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08060088 CITY OF CUPERTINO ��:, k •� , - %•�'=' 1µ - au'LDING DIVIFION PERMIT CONTRACTOR INFQRMATI®N x n ...trm✓,�-Pi„ .�_*'4w, k.P 5..-C . ..a.:. �'e.6r=R?irn tj BUILfTaVQRESS: PERMIT NO. BUBB RD AIR QUALITY HEATING & AIR 08060088 OWNER'S NAME: PERMIT ISSUE DATE - J7:ANLIN YU & HONG ZHANG 720 NORTHRUP ST 06/11/2008 NE: SANITARY NO. CONTROL NO. (408) 293-7138 ARCHITECT/ GINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH C= O O D u00 LICENSED CONTRACTOR'S DECLARATION Ib Description u 1 hereby affirm Nal 1 am licensed under provisions OBSCrI of Chapter 9(commencing P with section 70M)ofDivision 3 ofde Business and Professions Code.and my licmae is RPLC FURNC&DUCTWK& ADD A/C & ZONE SYSTEM in full force and drum. i L....Cl Lie t„ Date C,mImemr CHnECTS DECLARATION ` I mWmtand my plans about he used u public recr,nla D-0 B G� Licensed professional! - 3 OWNER-BURDER DECLARATION i Si 1 hemhy aRrm that 1 am eumpl from Ne Conuacmts License Law for Ne z cc following rtasan.(Section 7031.5,Business and Pmfesdons Code:Any city or county K E P,`. which nev uires a Permit m construct.titer.improve,demul W,or repair any somem. uZi Piurm it,issuemu.also requiw theapplicans forsuch Immiuofilcasigncd rumnoem < this he is liccaed pursuanl m the provisions of the Conuutor's Lamar faw(Chaper 9 Sq.Ft.Floor Area Valuation y�s in mmencingwithS don7000)dDivWon3ofthe Budmasand Profe omCode)m $15300 try — Net he is mmpt therafmm and tire basis for Ute alleged eumpdm Any violation of Section 7031.5 by tory applicant for a permit subject,the applicant to a civil penalty of y,y, Number O .set more man five hundred dollus(3500). 35620008 .jW Occupancy P Y T YPe ❑Lo the we of the prr,pcssy,m myesnpendedwire mgh uthe'uxk eompewtion, wdProfesion•toaNemuctureuw,kkn&dmawdoeoffered sulepplyananownerof Required Inspections and property who Code:The Cr,ntraerur's aid wue Law doh tort apply f an owner of q p propertywhos,proaimpmvea memprove wM1s donssmhwdedoro emthroulghusain his rovereer.the Wilding prat trodintIs semenuarenot carofcmolfered fmsel,r, bowevWilder me ave ftmimpmveeovinghathe suld withinoneyearormproefortheowner- builder will have tk burden of proving Wl he did not Wild m improve far purpose of sok.). ❑1.as awmr M the property.w hcluaively Weracting with licensed c durac'mn m consumer the project(Sec.7W.Business and Professions,Code:)The ContraeuYs L4 cense law doh not apply to N owmr of property who builds or imprum thereon.and, who contracts for such projects;with a contractor(s)licensed pursuant a the Conusemfs License law. ❑I am hemp,under Sec. ,B&P C for this moon Ownu Date WORKER'S COMPENSATION DECLARATION 1 hereby alliru under pewty of perjury We of the following declarations ' ❑1 haw aM MII malnuin•Certifiateof Corvenl to self-imam for Warkcr'n amen.as;u provided for by Section 3700 of cite labor Code.for the performance of use work for which this pcmlit is issued. have and will maintain Worker's Compensation Insurance,n rtquired by Section ] of dor Labor Code,for the pcAormSutt of the work for which Nis pmmil u Issuw_ ' My Worker's Compensation bssurarteu artier and Policy number are: Carver. 11�AIY 13eruar v-, lwyNo.:Qr,1 C TIFlCATE OF EX ON FltOM WORKERS' COMPENSATION INSURANCE (rdswedon recd not bcceepicted If t e permit Is,forces hundred&flan(SIM) or lhs.) T enroll,that in the performance of do,work for which this Permit is issued.1 abell not employ any person in any mammrm as b become subject a thoWorkers'Compensation Lam;of California.Date Applicant NOTICE TO APPLICANT:If,after making this Cenincae of Esemptir,n,you about; become Subject w me Wmkmu Con,wo lien proviaiom d IM Labor Cod,you thou .J O fr,Mwith comply with such provialom m this permit Shell Ise&erred revoked. 