08050157 (2) CITY OF CUPERTINO > 7 � -
HUILDIIQG'DIVISIdN PERMIT ,�COrITRA -TOUINFOOR,MATTO '
BUILDING ADDRESS: PERMIT NO.
'7937 CRANBERRY CL WING' S ROOFING INC 08050157
W NER'S NAME: PERMIT ISSUE DATE
SO OSCAR C AND LINA S 3243 SYDNEY WAY 05/20/2008
ONE SANITARY NO, CONTROL NO.
(510) 889-9068
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
ala j LICENSED CONTRACTOR'S DECLARATION Job Description
m 1 hereby affirm W,1 am licesed numkr Provisions of Chapter 9(cemmeraning
n with Section 7fC())of Division 3 of the Business and ftfossions Crda.md my license is RE-RF T/O ASPHLT SHNGL INSTL NEW ASPHLT SHNGL CLS
-�u in full force an fe
Ll a«wax f.ic.♦ g t A 19SQ
F p Dam Contractor
e pp uuua ARCHITECTS DECLAR i
W< 1 undermad my plans shall W used as public mcmd,
s u. Licensed Professional
5O OWNER-BUILDER DECLARATION
Z<y 1 booby affirm o n 1 am exempt from the end ore;Cods:
Anse Law for 1W
ZOO following moon.permit
t 7th1S.B.aIuO. and ne.desons Cade:Any city or rnomy
$ which requite,n permit m On suuc4 alter,improve,de permit
t car mash any gatemen
a
prior mirlissuance.also t.on
applicant for such permitmtiltasig.Cha statement
Chapter
< wturromenncd p°rman,mlW of Division
of Use Comrn.runcemc Law(Cbapmr9 Sq.Ft. Floor Area Valuation
Y�s (cmnmerming with Section]000)of Divesionlof the Buti.v..and Profastiom Cde)w $5000
`<.. that he a exempt thmefrom and the hues fm Ne alleged accretion.Any violadon of
Section 7031_7 by any applicant for a pewit saltiness the applicant to a civil Penalty ofNumber Occupancy
not more does five hundred dallsrs n!OyL 36203007 q1 Pane Y Type
❑I.uowneraft pmpety.mmyemploymwithwaguudeirmlc o pemdon,
will do the work,and dm swnum is notimended oroRered forsak(Sec.7014.Business
and Proreuiou Cade:The Contractors License Law dm Out apply m son owner of Required Inspections
Proton,wbo batiMs w imputes dmrton.and who does,uch work himrelf ar t uoogh hes
own employes,provided dratsuch improvements ale not mounted oraRered forsak:If.
however,the building or improvement is sold within one year of cornpletion,the owner.
Wilder will have the buden of proving that M did Out ddld or improve for Puspoe of
oak.).
❑1,as Owner or the property.am exclusively contracting with licensed convectors m
consumer the pmjem(Sec.7064.Business and Profusions Cade:)The Coobaerr's U.
coerr Law dm not apply m m caner of property who Wilds or improves danmmr,and.
who comorm for such projects with a comranm(s)licensed purcham to the Conlractars
License Law.
❑I am csempt uader 5 .B A P C rorthis maw.
nese
Data
WORKER'S COMPENSATION DECLARATION
1 hereby,affirm alder penalty of perjury mm of the following declaratima:
❑I hsm and will mountain aCeNfrnteof Comcnt to self-imurt fa Wod¢rs Comprn
cation,u provided fm by Section 370(1of the Labm Code.for the perfowawe of flan
work for which this permit is issued.
❑1 have and will maintain Worker's Comps nattion Insurance,as volumed by Section
3700 or dan Labor Code,for perform ee or the work for which this pewit B Issued. '
My Workers Cosmonaut ran¢ 'er and Policy number am: F
Carrier. f.1. Policy No.: OS
ty
CERTIFI TE OF MPTION FROM WORKERS'
OMPENSATION INSURANCE .
Thesstttlon red Out W compleed if the permit Is forme°hundred doRaa(2100)
Or less)
1 certify that in the performance Of Ne work for which this pewit is Wued.I shall nut '
employ any person in any mmmersu u in Woman subject m the Worsen'Compensator
Laws of California.Date
Applicmt
NOTICE TO APPLICANT:If.after making this Certificate of Eacmpoon.you should
become subject m tW W°rtw's Compeustion provisions of the Labor Cade.you mala
.J,Z fordwith comply with such provisions or this Permit shall W dccmd muted.
z O CONSTRUCTION LENDING AGENCY
[-+ IWrtbyalfiw then Vertuacosce.3n7.Cing agenry far1W perfermame of
a the work for which this emit u Wood(Sa.3(19],Civ.C.)
