08020067 CITY OF CUPERTINOY';: t �"�"' " "^« �»"' ^``"� ' R
w BUILWNG DIVISION PERMIT CONTRA ' OR�INFQRMA' IQN
.:,.`
BUILp 1p44,,Apq RFSS: PERMIT NO.
LL711 STONEBRIDGE ST BEST KITCHEN &BATH 08020067
NER'S NAME: PERMIT ISSUE DATE
JANES LINDA B 1850 HOURET CT ., 02/12/2008
PHONE: (408) 942-5520 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
300 LICENSED CONTRACTOR'S DECLARATION O O O O
w I bunchy affirm that 1 m accused mother provisions of Chapter 9(commencing Job Description
with Seedon 70(X))of Division J of the Business and Prefcuiov Code.and my"coast is KTCHN REMDL,RPLC CABNETS,ELECTCL&PLMBING(BRNG UP
in full fora and effect
LicenmClTO CODE)
w Lc.Is
^ Date Conmh=r
e ARCHITECTS DECLARATION
e 1 understand my plams.hall be used u public recon s
J�
5� Licensed Professional
OWNER-BUILDER DECLARATION
N
y 1 hemhy affirm that 1 amI.S.exempt from Ibu Contractors license Law for the
i o o following moon.(Saito 7.I. t.ado.. and Ne.do.,fl Code:Any any or County
e.
pMch its iss u a e.mnit oc cmm,the alum,impmm,h permit t ri repair any wunum
_40 thiorbiuiensedpmmelto mus to lbu Applicant for wchpermiHoiecuule asigned wthmcm
(emom nein,witpursunuoNeofDisiouofOatanBuinmYLiamclaw(CMpter9 Sq.Ft. Floor Area Valuation
(comet.exe pttSereirom and du Divisionr thaw Businwmton.Any Protections Code)or 40000
c5 9 the io r 31.5 b a"applicant
p li and or Mar for the alleged exemption.Any it penalty
of
Section hundred kmtforapermitrvbjecu the applkmttoacivil latndly of Number Occupancy Type
not mare Nan Rw nmmamd atom Isom. 3 4 213 0 51 .-W'
1,ao rofthapmpmy,mmyempioymwithw psatlatirmlecompcmdon,
will do Newark,and Nestruclure r mtinsnded oranmd foraar(SM.70s0,Businm
and Pm(eaelons Code:The Con iscmrs Liam Law dents not apply to an Owner of Required Inspections
property who bulla.nimprovea thman,and who d«a.uchwerk himeelfwtherugh his
Own employs,provided that such improvements m net intended croRered for sale If.
haweven Neow thegmimpmvemvinrwldwilinon year of ampleden.the owner-
builds will haw Uc buNm of paving WI M did MI build Or improv for purpose of
Z
.)• fin\
1,u owner of IM sec.
.m exclusively a ld contracting with Ranted anuas7on w
' coustmCl the projm(Stec.7000.Business and Profession Cade:)The Conu.nori LI-
<em law ds not apply b ts Owner of propene who licensed
or improv demon,ted,
who commcrfanmh projects wiNacanlracwga)Ikensedpursuemteate Ctnvmmrs w✓1M�1
License use.
❑lam tee pl unda[See ,B&PCI.N�h�mm'nt,
won DatC / __,
WORSATION DECLARATION' I
I thereby aBrm aKER'S ty of perjury oro of that following decl.tiote
❑Iluw andvHlulfor by
inetion 37 te ofCamenuoCode.rmm the
Performance
Compete
waan,r pmvMhi for mi Section]70th of We labor Cade.for Ne prformmce a!Ne
wok far whim this permit is issued.