'Zr'ut CONSrRumop;LENDING AGENCY [—i Ihereby a(firm But mem iSaconsumclimt lendingagmey]or the performance of CY. than work for which this permit is cound(See 3097,Civ.C.) Lender's Name C 0 Z Lender's Address U Q f certify that 1 have read this application and sate this the above infomtation is; IL P comeeL I agree Le comply with all city and county ordinances and state laws reu,ing to " 0U building construction,and hereby aumorix mprhenuuves of mu city u ether upon the, shove-aroodwad Property for impcc tur poryhes 6, (We)agree to use,indemnify and kith harmless the City of against l against Iiabilimanamm ent,.cauiand rdsisp.which may in any way aa7ve agalnil avid City U z in con vence of me Bunting f this permit. '-' APP 1 ANTU DERSTAN S ANO WILL COMPLY WITH LL NON-P INT Issued by: Date SOU E S. Signature ofA It UCon p Re-roofs AZARD MATERIALS DISCLOSU rop Type of Roof Will VP nntmfutum ildingom'upentstoremhandlc haaaNr,us maedal as dcMcd by partner,Municipal Cade.Chapter 9.11 and the Health and Safety co&,o on:ss3z(,)7 All roofs shall be inspected prior to any roofing material being installed. A4 0 Ya tOu. //� If a roof is installed without first obtainingan inspection,I agree to remove Will me opponent or furore defined occupant ere ea Air Quality of&Mama wblch P emit havardnm elr conumimnt,as&fiecd by the Bay Area Air Quality Managcmcnl all new materials for inspection. Dice tlmT ❑Ycs Ih3w mal a ardr,mmatedaurcquimmcwun&rChpw6.95orthcCalifor- n1eHWlthkSafctyCo .&ctiom M505.25533am125534.1uNknund mnifde building does not c dy have a tenor ma,it as my mihilily k notify dm occupant of the mquen issu ofa Ccnirihteofoc amp Signature of Applicant Date Own'.'mt 'iWd 4= 1 c6tc All roof coverings to be Class'f�."or better CITY OF CUPERTINO • 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35620008 . 00 DATE ISSUED. . . . . . . : 06/11/2008 RECEIPT # . . . . . . . . . : BS000005075 REFERENCE ID # . . . : 08060088 SITE ADDRESS . . . . . : 11151 BUBB RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : JIANLIN YU & HONG ZHANG ADDRESS . . . . . . . . . . : 11151 BUBB RD CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4956 RECEIVED FROM . . . . : STEFANIE FAUVOR CONTRACTOR . . . . . . . : MATTHEW FARBER LIC # 22791 COMPANY . . . . . . . . . . : AIR QUALITY HEATING & AIR ADDRESS . . . . . . . . . . : 720 NORTHRUP ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95126 TELEPHONE . . . . . . . . : (408) 293-7138 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------ ------ ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 15, 300 . 00 1 . 60 0 . 00 1 . 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 2 . 00 122 . 38 0 . 00 122 . 38 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 287 . 14 0 . 00 287 . 14 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 287 . 14 MC --------------- TOTAL RECEIPT 287 . 