08080003 CITY OF CUPERTINO ht.s`t' x+`•*^'4voa«+ z m
BUILDING DIVISION. PERMIT .CONTRACTOR IIVEQRMrxION
BUILDING ADDRESS: PERMR NO.
/495 PROSPECT RD T D ROOFING 08080003
OWNERS NAME: PERYMMUEDATS
SR.IV:IDHYA GOPALAN 675 TULLY RD 08/01/2008
NE: SANITARY NO. CONTROL No.
(408) 892-8872
ARCHI7EC(ENGINEER: BUILDING PER D`INFO
BLDG ELECT PLUMB MECH
0
30o LICENSED CONTRACTOR'S DECLARATION IOb Description
�t 1 barely affirm that I am IisvN o unser loWda n of Chapter 9(commencing p
with Section 70010 of Division 7 of the Business and Professions Code.and my lacerate is REMOVE COMPOSITION SHINGLES AND INSTALL GERARD
n
'DEM
tarn std est 8 � TILE
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z I.icensccl LIc.I
311Dam AacxrrsLsDiwRA N X4 AND 2X2 PLYWOOD
9 I on"mil mY plaru Mall bo umd an public
a tL LIL'CIIfCd Professional .
5
OWNER-BUILDER"ampfit DECLARATION
0 g 1 Wroby a(Hw that 1am 1. .Bumph from the Contractors :Any c Lew far ote
00 following mason.(SeNon 70714,Business and improve.
deras Code:Any city as county
$w, winch its requires;•pormR re rnsft char,Impat such
de Permit
t or repair any mica on
_.j} thalprinthe iLLlaNanee.site requires;intheinaZoolcml ear Wehpatoit btIlea Lrw(aYmmrnt
�< (cm a aBavad Semintto00epmaumon3tit eBusinbrannnm�onsCodmr9 Sq.FL F1oorArea $ Valuation
tcommene xem iNSection refrom andth basis n7 tithe oneemptoess and n.Any vi Code)in 15000
'd Natio u exempt smr appli and the tub d, the alleged emmant to Any it Penalty
of
Section 7071.5 by any red amt for a pewit rvbjcou dm applicant to a civil penalty of yp7�Number Occupancy Type
nm mare won Rw hundred maw,tssm) 3 6 615 0 5 3 .'rll7'
❑L m owner of tha the structure
t rc,a my ,Intended
snits wages as ak,(Sm.
n".Buse es
will do Newan,and the Me Omairots,Lacesa a.it torulapply in ad,B.or of
parent,a PmmminN Caen:rape COnVecbra rd ho oes dela nal\pity b N ownt!of Required Inspections
rconploMWilda provided
that
lNMOn, mmems ae.1intende earefffalfaraidebf.
awn wPloym,proHoWthssueeimprowm wind.
a.yourafam lenind dance If.
however.the Wilding or improwmantg mid within oro Lear or completion,dm owuer
Wilds will have Use burden of Moving mat ha did not Wild or improve far purycae of
coma.
❑1,as ewer of also Propmy w modulvely conusNng with IIaIUW mnustwa b
construct aha project(Sec.7044,Business and Professions Code:)The Contravenes U.
ansa law dean not apply in an owner of property who Wilds eir imprvw theater,ad
wait contracts for such prejeN with acomrmmr(s)Iicenmd pursuant in the Comuactora
Liceme law.
0 lamesemptunder See ,B&PCfmthumasos
Ower Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Mostly of perjury sue of that fallowing dcclarWans:
I haw and will maintain a Certificate o'Coneent to self-Immo for Weaker.Campos.
as provided for by Section 7700 of dm labor Cam,for the perfoamana of the
work for which this permit is usual.
h and will maintain Workers Compensation Insurance.as required by Section
the labor Code.for the performance ofthe work far which this permit Is issued. '
My Waiters Compemems.mrance nrtiw and Policy a9Xjr
Carrier. �-S i I— policy No.: '1 �� — ( S 9
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(76Osecam reed natal completed if the permb 1s foram hundnddoBan($I00)
or Ins)
1 unify Wt In Ne p rfa a a of the work for which this parch 4lssuld,l shall std
employ any Parent m ac—su!0.rvbjcctto the WOrkcn'CamMemNan
IaWa of Caliroml t
Appliant
NGnCE TD APP G L aMr a n6 Nu m of Exemption,you should!
become Subject an the Wither.Compensation provii of the labor Code,you mart
.J O roMWlthcomply aim weh provisisau mmu pewi sM1 bodnnted invoked.
