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07100053 CIT�' OF CUPERTINO ' � h,� •BUILDINCt DIVISION PERMIT �� ` ,:, >:; ..:...;:____ .. , PERMIT NQ. BUIL q�r�c,�,�q�ESS�.�INBOW DR R& S EF:ECTION OF SANTA 07100053 • 0 W NER'S NAME: A� PERMIT LSSUE DATE WOOLPERT BRUCE W AND ROSE A 1789 JLINCTION AVE 10/05/2007 SANITARY NO. CONTROL NO. ��D ( 408 ) 43E�-0484 BUILDING PERMITINFO ARCHITECC/ENGINEER: BLDG ELECf PLUMB MECH � � � � i p Q LICENSED CONTRACTOR'S DECLARATION JOU DeSCiIpUOi1 � V� 1 hcrcby afGrm that 1 am ticcnsed unAcr pravisions of Chap�cr 9(rommcncing ;z� withSccaon7000)ofDivisian3oftheBusinessandProfcssionsCodc INSTL EI �ECTRIC GATE @ PRIVATE DRIVE �� y in full Corce and e[fec� � � ? Licensc Clazs ��• �► p Datc Conuacar : �" � ARCHITEC�'S DECLARATION i a e I undcrswnJ my plans shail Ac used as puAlic records )yU ' u. � Licensed Professional ' � < OWNER-BUILDER DECLARATION '}� 1 hcrcby alTirm U�at I am ezcmpi Crum ihc Con�raccor's Liccnsc Law Car tlic � p O Collowing rcason. (Scction 7U31.5, Business and Profcssions Calc: Any eity or rnunty �,°, P�i which rcquires a pcanit to conswct, alur, improve, dcmolish, or repair any swcmre prior to i�s issuancc, alsu mquires ihc applicant Cor such permit io filc a signcJ sutcmcn� �; Ft. Floor Area Valuation ��< I h a t h e i s l i c e n s e d p u r s u a n � l o t h e provisions o( Ihe Convactur's Licensc law (Chap�cr 9 ` � 8 O O 0 r F� (commencing wiU� Secdon 7000) of Division 3 of the Business and Profeuinns Code) or i�� ihat he is ezempl ihecefrom and Ihe basis Cor the allcgcd eumption. Any violaUon o( Secdon 7031.5 �y arry applicant for a permic subjects the applicant to a civil penalty of -�N Nllmber Oeeupaney Type n o t m o c e t h a n f i v c h u n d re d d ol lars (5500). 3 6 6 3 7 � ��>. r� � ❑ I, as owner oC tlie propccty. a my employces with wages az �heir solc compensadon, will do ihc work, and ihe sttuctuce is not intendcd or of(ered far salc (Sec. 7044. Business Required Inspections and Professions Code: The Conuacwr's License Law docs not apQly �o an ownu of property who builds a improves tlurcon, and wha daes wch work himself ar ttuough his awn employccs. provided that such improvemenL4 are not intended or ofCemd (or sale. [f. however, the building or improvement is sold within oae year af compiction, �he owner- builder will have the burden of proving �hat he did not build or improvc for purpose of salc.). ❑ 1, as awner o( ihe property, am aeclusivcly conuacting wi�h littnsed conuactors a wnstruct the projett (Sec. 7044. Business and Profcssians Code:) The Contnctors U- ccnx Law docs not apply w an owna of propeny who builds ar improves theieon, and , who conuacts Cor such projects with a rnnuzctar(s) licensed pursuant to �he Convactor's License Law. ❑[ am esem t und r Sea . B dc P C(o 'ihis n Ownu Dalfi� � `� _... _. WORKER' PENSATION DECLARAITON 1 hereby affirm under nalty of pe�jury onc of the following declarations: ❑ I h:ve and will maintain a CertiCpm of Conunt to self-insure tar Workcr's Compen- sation, as provided for by Sectian 3700 0[ ehe [abor Code, for the performaircc oC thc work for which ihis permit is issucd. ❑ I havc and will maintain Workcr's Campensauon Insurancc, u syuired 6y Scction . 