08050144 (2) BUILDING DIVISION- PERMIT CUNTRACTOR IIF®RMATIO.N"
C
BuILD,tNy ADpgEs JOLLYMAN LN TBD — TO BE DETERMINED PERMIT08050144
OWNER'S NAME: PERMIT ISSUE DACE
lb LEE PINKY Y AND DANIEL W 05/19/2008
ONE: SANITARY NO. CONTROL NO.
ARCHITECT(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u o o LICENSED CONTRACTOR'S DECLARATION
I hrtby aRm tw 1,m l¢tta0 mortar Providom of mapur 9(eommeromg lob Description
with Section 70111))of Dwidon Jaf Ne Boom.and!Infesmars Code,aha my license is RE—RF 1/2 OSB TL PRESIDENTIAL CLS A 34SQ. SOLIS
D = in full farce and effect. de2�CC ROOF REPAIR PD FOR BUS LIC 5/19/8
z Ucmasa Clair Lk.k
Dow�// Commcmr
P I ' I I'-ARCHI-ARCHITECTS DECLARATION
` I uaEmu
snd my plan Nall bo ma a
epublic records
g G to Licemed Profcaional
Sys OWNER-BUILDER DECLARATION
f 1 hmby affirm that 1 am exempt from the Conuacmrs Lamm Law for the
COO following moan.(Section 7031.5.Busmss tuna Pmfesdom Code:Any city or county
$ which mquima a permit to consuun.alt Wpmn,demolish,or m*r any structure
_Z> poor m an
its issuance.slho reque irthe applicant forsuch permEknmemm
it u •signod c
s< dust ho,inlicemadInhalators anmeprovisions,ofineeammcmrivam><Law(chaptm9 Sq.FL Area Floor AValuation
xl-a (commencing with Setian 7000)of Division 5 ofth Bmineiand Rofessiov Cash)or $14000
laud he as campt tha Jmm and the basis for de alleged exemption.Any violation of
Section 7071.5 by any applicant for a permit subjects the applicant in a civil penalty of ,py Number QccU anC e
rot .dun fin lunaed dollars($M 35925043'.d'Otf P YTYP
❑1.u awrsm a(tlr prtpmty,m mY mPloyaa w'u6 wgn a thevsale cmnpewtion,
will asthework artalate he Coe,mminLt ormRuM Torok(Srs.70th,Busnw
arta anywh obu Cade The Cmuenuri cane few aces rot apply u sn OwanmuSh is Required IBspeCtlOns
propenywbo builds ftd ftt thmon.and whodoessuch oroffamthroughbra
avers r.ftbu,pcogani poonhimpmwments art ro,inlaMWmledom,forule.lf. ,
however,lau aam building m ilnPmnment u sale within am year or comPwnfoar the owmr-
bui.). will hon the burden of pmvin6 Dud h did not ddd a improve rm PutPoe of
ale.).
❑1,u Moor of the proper,,am mclusnly cammucting with licevul corW¢tms to
covwct th,pmjen(Sac.70".flusm.and Profassiav Code)The Couaw.7mrs U.
cove law doe mol apply Or an owner of property who Wilds or improve thamon,and
who nmVlcts for such pmjene with a canVactor(s)IIRRed parser,an the CanVCta/e
Licence law.
❑lameempdandm See ,Ba PCrurthufraust
Owns Dau
WORKER'S COMPENSATION DECLARATION
I hmby a m under pevlty of perjuryone of the following declsratom:
❑1 Wn std will for by
•CmdricM of Covem r Coda.fine for Warkcri Compeer -
worsf r provided for by Section 3]00 of th labor Code.for the perfomana of the
work for which this permit is iaucd
❑1 ban and will mainuin Workeh Compensation lasunna,as;required by Section
5700 of the labor Can.for the padmormac ofthe work for which this permit in issued. '
My workers omp, an harassment arum and Policy number art:
Cartier. I INy No.:
C RTIFlG OF^ATI N FRO WORT
COMPENSATION INSURANCE
(Thu amdan reed not c eomplcud u th fnmh is foram hanJrtCdawn(5101)
or I=)
1 atifY that in toe performance of the work for which this Owed is issch L l shill had
cmPloy any person in any mance,to as at hecomc subject u th Workers'Compevadon
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,afar making this Cenifieu or Enmption,you should
becorne subjm an the Workers Comperuation yrovuimhs of the Labor Code,you muu
.J ,Z forthwith comply with such provismv or this pcmit shall h aemcd mnkcd
z Q CONSTRUCTION LENDING AGENCY
[� Ihamby-firm thus ft.iso coastvction lendingagency for the perfamanaof
FC thc wort for which the Parrott is ivurA(Sm.3097,Civ.C.)