5Z; CONSTRUCTION LENDING AGENCY
[—a I Wreby affirm that them is a construction lending agency for the performance of
1x 7 the with for which this permit is issued(Sec.7097,Cl,C.)
Leaders Name
z leader.Address
U O 1 cwUfy that I ban mad this application and Tum thin the above information is
Iy correct.l agree in comply with W city and county oNln aces and sum laws missing in
.0 building cemmuction,and hereby aaWda representatives of this city in enter open the
W above-mrntiawA property for Insecumm Marinas.
LL (We)apo to have.indcmnily and keep sarcomas oro City of Cupertino against
by res liabilities,judgments,Cam and Cape.which may In my way acute against cold City
V Z Incinseguen c orthngrmil.s.f thu McrmlL
^� APPLICA U D RSTANDS AND WILL COMPLY WITH NPO NT Issued by: Date
SOURCE ONS. v/ `
lj 6 Re-roofs
Signnurt buitear Data
HAZARDOUS RIALS DISCLOSURE Type of Roof
Wier dm applies in flare (ding acupant share orhandle bassrtlon material
as defined by the Cupertin Manpal Cade.Chapter 9.13,and the Health and Safety
Cade.oYon 7557z (a)7 All roofs shall be inspected prior to any roofing material being installed.
era the.ppacant or ban Wilding occupant era equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
t b.,n es air emtamt stns in u_cieflaed by Ne Bay ArosAir Quality Management all new materials for inspection.
san ❑Yrs /
IhMw Lhlhasrdawumamriabrtq mewunderCMpler Q95ofthe Califor- ( I /
ria Hcatth& 9.1 sx..25505.75533wb2751 un mandwtifdm Wimmg
dela.1 cu nal ve a mnmL Out h ta my rtapomihility b otifY acc
occupant of Ne
myuiroman w t . issuuteeor.caLl/ir mor nO Signature of Applicant Date
Owner or authorissd agent
1
D t Dam All roof coverings to be Class'W'or better
• CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: TraciC
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36615053 . 00
DATE ISSUED. . . . . . . : 08/01/2008
RECEIPT #. . . . . . . . . : BS000005655
REFERENCE ID # . . . : 08080003
SITE ADDRESS . . . . . : 7495 PROSPECT RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SRIVIDHYA GOPALAN
ADDRESS . . . . . . . . . . : 7495 PROSPECT RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : LESLIE HOANG
CONTRACTOR . . . . . . . : LESLIE HOANG LIC # 23155
COMPANY . . . . . . . . . . : T D ROOFING
ADDRESS . . . . . . . . . . : 675 TULLY RD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95111
TELEPHONE . . . . . . . . : (408) 892-8872
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---—----- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 15, 000 . 00 1.50 0. 00 1 .50 0 . 00
1REROOFRES SQ FEET 25. 00 325. 00 0. 00 325 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 326.50 0 . 00 326 .50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 326. 50 VISA
---------------
TOTAL RECEIPT 326 . 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601
--------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
• I
CITY OF CUPERTINO
REROOF
•CUPEVINO PERMIT APPLICATION
APN # 3, w( , 05 :a)
Date: g /
Building Address: L I
14- qi VaS ec I tel
Owner's Name: Phone #:
S lVz 810 S;_To) 9 (Ogg
Contractor: Phone #:
(k�o8) �jqq 0 $ q0
Fax#:
Cupertino Business License #: Contractor License #:
$'( �SGI
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles n ---- p
❑ Other (Specify) Other(Specify) M C
umber of existing coverings ❑ Provide I.C.B.O. Report #
To be Removed ❑ Provide Mfg. Installation Specs.
Job Description: �
J
ICA
t X g X 1 ►N�6l 3� I krill
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:
1-�
I Have Read, Und"taand llComply with Cupertino's Tear-Off Policy:
Signature
Revised 6/16/08
CITY OF CUPERTINO '
REROOF
CUPER,TINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B ICOMMLROOF
1BSEISMICO Seismic Commercial B
2 5— IREROOFRES Re-roof Residential B ISFDWLROOF
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B IMFDWLROOF
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 "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: y- �/1Z� �1 �/ 0. G 12 C1•tcL n
Job Site Address: �-n e C,
Roofing Company Name:,
Applicant's Signature:- I.,
Date: g f O
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 IJoist, (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 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.
