in the performance of the work for which this Permit Is isman,1 shell not employ any person in any muarso u m became subject o Ne worker'Compensation laws of C.Iifun ia.D,te Applicant NOTICE TO APPLICANT:IL after making this CaniRete of Excerption.you should become subject m dee Worker'.Cmnpcamom proviai^a of Ne la Wr Code,you muds 0 z forrAwiih comply wide each provis roes or Nu pmi,001 be dermad mvokcd. 'Zi, CONSTRUCTION IENDINO AGENCY [--n 1 hemlim N hy afor Nen Is a covtruction Wading agency for the performance,of a.�< Ne work for which this permit Is issued(Sec.3097,civ.C.) WM Q Lender'sName 5 z Leder'.Add. V Q 1 cenify that I have read this application and sum than the above infomadun Is pi, ^ carrttt 1 qme to empty with all city and county abdomens and sum laws resting to .O CSJ' Wilding consuiction,and hereby ruNorirc representatives of this city m enter upon the W aWm-matioad property fm inspection purposes. gy (We)agree to sure,indemnify W toes hamlets the City of Cupertino against IA liabilities,Judgments.costs and expenses which may in any my accrue agsNet said City V in consequence of the granting of this NMIL APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SO RCE REGULATINS. Re-roofs noun of ApplicandC Data . . H US MATERIALS DISCLOSURE Type of Roof Will dx applicant or forum Wilding occupant icon nr handle haurdous malarial U de0ned by the Cupertino Muni W I Cade.Chap=9.12.and de Helth and Safety Code.Semon 25532(.)T [:]Y. o - All roofs shall be inspected prior to any roofing material being installed. WIII the applicant or forum building occupant lax equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove rt h..Wu.a air..noun.u defined by the Bay Area Air Quality Management all new materials for inspection. uinT � Ova Ion 1 have mad the harardmu materiabmquirements unJcr Chaps S95ofthe Glifa. nu F.IN&SsfctyCode,Sado.2550.25533 W 25539.1 undvoand Noirtbe Wilding dam Out currently haw a mount.that it is my responsibility to etify the meopont of dte .q.intermorpsylaichasbeam pri�anaof.cerdnelaafamrmarmy. Signature of Applicant Date /Foy All roof coverings to be Class')?.,'or better Owner misedhorixed agent Dam" CITY OF CUPERTINO • 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: pHtg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32635049 . 00 DATE ISSUED. . . . . . . : 08/15/2008 RECEIPT # . . . . . . . . . : BS000005805 REFERENCE ID # . . . : 08080115 SITE ADDRESS . . . . . : 10470 MADERA DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . .. . . OWNER . . . . . . . . . . . . : MUZZIN ALBINO ADDRESS . . . . . . . . . . : 10470 MADERA DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1134 RECEIVED FROM . . . . : RAINBOW ROOFING 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 10, 945 . 00 1 . 10 0 . 00 1 .10 0 . 00 1BUSLIC FLAT RATE 1 . 00 110 . 00 0 . 00 110 . 00 0 . 00 1REROOFRES SQ FEET 28 . 00 364 . 00 0 . 00 364 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 475 . 10 0 . 00 475 . 10 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ` -------------------- CHECK 475 . 10 #10650 --------------- TOTAL RECEIPT 475 . 10 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 allV' •CUPEkTINO PERMIT APPLICATION APN # 2 /^ 1 o O Date: ., Building Address: `l/ /0x-70 MADC- (-A Owner's Name: L6 i tj o m U S S1lj Phone #: qv? yV,-- qj�q Contractor: 1-,�Aa130 yj k0orytAv Phone #: (050 3 G 3 Z�3 I z o S VA LO--A 1�-D • Fax #: SAME Cupertino Business License #: Contractor License #: � 9 � 2 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof o Asphalt Shingles Asphalt Shingles q� 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: TL—A ✓L _p f/- $ W X F5 I n/ SPA II O S C3 S; J EA71 )"67 11V5tA11 1s POvA//0 FE;LT� 11vSfn11 AfOvJ 30 yt'Ati. COMpoSl�ION• &HANGI; All r0 (5-n L C( ar1�l 2 a Residential LV 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: 02. 1D9 �5� I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: • Sign Revised 6/16/08 CITY OF CUPERTINO REROOF CUPEZTiNO FEE SCHEDULE • Number of Fee ID Fee Description Fee Permit Type Squares Group 1RER00FC0M Re-roof Commercial B ICOMMLROOF 1BSEISMICO Seismic Commercial B LcJ 1REROOFRES Re-roof Residential B ISFDWLROOF O IBSEISMICRE Seismic Residential B 1RER00FMRES Re-roof Multi-Family B IMFDWLROOF IBSEISMICRE 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 1/4 " 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: AL 5 ) N o m V S S I t Job Site Address: /04-70 (Y) A lD E KA P e- , Roofing Company Name: ' \A-� �I J� (�001/)N1J Applicant's Signature/:' Date: �' �l OS • Greg Casteel v 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 1-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 10 signify that every effort should be made to incorporate them into your projects. These Hems 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 