08090004 (2) CITY OF CUPERTINO pETCO%nit-+ •AmgO,3''i;u tI BUILDING.mWatoN
O. -ATIO.N
BUILDING ADDRESS: PERMITNO.
! 1527 SILVER SPRING CT CASTILLO' S ROOFING 08090004
OWNER'S NAME: PERAUT ISSUE DATE
VU LLU 1703 CATHAY DR 09./03/2008
lipNE: (408) 251-3565 SANITARY NO. CONTROL NO.
ARCHITHLTMNGINEER: BUILDING PERMIT INFO
HLOG ELECT PLUMB MECH
test o O LICENSED CONTRACTOR'S DECLARATION O O
MM m 1 hm N
emby affirm I am licensed ummr provisions of Chapter 9(commencing Job Description
-" with Sadon10110)bfDivwkw3ofNCBusiness aidPrommustCade,and mylicense u RE-RF RMV EXT RF & PUT ON 30LB FLT& INSTL NEW
uWllfamnuW alines. 9 L'c If O S CMP .
Co. GAF SHNGLS CLS A 18SQ
� u I understand my plane W used u publ' ells
a
g Liceruee Professional
5 OWNER-BUILDER DECLARATION
conus0N
'C a C 1 Maby.(Sero that 1 1. ,stent Item the Cssion; oa License:Anyc Law for the
C e° following reason.(Section 1031.5,Business and do Profession;Cadre:Any city m county
which mquims•permit rc crmWwa-aim(,improve.for such
mcrmiIt or repair any aramum
prior msiiccn na,also arequires theapplicantfor ouchonate'micconle ae ned Law(chapter
ss< UatWisliccnwitpursuantNmeofDivisio 3NeCotairomi dPiefUw(CMpter9 Sq.Ft. Floor Area Valuation
'ham he
concept
Sectian10ndth Division of theeged exemption.
Any
Cook)or $7800
y $ that her u exempt my applicant
and use aper it the subjects
the eaempton.Any l Penalty
of
Scalar 1031.3 by ary red doll for a permit subjects Ne applicant la a civil penalty a( Number Occu arc-Type
Trot mart than Rte hundred dollar(gate). 3 6 6 51027 .1W P Y
0 I,as.cams of t e property.or my employes with cages u Nen role compensadon,
will do the.,it.and the amRs.is not intended or.flared forum(Sen.TOad,Bananas
and Pnefessimu Cade Tun Convacmes License Lew does act apply as an owmmr of Required Inspections
pmpenywW Wildsaimprower domem,and whodoessuch work himalfmthrough his
awoemployena,pmNded that such improvements..at intended manarW for sale U.
bmam,na,the Wilding or improvement usold wioro man Year a(mmpletion.the aver-
Wilder will haw the hmmm of pmNng that W did not build or improve far Purpose of
sale.).
0 1,as ower of the property,w conclusively contracting with Hamed mmremau to
counteract the Project(See.ION,Business and Pmfasnms Code:)The Conuacmts V.
cert#law data.,apply man ownm of Property who Wilds or improwa ttereon,and
who contracts for such Projects with aeanuaewKs)licensed pursuant to the Comsat(.&
Lmeme Law.
O l em exempt under See ,B&P C for this moon
Owner Dan,
WORKER'S COMPENSATION DECLARATION
I herby afnsm order penalty of perjury and of iW following declarmosse:
I
have and will numuu rt a Cetalicate of Content as self-iuum for WorkeYs Coupon. -
mass,as provided fm by Sation 3700 of Ilse Labor Cade.(ar the pedorm as of the
wort for which was permit is issued
0 1 haw and will maintain Worke s Compensation Insurance,as manhood by Section
3M.f use Labor Code,for Ne per(armutet ofine work fa which Nr permit r issued. '
My Workce Cyymmggnsation Waseaz and licynumbcr ram: y
cirtio 37 �7-T,1 F.y 1 �J 00499/
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rlTisecti .need nota=completed lithe permit is farcue hundred call.(SIOD)
or rope.)
1 certify that in to Performance of the work for which this permit is issued,I Nell not
employ any person in my manner as Wcomesubject to IN Worker'Campor aloe
Laws of CaRlomia.Dam
Applicant
NOTICE TO APPLICAND If.after making this Certificate of Emulation.you should
became Subject m use Workers Compensation provisions of the Lala Cads.you mus
.J,z forthwith comply with such PeavLdam a tir Permitshad W deemed mwkee.
zOECONsrBuc ION LENDING AGENCY
aim hereby affirm Nem racopeunllmm krdingagercof
y for the performarc
ft wvrk
Permit r Wand(Sec 3031,Civ.C)
1 Q Undoes Nurse .
7 z Lenders Address;
U O I certify that 1 haw mad thr application and sate this use show information u .