❑1 haw;and will maintain Workers Compensation Ium ance,as required by Section
770D M the labor Code,for the performance ofthe work("which this permit is issued. '
My Workers Compensation buunmce cerin and Policy number m:
Cartier. Policy No.:
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(hr.eolen read net bu completed if tie pewit Is furnace hundred doll.($100)
or leu)
I ceni(y Wt in the perform.a the work for which this permit r issued.1 shall awl
employ any person in my mxm; pute esub) I to Compensation
Wmieri Compenson
Law.of Califamia.DW rl���� !/✓✓
Applicant �✓
NOTICE TO APPLICANT:IL—a eking this Cenifiam of Exemption,you should
become subject to the Wodtcrs Compensation provisions;of Ne Labor Code,you must
.J O forthwith comply with such provisions or this permit shall bu dcemed revoked.
z rj) CONSTRUCTION LENDING AGENCY
[-+ I hereby same that there I.a construction lending agency for the ism(mmana or
lY
the work,for which this permit la Wood(Sen.3097.Civ.C.) '
0 Lenders Nene
Z Ureters Address
V Q 1 certify Nat I have read We.pitilmoon and auto Ne ac show,information is
D.^ eonect.I agree to amply with all city and county aNinmas and ss¢laws missing at
'Q rU^ building construction,and hemby wNMre repreuenudwa ofthis city to enter upon race
Oil al,mc-mentiorcd property for inspection purptteL
py (We)agree to saw,indemnify and keep harmless;the City of Cuper int against
C') liabilities,judgments,costs and espenms which may in my my seems against said City
V Z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale 2-12
SOU E R UL ATIONS.
do
Re-roofs
Igneum ofApplion r Date
/HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will lie./appliam sir future building occupant art m handle bmandous material /v
u deRned by the Cupeniem Municipal Code,Chapter 9.11 and ate Health and Safety
^athm Section33sJx(.)7
CY. �N�o All roofs shall be inspected prior to any roofing material being installed.
❑Ya
Will the applicant or future building Occupant use equipment or de,leas which If a roof is installed without first obtaining an inspection,I agree to remove
emit hareNnua air centsminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District? �/
❑Ya I7Nu
I haw teal the haralaaus material,requimmcces under Chapter 6,95 Of Ne Califm-
N Fkalth&Safety Cod-Sean—T50S.155BEaml155B0.luedeaandW ifaat Wilding
does net correctly have a muni Nat II is my mapomiMlily,in wary that occupant or the
mquimmcnuwhkhmutt =lpitrmissuamcnfaC Cn wofac/ager Signature of Applicant Date
- � 4 �/:r All roof coverings to be Class"B"or better
senor or authorized egept oro
'I�' CITY OF CUPERTINO
IS ADDITION/REMODEL
CUP `
CITY PERMIT APPLICATION FORM
APN# Date:
Building Address:
Mailing Address (if different from building address):
Owner's Name: Phone#
Contractor: ._V7 /��fr�P� fj, Phone#:
/]A>" % 4 F Fax #. 3
Contractor License#:
Cupertino Business License#: `J_ Co
Contact: Phone#:eP// %la? 7d,, – ."aP P
Le yoa' -9ya - sSd�
Fax#:
Building Permit Info:
Bldg. ❑ Elect. Plumb. Mech. ❑ Hillside ❑
Job Description:
Addition (adding sq footage):
What is being remodeled?
