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08050039 CITY OF CUPERTINO aafi��>•xaa BUILDING DIVISION PERMIT CONTBAC7ORIATIU t1VIATI01� BUILpI ADDRESS: PERMIT NO. 72525 CRANBERRY DR C & C ROOFING 08050039 OWNER'S NAME: FORM ISSUE DATE DENIS CHURCH 89 S 21 ST 05/02/2008 NE: SANITARY NO. CONTROL NO, ARCHrrECTAENGINEER: BUILDING PERMIT INFO REMOVE EXISTING SHAKES ADD BLDG ELECT PLUMB MECH O O D O lO p LICENSED CONTRACTOR'S DECLARATION Job Description 4 U _ 1 lereamrm that ut 1 Am id pmru Ikermunder visioof Cltepmo r 9(commencing ^^"^ ^' - with force it cfcf DiHtlon7of dm Business and Pro^fessions Code.and myIiceAsets ^ N in full tone and ettryt 6�� zs Z j License Clam C Lk. �h Dale 0:-n 7 -n g: Co.,matter r1 f 2 d n'if el ARCHITECT DECLARATION 1 undersand my plans shall W nted As Public mcmd; 6 s Cin Lcensed Professional 1 OWNER-BUILI)ER DECLARATION ZO E 1 Wrthy.lire that I AMI.S.exempt ren the CAmmut Orf License Law for the p O which on mason.(Sonat 7M 1. Business IA Pmfecvom Code:My city at s wun1, $�s which nquima•Permit re Bores me pplic W(or such h Pedemr it t ri e pair DIY to ement prior to its issuance,al .(toires me for Contranor',Usleasigredsumment zpNUMulicensed withSru.71)(heofDivmuafdsConusinessslynerced. CMPux9 Sq.Ft. Floor Area ' Valuation (cortat W is esemptb econfr m and the Dhaw f r the al egeineuand on.Anyons Code)ladon of $ Nat W u enmpt Noefmm and Ne bssu for tun alleged exemption.Any violation of Section 70113 by any,Applicator for a Permit subjects the applicant to a civil fumy of APN Number - Occupancy Type ot nmom Nan Bw hundred dollars(1500). P Y YP ❑L u awrri of Ne pvpmsy,m my wplayots with cages u Neh sok mmpewtion, and Profession r thewok.andig TWConisrrotumndcde awdo fm We(Sce.10an owner and Pn wh ons Code:mim C soon oar License Law dints trot apply lf r t nwrcr is Required Inspections psopeny whobuildsrrirepmces A•Mnn,and whodoessuch workbimsel(orNrough his home ,th Wilding ipr smehi ,is sold within itfomoRUW(orale r. builder the Wil ding bor uieproweentusold withinet yearofWIMMtifrNeowtmr- builder will have tie bmdra of proving dot W did net build m leprose far purpose of sale.} O 1,as Mr.of it.property,am exdnsively contracting with licensed comme as a cquuuel the project(Sec.I(Hd,Business;mil Professions;Code:)Tlm Contracers U. conn Law does not apply to an owner of Psopety who Wi1N or improves thenar.andl. who contracts for such projects with aconuauor(s)licensed pursuant in the Contractors License Law. ❑I am exempt under Ss ,B k PC for this moon Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of Ne following decimations: I hs.e and will maintain•CeniOon of content to self-insure for Workces Compco salon,As provided for by Seeemi 1700 of on,Labor Code.for the yerfareant,of the - wok for which 0u,perrni,is issued. Q 1 have and will mainu;n Workers Compensation losurano,As required by Section 3700 of the Labor Code,for Ne perfenermanofthe work for which Nis Permit is issued. ' My Workers Compensation Wuana carrier and Policy number am: Cartier. 'RTS ICU ti n /'P'Policy No.: � 7 Z 9' CERTIFICATE OF EXEMMON FROM WORKERS' COMPENSATION INSURANCE (Thu inion need makcomplemd HNe permh ufmme hundred dolls.(SIOB) or less.) I comfy Nat in Ne perio mane of the work for which this Permit is issued.)"I ret employ any Permit!.my amene,so as m Weume subject to the Wmkeri Compuuadan Laws of Califom;&Dam Applicant NOTICE TO APPLICANT:If.after maldng this Cenifmam of Exemption,you should become subject In the Workers Compensation provisions of the tabor Code,you moat .J.Z formWthcomply with such povirions no this permit dull W domed.ked. O CONSTRUCTION LENDING AGENCY I Iscomy AM.than Vert u•crmerweimm work for which this lendin a !Yi the g FncY rte Ne pvfomarc of Lenders Name permit u iuued(Ace.X1Yl,Civ.C) 7 Z LeMera Aed-.• U Q 1 certify Net I have mail Nis application and some not Ne eW ve information Is U,~ cmne6l agree be comPly wit Al city WI county mdllWKea and sum laws relating to .