08070175 (2) CITY OFCUPERTINO
BUILDING DIVISION PERMIT p�ONTRACTQRI1�[i''aRM.tT°I¢N w -
BUILDING ADDRESS: PERMIT No.
924 PROVIDENCE CT WOODS ROOFING 08070175
OWNERS NAME: PFRNITT ISSUE DATE
PMC:Lf:;OD RICHARD 17700 SERENE DR 07/24/2008
ONE: SANITARY NO. CONTROL NO.
(831) 637-5576
ARCHf7ECDFNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
300 LICENSED CONRACIOWS DECLARATION O O O
F I hereby smfm that I un li¢nxM umleur provisions of Gapmr 9(commencing Job Description
nzjn wlHSection7gM0ofDivisionSofNCBudnevaMPraresdumCode.aMmylittve4 RE-RF RMV SHK RF, OSB 30#PAPER PRES SHNGL 50 YR
mw nfWl(on'sube 3� 5 / 3 ./
_p o¢ny' =�co�uanr CLS A29SQ
Ry� CImECrSDECLAMnoN '
.e 1 uMereund my plans shall w used as public=cords
s G� Licensed Profcastoul
5 OWNER-BUILDER DECLARATION
<E I hemby aRren that 1 am exempt from to Contractors License Law for the
O O following won.(Secdan 70S U.Business and Professions Code:My city Or county
$ which requires a permit to construct,ager,improve,demolish,or repair my structure -
-zi prior m its ismm¢e,alw mquirea the applicant for such Permit to file a signed sutement
ssm`o wtkislicensed Purmatutto the povisioroafthe Contractors ues.Law(G.ptm9 Sq.F[. Fl nor Area Valuation
(commencing with Section 700M of Division]of the Business ark Professions Code)or $13970
l� that he is esemPt therefrom sued the basis for the alleged momption.Any violation or
Section 7031-5 by airy applicant for a pcmdl subjew than applicant to a civil Penalty ofNumber O
not mom than five hundred dolbn(SSW). 3 5 6110 5 9 .'V(j ccas ane P y Type
❑1.u oww of the PODr+tY,or my moPlOYws with wage ss tie'vsok mmpensWon,
win do the work,and the structure I,nota ended or oBsrW for sale(Sec.7011,Busiwa.
and Prolevtiaru Cade:Tae Contractor,Li.Law does Out apply to an owner of Required Inspections
property wino ilds«improves Hereon,and wwdoessuch work himselfor timings his
own employees proNdN that such impmvemenu ase not intended wafered forsale B.
however,He Wilding or improvement U sold within one year of ctun,im an.the owner-
builder MB have the burden of proving that k did one Ntik or improve for purpose of
❑1,as owner of than property,sin exclusively contracting with licensed contractors e
constrict the project(Sec.7014.Business and Pmfew ans Cade:)Tae ComraetWs LI-
come Law does not apply an an owner of property who Wilds or improves thereon,and
who contracts for such pmjcm with a conuacmKa)licensed pursuant to the Contractors
License Law.
❑lmneaemprundm See ,B&PCfmthiawon
wrc Dean
WORKERS COMPENSATION DECLARATION
1 hemby affirm under petWty of perjury one of He following declaudons:
❑I hive and w111 mAnW n•Cmlfrcam of Comcnt to elf-insert rw Workers Camper-
.roto.,as provided far by Section nW of the labor Code,far the performance of the
wars for which this Permit u imucd.
❑I base and will mainuln Workers Compensation lowermost.u regmired by Section
37W of the labor Code.for the Performance of the work fafwMch thin Permit Is WM&
My Workers Compeomtinn 4ummce- rier W Poliry number are:
Grsicr rniSrA7 ✓z.Yl vWv� MAS-9P- ?046o c(
Policy No.