u.F cortaL 1 agree to comply with all city and county onlinancesand sum Paws mladng m
U Wilding connaction,and hereby suthonm repreaenutivee of this city te enter upon the
r W above-mentioned property fm Inspection purposes
(~ gL (We)agreeto cost,indemnify ad keep hay inmate City of Cupenit said
City
Z in
equence enWc of the starting
atting of this experwetrosy in any way,anse gainilsafd City
v z APPLI ANT UNDERSTANDS
ANPermit. Issued b
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT y; Dale
rErULAjoULA NS _ Re-roofs�taH�AZARDOUS MATERIALS DISCLOSURE DateType of Roofe appliont m fusum Wilding aavpmt acre or IUMk nuardoua mari,l
the Cupertino Municipal Cade.Chapter 9.13.anal Ne Heath and Safety vs3z(,)T ❑! All roofs shall be inspected prior to any roofing material being installed.
FYea licant or future buildin aaa nt ora If a roof is installed without first obtainin an ins ection,I a e to remove
pP l W ea Air Qa at Manna Mich g P gee air conuminmu u mfimred by IW Bay Art,Air Quality Management all new materials for ins ection.
P
oya l3.,h
I have mW the huardnmmateri,rmquimmens unser Chapmr6.95 of the Califor.
riaHand,&Sal=ty Com.Secdom25505,25533 ard25534.I understand Nuifte Wilding
does not cu Illy has a tenml that it r my responsibility aa
ibility notify me pant of the
regaimmc wow .2!:� ipewucar ��] Signature of Applicant - Date
o =ear marireag=vel Dow All roof coverings to be Class'.)¢"or better
CITY OF CUPERTINO
• 2 :ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36651027 . 00
DATE ISSUED. . . . . . . : 09/03/2008
RECEIPT # . . . . . . . . . : BS000005965
REFERENCE ID # . . . : 08090004
SITE ADDRESS . . . . . : 11527 SILVER SPRING CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : YU LIU
ADDRESS . . . . . . . . . . : 11527 SILVER SPRING CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5132
RECEIVED FROM . . . . : CASTILLO' S ROOFING
CONTRACTOR . . . . . . . : JOSE CASTILLO LIC # 25850
COMPANY . . . . . . . . . . : CASTILLO' S ROOFING
ADDRESS . . . . . . . . . . : 1703 CATHAY DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95122
TELEPHONE . . . . . . . . : (408) 251-3565
• L'EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- --- --- -- ---- ---- ------ --------- ----------
12SEISMICR VALUATION 7, 800 . 00 0 . 80 0 . 00 0 . 80 0 . 00
1.f2EROOFRES SQ FEET - 18 . 00 234 . 00 0 . 00 234 . 00 0 . 00
--- ---------- --------- ----
TOTAL PERMIT 234 . 80 0 . 00 234 . 80 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
-- --------------- --------------------
CHECK 234 . 80 #15309'
--------------
TOTAL RECEIPT 234 80
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----- ----------------------------- --- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
0fo 70 0
CITY OF CUPERTINO
r' REROOF
COF
OUPERTINO PERMIT APPLICATION
APN #2j,
2j (o5_ `v a 7 U Date:
Building Address:
rer1cl C4
Owner's Name: Phone #:
Yu Liu
Contractor: r Phone #:
CZS Fax #:
Cupertino Business License #: Contracto License :
3d S
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles V/Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
�N ber of existing coverings ❑ Provide I.C.B.O. Report
V ' #
o be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: S n , U D n �
1 4A 1 t i'1Gt, � C ��(A Sal iYL C't�ll
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 61`610y06
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
*;4' are '
Revised 6/16/08
CITY OF CUPERTINO
REROOF
Of
CUPER,TINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1RER00FRES Re-roof Residential B 1SFDWLROOF
Le
/ 1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
IBUSLIC 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 1/a "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: I1 l � l L2
Job Site Address: l I S! I V P r p r i Act C� .
Roofing Company Name: Om-
Applicant's
-Applicant's Sign r Date:
• 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 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 oint
P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS1 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 with
ease of implementation and relative low cost. These measures can be used as a starting point for"greening"your project.