14 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • CITY OF CUPERTINO 00F FURNACE/AC CUPERTINO PERMIT APPLICATION FORM APN# Date: q Building Address: 1115) 1166 1b r-u Foe-n"a , CA .9 5-614 Owner's Name: 14N L I/J �U Cy HU,, (j 21-10w Phone #: C4bc)511 . Contractor: A I P- &,VALI HeA-( kJCJ `Y/AIQ C�1 Ixabu Phone #: "� (�. . Contractor License #_ Fax #: 46 - _ . __ Cupertajo_Business License -�0 IC) I - Contact: �l/�l LI H l \ U Phone #: `1 X0`6 —16tbi— Buildingng Permit Info: Elect Plumb ❑ Mech-X Residential Commercial LJ Job Description: WfLRCf5 F-U0,AL-6—AkJ6 bU(�-tuJ-V—K _ qC� For Residential Installations: Attic ❑ 1" floor ❑ 2 Id floor ❑ Adhere to minimum setback re uirement;g For Commercial Installations: Replacement same weight ❑ Additional weight (structural talcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project:�l I�) jb. Type of Construction (Usage Class): Strapped On Platform Bonded New Location Replacement aluation: Green Building: Must attach Green Building Check list to this application CITY OF CUPERTINO FURNACE/AC CITY 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_c_ontrols.regulatedby-this ______ code. 1MCREPALT Commercial for the repair of alt/add to M ea heating appliance,refrigeration unit,cooling unit,VAV boxes, absorption unit or ea heatEng, 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. 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1BPGAS 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 permit, 1BSEISMICO Commercial Seismic B 1MRRAA Residential 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. • 1MRSUSHTR Residential Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1MRAPPVNT Residential for the installJrelocate/or M replacement of ea appliance vent install &not incl in an appl permit. CITY OF CUPERTINO FURNACE/AC CITYCUPEf�TINO 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. IBSEISMICR Residential Seismic B 1MECPLNCK Mechanical Plan Check M IMFR=<100 Furnace Syst <=100k BTU install or M s 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 famace/bumer, incl ducts/vents attached to such appliance over 100,000 Btu/h IEPERMITFEE Electric Permit Fee E 1MPERMITFEE Mechanical Permit Fee M IPPERMITFEE Plumbing Permit P 1TRAVDOC Travel Documentation B IBUSLIC Business License B • CITY OF CUPERTINO ' FURNACE/AC • CUPEkTINO OF I FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group AIR FURN/AC CONDITIONING 1BCAIRHAN Commercial A/C Units <= l0k CFM B 1MCRAA Commercial Mech Repair/alt/add M IBSEISMICO Seismic Commercial B 1PGASCOM Commerical for ea gas piping System P 1-4 outlets - —-----------1PGASRES of 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. Comm/Resid 1BREMAIR14AN Residential A/C units <= l0k CFM B • / 1J1 � Residential Mech Repair/alt/add M r vl tBSEISMICR Seismic Residential B + / IEPERMITFEE Electric Permit E 1MPERMITFEE Mechanical Permit M * / 1PPERMITFEE Plumbing Permit P 1TRAVDOC Travel Documentation B 1BUSLIC Business License B • ' Single Family Green Point Checklist date:lQ Build It Green The GmenPoinl Checklist Is based on the various green lectures Incorporated tine the home and is the SolSoMioru Fran Tire Ground Op bases for Ina GreerlPoiru Rated program,A home can be considered green g It tuMls the prarequis1n, • Hams at least 60 grins,and meetsminimum points per category.Energy Indoor Alr 9ualiryl Health(S),Resources(6),and Waterr((g).Please mould Build It Green for a Ilsest of of qualified GreenPWnt pullers If you are Interested In pursuing thlyd-parry,velifcaton. The green building practices Ireland below are described In the New Home Conslruc ion Green Building Guidelines,available at www.buliddoreen.om. E F]i ENTER PROJECT NAME 75 is a m .."{.r ,.'< a i .; 1.:.- a. tl,:T?.. ,fl, � � ...r. Ew E U Poems Available Per Measure I 1 Prolate Topmll and Nmimira Diwption of Ensting Plants a Trees ❑ e Protect Tapsod from Erosion end Reuse after Construction 0 1 1 ❑ b.Limit and Dedneab Construction Foccrrint for Maximum Protection __O_ - -'- --'---- ---- LJ 2 DeronstmG Nrtead of pemo6ching Existing Suil,in a On Site 0 3 3.RelJob She Construction Waste(Including Green Waste) ❑ aMUGmum 50%waste D'verakw by Weigle(Recyching or Rouse)-Required 0 R ❑ 4 Minimum 65%D19mbn by Weigle(Recycling of Reuse) —"' --"-T"' --'----- ❑ c.Minimum 80%Diversion by Weight(Recycling a Rouse) 0 ___..._.