Q Lenders Name '
Z Lenders Addmai
U Q I a4tify that I hon red this application and sou and the show uJamadw is
IT. ^ coma.l-VM u comply with all city and county oNlnanas end sou laws ortolan,an
c) building construction.and bratty suthodre mpreentatins of this city to en,r upon the
r W slave-mentioned property for impaction por,mos.
t„ C (We)-gra m an,indemnify and trop hamkas the City of Ca,crhma agaiast
lZl liabilitimmosments.costs W expeme which may In any way amus agaimt aid City
odusuca Of to Starting
f this Farrah.
V z APPLs1CCANT UNDERSTAN oS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /�] t
SOU CE REGULATf0 S`-� 7^L p -
/� a Re-roofs ✓z/
Signauue of pplimnsCondranor Dau .
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fulmc Wilding W,nom aw lord,haandons malarial
as defhneJ by lac Cupenina Municipal Code.Cbapur 9.11 and the Health and Safety
Code,Section I5532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ye
ONO
ase applicant m rutum Wilding occupant use equipment m da,d.which If a roof is installed without first obtaining an inspection,I agree to remove
Disuic 7�nm sf mmuminsnu u de0ned by Ne Bay Arean
Arca Air Quality Management all new materials for inspection.
❑Ye ONo
I haw mad the havNwsmaurissrcquimmcou under CLapur15.95o1'the Calif..
dooractcur5a&yyban ltSredauust it my and 1955d.l aMmiWdthuifae Wilding _ z
tanrotcurtcnhic haws over dust it 6mymspofa Cotybhoa, that uxupand of the w' �`/(E.
mq 'mmcnu which mordhmet priormissuana ofd CmtiEme of Occupenry. nature ofA SI Applicant g PP Date
Owra,or authmreL age., Dicer' All roof coverings to be Class'Af'or better
CITY OF CUPERTINO
;__Cm REROOF
*CUPEkTINO PERMIT APPLICATION
APN # 9, Date:
.,v ,3 , v
Building Address:
v S v1/ /w.(x
Owner's Name: Phone #:
ti�'�L �✓. SEC 40 G
Contractor: Phone
E Z4Z c;9 6zY6
Sa 0' /gooFax #: , Va ?Sr `
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles .2- Asphalt Shingles
e"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: 0A TL Pref dkp --�L—\ C(c,Sf AIC24
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:
•I1HHave
/Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
—mss
Signature
CITY OF CUPERTINO
-" r REROOF
OCUPEIiTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Residential B 1SFDWLR00F
IBSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
IBSEISMICRE Seismic Residential B
IBUSLIC 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: �i4n i' fi Z
Job Site Address: 20 2"9
Roofing Company Name: 5 0 /t• f &etc, jA:'
Applicant's Signature: Date:
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
i3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35925043 . 00
DATE ISSUED. . . . . . . : 05/19/2008
RECEIPT #. . . . . . . . . : BS000004815
REFERENCE ID # . . . : 08050144
SITE ADDRESS . . . . . : 20894 JOLLYMAN IN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER LEE PINKY Y AND DANIEL W
ADDRESS . . . . . . . . . . : 20894 JOLLYMAN IN
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4349
RECEIVED FROM . : GERARDO SOLIS
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
---------- ------------- ----- --- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 14, 000 . 00 1 . 40 0 . 00 1 .40 0 . 00
1BUSLIC FLAT RATE 1 . 00 110 . 00 0 . 00 110 . 00 0 . 00
1REROOFRES SQ FEET 34 . 00 442 . 00 0 . 00 442 . 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 553 . 40 0 . 00 553 . 40 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CASH 553 . 40
---------------
TOTAL RECEIPT 553 . 40
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 . ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
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
A
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
TOTAL POINTS1 40 points
ZD�4k
•
V�R�6
#Wj
97�OB
. UG
A• .
