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13UILDIN(pD1VIS5GN PERMIT
;RCONTR'A@TQR„I,1}�f}RMAT QN
BmL1T1�G69T"SkANCHI WAY UNIT 209
CONSOLIDATED PLUMBING INC
PERMIT NO.
08090058
OWNER'S NAME:
PERMIT ISSUE DATE
CUPERTINO COMMUNITY HSNG
3732 CHARTER PARK DR STE D
09/11/2008
NE:
SANITARY NO. CONTROL NO.
(408)978-3093
ARCHIfECTFENGINEER:
BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
p LICENSED CONTRACTORS DECLARATION
Chapter 9
- Job Description '
1 hereby affirm Net 1 am licensed under provisions of (commencing
u, with Session70M)ofDivision 3ofNeBadnessandPm(cuiovCode. andmyleenu
GAS REPAIR ON EXISTNG GAS LINE; GAS TEST(AIR)
0.n full form and ellen. U
Z License Cl s Lle. Y
q Date Comate
7W ARCHIIE
1 understand my plarus shall he o� blit recorda
U
Licensed Professional
3 OWNER-BUILDERDECLARATIONthe RAT70N
. 1 hereby a(Ertn shat 1 License law for the
umpt from the Contracrkmons
O following moon.erten(Section 103 1.5, Business and Ptofcssinns c
0 1. , o Any city or county
t. or
which require a Permit m ennwuq alter, impaw. consultant. Or rtooir any stmnure
j, prior w its issuance, also counts the applicant for such permit to file a signed statement
that M u licensed moment dtn provisions of the COnuactor's Licnuc Law (ChameT9
Sq. Ft. Floor Area
Valuation
9 (commencing with fined.7000)ofDivision3ofthe Bminessand ProfessimsCount Or
$1000
.• that h u eumpt thetefmm and site buns for The alleged cumpUon. Any violation of
3 5 9 0 7 0 2 0 $1PiF§er
Occupancy Type
Section 7031.5 by any applicant for a permit subjccs the applieanuo a civil penalty of
not mare man RK hmdmd dollaa (3300)
.
O I. u Ownu of tis, popery, o mY emploru with vngu u thebsele=N=dm.
will do the work, and the muctum u not intended Or offered for ale (Sec. 70a, Business
and Prefesdors Cade: The Conaute's Litua law dao rot appy b an Owner of
Required Inspections
progeny who buildsorimprom thacon, and whodoessuch work himvlfor through his
awncmployne, Pmrided that such improvements are not intended oroRaed fmsale if.
however. sew building m impmvcment Issold within one year of completion. me awner-
Wilder. will have the burden of proving dust le did not build a intpom Inc peryme of
sale.).
0 1, u Owner of the property. am exclusively contracting wish licensed contractors m
mnatrsct the project (Sec. 70th. Besides and Professions Code:) The Caotra:mra U.
.
ecus Taw does not apply ce an owner of property who Wilds or impovu Norton, and
whocontactsforsuch pajece, with a coeua=K,) licensed pogo of m the Commuter,
Licata law.
0 lanexemptonder See .B&PCforthi]reaOO
0. Data
WORKER'S COMPENSATON OECLARATiON
1 hereby aB'um under penalty of perjury, one or tis, following de danoam:
I ham and will maintain • Certifram of Concert self -Ilium for Workers Campn-
fro m, u provided for by Section 3700 Of the Labor Code, for the perfor . of Ne
'
wart for which this permit is issued.
0 1 have and will msinain Worlds CompensNon Inssu . u required by Second
3700.1the labor Code. for me perfmmanm of Ne work for which this permit is issued.