� Witiing corstrtmtion.aM hereby numee,rtprennutivrs of this city in cneruprm the F yaWve-menuaned property for inspection purposes (We)agree to revs,indemnify Arun kop haerric.the City of Cupertino against rte liabilities,judgments,costs and expenas which may In any wiy..against said 01, („)Z in consequeocc or the grinning of this permit. �••� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGUi.AT10��NBB A �I'GFcn 5'r'o k Re-roofs HAZARDOUS Signstum ofAppliaDam HAZARDOUS MAng occu DISCLOSURE Type of Roof Will NeaCuPorttm(Muni WilMunicipal Cge.Chaplin 9.Jof hamAnd haallonsmamrial C de,Sec io the Cupenim Municipal Code.Chapter 9.12 and tun HpIN and Safety Cade,Sectionzsssz(,I ❑y. � All roofs shall be inspected prior to any roofing material being installed. Will Ne applicant or future Wilding occupant use equipment in devices which If a roof is installed without first obtaining an inspection,I agree to remove tit haraAnua air contaminants as&flood by dm Bay Area Air Quality Management all new materials for inspection. District? []Ya ecrm- Ih..madthe wasdos mamriala tequireeenuunder Clumm45.9safthe Califm. does nodmh Safc1,Code,emarmts .tit in, Nnifon Woking dna tilt cu Sohl ham a enol 25 It is 55 re33 am!25534. 55 l4.I to nodi the rcft1W or Ne reyuirtmc n;ehmtatlomelp,;arm;aeanrenracenire.mnraaparmy. Signature of Applicant Date i;—=z-o,(- Owner or authorind agent Dam g All roof coverings to be Class'1W'or better CITY OF CUPERTINO • 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: B1k: Lot: APN . . . . . . . . : 36202006 . 00 DATE ISSUED. . . . . . . : 05/02/2008 RECEIPT #. . . . . . . . . : BS000004653 REFERENCE ID # . . . : 08050039 SITE ADDRESS . . . . . : 988 CRANBERRY DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . .. DENIS CHURCH ADDRESS . . . . . . . . . . : 988 CRANBERRY DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : OSVALDO CAMARA CONTRACTOR . . . . . . . : OSVALDO CAMARA LIC # 22982 COMPANY . . . . . . . . . . : C & C ROOFING ADDRESS . . . . . . . . . . : 89 S 21 ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95116 TELEPHONE . . . . . . . . : (408) 298-1868 • FEE ID UNIT QUANTITY AMOUNT' PD-TO-DT THIS REC NEW BAL ---------- ------------ ------ ---------- -- ----- --------- 1BSEISMICR VALUATION 10, 300. 00 1 .10 0. 00 1 .10 0. 00 1REROOFRES SQ FEET 26 . 00 338 . 00 0. 00 338 . 00 0. 00 ---- ---------- ---------- ---------- TOTAL PERMIT 339 . 10 0. 00 339 .10 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 339 . 10 MASTER CARD --------------- TOTAL RECEIPT 339 .10 VOICE ID DESCRIPTION . VOICE ID DESCRIPTION -------- ---------------------------- -------- -------- -------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF • CITY OF CUPERTINO CSG_, REROOF COf OCUPEkTINO PERMIT APPLICATION OR057ML39 APN # Date: �XG2 . 02 00 Co S- 2- -6d Building Address: � g 4 V5LRRr 2 Owner's Name: Phone #: G CN i S C h v R C k Contractor: Phone #:yo Q, Z 9- IE 6 9 C' C'_ Fax #: 5/,i� -ZyY-33,61) Cupertino Business License #: Contractor License #: y99Z�z Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles A( Asphalt Shingles ^f' 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: / /Z�v�ov6 maxis%in/� S1Lr �KtS {9Dp �� d>F' 6 C tcss /� 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 REROOF CITY OF 40CUPERTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Commercial B 2 1REROOFRES Re-roof Residential B ISFDWLROOF 1BSEISMICRE Seismic Residential B 1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF AM 1BSEISMICRE 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: f7 C t, U QC k, Job Site Address: 9,cs (2 a2 f9✓In R oa l 2 l p R Roofing Company Name: (2 �' 20a vCi r�U Applicant's Signature: Date: f_-2 -Ce • 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 q 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 `jam cry R� o,? J T C� • '. IL�J LI CD C1 0 • Plan Review Process Work Book Page-12-Revised 3/25/08 J 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. NPUT Resources Energy IAUIHea� C A:Site 1.Recycle Job Site Construction&Demolition Waste 165%=i point;75%"= 2 points;60%=4 points up to 4 Resource pts D 2.Salvage Reusable Building Mate als 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 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 6.Design Resource-Efficient Landscapes and Gardens, _} 4 Resource pts y=yes 0 9.Reuse Materials/Use Recycled Content Materials for Landscape Areas 2 Resource pts y_y as . 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 p 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 LL 2.Use Recycled Content Aggregate 2 Resource pts y=yes 3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes 1 C.Structural Frame H._Substrtute Solid Sawn Lumber with Engineered Lumber 3 Resource pts y=yes p 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 kJoists 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 p B.