rte
1.Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;60%=4 points J, up to 4 Resource pts 0
12.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=yas D
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
F.Design Resource-EffcienbLandscapes and Gardens_ 4 Resource pts y=yes 0
9.Reuse Materials/Use 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 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 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-JDinted Studs for Vertical Applications 2 Resource pts y=yes 0
7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes 0
6,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
12.Use OSB
a.Subfloors ( 1 Resource pt y=yes 0
•, b.Sheathing_ _ 1 Resource pt y=yes 0
I 1 1
ror ne
1.Use Sustainable Decking Materials
a.Recycled content 3.Resource pts y--yes 0
b.FSC Certified Wood 3 Resource pts y--yes; 0
2.Use Treated Wood That Does Not Contain Chromium/Arsenic 1 IAO/Hsaith pt y--yes D
3.Install House Wrap under Siring 1 IAQ/Health pt y=yes 0
4.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) Up to 2 Resource pts. 0
b.Showerheads(1 point each,up to 2 points) Up to 2 Resource pis. 0
4.Replace Toilest with Ultra-Low Flush Toilets
(1 point each,up to 3 points) Up to 3 Resource pis. 0
5.Install Chlorine Filter on Showerhead 1 IAQ/Heallh pt y=yes 0
6.Convert Gas to Tankless Water Heater 4 Energy pts yryes 0
7.Install Water Filtration Units at Faucets
(2 points each,up to 4 points) Up to 4 IAC/Health pts. 0
6.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
r.ciectncer
,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 pis. 0
4.Install High Efficiency Ceiling Fans with CFLs
(1 point each,up to 4 points) Up to 4 Energy pts. 0
1 I 1
G.Appliances
1.Install Energy Star Dishwasher 1 Energy pt y=yes 0
2.Install Washing Machine with Water and Energy
Conservation Features 1 Energy pt y=yes 0
3.Instail Energy Star Refrigerator 1 Energy pt y=yes 0
4.Install Built-In Recycling Center 3 Resource pts y--yes 0
1
H.Insulation
1.Upgrade Insulation to Exceed Title 24 Requirements
a.Wails 2 Energy pis 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 Racycled-Content,Fiberglass Insulation with
No Added Formaldehyde 3 IAQ/Health pts y=yes 0
4.Use Advanced Infiltration Reduction Practices 2 Energy pis Y_—Yes 0
5.Use Cellulose Insulation
a.Walls 4 Resource pts yryes 0
b.Ceilings 4 Resource pts y=yes 0
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y--yes 0
n.cemngs 4 Resource pis y--yes 0
1 1 1
m ows
11.Install Ene gy-Effcienf Windows j
• a.Double-Paned 1 Energy pt y=yes 0
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 Transmission Glazing 1 Energy pt y=yes 0
1 1 1
J.Heating Ventilation and Air Conditioning
r.Use Duct Mastic on All Ducl 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 IAO/Health of y=yes 0
4.Clean all Ducts Before Occupancy 21AQ/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
6.Install Sealed Combustion Units -
a.Furnaces 31AQ/Health pts y=yes 0
b.Water Heaters 31AQ/Heaith pts y--yes 0
9.Replace Wall-Mounted Electric and Gas Heaters with
Through-the-Wall Heal 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 stovesrnserts 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 41AO/Health pts y--yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pis 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 pis y=yes - 0
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=18p cints) Up to 18 Energy pts 0
r— _ g _ 1 Resource t
6.Select Saie and Durable Roofin Vete els
i-___ _ _ p y--Yes 0
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--yes0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts Y--yes 0
1 1 1
•
INPUT RUSDUrces Energy lAOMarifth
. n oor r ue ry an Ins BB
1.Use LowNo-VOC Paint 1 IAO/Health pts y--yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAO/Health pts y--yes 0
3.Use Low/No VOC Adhesives 3 IAO/Health pts y=yes D
4.Use Salvaged Materials for Interior Finishes 3 Resource pis y--yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61A0/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAO/Health pts y--yes 0
7.Seal all Exposed Particleboard or MDF 4 IAO/Health pts y--yes 0
B.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 31AO/Health pts y--yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring B 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 yryes 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 1
Total Points Available: 1 1401 130f- 57
Total Points Project Received: 1 01 01 0
G:da&pmgsrgreenhulldtngguldellneslremodslerslgmonpointOnal212.04prcdwted.ds
Community Development
' 10300 Torre Avenue
It sm' 'Zo
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
4- 9 s Q-C,f 2--c o X600 3
OWNER'S NAME: 'SvivAoL / h PHONE # .5-10
S'
GENERAL CONTRACTOR: T -D Vrn Q Yk Ct FAX 4t q p
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the follo ' 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