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08050211 (2) 18.0 ITY OF CUPERTINO r ma�[1 BUILDING DIVISION PERT R Oc ,llkC�QR PERMIT NO NORTHFIELD SQ BLUE MOUNTAIN AIR 08050211 HER'S NAME: PERMIT ISSUE DATE PAUL NARAYAN 707 ALDRIDGE RD STE B 05/27/2008 ONE: SANITARY NO. CONTROL NO. (707) 451=8111 . ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLOC ELER PLUMB MECH t� � 1� 0 A" LICENSED CONTRACTOR'S DECLARATION Job Description in� ffirm I Wn,hy athe 1 am licensed under pviaiou of Chaper 9(ammcncing p with Section 7")of Division 3afthe BoodoessArld Prafessium Code,arW my license is Rte/ & RPLC FURNACE 80K BTU 93% EFF ADD AC 2 . 5 TON mea^F, LDlac¢emed _M'N 15 SEERclass Lie. Co. ARCSITECTS0 AFF w< 1 understand my Plum tall be used As Public retards Jy �c� Licensed Pnsfesdonal OWNER-BUILDER DECLARATION i 1 hereby Affirm thfamet 1 am mmpt fmthe Contractors License Law for the is p o following mason.(Section 11131.5,euiass and Profs'nm Code:Any city or county which mquhes a permit m cmnbucL alcor,impmw,demaltvh,or repair any structure Z i an.m its issuance,also teen.the applicant forsuch permit m 6k a signed Amo..., < that he is Hemmedpursuant10thePmvisiomOftheConlranm'3UCC=Law(Chapta9 Sq.Ft. Moor Area Valuation x�$ (commencing with Sation7")OfDivision 3of dac Business Am Proksmom Coax)w $5500 that he ta exempt tlmrtfroa and the bust fw the alleged exemption Any violation of Su'don 10313 by airy dont far a subjects the subjects applicanuo a rival penalty of 31637043 �Number Occupancy Type Ann,more than fl.hundred red dolle ❑I.asawnaofed hesedctre my 1intended ntendes wlthwagcauthcv Wil.cmmp.matiess wiBmtf..I.hm .sed the he Cmoneme,mends. A.demra.l apply las.aw.of Required Inspections and Pmfudobu Cade The Conuacmrs License Law don set apply m rt owns is q - Ownproperty who mployab,powi impet such uh imparondwho are htan himseRor Waugh his awnem.the building pr PunimProwmenuart not amendedmplcded formicthe ow.lr- builda, the building orImpmwmatAt gdol within oaeKuofcompletion,Neowwr- Ask.). will haw the burden of proving Nu he did not build or improv for purpose of . ale.). 0 1,as owner of the Property,am eacluslwly contracting with licensed aruacmn to cawrect the project(See.l(34d.Business and Pmfessiom Cade:)The Comeaemea Li- cane raw does Out apply m an owner of pra,crt,who Wilds or impmws thereon.and. who central for such projecu with a conAnomr(s)licensed punuana m me Contnctofs License law. ❑Iamewmpaunder Stn ,BRPCfwdmmason - mr Dau WORKERS COMPENSATION DECI.aRATION 1 hereby aRnm under pcaalty of perjury ore of the following declaration e 01 haw and will maintain a Cardficamof Cement to self-imum fa Wo sCamper. sad...as provided for by Section 3100 of the Labor Code.far the pesfomuna of the work for which this Permit is issued. 0 1 have and will maintain Workers Compensation Imursoa,as required by Section 3100 of the Labor Code,for the performance of the work for which this permit is Issued. ' My Wor Ya ompe action hamrsnce anew tab Policy number are: Cam - ✓s. Policy N o CE TE OF IXEMTnON FROM WORT S' COMPENSATION INSURANCE (Ihisaadms recd notbecompleted ifine permit ta faane hundred do0u t(Saw) or leu) I ardfy dust in the poolmor a'of du wart Iw which this Permit u cannon.I shall not ..,play any person in any mannerso as in became wbjat m the Worker!Compemadon Laws of Coliform..Data Applicant NOTICE TO APPLICANT.If.after making the CeniEcam of Exemption,you should become subject to the Workers Compensation provisions of dm labor Cade,you must .,Qth forthwith comply with such provisiam or this permit shall M deemed mwked. .Zi Z) CONSTRUCTION LENDING AGENCY [-+� I bemby allmon thst Wm is a constowedom lending agency for the arformame of ai > du woM1 fun which this permit u caved(Sec.3191,Civ.C.) a O^ lender:Nanus =z Landers Address C.)O I craft that I haw mad this application and sum that the abow iNwmatim is CwleeL I agree to comply with all city And caWly call.and mute laws relating to Wilding construction,and hereby authonm mpreaentaim of the city to enter upon the show-mentioned property for inspection normal F y (We)agree m per.indemnify and kap hay in m W City ra Cupertino against Zt,l incomeameneofthecostsandoxpmaOr f thismwhmchmay in onY way acme againsasaid City V z inconsequence of the Lrantin6 of this permit. � �-+ APPL UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU ULATIOy$. - L[fYid/Jorma ° "ace" S�7Q� Re-roofs Stgnuurt of Appl,canuctmuscro, Data HAZARDOUS MATERIA a mor URE Type of Roof Will IMa COPAnwfuturebuildingla,Otantstoreor lmndk Health md Seely As definedSm io Nc Cupertino Municipal Code.Chapur 9,11,and dm Ha1N aM Safety mm.Schon I5532(,)1 All roofs shall be inspected prior to any roofing material being installed. 