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0 9.Use Structural Insulated Panels(SIPS) a.Floors 3 Energy pts y=yes 0 b.Wall c.Roof 3 Energy pts y=yes 0 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 12.Use OSB "-- a.Subfloors 1 Resource pt y=Yps 0 • b.Sheathing i 1 Resource pt y=yes 0 1 1 1 INPUT Resources Energy 1ADIHealth D. error Fmsh I 11.Use Sustainable backing Materials a.Recycled content 3 Resource pts Y--yes 0 • b.FSC Certified Wood 3 Resource pts y=yes 0 1 12.Use Treated Wood That Does Not Contain Chromium/Arsenic t 1 IAO/Health pt y=yes 0 13.Install House Wrap under Siding 1 IAO/Health pt y=yes D 14.Use Fiber-Cement Siding Materials 1 Resource pt y=yes 0 E.Plumbing 1.Install Water Heater Jacket _ I Energy Pt Y=Yes D 2.Insulate Hot and Cold Water Pipes _ 2 Energy pts y=yes 0 3.Retrofit all Faucets and Showerheads with Flow Reducers a.Faucets(1 point each,up to 2 points) 3 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 IAO/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 IAO/Health pts. 0 6.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes D r,uecrncar 1 f1.Install Compact Fluorescent Light Bulbs(CFCs) (6 bulbs-2 points,l0 bulbs-3 points 12 bulbs=4 points) Up to 4 Energy pts. 0 L ---- — • 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 i.Install Energy Star Dishwaa a TiT 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 f3.Install Recyycletl-Contenl,Fiberglasslnsulation with No Added Formaldehyde I 31AO/Health pis y=yes C 4.Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes 0 5.Use Cellulose Insulation a.Walls 4 Resource pts y=yes D b.Ceilings 4 Resource pts y=yes C • 6.Alternative Insulation Products(Cotton,spray-foam) a.Walls 4 Resource pts y=yes 0 D.Callings - 4 Resource pts y=yes 0 INPUT ResDurces Energy lAoNealth indows 11.Install Energy-Efficient Windows - a.Double-Paned 1 Energy pt y--yes 0 b.Low-Emissivity(Low-E) 5 2 Energy pts Y--yes 0 c.Low.Conductivity Frames _ 2 Energy pts Y=Yes 2.Install Low HeatTransmission Glazing 1 Energy pt y=yes 0 1 1 t J.Heating Ventilation and Air Conditioning 1.Use Duct Masfic onAll Duct Joints __,_ 2 Energy pts y=yas 0 2.Install 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 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 9D%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes 0 13.Retrofit Wood Burning Fireplaces • a.Install EPA certified wood stoveslnserts 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 41A0/Heallh pts y=yes 0 16.Install Heal Recovery Ventilation Unit(HRV) 51AQ/Health pts y=yes 0 17.Install Separate Garage Exhaust Fan 3 IAQ/Health pis y=yes 0 1 1 1 K.Renewable Energy and Roofing 1.Pre-Plumb for Solar(Nater 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 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 Sate and_Durable Roofing Materials - 1 i Resource pt y=yes 0 7.Install Radiant Barrier_ —. 3 Energy pts Y=yes p . 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 0 3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0 1 1 1 INPLiT Resources Energy MDIHeafth -Windoor Air Qua ity an Fints es '1.Use Low/No-VOC Paint - 1 IAO/Health pts y=yes D 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 . 13.Use Low/No VOC Adhesives __ _ _ 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 6lAQ/1dealth pts y=yes 0 B.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 '7 Seal all Exposed Particleboard or MDF 4 IAQ/Healthpts y--yes D B.Use FSC Certified Matedals for Intedor Finish 4 Resource pts y--yes D 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 1 t 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes0 P.Use Rapidly Renewable Flooring Materials — _ 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tilesy 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 130 57 Total Points Project Received: --6-01 0 0 • G:datarprogslgreenbuildingguideiinas4emodelersrgmenpointsfina@ 12.04pmlected.zls • b - Community Development 10300 Torre Avenue t Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 SCUPEkTINO Building De artment JOB ADDRESS: PERMIT # L ©moo - v' O R'S NAME: ,6/v rt C t, 0 (1 (- k PHONE GENERAL CONTRACTOR: o V-11 yj a FAX # elof — 9k O I am not using any subcontractors: 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 b,'- Roofing Septic Tank Sheet Metal Sheet Rock Tile • Owner/Contractor Signature Date