3700 0[ ihe Labor Code, Cor the per[armance of the worlc (or which this permit is issued. My Worker's Compensauon Insurance carrier and Policy number are: Carrier. Policy No.: CERTIF[CATE OF EXEMPI70N fROM WORKERS' COMPFNSAT[ON INSURANCE (Iliis scctioa necd not be completcd i[ the permit is for anc hundred dollars (5100) or IcssJ 1 cenify that in thc performancc of thc work for which ihis permit is issucd, l:hall not employ any person ' mncr w to beeome subject �o �he W rkers' C pe uon Laws of Califo ' . D Applicant NOTICE TO APPLIC : lf, af�r ing U�is CcrtiCicatc f Exc ption, you should become subjcct ta �he Workcr's Co nsation provisions of iAc La6or Codc, you must �,Z forthwiih comply with such provisions or this pecmit shall6c deemed revoked. Z O CONSTRUCTION LENDING AGENCY (.�-� r�-� I hereby aRrm U�at there is a conswction (ending agency [or the performance of . �Y., .� �hc wurk for which ihis permit is issued (Scc. 3097, Civ. C.) , W A Lendcr's Namc � z Lcnder's Address () � I certify ihat I havc rcad this applieation and statc that tAc aAovc informadon is w � cortccl. 1 agrce �o comply with all ci�y and county onlinances and s�ate laws relating to � U building wnswction, and hercby authori�e representatives of �his city to enter n�n the abovc-mcn�ioncd property for ins{xction puriwses. �'' a (Wc) agree to save, indcmni(y and kccp harmlcss the Ciiy o( Cupcnino against „E'',,� � liabilitiu, judgmcn�s, costs and expcnses which may in aoy way accruc against said City U z in consequence oC thc granting of Ihis permi� �ate .� �—+ APPLICANT NDERSTANDS AND WILL COMP Y WITH LL NON-POINT Issued by / Z "� SOUR N • � �� .S � Re-roofs Signawrc af Applicant/Co wr �a� T e of R oof - � HAZARDOUS MATERIALS DISCLOSURE YP � II ihe applicant or futurc building occupant sarc or handlc ha•rardous matcrial u dcFined by 1he Cupenino Municipal Codc. Chaptcr 9.12. and thc Hcal�h and SaCcty c«k Scction 25532(a)? All roofs �hall be inspected prior to any roofing material being installed. ❑ Ycs ❑ Ma , Will thc applicant or futurc building occupant usc cyuipmcn� or Jcvices which If a roof i� installed without first obtaining an inspection, I agree to remove cmit harardous air contaminan�s as elcfincd by thc Bay Area Air Quality Management all new rr aterials for inspection. District? Q Ycs ❑ Nu I havc rcad the hvardcws mauerials rcyuircmcncs undcr Chap�er6.95 af ihc CaliCor- nia Hcalih & Safcry Codc, Sections 255Q5, 25533 and 25534.1 undcrstand �haz iC �hc buildioB docs not curtcn�ly huvc a �cnan4 it is my responsibiliry w n 'I'y �hc axupant of �hc rcyuircmcnts ' r ccoCaC�cr r �r. Signature ofApplicant Date l � 0 All roaf coverings to be Class "B" or better Owncr or au�horizcd agcnl �� CITY OF CUPERTINO ITEM 1 OF 1 PERMI'I RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk.: Lot: APN ......... 36E37006.00 DATE ISSUED.......: 10/05/2007 RECEIPT #.........: BSC00002913 REFERENCE ID # ...: 07]00053 SITE ADDRESS .....: 21;17 RAINBOW DR SUBDIVISION ....... CITY .............. CU�'ERTINO IMPACT AREA ....... OVJNER ............: WOC>LPERT BRUCE W AND ROSE A TR ADDRESS ........... 21"17 RAINBOW DR CITY/STATE/ZIP ...: CU�'ERTINO CA, 95014-4828 RECEIVED FROM ....: BRiJCE W WOOLPERT CONTRACTOR .......: DAP1A R THOMPSON LIC # 8421 COMPANY ..........: R f� S ERECTION OF SANTA CLARA ADDRESS ..........: 17£39 JUNCTION AVE CITY/STATE/ZIP ...: SATd JOSE, CA 95112 TELEPHONE ........: (4()8)436 FEE ID UNIT QUANTITY ��MOUNT PD—TO—DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- --------- BREMPOWER POWER UNITS 1.00 47.96 0.00 47.96 0.00 ----------- ---------- ---------- ---------- TOTAL PERMIT : 47.96 0.00 47.96 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 47.96 #4347 --------------- TOTAL RECEIPT : 47.96 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- --------------------------- 101 FOUNDATION 102 PIERS 103 UFER 104 REBAR 105 ANCHOR BOLTS . 