'
My Workers Compensation Ince. artier and Policy number are:
Carver..� Poliry No.: C4'.JLtiDe-72 CLt7
CERTI LATE-I�OFE Z.PPI70N FROM WORKERS'
COMPENSATION INSURANCE
(Thu seNra need not he completed If the permit u foronc hundred dollar (SIM)
m las)
I certify Nat in the Performance of to work for which this permit u issued. I shall net
employ any parson in my summer an u m become subject to Ne Workers' Compeadmine
Laws of Califorria. Date
'
Applicant
NOTICE TO APPLICANT. If, after making this Certificate of Exemption, you should
become subject m ds, Wmkcr'a Compen utdon provisions of On labor Code. you most
Oforthwith comply with such povisiens or Nu Permit shall W bummed remkcd.
_
lin CONSTRUCTION LENDING AGENCY
1 hemby.M. that Nero Is. cuwctinn lending agency for the performance of
> the work for which Nu Permit is Wood (Sm. 309'7, Civ. C)
Lcrd sName
z Lenders Address
Q 1 certify that I ham mad this applicuum and sore Net the ashes information is
conecL 1 al m comply with all city and county ardinanaa and mute laws mlaont or
Wilding construction, and hereby authorise mpracnuotes of Nu city m roto noun Ne
ashes:-mcnooned property for es
(We) agree m ave, indemnify and kmp humless the City of Cuikmno against
..poresen which
ens,msB engo sPewhich may in any waramrve againslmsid Cly
incomummen th
APPLICANT Olthegran
TANDf AND WILL
APPLICANT UN ERSTANDS AND WILL C LY WITH ALL NON -POINT
SOURCERE N5.
Issued b y; Date)—'�
ve
Re -roofs o
Type of Roof
fin"of AWlicmWCommumr te
HAZARDOUS MATERDMS'DISCLOSURE
Will the appliam or future building Omupantmore m handle hazaEons memrial
u defined by the Cupertino Municipal Code. Chapter 9.12 and the Health and Safety
Code. Schon 25512(a)?All
0Ta
roofs shall be'inspec[ed prior to any roofing material being installed.
0win Nn applicant or future Wilding Occupant use equipment m devices which
If a roof is installed without first obtaining an inspection, I agree to remove
'Z'1Y�ha'W:f'.t air contaminants a deflood by the Bay Area Air Quality Management
all new materials for inspection.
0ya Er".—
.Ihave
Ills.read she heardmu materials nomf cmenn under Chapter 6.95afNe Calif..
nu"tud kSafety COdc Sc d.25505,25533 ash 25534.1uMersantl Na Ras, WildNg
docs not curre.0y cane a tenant met it as my mapo dity m d.ofy me conupent of Ne
rcquirnmcnts which prior m iss a Ccr i1 ca c Of (kcu
Signature of Applicant Date
,i
�
All roof coverings to be Class'n3' or better
nester Pr rira
nnd egem ,te
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: pdtg
•
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 35907020.UNIT209
DATE ISSUED.......: 09/11/2008
RECEIPT #....:....: BS000006049
REFERENCE ID # ...: 08090058
SITE ADDRESS .....: 10092 BIANCHI WAY UNIT 209
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT
AMOUNT
---------------
143.27
---------------
143.27
REFERENCE NUMBER
--------------------
#4023
VOICE ID
-------- -----------------------------,..
OWNER ............:
CUPERTINO COMMUNITY HSNG
- DESCRIPTION
301 ROUGH
PLUMBING
ADDRESS ..........:
10092 BIANCHI
WAY UNIT 209
CITY/STATE/ZIP ...:
CUPERTINO, CA
95014
RECEIVED FROM ....:
CONSOLIDATED
PLMB
CONTRACTOR .......:
D DOUGLASS
LIC # 22941
COMPANY ..........:
CONSOLIDATED
PLUMBING INC
ADDRESS ..........:
3732 CHARTER
PARK DR STE D
CITY/STATE/ZIP ...:
SAN JOSE, CA
95136
TELEPHONE ........:
(408)978-3093
• FEE ID
----------
UNIT QUANTITY
-------------
AMOUNT
PD -TO -DT THIS REC
NEW BAL
1BSEISMICR
----------
VALUATION 1,000.00
--------------------
0.50
----------
0.00
0.50
----------
0.00
1PGASRES
OUTLETS 1.00
61.19
0.00
61.19
0.00
1PPERMITFE
FLAT RATE 1.00
40.79
0.00
40.79
0.00
ITRAVDOC
FLAT RATE 1.00
40.79
----------
0.00
40.79
0.00
TOTAL PERMIT
----------
143.27
----------
0.00
143.27
----------
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT
AMOUNT
---------------
143.27
---------------
143.27
REFERENCE NUMBER
--------------------
#4023
VOICE ID
-------- -----------------------------,..