�"/mac �i , 'tea/ -� /�/u� h•i+� �/f. , 'n� �� �o i'o�%�
Remodel Includes Re-Roof: Yes ❑ No [�T If yes list number of squares
Remodel Includes Structural: Yes ❑ No
Square Footage:
Addition: Poo�r��ciih: � Deck: Garage: Detached Attached
Remodel: Kitchen Ilk<6_`f,Bath Other
Type of Construction (Usage Class): Occupancy Type:
1 FR, 11FR ❑ 11, 111, V-IHR ❑ 11, 111, lV V-N ❑ f 1 e9/ ,rle Q/
Valuation: Please check this box if the project is a
oad — second-story addition ❑
Green Building Check list must be completed and
attached to the plans. Green Building Points Achieved: 2 y
***For Office Use Only***
Over-the-Counter ❑
CITY OF CUPERTINO
acor ADDITION/REMODEL
CUEIINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft '
ADDITIONS 1R3SFDADD
PLLONGRNGR Long Range PL
Planning/Residential
IR3INSP Dwellings Inspections B
1R3PLNCK Dwellings plan check B
1R3REPINSP Dwellings Repeat .B
Inspection
1R3REPPLNC Dwellings Repeat Plan B
Check
1R3HINSP Dwellings Hillside B
inspection
IR3HPLNCK Dwellings Hillside B
plan check
1R3HREINSP Dwellings Hillside B
Repeat Inspection
1OHREPLNC Dwellings Hillside B
Repeat Plan Check
1R3ALTINSP Dwellings Alternate B
Materials Inspection
1R3ALTPLNC Dwellings Alternate B
Materials Plan Check
1PCESS Cesspool P
IPPRSEWG Ea. Private Sewage P
Disposal System
1PRSEWER Sewers P
113PSPRINK Lawn P
S rinklerBackflow
IBPWSVCS Main Water Service P
113SEISMICRE SeismicResidential B
DECKS 1R3SFDADD OR
1R3SFDREM
1DECKWOOD Deck(Wood)-Each B
Each
1DECKRAIL Deck Railing-Each B
(Each)
CITY OF CUPERTINO
ADDITON/REMODEL
FEESCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
GARAGES 1R3SFDADD OR
MSFDREM
1GARDTW<=lK Wood Frame up to B
1,000 SF
1GARDTM<=1K Masonry up to 1,000 B
SF
BCONSTAXR Construction Tax Res
new detached garage)
PATIO'S OPEN 1R3SFDADD OR
1R3SFDREM
1PATIOWOOD Wood Frame up to.300 B
SF
1PATIOMETAL Metal Frame up to 300 B
SF
1PATIOOTHER Other Frame up to 300 B
SF
PATIO'S CLOSED 1R3SFDADD OR
1R3SFDREM
1PATIOENCLW Enclosed Wood up to B
300 SF
1PATIOENCLM Enclosed Metal up to B
300 SF
1PATIOENCLO Other Enclosed Patio . B
up to 300 SF
1COVPORCH Porch Covered-Each B
Each
1REROOFRES Residential Re-roof B
Each 100 SF
REMODELS 1R3SFDREM
1REMRESKIT Kitchen Remodel up to B (Deduct 'W'for ea plan
300 SF check
1REMRESBAT Bath Remodel up to B 66
300 SF
IREMREOTH Other Remodel up to B
300 SF
REMODEL PLNCK
/ 1STPLNCK(1-3 for Standard Plan Check B NOT FOR OVER THE
remodel) COUNTER PLAN CKS.
3 of 3
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
WINDOW/SLIDING 1R3SFDREM
GLASS DOOR
1 WINREP Replacement windows B
ea S windows
1WINNEWNSTR New Window (non- B
structural
1WINMEWSTR New Window B
(Structural Shear
Wall/Masonry)
1 WINBAYSTR Bay Window B
Structural
SKYLIGHTS 1R3SFDREM
1SKYL<10 SF Skylight less than 10 sf B
1SKY >10SF Skylight greater than B',
10 sf or structural
1STAIRS Stairs-first flight/ea B
addt'1
1BUSLIC Business License , B
4 of 3
• CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34213051. 00
DATE ISSUED. . . . . . . : 02/12/2008
RECEIPT # . . . . . . . . . : BS000003915
REFERENCE ID # . . . : 08020067
SITE ADDRESS . . . . . : 22911 STONEBRIDGE ST
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER JANES LINDA B
ADDRESS . . . . . . . . . . : 22911 STONEBRIDGE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5640
RECEIVED FROM . . . . : LINDA JANES
CONTRACTOR . . . . . . . : DAT LE LIC # 25716
COMPANY . . . . . . . . . . : BEST KITCHEN & BATH
ADDRESS 1850 HOURET CT
CITY/STATE/ZIP . . . : MILPITAS, CA 95045
• TELEPHONE . . . . . . . . : (408) 942-5520
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- --------- ------
1BSEISMICR VALUATION 40, 000. 00 4 . 00 0. 00 4 .00 0. 00
1REMRESKIT SQ FEET 114 . 00 449 . 00 0. 00 449 .00 0 . 00
1STPLNCK HOURS 1. 00 . 122 . 00 0. 00 122 .00 0. 00
-- ------ ---------- ---------- ----------
TOTAL PERMIT .575. 00 0. 00 575 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 575. 00 #4237
---------------
TOTAL RECEIPT 575. 00
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ivi plans and specifications MUST
� This it of p
oe k Pt on the lob achangesaornalterations
LellL. lawf Ito make any permission from
oncame without written
put City of Cupertino.