0 Yus Will the. dant a mture buildin nae oat m a If a roof is installed without first obtainingan inspection,I agree to remove PP d P e.Air a tat devise which P g emit hauardou air conuminanm as defined by the Bay Arta Air Quality Management all new materials for inspection. D'umctl ❑Yes o I hove real the hxaaNmm mammals requirenunuunder Chapmr6.95 of drt Califor- his Hcahhh Safctycode,Sections x5505,25533 and25530.1 understand thatiflhe building V 7� ^ _ does t ncnuy haw a mtunL that it u my responsihility m notify W acupmit of NcE�L O reyu' wbmch m de ma 'arm intima of a luau of(kapanry. _ Signature of Applicant Dale Owner wmthonpe age., ' prem All roof coverings to be Class'J?."or better CITY OF CUPERTINO • 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31637043 . 00 DATE ISSUED. . . . . . . : 05/27/2008 RECEIPT # . . . . . . . . . : BS000004904 REFERENCE ID # . . . : 08050211 SITE ADDRESS . . . . . : 10892 NORTHFIELD SQ SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER PAUL NARAYAN ADDRESS . . . . . . . . . . : 10892 NORTHFIELD SQ CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0514 RECEIVED FROM . . . . : EDWARD A GREGORY CONTRACTOR . . . . . . . : GREGORY S. OWEN LIC # 29600 COMPANY . . . . . . . . . . : BLUE MOUNTAIN AIR ADDRESS 707 ALDRIDGE RD STE B CITY/STATE/ZIP . . . : VACAVILLE, CA 95688 • TELEPHONE . . . . . . . . : (707) 451-8111 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BREMAIRHA NO.UNITS 1 . 00 61. 19 0 . 00 61 . 19 0 . 00 1BSEISMICR VALUATION 5, 500. 00 0 . 60 0 . 00 0 . 60 0 . 00 1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0. 00 1MPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 IMRRAA UNITS 1 . 00 61 . 19 0 . 00 61 . 19 0 . 00 1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 1TRAVDOC FLAT RATE 1 . 00 40,. 79 0 . 00 40 . 79 0 . 00 ------- ------- ---------- ---------- TOTAL PERMIT 286 . 14 0 . 00 286 . 14 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ------------- --------------- .----'---------------- CREDIT CARD 286 . 14 MC --------------- TOTAL RECEIPT 286 . 14 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • sr%� CITYOF CUPERTINO FURNACE/AC • TY OF CUPERTINO PERMIT APPLICATION FORM '" 21 (, 570V3 , # 2 WJ7UV3 . Date: s o� 7 a cts &I Building Address'' /l: 9z /or Owners Name: A f Phone#: IJ et c/ / �+ r 4 y< a a r 1/0(? CD Contractor: Phone#: 707 —s'S/- d'l// 1,.e A Fax #: 707— 114- '/,212 6 Contractor License#: Cupertino Business License#: 3 Zy6w Contact: Phone#: 707 --7e,be cci Fax #: Building Permit Info: Elect Plumb Mech Residential Commercial Job Dption:�fe ,9 J �� ,� C 2�s oto /s s eel- For el- For Residential Installations: Attic ❑ I51 floor rll"-, 2"d floor ❑ Adhere to minimum setback requirement For Commercial Installations: Replacement same weight, ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): Strapped LJ On Platform M 5onded New Location Replacement Valuation: SSUJ Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, include in plan set& the sheet index. / CITY OF CUPERTINO FURNACE/AC C17Y OF CUPERTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1MCRAA Commercial-Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1 MCREPALT Commercial for the repair of alt/add to M ea heating appliance,refrigeration unit,cooling unit,VAV boxes, absorption unit or ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by • this code. 1MCSUSHTR Commercial Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1 PGASCOM Commerical for ea gas piping System P 1-4 outlets 1 BPGAS For each gas piping system of 5 or P more per outlet. 1MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed & not incl in an appliance ermit. IBSEISMICO Commercial Seismic B 1MRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, J cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1MRSUSHTR Residential Install/Relocate eaTT • suspended heater,recessed.wall hfloor mounted unit heater. IMRAPPVNT Residential for the install/relocatreplacement of ea appliance vent install &not incl in an a 1 permit. CITY OF CUPERTINO :Cel FURNACE/AC I�T • CUPEINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1PGASRES Residential for ea gas piping system of P 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 1BSEISMICR Residential Seismic B 1MECPLNCK Mechanical Plan Check M 1 MFR=<100 Furnace Syst<=100k BTU install or M relocate ea forced-air/gravity type fumace/bumer, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h 1MFRN>100 Furnace Syst> 100k BTU install or M relocate ea forced-air/gravity type fornace/bumer, incl ducts/vents attached to such appliance over 100,000 Btu/h 1 EPERMITFEE Electric Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit P 1TRAVD0C Travel Documentation B 1BUSLIC Business License B • Q� CITY OF CUPERTINO FURNACE/AC CITY OF CUPERTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group AIR FURN/AC CONDITIONING 1 BCAIRHAN Commercial A/C Units<= l Ok CFM B 1MCRAA Commercial Mech Repair/alt/add M 1BSEISMICO Seismic Commercial B IPGASCOM Commerical for ea gas piping System P 1-4 outlets 1PGASRES Residential for ea gas piping system P of 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. Comm/Resid 1 BREMAIRHAN Residential A/C units <= l Ok CFM B 1MRRAA Residential Mech Repair/alt/add M • 1BSEISMICR Seismic Residential B J IEPERMITFEE Electric Permit E 1 J ( 1MPERMITFEE Mechanical Permit M J 1PPERMITFEE Plumbing Permit P / ITRAVDOC Travel Documentation B V 1BUSLIC Business License B • /f/)r � e (�5339u9t e__ 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 IAO/Health A.Site 1.Recycle Job Site Construction&Demolition Waste } 65%=1 point;75%= 2 points;80%=4 points up to 4 Resource pts 0 t2.