DESCRIPTION
VOICE ID
--------
- DESCRIPTION
301 ROUGH
PLUMBING
----------------------------
1 507 FINAL
PLUMBING
0
tlwo.,
cm of
• CUPEkTINO
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
PERMIT APPLICATION FORM
DSU9DU5
APN # 2� nO
J 7
Date:
Fee Description
it S a�
Building Address:
7QuantityFee
DOgZ Uv fl 2e�9
Commercial building
sewer/sanitary sewer
Owner's ame:
Phone #:
-f- QfM�
6� 3)J/ -e 2e
Contractor: F
Phone #: q wo 9-21; 3o''-?
S21��4+�t & u 21
Fax#: cG897S 3o46
Contact:
Phone #: tl vo 97e �vy�
r� cam(
Fax #: % `ll 362 6
Contractor License #: SOS ! 6 Z e3&
IBSEISMICOM
Cupertino Business License #:
P
Job Description: 6--1 S PeI04ji eK t Xis��µ
9
ys It ve,
5
lx�s �e54-,�,qiQ)
Seismic Residential
p
esidential [� Commercial
Q
Valuation:
1RPSS
UdC
Project Size: E press Standard ❑ Large Major
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.
Green Building Points:
ID
Fee Description
Fee
Group
Permit Type
7QuantityFee
1PCSEWER
Commercial building
sewer/sanitary sewer
P
1CPSS
II PREPIPE
Commercial re -pipe per fixture
P
1CPRP
1PGASCOM
Commercial Gas Piping System
1-4 Outlets
p
IBSEISMICOM
Seismic Commercial
P
{
1BSEISMICR
Seismic Residential
p
1PRSEWER
Residential building
sewer/sanitary sewer
P
1RPSS
CITY OF
CUPEkTINO
CITY OF CUPERTINO
REPIPE/SEWERIMAIN SERVICE
FEESCHEDULE
Quantity
Fee ID
Fee Description
Fee
Group
Permit Type
1PRREPIPE
Residential re -pipe per fixture
P
1RPRP
1BPWSVCS
Water Service
P
ICPWS or
IRPWS
1PPRSEWG
Private Sewage Disposal System
P
1PCESS
Cesspool
P
1BPWATER
Install/alter Water Pipe
P
IBPFIXTURE
Plumbing Fixture
P
1PGASRES
Residential Gas Piping System
1-4 Outlets
P
1BPGAS
Gas Piping System 5+ Outlets
P
/
1PPERMITFEE
Plumbing Permit Fee Issuance
P
1PLMBLNCK
Plumbing Plan Check
P
IPLMBINSP
Other Plumbing/gas Insp.
P
/
/
1TRAVDOC
Travel -& Documentation Fee
B
1BUSLIC
Business License
B
Revised 6-16-08
•
0
11
•
Plan Review Process Work Book Page -12-Revised 3/25/08
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 paints
11.
Permeable Paving, Note
L-1
2 oints
C.
Foundation
I.
Use 15 % Flyash Concrete, (note)
S-1
5 paints
D.
Structural
3.
Uses Wood ]Joist, (See Spec.)
S-2
5:
Use Truss with heels, (detail)
S-2
2 points
2 points
6.
B. OSB Sheathing, detail
S-2
2 tints
E.
Ext. Finish
1.
Composite Decking, (Nate/Spec.)
A3
2 points
4.
B. Fiber Cement Siding,(Note/Spec.)A-4
F.
Plumbing
1.
Insulate all H.W. pipes, (Note/Spec.)
P-1
__joints
2 points
5.