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Tads section stood not M completed line Museit Is two=hundred dollars($100)
or lest)
1 certify that in dsc performance of the were for which this Permit is issued.I shall not
employ any person in any meonerso as us become subject in the Worters'Compensation
Laws of Glifomit Dose
Applicant
NOTICE TO APPLICANT:If.Her making the Certificate of Exemption.you alsmZ
become mbjm an the Worke.Compenution provisions,of IM Labor Code.You mum
.J O forthwith comply with men provision or His permit shell w deemed in
voked.
z IVI CONS BucnON LENDING AGENCY
t-r.y. I herehy efllrm this there ion.construction kndieg egenry for He performancoof
fx > He work for whim this permit is issued(Sec.3M.Or.Q
QLanders Name '
z fenders Address
U O I coolly Nat I have mad this application aM sum Hat tie above Information u
gy correct.I agree an comply with all city and cowry mtii""M•and awe laws mlating un
O building construction.and hemby auNori a represemativeS of Nis city to enter upon the
aleve-mentioned property for inspection purposes.
H y (we)agree to save,indemnity and keep harmless the City of Caperton against
Cn Iiibilides,judgmenu.,cans and.1.which may in any way acme agknst said City
U Z in consequence of the granting Of this porton. s�
^ APPLICANT UNDERSTANDS AND WILL COMPLY WI77H ALL NON-POINT Issued by: Date
Ssgmeure of ApplianUConuacum f--Pau Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de applicant or future building occopest mom or handle havanamu.me¢rial
as deRoed by the Cupertino Municipal Code.Chapter 9.1;and the,Health and Safety
Code.Semon 255320)7 Yea 9W.— All roofs shall be inspected prior to any roofing material being installed.
Will He Applicant or future wilding Occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haraNmms wrcwssmiwm as defined by the Bay Ams Air Quality Menagemc.L all new materials for inspection.
District? - p
❑Yes �Nn�
Iban mad the oduvNusmauvialsmquicmeeuunder CNprcd6 ifHe Wilding
nias buthormAdYy Cade,Satiaasxat it
mSYTmdxa734.1 as roofed theifde bulking
tau but curmntiY hese a sensnl the it o my maponsibilitY an nmify the occupant of the s
mqu menu which mutt he toot prior to issuance of.Ccolaca,orOccupaucy. Signature of Applicant Date
p
Owucr or authorised agora / > All roof coverings to be Class'nq v or better
psis'�'
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN 35611059 . 00
DATE ISSUED. . . . . . . : 07/24/2008
RECEIPT # . . . . . . . . . : BS000005571
REFERENCE ID # . . . : 08070175
SITE ADDRESS . . . . . : 924 PROVIDENCE CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . .. MCLEOD RICHARD
ADDRESS . . . . . . . . . . : 924 PROVIDENCE CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : LAWRENCE E WOOD
CONTRACTOR . . . . . . . : WOOD, LAWRENCE E LIC # 20810
COMPANY . . . . . . . . . . : WOODS ROOFING
ADDRESS . . . . . . . . . . : 17700 SERENE DR
CITY/STATE/ZIP . . . : MORGAN HILL, CA 95037
TELEPHONE . . . . . . . . : (831) 637-5576
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--------- ------------- ---------- ---------- ---------- ---------- ----------
IBSEISMICR VALUATION 13 , 970 . 00 1 . 40 0 . 00 1 .40 0 . 00
1REROOFRES SQ FEET 29 . 00 377 . 00 0 . 00 377 . 00 0 . 00
------ ---------- ---------- ----------
TOTAL PERMIT 378. 40 0 . 00 378 . 40 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 378 . 40 AMEX
---------------
TOTAL RECEIPT 378 .40
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
407 0 75
- ✓ CITY OF CUPERTINO
fl REROOF
CITY 0
•CUPERTINO PERMIT APPLICATION
APN # Date:
Building Addre :
R Yew
Owner'sName: Phone #:
Contractor: Phone #:
yo g- & qo- o9-d 12,
Fax #:yo$- 776
Cupertino Business License #: Contractor License #:
323-131
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
X. 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:
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:
•I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 6/16/08
CITY OF CUPERTINO
REROOF
CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
IREROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
IREROOFRES Re-roof Residential B 1SFDWLR00F
1 1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
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 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: R> c 9,9x7 p /fit e F b
Job Site Address: ✓ 7
Roofing Company Name: moo h S �mo/ i�✓G �^'
Lo _ yam'
Applicant's Signature: Date:7`_2 5` d
• Greg Casteel
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 oints
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. A4 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.