106 SEWER '& WATER 202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL 204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION 301 ROUGH PLUMBING 302 TUB & OR SHOWER 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 305 FRAME 306 HOLDOWNS 307 INSULATION 308 SHEETROCK _ � 7� c� o � 5,� � � � CITY OF C UPERTINO . ,� c�� F pERMIT APPL]=CATION FORM cuP�� t�vo .�PN # Date: .� � � 3 �7� U � . � o � o�-r-� � Buildin Addres :� , Vlailing Address (if different from building address): :�/ �/ � ��1 i�/1�J !�i^� �- -�j� � SZj `� Owner's Name: �� Phone #: �� ?" ��(� � �' -�1'� -- �? U ? Contractor: License #' ,�' � 5 . � ��JG v _�' �hL �rar� �'�l�C=��- c��} / �� 7 Conta : Phone: %,3G-�� Cupertino Business License#: �7 Fax: ��3 � ' �� °�� Y� Building Permit Info: Bldg ❑ Elect �� F'lumb ❑ Mech ❑ Job Description: �S.{�� '�� Q,rre �� 'r.�e.. Residential t� Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Projec � Occupancy Group: ,$'� l� �C)p c� �� Type of Construction: Please check this box if t� project is a second-sto addition: , Project Size: Standard ❑ Large ❑ Major ❑ Quanti Fee ID Fee Descri tion Fee Grou BAPPLOTHER c�ther Appliances MECHANICAL BBOILERl Bo:.ler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to SOOK Btu MECHANICAL BBOILER3 Boil �r > SOOK to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILERS Boiler > 1.75M Btu MECHANICAL BCONSTAX ��onstruction Tax BUILDING BCONSTAX In�i/Off/Comm/Quasi BUILDING BCONSTAXBQ Co n. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Co:�stax — Resi/Mobile BUILDING BELEC 1000 El �c 600V <= l 000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD I?nergy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 - f " � CITY OF C'UPERTINO ��7Y�F pERMIT APPLI:CATION FORM CUPE(�TINO Quanti Fee ID l�ee Descri tion Fee Grou BMISCELL 1V[iscellaneous Fee BUILDING BMITIGATC Comn. Housing Mit. Fee BUILDING BNUCOMME Ne w Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP N��w Comm Plumb PLITMBING BOVERTIME In:,pection Overtime BUILDING BPBACKFLOW Atr�ospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLLJMBING BPERMFEE Bld Permit Fees BUILDING BPFIXTURE Pbl Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK I'lan Check Fee BUILDING BPLANCKADD Plari Check Add Multi BUILDING BPLANCKREP Plar. Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewa e Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawl S rinklerBackflo PLLTMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Tra PLUMBING BPVENT Al�: of Drain & Vent PLLTMBING BPWATER InstalUAlter Water Pi e PLUMBING BPWHEATER W:iter Heater/Vent PLUMBING BPWSVCS M:�in Water Service PLUMBING BREINSPECT R einspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfin MECHANICAL BREMAIRHAN A/C iJnits <= 10,000 cfm MECHAI�TICAL BREMAPPLI �.ppliance Install MECHANICAL BREMBUSWAY R�,model Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Rel��cation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT H .ater Installation MECHANICAL BREMINHOOD Ins tallation of Hood MECHANICAL BREMMISC P✓Iisc Apparatus ELECTRICAL BRET�NRAFP Rem [�Ton-Res Appliance ELECTRICAL BREMPOLE Pol�;/Platform Fixture ELECTRICAL BREMPOWER Powe�• Device/A aratus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Re�►air/Alter Heating MECHANICAL BREMRESAPP Rem��del Res Appliance ELECTRICAL 2 cf3 � , r � = - CITY OF C'UPERTINO CUPEI�TINO