Tankless W.H., (Note/Spec.)
A-2
2 points
11. A 2500 Ga]. Tank, (Note/Spec
L-110
o]nts
G.
Electrical
4.
E. Ceiling Fans, (Note/Spec.)
A-3
H.
Appliances
1.
Energy Star Dishwasher, (Note/Spec.)
A3
4 points .
3.
Enerqy Star Refrigerator, (Note/Spec.
A3
1 point
1 oint
P.
Other
1.
List Green Features on Plans
A-1
TOTAL POINTS
1 paint
40 paints
11
•
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.
1. Recycle Job Site Construction & Demolition Waste
65%=1 point; 75%= 2 points; 80%= 4 points
up to 4 Resource pt:
12. Salvage Reusable Building Materials
4 Resource pts
y--ye!
3. Remodel for Mixed Use, Adaptive Reuse, and
2. Use FSC Certified Wood for framing
Historic Preservation
4 Resource pts
yrye;
4. Protect Native Soil
2 Resource pts
y=ye:
5. Minimize Disruption of Existing Plants & Trees
1 Resource pt
yrye:
6. Implement Construction Site Stormwater Practices
2 Resource pts
yrye:
7. Protect Water Quality with Landscape Design
2 Resource pts
yrye!
fe. Design Resource-Eifcient Landscapes and Gardens _ _'
4 Resource pts
yrya<
9. Reuse Matenals/Use Recycled Content Materials
2 Resource pts
y=ya
for Landscape Areas
2 Resource pts
yryec
10. Install High -Efficiency Irrigation Systems
2 Resource pts
y=,a,
11. Provide for On -Site Water Catchment / Retention
2 Resource pts
y=yes
B. Foundation
1. Incorporate Recycled Flyash in Concrete
• 25% Recycled Ryash = 2 points; Add 1 point for every 10%
increase of flyash, up to 5 points up to 5 Resource pts
2. Use Recycled Content Aggregate 2 Resource pts yryes
3. Insulate Foundation/Slab before backfill 3 Energy pts y=yes
C. Structural Frame
r
r
0
r
r
r
r
r
r
r
�1. Substitute Solid Sawn Lumber with Engineered Lumber - J
3 Resource pts
2. Use FSC Certified Wood for framing
y --ye
(For every 10% of FSC lumber used = 2 points, up to 10)
up to 10 Resource pt:
3. Use Wood I -Joists for Floors and Ceilings
2 Resource pts
y=ye
4. Use Web Floor Trusses
2 Resource pts
y --ye
5. Design Energy Heels on Trusses 6" or more
2 Energy pts
yrye
6. Use Finger -Jointed Studs for Vedical Applications
2 Resource pts
y=ye
7. Use Engineered Studs for Vertical Applications
2 Resource pts
y=ye.
6. Use Recycled Content Steel Studs for Interior Framing
2 Resource pts
y=ya
9. Use Structural Insulated Panels (SIPS)
a. Floors
3 Energy pts
y=ye:
b. Wall
3 Energy pts
y=ye:
c. Roof
3 Energy pts
y=ye:
10. Apply Advanced Framing Techniques
4 Resource pts
yrye;
11. Use Reclaimed Lumber for Non Structural Applications
3 Resource pts
12.Use 0513
y=yas
a. Subfloors
1 Resource pt
y=ye=-
b. Sheathing
•
1 Resource pt
y=yes
r
r
0
r
r
r
r
r
r
r
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r
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r
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0.