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.
INPUT Resources Energy IAQ�Heaftl�_
A.Site
1.Recycle Job Site Construction&Demolition Waste
�65%=1 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 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
B.Implement Construction Site Stormwater Practices 2 Resource pts y=yes 0
7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0
B.Design Resource-Efficient Landscapes and Gardens 4 Resource pts y=yes 0
9.Reuse Materia YUse Recycled Content Materials
for Landscape Areas 2 Resource pis 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 D
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 D
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 D
B.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes p
9.Use Structural Insulated Panels(SIPs)
a.Floors 3 Ener is
9Y P Y=Yes
b.Wall 0
C.Roof 3 Energy pts y=yes 0
3 Energy pts y=yes 0
10.Apply Advanced Framing Techniques 4 Resource pts y=yes p
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes 0
l. 2..-...U _
1se OSB
•
a.Subfloo s }}( 1 Resource pt y=yes p
1 Resource pt Y=Yes
J.Sheathing 0
1 1 1
D.Exterior Finish
I1..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 7 1 IAQ/Health pt y--yes 0
3.Install House Wrap under Siding i 1 IAQ/Health pt y--yes 0
4.Use Fiber-Cement Siding Materials 1 1 Resource pt y=yes 0
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 Row Roducers
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 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 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
S.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes D
r.trecmcai ! 1
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 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 Recycled-Conteni,Fiberglass Insulafion wi T—
No Added Formaldehyde _ _ 1 31AQ/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.uenings 4 Resource pts y=yes 0
1 1
INPUT Resources Energy IAQhieaMM
Windows
. I1.Install Energy-Efficient Windows -�
a.Double-Paned ; 1 Energy pt y yes 0
b.Low-Emissivity(Low-E) f 2 Energy pts y--yes 0
c.Low.Conductivity Frames __ 2 Ener is es
------ 9YP Y=Y 0
2.Insta l Low Heat Transmission Glazing 1 Energy pt y=yes 0
1 i !
J.Heating Ventilation and Air Conditioning
�.U'se Duct Mastic on All Duct Joints 2 Energy pts y yes D
2.Instal Ductwork within Conditioned Space 3 Energy pts y=yes 0
3.Vent Range Hood to the Outside 1 IAQMeallh pt y=yss 0
4.Clean all Ducts Before Occupancy 2 IAO/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 3 IAQ/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)Furnace 2 Energy pts y=yes .0
13.Retrofit Wood Burning Fireplaces
• a.Install EPA certified wood stovesfinserts 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 41AQ/Health pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 51A0/Heallh 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-Vire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes p
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=18 points) Up to 18 Energy pts 0
I6.Selacf Safe and Durable Roofing Materials 1 Resource pt y=yes 0
7 Install Radiant Ba—mer3 Energy pts y=yes 0
1
L.Natural Heating and Cooling 1 1
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 p
• 1 1 1
In oor Air 0uallty and Finishes
r Use LowMo-V0C Paint 1 1 IAOMealth pts y--yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAOMealth pts y--yes 0
3.Use LowMo VOC Adhesives 3 IAQ/Health pts y=yes
4.Use Salvaged Mate alsforinte or 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
�.Sea all Exposed Padicleboa d or MDF _ _i 4 IAQ/Health pts y=yes 0
8.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 31AQ/Health pis y=yes 0
f 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2.Use Rapidly Renewable FFbnng Materials _v_J 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 IAQ/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
Total Points A 1 1401 1301 57 •
Total Points Project Received:1 1 01 01 0
G:datalprmsigreenbuildnoguldelineshemodelersrgreenpointsfinal27 204pm1saed.x1s
•
Community Development
Gam/
10300
Crtino CA 95014
:M1 �«
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
OCUPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
0 0// s!r� `7`� d fOSo( (-t
OWNER'S NAME: yr,'L""C F_`� PHONE # � 10 p 6 c% G
GENERAL CONTRACTOR: = p/ rrJ / ` FAX #
I am not using any subcontractors: S25A9 — tel! a
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