PERMIT APPL]_CATION FORM Quanti Fee ID ]+ee Descri tion Fee Grou BREMSIGNAD Rmc.l Signs Add Branch ELECTRICAL BREMSIGNS Rem �del Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vei►t Fan Sin le Duct MECHANICAL BREMVENSYS Ventilation S stems MECHANICAL BSCBLVD � cb S ecific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE :�eismic Fee Res BUILDING BSPECIAL S pecial Inspection BUILDING BSWIM �3wimming Pool BUILDING BTEMP T��m orar Power ELECTRICAL BTEMPPERM Tem orar Bld Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC F�usiness License BUILDING ELECTRIC Electrical s foot ELECTRICAL EPERMITF'EE Elec Permit Issuance ELECTRICAL MPERMFEE M echanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plu�nbin Permit Issue PLUMBING PPLBG Ph�mbing Fee s foot PLUMBING PLLONGRNGC Plannin LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin Lon Ran e Residential PLANNING 3 of 3 l�ug C'�Z �' 08:38p Woolpert Residence 408 253 4329 p.2 Aus 02 D7 04 :z5p Je Martinez 40Q 371448 p.3 '� . • ` `+'` �, / :/ � ( ! , � . 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' ? � ia�N(ui to m:�l�c -;;;y c�;�;;�,�s a, aiteration. �I� �►'U�/►'� �1/�YItiYS ��PSS��/Cl-/J , ► � :� � ,, ,,,,.;,.., , �i; s4rna vti,�l,;;u; �:_�i��n pe�missian frori°. ��,,,, '' :f�e buii�in� LcNi., �;;;� uf C?�p�rt;no. •�� v G� I � �� rhe stampin� cf �h;s �:un ana s� ec�fication� �- '�"o Su.P�c�-� -�'�� i��VV j � � �tiALL NUT� be t;e;d to pa�mit c r to �e ar � ; o t� �pprovai of the ai�IQtioi� of tlny uravtsion- ��°`�' G �� , � �� f any City Ord�ncrice or )t�te ;.avr. ''�•,� � � � �� ;�� . y` _��^� . S - ✓ t ' �� ,�` ;� � :� � � �: j .,�` � 6r � � J ' r, � /� � � ( i . � . � �. �� 1 t -.--- � . 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D -� . � � -. � � D -� � �, O � � � � � . . - m� t � � A � � � t�o � m � °� � � {f} � I � - �- - � �- , , c� � � � z•d g�bTLEia-SOt► zaui��eW ,}�aC d},2={,O LD �O ��d Rug 02 07 04:25p Jeff Martinez 408-4371449 p•3 �, �'. . . .• t ; . , , ' % � � �; �= i c � ! - G ' 1 i � � � f ,.,� � �. . �'i� ":'i� t,� �,n ►'sv� 1 1 , ��. .� _�--+-- (.� �! + � _'. � ti• � � � � '� ' ( �- -- - ----�,d .� � � l:� �-�� j � � ; �� v�e. ,/-�n � / Q ./ f � � ' � r ? � ? •%L?�T %� b�-,..� ��'' r �. � € � , ' ' `'z-v / C.�4- �� ..�Z' �S� ( � /� J (� f''t�7�*"( � -T' ��`�r"'•� C3Cif!� M[7�l 4 �j � ' � J ' � s ll C'��'C {y�a �-r �c � � �� ; 1 �, � ! _ � �t � � � . , . € - f = r �; t . I j f � � ' f e �t � _ �J � r j 1F • ' + r r � 4 � } � t � I , � , i { i 1 � � �� V� � ' - d'i � '``.• . C � -�� y , 1;, �s�� ""^-�-.."'___,--- --._„ OJ� �\ �SC� \ R �- ��p s I �� . � \ \!"� 't .``• `.. � ,_�.._ L � , ` �� -� J L - - .''Q ` � ��- � ` � � � � j' � � � ; . � � � _, �` t � k � E :. _ - �, �- --. ' i e � � '" - - ' � rc. _- . \ Community Development �W'�- 10300 Torre Avenue ;� Cupertino CA 95014 � "'�' � Telephone (408) 777-3228 Fax(408)777-3333 CITY OF �;UPERTINO B1.i11C�111 De artment JOB ADDRESS: PERMIT #, .�l717��%�� j�, t C.��f��t�� :. %�`7 jdOU� 3 OWNER'S NAME: � �f'./�i? �. �� /,DGa° PHONE #�5� — �'l 3 - � �� r' GENERAL CONTRACTOR l�D�r �%�C� % c FAX #¢>.