0,
Q
1. Use Sustainable Decking Materials
1 Energy pt y=yes
2 Insulate Hot and Cold Water Pipes
2 Energy pts y=yes
13. Retrofit all Faucets and Showerheads with FlowAeducers
0
a. Faucets (1 point each, up to 2 points)
a. Recycled content
3. Resource pts
y=yes
D
0
;(1 point each, up to 3 points)
Up to 3 Resource pts.
b. FSC Certified Wood
3 Resource pts
y=yes
0
7. Install Water Filtration Units at Faucets
•
I2. Use Treated Wood That Does Not Contain ChromiumlArsenic
1 IAQ/Heafth pt
y=yes
D
3. Install House Wrap under Siding
1 IAQ/Health pt
y=yes
0
14. Use Fiber -Cement Siding Materials
1 Resource pt
y=yes
0
E. Plumbing
1. Install Water Heater Jacket
1 Energy pt y=yes
2 Insulate Hot and Cold Water Pipes
2 Energy pts y=yes
13. Retrofit all Faucets and Showerheads with FlowAeducers
0
a. Faucets (1 point each, up to 2 points)
Up to 2 Resource pts.
b. Showerheads (1 point each, up to 2 points)
Up to 2 Resource pts.
I4. Replace Toilest with Ultra -Low Flush Toilets
0
;(1 point each, up to 3 points)
Up to 3 Resource pts.
5. Install Chlorine Filter on Showerhead
1 IAQ/Health pt y --yes
6. Convert Gas to Tankless Water Heater
4 Energy pts Y --yes
7. Install Water Filtration Units at Faucets
(2 points each, up to 4 points)
Up to 41AQ/Health pts.
B. Install On -Demand Hot Water Circulation Pump
4 Resource pts y=yes
r. mecmcar
It. Install Compact Fluorescent Light Bulbs (CFLs)
i1. Install Energy Star Dishwasher
1(6 bulbs=2 points, 10 bulbs =3 points, 12 bulbs = 4 points) Up to 4 Energy pts.
0
_
2. Install IC -AT Recessed Rxtures 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 Energy pt
(1 point each, up to 4 points) Up to 4 Energy pts.
0
G. Appliances
i1. Install Energy Star Dishwasher
1 Energy pt
y=yes
2. Install Washing Machine with Water and Energy
0
0
0
0
D
Conservation Features
1 Energy pt
y=yes
!3.lnstall Energy Star Refrigerator
1 Energy pt
y=yes
i4. Install Built -In Recycling Center
3 Resource pts
y=yes
H. Insulation
1. Upgrade Insulation to Exceed Title 24 Requirements
a. Walls 2 Energy pts y=yes
b. Ceilings 2 Energy pts y=yes
2, Iristall Floor Insulation over Crawl Space 4 Energy pts y=yes
3. Install Recycled -Content, Fiberglass Insulation with
jNo Added Formaldehyde 3 IAQ/Health pts y=yes
4. Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes
5. Use Cellulose Insulation
a. Walls 4 Resource pts y=yes
b. Ceilings 4 Resource pts y=yes
6. Alternative Insulation Products (Cotton, spray -loam)
a. Walls 4 Resource pts y=yes
o. uewngs 4 Resource pts y=yes
•
D
D
0
0
0
0
0
0
D
1. Install Energy -Efficient Windows
2 Energy pts
y=yes
a. Double -Paned
• b. Low -Emissivity (Low -E)
1 Energy pt
2 Energy pts
y=yes
y=yes
c. Low. Conductivity Frames
-Low
2 Energy its
y=yes
_
2. Install Heat Transmission Glazing -
. 1 Energy pt
Y --yes
J. Heating Ventilation and Air Conditioning
1 Energy pt
y=yes
11. Use Duct Ivtastic on All Nu_ct Joints _
2 Energy pts
y --yes
_
2. Install Ductwork within Conditioned Space
3 Energy pts
y=yes
3. Vent Range Hood to the Outside
1 IAQ/Health pt
y=yes
4. Clean all Ducts Before Occupancy
2 IAQ/Health pts
y=yes
5. Install Solar Attic Fan
2 Energy pts
y=yes
6. Install Attic Ventilation Systems
1 Energy pt
y=yes
7. Install Whole House Fan
4 Energy pts
y=yes
8. Install Sealed Combustion Units