—_—__2 /.Use Recycled Cement Aggregate(eenlmum 25X) 0 2 ❑ a.Walkway and Driveway ❑ b.Roadway Sese 0 S 0 1 Tater Points Available in Site-12 p H.FOU Rel Po. 1. . 1.Replan Portland Cement in Controls with Recycled Flyazh or Slag Points AvallatAe Per Measure ❑___a.Minimum 20%Fyashbr Slay____._._... -..__-_.—....._._._. ._._._._.___.—_.. ___ ❑ b.Minimum 25%Flyash or Slag — —- --- - 2 Use Frost-Protected Shallow Foundation in Cold Areas(FEC.Climate Zone 16) 0 3 3.Use Radon Resistant Construction n At-Risk Locations Only) 0 1 4.Design and Builtl StrocNrel Pett Controls ❑ a Instep Tomtits Shields 5 Separate Al Exterior Wood-io-Comnele Connections Meal a Plastic FastenervDHiders p I b.AN New Plants Have Tmnk Base.a Stan,Localed At Least 36 Inches from Foundation --"-'-"' _-"'-"------ - 0 1 TOW Pdnb Ava6abe NFoundetlon=B 0 C.LANDSCAPuNl3 Points Available Per Measure ❑ a. • 1. nsWgResSpot l6rianl Landscapes - -- "-- -----_"-- --- a.No ImsWe Species aListed by Cal-IPC Are Planted p ) ❑ b.No Plant Species WN Require Hedging 0 S ❑ C.75%of Planes Are DmuphFtoleram California Nerves,Metlitenanaan,a One,Appropriate Species "'-" -'--"'-'—"--- ----�- 2.Use Fire-Sale Landsca in techniques 0 1 3.Minimize Tuff Areae in Lan0 dscape Installed by Suilder ❑ aAd Tuff Wid Have a Water Requirement Less Nan or Equal to Tad Fescue(scla plant factor) 0 2 ❑ b.Tud Shall Not Be Installed on Slopes Exceeding 10%win Areas Lentil 6 Feel Wide 0 ----- -- ❑ c.Ted is Sia%of 2 Landscaped Area(twat 2 points) 0 _--- 2 ❑ d.TW is 510%of Landscaped Area(total4 points) 0 ❑ 4,Plant Shade Train S.Grou Ptenb Water Needs tlmxonin 0 3 6.Install High- clar ry lrtipation Systema 0 z ❑ a System Uses Only Low4clow Drip,Sub tem,a LOW-i Spdnklen: ❑ b.System Has Smart Controllers 0 _ _._— 2 7.Incorporate Two Intoes of Compost in the Top 6 012 Inches of Soil 0 3 a.Mulch All Plan in Beds to the Greater of 2lnchev or Loeai We,Ordinance Re uirement 0 9.Use 50%Salvs ed or ReryeletlConfene Materials for 50%of NomPIanl 4ntlsce a Elements Z 10.Reduce Li hl Pollution Shieltlin Frtures and/or directing Light Downward 0 S p I Taal Polnh Avalleble in D. SIRUCTLJHAL FRAM R N(3 EIiVEIAPE Lantlscapin =31 0 1 L Appy Optimal Value Engineering PDIRf6 AvailaNa Per Measure I ❑ a Ram Rafters and Studs at 24-Inch On Canter Framing ❑ 0 b.Ste Door and Wmtlaw HeeOers to Load - ❑ c.Use Ony Jack and Cripple Studs Required for Load 2.Use En .ad Lumber 0- - ❑ a Beams and Headers ❑ b.Insulated Engineered Headers 0 ❑ c.Wood l-JoisbaWeb Trusses la 0 Floss - ❑ d.Wood l-Jaisls to Rad Ratters - 0 _._...... 0 e.Engineered a Finger Joined Studs for Venial Applca6ons ❑ (.Oriented Strand Board eor Subilia 0 ❑ p."denied Stand Sovd ter Well and Roo Shoal 3.Ute FSGCer6fied Wood 0 1 • ❑ A.DtmBnsil Lumber,Sud,and Timber.Mil 40% El O, 0 __.____ DimenSionM Lumber,Studs and ember.Minimum 70% '_._._._. 2 ❑ a Panel Products:Minimum 40% 0El l _ tl.Panel Protistae:Minimum 70% 0 0 y 02007 Build It Green Sinola Family GreenPnini rhe-loot 2nm%/ .-nn , � / I ENTER I PROJECT NAME 5 FF t 2 u � x • L46Solid WWI SyctarN pnNuda SIPS,iCFq a Any Nom56ck Frarrw,Assembly) oors 0 7 ails -____oots m Pollution Entering the Home from Me Garega lghmy Seel the Ab Beller between Garage and Uvmg Areabtsil Geta a Etluust Fan OR Build a Detached Gera n Hees on Twnur 5%d Altic Mwlation Height at Outdda Edge al EMdor Wel l RDMTw WA=ro Od aDusevorkD RarydW GOntw Satl Studs for 90%of Interior WWI FrarMng 0 ! I LJ &Thenal Yea Wws:604nch Dryeen on An Interior Waft or Walls Weighing mon than ID Ibreatl. 