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 6.Implement Construction Site Stormwaler Practices 2 Resource pts y=yes 0 7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0 8.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=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 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[I 0 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=Yes b.Wall p 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 12.Use OSB a.Subfloors 1 Resource pt y=yes 0 • b.Sheathing f L 1 Resource------ -- pt Y=Yes 0 1 1 INPUT Resources Energy IAQIHealth xtenor ims r1.Use De Sustainable cking Materials a.Recycled content 3 Resource pts y=yes 0 b.FSC Certified Wood I 3 Resource pts y=yes 0 2.Use Treated Wood That Does Not Contain Chromium/Arsenic f 1 IAQ/Health pt y=yes 0 3.Install House Wrap under Siding 1 IAQ/Health pt y=yes 0 4.Use Fiber-Cement Siding Materials 1 Resource pt y=yes 0 1 1 1 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 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. 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 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 8.Install On-Demand Hot Water Circulation Pump 4 Resource pts Y--yes 0 1 1 1 r.❑iecmcai 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 I 1 Energy pt y=yes 0 3.lnslall 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-Content,Fiberglass Insulation with No Added Formaldehyde _ j 3 IAQ/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 - .Windows INPUT Resources Energy IAQ/Heafth • �1.Install Energy-Efficient Windows - a.Double-Paned 1 Energy pt y=yes 0 b.Low-Emissivity(Low-E) 2 Energy pts y=yes 0 c.Low.Conductivity Frames _ 2 Energy pts y=yes 0 2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 0 1 1 1 J.Heating Ventilation and Air Conditioning 1.Use Duct Mastic on All Dud Joints 2 Energy pts y=yes 0 2.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0 3.Vent Range Hood to the Outside 1 IAQ/Heallh pt y=yes 0 4.Clean all Ducts Before Occupancy 2 IAQ/Heallh 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 B.Install Sealed Combustion Units a.Furnaces 3 IAQ/Health pts y=yes 0 b.Water Heaters 31AQ/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 stoves/inserts 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/Heallh pts y=yes 0 16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/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-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0 4.Install Photovoltaic(PV)System (1.2 kw=6 points,2A kw=12 points,3.6 kw=18 points) Up to 18 Energy pts 0 Select We and DurabeRoofing Materials 1 Resource pt y=yes 0 7.Install Radiant Banier 3 Energy pts y=yes g 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 INPUT Resources Energy IAQ/Heafth n oor Air Qua ity and Finishes �.Use Low/No-VOC Paint J 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/No VOC Adhesives _ 3 IAOMealth 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 61AQ/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 F7.Seal all Exposed Particleboard or MDF J 41AQ/Health pts y=yes 0 B.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 pts y=le, ! 0 N.Flooring1.Select FSC Certified Wood Flooring 8 Resource pts y=2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=3.Use Recycled Content Ceramic Tiles 4 Resource pts y=4.Install Natural Linoleum in Place of Vinyl 5 IAO/Health pts y= 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=6.Install Recycled Content Carpel with Low VOCs 4 Resource pts y= 1 Total Points Available: 1 1401 1301 57 Total Points Project R 1 01 01 0 G:datalprogslgreenbuildingguidellneshemodelers/greenpointsfinal2.12.04protected.xls Community Development 10300 Torre Avenue Cupertino CA 95014 '�' � Telephone(408)777-3228 CITY OF Fax(408)777-3333 WUPEQj1N0 Building Department JOB ADDRESS: / PERMIT# OWNER'S NAME: a < PHONE # c p Z-0 GENERAL CONTRACTOR:'&,Q <-1Q,'n FAX # I am not using any subcontractors: 5-- 27- LO Signature Date Please check applicable subcontractors and complete theo owin information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting . Linoleum/ Wood Glass / Glazing Heating �j� Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock • Tile S- -2 7- Owner/Contractor -Owner/Contractor Sign Date