A.Site P
fflealth
I7 Recycle Job Site Construction&Demolition Waste^
65%P=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,Adaptive Reuse,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 of y=yes D -
6. Implement Construction Site Stormwater Practices 2 Resource pts y=yes D
7.Protect Water Quality with Landscape Design 2 Resource pts y=yes D
I8.Design Resource-Efficient Landscapes and Gardens___ _ _ 4 Resource pts Y--yes - D
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 D
11.Provide for On-Site Water Catchment/Retention 2 Resource pts y=yes D
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 F;Fp
1 1 1
C.Structural Frame
(1 Substitute Solid Sawn Lurnber with Engineered Lumber _ 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 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 D
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 D
9.Use Structural Insulated Panels(SIPS)
a.Floors 3 Energy pts y=yes
0
b.Wall
3 Energy pts y=yes p
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 p
12.Use OSB ----- -- - - - - ' '
a.Subfloors
b Sheathing 1 Resource pt y=yes p
•
1 Resource pt y=yes p
1 1 1
—U.—Ex—ter—or Finish
4.Use Sustainable Decking Materials
I a.Recycled content 3,Resource pts y=yes 0 •
b.FSC Certified Wood 3 Resource pts Y_–Yes D
i2.Use Treated Wood That Does Not Contain Chromium/Arsenic f 1 IAQ/Health pt y=yes D
I3.Install House Wrap under Siding 1 IAQ/Health pt y=yes 0
4.Use Fiber-Cement Siding Materials 1 Resource pt y=yes 0
E.Plumbing
1.Install Water Heatei Jacket – y J 1 Energy pt y=yes 0
2.Insulate Hot and Cold Water Pipzs 2 Energy pts y=yes 0
3.Retrbft 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 pts. D
4.Replace Toilest with.Ultra-Low Flush Toilets f
(1 point each,up to 3'points) _ _ _ _ ', Up to 3 Resource pts. 0
i 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/Heanh pts. 0
B.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
1 1 1
r,niecuicar
L1.Install Compact Fluorescent Light Bulbs(CFCs)
(6 bulbs=2 points,10 bulbs=3 points,12 bulbs=4 points) _ Up to 4 Energy pts. 0
L(6
— ---- – •
2.Install IC-AT Recessed Fxtures with CFCs(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 1
G.Appliances
I7.instil Energy Star Dishwasher i 1 Energy pt y=yes 0
2.Install Washing Machine with Water and Energy 1
Conservation Features, 1 Energy pt y=yes 0
f3.Install Energy Star Refrigerator 1 Energy pt y=yes 0
14.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–yYze 0
b.Ceilings 2 Energy pts y=yes 0
2.Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0
13.Install Recycled-Content,Fiberglass Insulation witfi
INo Added Formaldehyde 31AQ/Health pts y=yes D
4.Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes 0
5.Use Cellulose Insulation -
a.Walls 4 Resource pts =yes 0
b.Ceilings 4 Resource pts y=yes 0 •
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes D
o.callings 4 Resource pts y=yes1 0
1 -0- 1
INPUT ResDurces Energy IAQIHealth
endows
1.Install Energy-Efficient Windows
• a.Double-Paned 1 Energy pt y=yes D
h.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 y=yes D
1 1 1
J.Heating Ventilation and Air Conditioning
t.'Ose Duct Mastic on All Duct Joints _ 2 Energy pts y=yes 0
Z.Install Ductwork within Conditioned Space 3 Energy pts y--yes 0
3.Vent Range Hood to the Outside 1 IAQ/Health pt 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 0
B.Install Sealed Combustion Units
a.Furnaces 3 IAQ/Health pts y=yes 0
b.Water Heaters 3 IAQ/Health pts y=yes D
9.Replace Wall-Mounted Electric and Gas Heaters with -
Through-the-Wall Heat Pumps 3 Energy pts y=yes 0
10.Install 13 SEER/1 t EER or higher AC with a TXV 3 Energy pts y=yes D
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 stoves/inseRs 1 1A0/Health pt y=yes 0
b. Install/Replace Dampers 1 Energy pt y=yes 0
c.Install Airtight Doors 1 Energy of y=yas 0
14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes D
15.Install High Efficiency Filter 41AOJHealth 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 IAO/Health pts y=yes 0
1 1 1
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar Vater Heating 4 Energy pts y=yes 0
2.Install Solar Water Heating System 10 Energy pts y=yes D
3.Pre-Kire 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=18 points) Up to 18 Energy pts 0
6.Select Safe and burable.Roofing We-i dais 1 Resource pt y=yes 0
7.Install Radiant Barrier 3 Energy pts y=yes D
1 1 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 pts y=yes 0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pis y=yes D
Q. 1 1
•
INPUT ReSDUTCES Energy 1ADII-lealth
ndoor Au Quality and Finishes
;1.Use LowMo VOC Pa of 1 IAO/Health pts y=yes 0
2.Use LowV66,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 •
�3.Use LowRJo VOC Aahe§ives _ 3 IAQ/Health pts y=yes D
4.Use Salvaged Matedals for Interior Finishes 3 Resource pts y--yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 6lAQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
.7.Seal all Exposed Pe t clebbard 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 IAD/Health pts y=yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 6 Resource pts y--yes 0
L.Use Rapidly Renewable Flooring Materials . _ - - 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 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
F 1 1
Total Points A 1 1401 130 57
Total Points Project Received: 1 01 0 0 •
C:daWprogsrgreenbuildngguidelinesrremodelersrgreenpointsfnalZIL04prol"ed.zls
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OUPEkTINO
Building De artment
JOB ADDRESS: PERMIT # O 9 0o vy
OWNER'S NAME: Yu L i U PHONE #
GENERAL CONTRACTOR (t,?-S-7-1&10S'/ /� �
otf3 FAX# �
I am not using any subcontract/ C /
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 SgnatureDate