1.Recycle Job Site Construction&Demolition Waste i 65%=1 point;75°h= 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 CO.Design Resou ce Efficient Landscapes and Gardens J _ 4 Resource pts y--yes 0 9.Reuse MatedaWUse 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 D 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 0 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 1 C.Structural Frame (1 Substitute Solid Sewn 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 1 D 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=yas 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.Root 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 b8B a.Subfloors j 1 Resource pt y=yes 0 b.Sheathing 1 Resource pt y=yes 0 I 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 yryes D 2.Use Treated Wood That Does Not Contain ChromiurrVArsenic 1 IAO/Health pt y--yes 0 3.Install House Wrap under Siding 1 IAWealth pt y--yes 0 4.Use Fiber-Cement Siding Materials 1 Resource pt yryes 0 i 1 1 E.Plumbing 1.Install Water Heater Jackal 1 Energy pt Y_—Yes D 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) Up to 2 Resource pts. 0 b.Showerheads(i point each,up to 2 points) Up to 2 Resource pts. 0 4.Replace Toilest with Ultra-Low Flush Toilets (1 point each,up to 3 points) Up to 3 Resource pts. 0 5,Install Chlorine Filter on Showerhead 1 IAO/Health pt y--yes 0 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 IAO/Hsalth pts. 0 6.Install On-Demand Hot Water Circulation Pump 4 Resource pts y--yes 0 r.riecmcar 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 e 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 yryes 0 2,Install Washing Machine with Water and Energy Conservation Features 1 Energy pt y=yes 0 3.Install Energy Star Refrigerator 1 Energy pt Y--yes 0 4.Install Built-In Recycling Center 3 Resource pts y=yes 0 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 3.Install Recycled-Content,Fiberglass Insulation 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 0 b.Ceilings 4 Resource pts y=yes 0 6.Alternative Insulation Products(Cotton,spray-foam) a.Walls 4 Resource pts y=yes D o,ueiiings 4 Resource pts y=yes 0 1 1 1 114PIJT Resources Energy IAQ?H�afih m ows 1.Install Energy-Efficient Windows I a.Double-Paned 1 Energy pt y=yes D b.Low-Emissivity(Low-E) 2 Energy pts y=yes 0 c.'Low.Conductivity Frames 2 Energy pts y=yes 0 . 2.Install Low Heat T ansmission Glazing 1 Energy pt y=yes 0 1 i 1 J.Heating Ventilation and Air Conditioning F.Use ikt—Wsk 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 7 0 5.Install Solar Attic Fan 2 Energy pts y=yes D 6.Install Attic Ventilation Systems 1 Energy pt y=yes D 7.Install Whole House Fan 4 Energy pts y=yes 0 B.Install Sealed Combustion Units a.Furnaces 3 IAO/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 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 D 12.Install 9D%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes 0 13.Retrofit Wood Burning Fireplaces • a.Install EPA certified wood stoves/inserts 1 IAQ/Hsalth pt y--yes 0 b. Install/Replace Dampers 1 Energy pt y=yes D 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=yes 0 16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes 0 17.Install Separate Garage Exhaust Fan 3 IAQ/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=1 B points) _ Up to 1 B Energy pts D -- r6.Select Sete andDurabie�Roofing Mater_IaIsT - v 1 1 Resource pt y=yes 0 7. Install Radldnt Bomar—� _� 3 Energy pts y=yes 0 1 1 1 L.Natural Heating and Cooling 1. Incorporate Passive Solar Heating 5 Energy pts y=yes D 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 . n oor r ua ty en n s ea 1.Use LowMo-VOC Paint 1 IAQIHeaith pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQIHealth pts y=yes 0 :.Use LowMo VOC Adhesives 3 IAQIHeaith 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 61AO/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 IAQ/Health. pts y=yes 0 6.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 D 10.Install Whole House Vacuum System 3 IAQ/Health pts y--yes 0 f 1 1 N.Flooring 1.Select FSC Ce ified Wood Flooring B Resource pts y=yes 0 2.Use Rapidly Renewable Flooding 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 IAOIHsaith pts y--yes D 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 1 0 1 1 Total Points Avallablel 1 1401 130 .57 Total Points Pro'ect R 1 0 0 0 G:datalprngsrgreonbuildngguidelineshemodelerslgmenpointsfinal2.12.e4pmtecled.xl5 Community Development 10300 Torre Avenue ( ✓ Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ' $CUPERTINO Building De artment JOB ADDRESS: I C)g 7 D M q 0 E/QA pt PERMIT# OF 0907 ( 5 OWNER'S NAME: V 5EW PHONE # 0 —Z4,5— I GENERAL CONTRACTOR: A I \160VJ OojCjIV& FAX # I am not using any subcontractors 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