a. Furnaces
3 IAQ/Health pts
y=yes
b. Water Heaters
31A]/Health pts
y=yes
9. Replace Wall -Mounted Electric and Gas Heaters with
Through -the -Wall Heat Pumps
3 Energy its
y=yes
10. Install 13 SEER/11 EER or higher AC with a TXV
3 Energy pts
y=yes
11. Install AC with Non -HCFC Refrigerants
2 Resource pts
y=yes
12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace
2 Energy pts
y=yes
13. Retrofit Wood Burning Fireplaces
10 Energy pts
y=yes
• a. Install EPA certified wood stovesrinserts
b. Install/Replace Dampers
1 IAQ/Hsalth pt
y=ye=-
4. Install Photovoltaic (PV) System
1 Energy pt
y=yes
c. Install Airtight Doors
1 Energy pt
y=yes
14. Install Zoned, Hydronic Radiant Heating
3 Energy pts
y=yes
15. Install High Efficiency Filter
4 IAQ/Health pts
y=yes
16. Install Heat Recovery Ventilation Unit (HRV)
5 IAQ/Health pts
y=yes
17. Install Separate Garage Exhaust Fan
3 IAQ/Health cis
v=ves
K. Renewable Energy and Roofing
1. Pre -Plumb for Solar Water Heating
4 Energy pts
y=yes
2. Install Solar Water Heating System
10 Energy pts
y=yes
3. Pre -Wire for Future Photovoltaic (PV) Installation
4 Energy pts
y=yes
4. Install Photovoltaic (PV) System
(1.2 kw = 6 points, 2A kw =12 points, 3.6 kw = 18 points)
Up to 18 Energy
pts
6. Select Safe and durable Roofing Materials_
1 Resource pt
y=yes
7 Install Radiant Barrier
3 Energy pts
y=yes
L. Natural Heating and Cooling
1. Incorporate Passive Solar Heating 5 Energy pts y=yes
2. Install Overhangs or Awnings over South Facing Windows 3 Energy pts , y=yes
3. Plant Deciduous Trees on the West and South Sides 3 Energy pis y=yes
1. Use LOW ND-VOC Paint
2. Use Low VOC, Water -Based Wood Finishes
13. Use Low/No VOC Adhesives
4. Use Salvaged Materials for Interior Finishes
5. Use Engineered Sheet Goods with no added Urea
Formaldehyde
6. Use Exterior Grade Plywood for Interior Uses
7. Seal all Exposed Particleboard or MDF
6. Use FSC Certified Materials for Interior Finish
9. Use Finger -Jointed or Recycled -Content Trim
10. Install Whole House Vacuum System
N. Flooring
1. Select FSC Certified Wood Flooring
i2. Use Rapidly Renewable Flooring Mater als
3. Use Recycled Content Ceramic Tiles
4. Install Natural Linoleum in Place of Vinyl
5. Use Exposed Concrete as Finished Floor
6. Install Recycled Content Carpet with Low VOCs
1 IAQ/Health pts y=yes 0
21AQ/Health pts y=yes 0
31AQ/Health pts y=yes 0 •
3 Resource pts y=yesH 0
61AQ/Health pts
y=yas
1 IAQ/Health pts
y --yes
41AQ/Health pts
y=yes
4 Resource pts
y=yes
1 Resource pts
y=yes
3 IAO/Health pts
y=yes
8 Resource pts
4 Resource pis
4 Resource pts
5 IAQ/Health pts
4 Resource pts
4 Resource pts
Total Points A 1 1401 1301 57
Total Points Project R 1 01 01 0 •
/!
5
G:data/pmgslgreenbulldinaguidelineslremodelerslgreenpoints5na12.12.04pmleled.zls
0
CITY OF
16UPEkTINO
0
•
Community Development
10300 Tone Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:{{�� (z, ,+
PERMIT # //,,[�
0?(D
10022-/& a vL r. 1 vq
BUSINESS LICENSE #
OWNER'S NAME: c'
PHONE #
GENERAL CONTRACTOR:
FAX #
o
Cement Finishing
I am not using any subcontractors: ���5—/�� o
a
Sieg atrg ate
Please check applicable subcontractors and comvlete the following information:
Owner/ Contractor Signature
Date
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