A.Si INPUT Resources Energy IAD/Heafth
1.Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;60%=4 points 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=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
rrB--.Design Resource-Ef cfent Landscapes and Gardens 4 Resource t�
L—_._ _ _ _-- 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 Flyashin 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=yesF4 p
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-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=yep p
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
1.Use0S6 --�-- ---- — --- ---
a.Subfloors 1 Resource pt y=yes 0
• 1 b Sheathing— --- — — --- — —
L _ 1 Resource pt y=yes p
1 1 1
INPUT Resources Energy
aKh
D. error Finish , -
;'fuse Sustainable Decking Materials -
a.Recycled content 3 Resource pts y=yes 0 •
b.FSC Certified Wood 3 Resource pts y=yes 0
12.Use Treated Wood That Does Not Contain Chromium/Arsenic 1 IAQ/Health pt y=yes D
13.Install House Wrap under Siding 1 IAQ/Health pt y=yes D
14.Use Fiber-Cement Siding Materials 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
P.Retrofit ell Faucets and Showerh-aads with Flow Reducers-
a.
educersa.Faucets It point each,up to 2 points) f Up to 2 Resource pts. 0
b.Showerheads(1 point each,up to 2,points) Up to 2 Resource pts. D
4.Replace Toilest with Ultra-Low Flush Toilets
i
16(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 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 IAQ/Health pts. 0
6,Install On-Demand Hol Water Circulation Pump 4 Resource pts y=yes 0
1 1 1
r,uectncai
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 I f
G.Appliances
I1.Install Energy Star Dishwasher 1 Energy pty=yes 0
2.Install Washing Machine with Water and Energy
Conservation Features 1 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
1 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 0
2.Install Floor Insulation over Crawl Space 4 Energy pts y=yes D
JYInsfall Recycled-Content;Fiberglass InSUlatlgn wild
INo Added Formaldehyde 31AQJHealth pts y=yes 0
4.Use Advanced Infiltration Reduction Practices 2 Energy pts Y--yes D
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
0.Cemngs 4 Resource pts y=yes D
1 1
INPUT Resources Energy ]AWHeafth
I.Windows
IT Install Energy-Efficient Windows
• a.Double-Paned 1 Energy of y=yes 0
b.Low-Emissivity(Low-E) 2 Energy pts Y--yes 0
c.Low.ConductivityFrames
_____. _ 2 Energy pts y=yes p
2.Install Low Heat Transmission Gla-ng 1 Energy pt y=yes 0
1 ! 1
J.Heating Ventilation and Air Conditioning
11.Use Duct Mastic on All Duct Joints J 2 Energy pts y=yes 0
2.Install Ductwork within Gondfionecl Space 3 Energy pis y=yes 0
3.Vent Range Hood to the Outside 1 IAQMealth of 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 0
6.Install Attic Ventilation Systems 1 Energy pt y=yes 0
7,Install Whole House Fan 4 Energy pts y=yes p
B.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-Mouhied Electric and Gas Heater 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 yryes 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 stovesrinserts 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 4 IAQ/Health pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes p
17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes 0 .
I
K.Renewable Energy and Roofing 1 1
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 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
6.S6lect Safe and Durable Roofing Materials _ 1 Resource of y=yes p
7 Install Radiant Barrier -- - 3 Energy pts y=yes p
1 I 1
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 pts3.Plant Deciduous Trees on the West and South Sides 3 Energy pts p
1 ! 1
•
INPUT Fiesnwres Energy IAD/Heafth
Moor A r Quallry an Finishes _
1.Use LowAo-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/NoVOC Adhesives 3IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y--yes 0
S.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.Seal all Exposed Particleboard or MDF 4 IAQ/Health pts y=yes D
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 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y--yes 0
t 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials - 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles J 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 Available: 1 1401 1301 57
Total Points Project R 1 01 01 0 •
G:data/pmgslgmenbuildingguidelinesrremodaleislgreenpoi,tsfinal2.12.04pmtected.xls
•
Community Development
! I Cu0 Torre Avenue
pertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
4CUPERTINO
Building De artment
JOB ADDRESS: /� PERMIT # n v/ �S—
�r10 / /�c�/�� C-j1
OWNER'S NAME: r D , �-rv25 PHONE # o 3
GENERAL CONTRACTOR: Woop s ,r FLAX # Z
o 77G– 9 7 a d
I am not using any subcontractors: oq�2�
Signature ' Date
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
Owner/Contractor Signature Date