0 1 10.IruWl D KtoV and Ouaare ❑ A Minimum 16-inch Overhangs aim Guners 0 ❑ b.Minimum zanch 0verhe s and Gunea D Toll Poins Avalbsae In Swctuial Buiidin Frame and Envelope-36 D E.EETENIOH F1111SH PoihAS.Avallable Per Mea.Sure LJ t.Use Reryolsdtomsm(No Virgin Piano)or FSCteNfied Wood Daeldn 0 2 z In a Rain Screen wd SYwm1 0 n 2 1.Un Durable and Noncombustible Shim Yetedala D 1 Lj A.Select Durable and NoxombuNbla Roofin Materials 0l 2 TOMI Poins AvatlaNe In Exledor Finish 7 0 M N Points Available Per Measure Inwletion eith 75%Recycled Content s Whom Floors 0m — MwMtion Met isLine-Emitting(Certified Sectionils ntlla,FhMsin s0uall otlnsulation Installation before Applying Dwell 0 1 TOW Points Available In Insulation•5 0 O-PLOb18IRG Points Available Per Measure 1,Distribute,Domestic Hot Water Et6Nanut,(Maximum 7 Poins). ❑ a lnsulato Hot Water Pipes from Walsh Healer to Kitchen 0 • ❑ b Insulae M Hol Water Pipes 0 ❑ c.Use Engiosered Parallel Pacing 0 I_ 1 ❑ It Use Engineered Parallel Piping vAth Demand C,mVoilaO Circulation Loop 0 ❑ e.Use Structured Plumbing In Demand Controlled Circulation Loop _ _ ..._ —___ __ ❑ I.Use Central Con Plumbing 0 1 1 1 2 ❑ z Inman Only High Efficiency TD119%(Dual-Flush or 51.25 9PO 0 i 4 TOMI Points AvalMble in Plumbing=TOW 12 D H-HFATD9G VENTHATION f4 ADi CONDITIONING Points Available Per Measure t.Design end Iretw HVAC System M ACCA Manual J.D,and S Recommends tions, 0 4 2.Install]Sealed Combustion Units L Furnaces _ 0 2 b.Water Hearn 0 2 S.InataO Zonetl,llydhonie Radiant Hurting with Stab Edge Insulation 0 /.Install High Et6cienry AIr Conditioning with Environmentally Responsible Rehlgennts 0 i 5.Design and Install Effective Ducheork a Instal HVAC Unit arta Duchawk Mthin Conditioned Space _ 0 ❑ b.Use Dun Mastic on M Duct Joins and Seems 0 ❑ e.ImWl Duchark under Alpe luulatiou(Boded Ducts) 0 I , ❑ d.Pressure Balarce the Ductwork System ❑ , e.Protan Duds during Construction and Clean M Ducts before Occupancy D S.Install High Efficiancy HVAC Flier ERV 6« 0 1 ❑ 7.Dont Install Flnplacs or Insall Sealed Gas Fireplaces with Efficiency Rating Not Leu Than So% 0 1 using CSA Somdards n l S Install Effective Exhaust Systems in Bathrooms end Kitchens ❑ a.Install ENERGY STAR Bathroom Fans Vented io the Outside 0 ❑ It.M Bathroom Fars An on Timer or Humidstal 0_ _! 1 ❑ c.Install Klthen Range Hood Vented m the Ouside 0 1 9.Install Mechanical Ventilation System for Cooling(Maximum 1 Points) ❑ a Instal ENERGY STAR Ceifmg Fans 6 Ugld Kits In Living Areas A Bedrooms D ❑ b,Instal Whole House Fan won Variable Speeds 0 1 l ❑ c.Automatically DmtrDOad Integrated System 0 ❑ d Aulomatcaly Controlled Integrated System with Variable Speed Control 0 3 10.Install Mechanical Fresh Ah Ventilation System(Maximum 3 Points) ❑ a.Any wnoia House Vamlanon System That Maes ASHRAE 622 0 ___ 2 •;__ El b.InstallAir-to-Afr Heal Exchanger that areata ASHRAE 622 0 3 2 1 L lowelll Carbon Mono:Ide Al.(.) 0 1 Total Points Available In Heatin ,Ventilation and Air Conditioning=30 D Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 SUPEkTINO Building Department JOB ADDRESS: ll tZ51 Not) lft>_ PERMIT # C,t,(mzn ,u CR• cie5IA d�6 6 Od�F&—� OWNER'S NAME: )A"I,I N U PHONE # 0 GENERAL CONTRACTOR: !t2 FAX # °I-,PC)2 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile • ' rr er/Con actor Signature Date