he wilding P plan and speatication%
t fhe stamping of this P Permit or to he ar.
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• 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 EDETcy AUTIlealth
a 5rte LZ C ,
1k Recycle Job Site Consfmdion&Demolition Waste
165%a''l 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 Rause,and
Historic Preservation 4 Resource pts y=yes D
4.Protect Native Soil 2 Resource pts y=yes D
5.Minimize Disruption of Existing Plants&Trees 1 Resource pt y=yes D
6.Implement Construction Site Stonmwater Practices 2 Resource pts yryas D
7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0
B.Design Resource-EfAbient Landscapes and Gardens 4 Resource pts y=yes 0
9.Reuse Materials/Use Recycled Content Materials.
for Landscape Areas 2 Resource pts y=yes D
10.Install High-Efficiency Irrigation Systems 2 Resource pts y=yes 0
11. Provide for Dn-Site Water Catchment/Retention 2 Resource pts y=yesl 10
! 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 D
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes 0
i ! 1
G.Structural Frame
1 5uti titute Solid Sawn Lumbef wi{hyEnginee ed_Lumber-4 j'1 3 Resource pts y=yes D
2.Use FSC Certified Wood for framing
(For every 10%of FSC lumber used=2 points,up to 10) up to 10 Resource pts. D
3.Use Wood I-Joists for Floors and Ceilings 2 Resource pts y=yes D
4.Use Web Floor Trusses 2 Resource pts y=yes 0
5.Design Energy Heals on Trusses 5°or more 2 Energy pts y=yes 0
S.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 D
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
o Roof 3 Energy pts y=yes D
10.Apply Advanced Framing Techniques 4 Resource pts y=yes 0
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes D
12.Use OSB
• a.Subfloors 1 Resource pt y=yes 0
J.Sheathing 1 Resource pt y=yes 0
1 1 !
a or n s •
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 IAQ/Health pt y--yes D
3.Install House Wrap under Siding 1 IAQ/Hsalth pt yryes '0
4.Use Fiber-Cement Siding Materials 1 Resource pt Y--yes 0
1 1 1
E.Plumbing
1.Install Water Heater.ackat 1Energy 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.Showerhsads(1 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 Showarhead 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
i
e.trectncer
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 Fxtures with CFLs(1 point each,up to
5 points) Up to 5 Energy pts. g 0
3.Install Lighting Controls(1 point per fixture,up to 4 points) Up to 4 Energy pts. 0
4.Install High Ef deny Ceiling Fans with CFLs
(1 point each,up to 4 points) Up to 4 Energy pts. D
1 1 1
G.Appliances
1.Install Energy Star Dishwasher 1 Energy pt Y--yes J 0
2,Install Washing Machine with Water and Energy
Conservation Features 1 Energy pt y=yes D
3.Install Energy Star Refrigerator 1 Energy pt yryes D
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 0
b.Ceilings 2 Energy pts Y--yes D
2. Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0
3. Install Recycled-Content,Fiberglass Insulation with
No Added Formaldehyde 3 IAQ/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 0
D.Ueilings 4 Resource pts y=yes 0
1 1 t
!. mows
® 1.Install Energy-Efficient Windows
a.Double-Panad 1 Energy pt y--yes D
b.Low-Emissivity(Low-E) 2 Energy pts Y--yes 0
c.Low.Conductivity Frames 2 Energy pts yryes 0
2.Install Low Heat Transmission Glazing 1 Energy pt Y--yes D
1 1 !