GQ lender's Name ._
=z lenders Add.
U O 1 certify that I have read this a,,icrion and sum that to above information is
W correct 1 agree to comply with all city and county ordinances and sou laws relating to 1
.p Wilding construction,and hereby authorize mprtsenudvu of then city in mor upon Ne
W above-menuamd Property for inspection Impacts,
G (We)agree to save,indemnify and keep hamlets the City of Cupenin°against
y liebilitiu,judgments.cu and upcuu wM1ich may in my way accrue agalnstsud C,y
U z in earurgwxe of the d Ing of this pemit.
APPLICANT UNDER A IDSA WILL COMPLY WITH ON- 1" Issued by: DateF--
SOURCERE L 'IOL S. O
Re-roofs
Signuum of an atm hm
AZMDQ S MATERIALS DISCLOSURE Type of Roof
Will danaCusto,or In C pal Cgacempantrmmor Mnoc huudoumamrial
u defirand by tan Cupertino M pal Cdc.Chapter 9.13,and the Health and Safety
Cade,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
Yu No
Will Jan opium or furore Wilding aceupan,err cquipmrnt or dcvim which If a roof is installed without first obtaining an inspection,I agree to remove
_nit humlons err cmuminana an tcfind by the Bay Am"r Quality Management all new materials for inspection.
District? ppyyr�.. P
❑Yu IQ o
'have readth hanNous "s requirements underChapter6.95ofthe Csifor-
nis Health 85 afctyC duS¢Gons255f15,25533 and 25534.1 understood this ifthe Wilding
toes no,cu t Y h e a lenane du,is u mY responsibility m notijg tan occ an of de
req"+roments an mlWmctparmssaawxaracnraa`mdO up y' Signature of Applicant Date
�1 �A
Owner or d agen Dom All roof coverings to be Class'%¢"or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36203007 . 00
DATE ISSUED. . . . . . . : 05/20/2008
RECEIPT # . . . . . . . . . : BS000004841
REFERENCE ID # . . . : 08050157
SITE ADDRESS . . . . . : 7937 CRANBERRY CL
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SO OSCAR C AND LINA S
ADDRESS . . . . . . . . . . : 7937 CRANBERRY CIR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4923
RECEIVED FROM . . . . : WINGS ROOFING INC
CONTRACTOR . . . . . . . : CHEA, WING LIC # 21239
COMPANY . . . . . . . . . . : WING' S ROOFING INC
ADDRESS 3243 'SYDNEY WAY
CITY/STATE/ZIP . . . : CASTRO VALLEY, CA 94546
TELEPHONE . . . . . . . . : (510) 889-9068
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 5, 000 . 00 0 . 50 0. 00 0 . 50 0 . 00
1REROOFRES SQ FEET 19 . 00 247 . 00 0 . 00 247 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 247 . 50 0 . 00 247 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 247 . 50 VISA
---------------
TOTAL RECEIPT 247 . 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
010501s7
CITY OF CUPERTINO
OR S'-
REROOF
CUPERTINo PERMIT APPLICATION
APN # ,3 ( g OS _d D -7 , d D Date 2� b
Building Address: 5 7 .
Owner's Name: Phone #:
LlN/B S o
Contractor: Phone #: Lfp,?,�i-06 — Q
�J Fax #: Jw — d 6P
Cupertino Business Li ense #: C�/eR 3n Contractor License #: 69
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
)6(. Asphalt Shingles X Asphalt Shingles
❑ 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//U-- " AAA�__�_ S14/�Fle T44S-fell 41aw G�S� 14W
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 Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
CITY OF CUPERTINO
' sm REROOF
CITY OF
_ CUPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
IREROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Residential B 1SFDWLR00F
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
IBSEISMICRE Seismic Residential B
1BUSLIC Business License B
•
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 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:
Job Site Address:
Roofing Company Name:
Applicant's Signature: D ; 2_6/ pVl
• Greg Casteel ( V
Building Official
Revised 11/2/04
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
MOMMM TOTAL POINTS 40 points
f Crc.t CY
I� Q�
MAY 2 0 7008
CM_
O�
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.