� -- �''� 3 ' `1�� I am not using any subcontractors: _ � `' '�' Si�;nature Date Please check a licable subcontractors and com lete the followin information: SUBCONTRACTOR BUSIl\�ESS 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 � - s- �-� Own Contractor Signature Date �0�f000�� CITY OF (;UPERTINO '��'':�' l�E�Z�OF CU�E�T�NO PERMIT APPLICATION FORM APN # � „_. Date: ��a�c�� l�a� Building Address: 1 I C� Owner's Name: Phone #: � Contracto . License #: � � , 7 s�� Contact: Cupertino Business License #: ,�% � � a r� ° ` ` � _ Type of R�of Covering: E�sting: Proposed: ❑ Built-Up Roof ❑ Built-Up roof 1� Asphalt Shingles 5� 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. I Have Read, Understand and Will Com ly With Cu �ertino's Tear Off Policy: Job Description: 12e � �D�j� � � �- d r� ��e o� �s Residential Commercial ❑ Fire Zone: Yes ❑ No Confirmed with Planning D�t. if there are any restrictions: LJ Cost of Project: Type of Constru�;tion: Occupancy group: Qty. if Applicable Fee ID Fee Description Fee Group BPERN�'EE . Bldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING , _ _ Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 Fax: (408) 777-3333 Building I�epartment Subject: Re-roofing policy for the C'ity of Cupertino 1. Prior to permit issuance, you must agre � to comply with 1997 UBC Standards and manufacturers specifications on re- roofing. 2. New roof coverings shall not be appliec without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the bui �ding 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 appro val. 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 matE rial 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 c,f $176.18. The re-inspection fee must be paid before another inspection can l�e scheduled. IMPORTANT 1. Flat roofs must have a min;mum 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 die job site at the time on inspection. I understand and will comply with the above ;tated policy on re-roofing. Homeowner's Name: �/Vl, G f a� r�`� �(� IL �� Job Site Address: � r6 S�(�_�� L� Roofing Company Name: 1�1�� (�s � G�� i p n. Applicant's Signature: �� Date: ?' Greg Casteel Building Official Revisec 11/2/04 CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 37525017.00 DATE ISSUED.......: 10/09/2007 RECEIPT #.......... BS000002939 REFERENCE ID # ...: 07100072 SITE ADDRESS .....: 18590 R.ALYA CT SUBDIVISION ....... CITY .............. CUFERTINO IMPACT AREA ....... OWNER ............: MARGARET JONES ADDRESS ..........: 18590 R.ALYA CT CITY/STATE/ZIP ...: CUFERTINO, CA 95014 RECEIVED FROM ....: OMAR ORTIZ CONTRACTOR .......: COSMOS, RICHARD LIC # 18844 COMPANY ..........: COSMOS ROOFING ADDRESS ..........: 1901 OLD MIDDLEFIELD WAY #22 CITY/STATE/ZIP ...: MOUNTAIN VIEW, CA 94043 TELEPHONE ........: (650)969-7663 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 8,625.00 158.76 0.00 158.76 0.00 BSEISMICRE VALUATION 8,625.00 0.90 0.00 0.90 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 159.66 0.00 159.66 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CASH 159.66 --------------- TOTAL RECEIPT : 159.66 Commwaty Devalopomeat 10300 Tars Avanue - Cupe�tiao CA 950l4 re�� 4os� m-s�s Fa�c (�W8) 777-3333 ' CUPEI�TtNO Buildin De artment �OB ADDRESS: PERIMIIT � t8590 R�4L`i� Cou..�,�' �'�(1 C��C��'"J OWNER'S NAME: ►rY1 F4 ` PHONE � ST> 69 - 7 GS 6.� GIIV'ERAL CONTRACTOR FAX #� St� 9 6 � 9�5 I am not using any subcontra `" ' -- _ l� °�' ' � tur ate Pleaise check a licable subcantracsors an�co�� lete the followin infosvnation: SUBCON"�RACTOYi BUSII�TESS NAME BUSINESS LICENSE # � Cabinets 6t M�lwork ^ Cmnent Finishing IIec�rical F�ccavation Flovrir�g: C.erpeting Linoleum / Wood Glass / Glazing Heating Insulation La:�dscaping Lat�wng Urnaanss�ta151ieet Metal � Pamti�B / tiVallpaPer Paving PZastering Plumbin � Roofin Septic Tank Sheet Metal Sheet Rock T' . � _ !� � �OG 7 Con�actor Si Date