J.Heating Ventilation and Air Conditioning
1 Use Duct Mastic on All Duct Joints 2 Energy pts yryes D
2.Install Ductwork within Conditioned Space 3 Energy pts y=yes D
3.Vent Range Hood to the Outside 1 IAQ/Hsalth pt y--yes D
4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y--yes D
5.Install Solar Attic Fan 2 Energy pts y=yes 7 D
6.Install Attic Ventilation Systems 1 Energy pt y=yas D
7.Install Whole House Fan 4 Energy pts y=yes 0
B.Install Sealed Combustion Units
a.Furnaces 3 IAO/Haalth pts y=yes 0
b.Water Heaters 3 IAO/Health pts y--yes 0
9.Replace Wall-Mounted Electric and Gas Heaters with
Through-the-Wall Heat Pumps 3 Energy pts y=yes D
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 Enercy pts y=yes p
13.Retrofit Wood Burning Fireplaces
a.Install EPA certified wood stoveslinserts 1 IAO/Health pt yryes 0
b. Install/Replace Dampers 1 Energy pt Y--yes p
c Install Airtight Doors 1 Energy pt y--yes p
4.Install Zoned,Hydropic Radiant Heating 3 Energy pts yryes 0
15.Install High Efficiency Filter 41A0/Health pts y=yes p
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts yryes 0
17.Install Separate Garage Exhaust Fan 31AO/Health pts y=yes p
! 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 yryes 0
3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=16 points) Up to 16 Energy pts 0
5.Select Safe and Durable Roofing Materials 1 Resource pt yryes D
7.Install Radiant Barrier 3 Energy pts y=yes 0
1 1 t
L.Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy pts y=yes p
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts '=yes
0
3,Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes p
. n oor r ua ty en n s es •
1.Use Low/ND-VOC Paint 1 IAC/Health pts y--yes 0
2.Use Low VOC,Water-Basad Wood Finishes 2 IAC/Health pts y--yes D
3.Use Low/ND VOC Adhesives 3 IAC/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts Y--yes D
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61A0/Health pts y--yes D
6.Use Exterior Grade Plywood for Interior Uses 1 IAC/Health pts y--yes 0
7.Seal all Exposed Particleboard or MDF 4 IAC/Health pts yryes D
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y--yes D
9.Use Fingerm,lointed or Recycled-Content Trim 1 Resource pts y--yes D
10.Install Whole House Vacuum System 3 IAC/Health pis y--yes D
1 I 1
N.Flooring
1.Select FSC Certified Wood Flooring 6 Resource pts Y--yes D
2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes D
4.Install Natural Linoleum in Place of Vinyl 5 IAC/Health pts y--yes 0
5,Use Exposed Concrete as Finished Floor 4 Resource pts y--yes 0
S.Install Recycled Content Carpet with Low VOCs 4 Resource pts y--yes 0
I 1 !
Total Points A779 r--1401 130 77 •
Total Points Project 10 �—0�
G:dateIpmgslgmenbuildnguldellnerJmmodelmelgmenpointsiina1212Npuecledxls
•
r - Community Development
10300 Torte Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
4PUPEKTINO
Building De artment
JOA ADDRESS: �CJ/7C / G ]PERMIT
o22PD ed 72-1) U 67
OWNER'S NAME: Zi ' PHONE # 5;p
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: O D�
ySi afore Da e
Please check applicable subcontractors and complete the followinginformation:
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
� • ontractor Signature D to