A.Site INPUT Resuuices Energy IAQIflea�h
1.Recycle Job Site Construction&Demolition Waste i
65'/"=1 point;75%= 2 points;60%=4 points [ up to 4 Resource pts , 0
2.Salvage Reusable Building Materials 4 Resource pts y=yes 0
3.Remodel for Mixed Use,AdaptNe 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
IB sign Resource=Efficient Landscapes and Ga dens_ 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 pis y=yes 0
1 1 1
B.Foundation loft
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 p
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes p
1 1 1
C.Structural Frame
i.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 p
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
B.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0
9.Use Structural Insulated Panels(SIPs)
a.Floors 3 Ener is
9Y P Y=Yes 0
b.Wall
3 Energy pts y=yes 0
c.Roof 3 Energy pts y=yes p
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.Subfioors
• b.Sheathing_ 1 Resource pt y=yes p
1 Resource pt Y=Yes 0
1 1 1
.Eztenor Finish
1.Use Sustainable Decking Materials
a.Recycled content 3.Resource pts e=yes 0
1 b.FSC Certified Wood 3 Resource pts y--yes 0
2.Use Treated Wood That Does Not Contain Chromium/Arsenic 7 1 IAQ/Health pt y--yes 0
3.Install House Wrap under Siding 1 IAQ/Health pt y--yes 0
4.Use Fiber_Cement Siding Materials _ _ 1 Resource pty=yes 0
1 1 1
E.Plumbing
1. Heater Jacket Install Water
_ � - � 1 Energy pt e=yes D
2 Insulate Hot and Cold Water Pipes 2 Energy pis e=yes 0
3.Retrofit all Faucets anddSShowerheads with Flow Reducers
a.Faucets(i 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 Tallest 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 IAQ/Health pt y=yes D
6.Convert Gas to Tankless Water Heater 4 Energy pts y=yes D
7.Install Water Filtration Units at Faucets
(2 points each,up to 4 points) Up to 4 IAQ/Health pts. 0
8.Install On-Demand Hot Water Circulation Pump 4 Resource pts y--yes 0
r.eiecrncer 1
1.Install Compact Fluorescent Light Bulbs(C—Fls)
(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,
5 points) Up to 5 Energy pis. 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
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 Redycled:Content,Fieerglasslnsulation 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 C •
b.Ceilings 4 Resource pts y--yes 0
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
D.uerings 4 Resource pts y=yes 0
INPUT Resources EnerM, IAQIHeafttr�-
endows
1.Install Energy-Efficient Windows
a.Double-Paned i 1 Energy pt y=yes D
b.Low-Emissivity(Low-E) 2 Energy pts y=yes D
c.Low.Conductivity Frames _ 2 Energy pts y=yes D
2.Install Low Heat Transmission Glazing 1 Energy pt Mes 0
t 1 1
J.Heating Ventilation and Air Conditioning
1 Use Duct Mastic on All Duct Jointe _ J 2 Energy pts y=yes 0
2.1nstall Ductwork within Conditioned Space 3 Energy pts y=yes 0
3.Vent Range Hood to the Outside 1 IAO/Health pt y=yes 0
4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y--yes 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
8.Install Sealed Combustion Units
a.Furnaces 31AQ/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 0
12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Fumace 2 Energy pts y=yes 0
13.Retrofit Wood Burning Fireplaces
• a.Install EPA certified wood stoves4nsens 1 IAQ/Health pt y--yes 0
b. Install/Replace Dampers 1 Eneroy pt Y--yes p
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 3 IAQ/Health pts y=yes 0
1 1 1
K.Renewable Energy and Rooting
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-W re for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2A kw=12 points,3.6 kw=18 points) Up to 18 Energy pts 0
I6.Seiect Safe and Durable Roofing Mate els 1 adiant Resource pt y=yes p
7.Install RBarrier �� 3 Energy pis 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 p
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0
• 1 1 1
M.Indoor Wr Quality and Ftmshes -
(1.Use Low- 1 VOC Pai rt _ _ j 1 IALUHealth pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAD/Health pts y--yes 0
3:Use LowMo VOC Adhesives 3 IAQ/Health pts y=yes D
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7 Segl ofExposed Padideboard or MDF . 4 IAQ Health is es
— - ---- — -- --- — t P y=y D
B.Use FSC Certifed Matedals 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 31AQ/Health pts y--yes 0
t 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
Use Rapidly Renewable Floonng Matedals_ "� 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 IAO/Health 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 0
1 1
Total Points Available: 1 1401 1301 57 •
Total Points Project R 1 0 0 0
G:dela/progsrgreenbuil6ngguidellneshemodelersrgreenpoinisfinal2.12.04prmededxJs
•
Community Development
i 10300 Torre Avenue
L / Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
OCUPEI,TINO
Building Department
JOB ADDRE PERMIT #
3 4 � civ a dl-r
OWNER'S NAME: NE # c vis
GENERAL CONTRACTOR: I S r I N FAX #
I am not using any subcontractors: VV
z o
Si nature Date
Please check applicable subcontractors and complete the following information:
66 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
• ZJ �
Owner/C ntractor ignature t Date