08050057 CITY OF CUPERTINO
aulLmnc DlVlSlOf4 PERMIT CO INT(?RMATIQN
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7 � ERIN WAY CASTO ROOFING P08050057
ER'SS NA�t$SME: PERMIT LSSIM DAISDAVIS BARBARA J 1938 OLD MIDDLEFIELD WAY 05/05/2008
NE: SANITARY NO. CONTROL NO.
R (650) 961-8922
HSCT(FNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
X00 LICENSED CONTRACTOR'S DECLARATION
u 1 hereby affirm Nal l wo document under provisoes of Chapter 9(commencing Job Description
wiNS don)OW)ofDiviuon3ofN BudnmmdProfessionsCoder,andmyliccnsek RE—RF, RMV EX SHAKE RF & RPLC W 40YR COMP, CLS A
in full force and effect Z-772
-
Lt....License Cl s-y-��Lic 22SQ
=p Date ZSZT Connanor
£77WW ARCHITECTS DECLARATION
W U 1 umlerananJ
my plans shall W:used act public necomb _
s LLo Licensed Professional
OWNER-BUILDER DECLARATION
1 hemhy affirm that 1 am exempt from the Cwnumcmr'.License Law for the
i O o following moan.(Section 1031.5,Business and Profee uct Code:Any city or county
$ri which mquims a permit to crnsrom alter•improve,demolish,or miser any stmctum
prior N its issuanc,aku requires the applicant for such permit to rile a signed suament
N
i o atheislicroudpmm
nantNepmaisonsofinentact
cnor,LocnseLaw(Chapter9 Sq.Ft. Floor Area Valuation
x�8 (commencing with Section 7")of Division 3 of the Busoess and Professions Coda)Or $9000
Q than W is mampt therefrom and the basis for the alleged nempdon Any AoUdno of
Section 7031.5 by any applicant for a permit subjects the applicant N a Civil penalty ofNumber Occas
am mme Nan five hundred dollar.(15M. 3 592102 0�J Occupancy Type
❑1,u owner o!the property,or my employees wvh regi a.thelrcok cmmpewtion,
will de theworL and due strucuve u nc,ktended sur offered Tarsale(Sec.R)a,Business
and professions oma:The eontraeNrs L.immse Law ones not apply te an owner of Required Inspections
property who b W Ids or imgosea Nvmn,am who docs such wok hkvelf or through his
ower employru,provided thusuch improvemrnu are not intended motioned forsale R.
howevm-the building or impwommot is cold within one year of complow n.the owner.
builder will have t ire burden of proving Nat Ito did not Wild or improve for purpose of
ale.).
❑I,as owner of due property.am=elusively connecting with licensed conuacums N
Construct the projen(Sec.IOM,Bush.and professions Code:)The Coermmor'.U.
come law oma not apply te an owner clinometry who builds or improves thereon,and
who cents ate fur sw:h projects withaconussbru)ficetued pursuant N the Convenor's
Lice.Law.
❑l am exempt under See ,B&PC fm this maven
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury,one of the fallowing declananiwas:
haw and will maintain a Cenificateof Consent te calf-insere fm Wmamt sCompere
on.as provided for by Section TIDO of the Labor Code.for the Performance of the
work for which this permit is issued.
0have and will maintain Worker's Compensation resonances,as required by Section
of the ubwr Cade,far the pedarmance of the wort fwrwhich Nis permit u ivncQ
My Wa roar rax:e��a/r/5yr and Policy numtber art:
Cartier. P�^�f� 1kyNo.: 2 Lc&?
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thisseetlon need not comnplcu:l dthe Permit is frown hundred dollars(SIM)
or kis)
1 certify then in the performance of the work for which this perm,u issued.I small am
employ any person in any m=mran as In become subject to the WorkersCompeasation
Laws of CahfomiL Date
Applicant
NOTICE TO APPLICANT:If,at making this CaniEcate of Eampuon,you should
become Subject N the Worker's Compensation previsions of the Law Code,you must
.J z fo d with comply with such provisions m thk permit shall W deemed revaked.
z O CONSTRUCTION LENDING AGENCY
[-s r l hereby affirm that Nem u a construction lending agency for the performance of
a> the went for which this pammit k issued(sec.3097.Civ.Q
0 undoes Name .
]z Lender's Add.
V Q 1 certify that 1 have seed this application and sate Net due above information u
{T+ r'�. COMM I agree m comply with all City and county ordinances and sum Jews miming N
-Q trJ" building construction,and hcrobyauNouae minomnuuvra of this city a enterupnn the
r V) men
en Licrnuoncd promc a fan hupcorms purymes
t--,a (We)agme N-tett indemnify and kecp h.read.the City of Cepeninw agsnst
Z Iiabilmiu.-I''th- oorting du'pa niich may io any wayamue aPinu aid City
V z inconsequence of Ne tanun6 of Nis permit
" APPLICANT UNDERSTANDS ND W WITH ALL NON-POINT Issued by: Date tet$
SOURCEREGULA NS.
si m / Re-roofs
g � FIAlARDOUSMATERIALSDISCLOSURE ale Type of Roof
dl the Pliantmfutum WtllNng mcupantsmm mlundk hevrdovs matesil
as dermad by the Cumeman Municipal Codc.Chapter 9.11,and the Hdand d Safety
trek,sermon zs532(a)+
0y. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant 0,
oncNo e building weapon,use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
dhcCudnm sur contaminants a defined by the Bay Area Air Quality Management all new materials for inspection.
❑Yes
1 have owl the haraNmk data numMinents under Chapter 6.95 ofdw Cairo,
niaH [Lh&SafetYCme,Swc Om5505.15533md155N.iundcrsundthaniftho building
dna not currently haw a muni,out it u mpoasihiliry N nml'y the occupant of the
no uimmen It It muss met psi z of a Certificate of CC
Signature of Applicant Date
Ownerurauthw' gem Date 11 All roof coverings to be Class'W'or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 35921020 . 00
DATE ISSUED. . . . . . . : 05/05/2008
RECEIPT # . . . . . . . . . : BS000004672
REFERENCE ID # . . . : 08050057
SITE ADDRESS . . . . . : 7608 ERIN WAY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . .. DAVIS BARBARA J
ADDRESS . . . . . . . . . . : 7608 ERIN WY
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4343
RECEIVED FROM . . . . : LINDSEY CASTO
CONTRACTOR . . . . . . . : CASTO, LINDSEY LIC # 21324
COMPANY . . . . . . . . . . : CASTO ROOFING
ADDRESS . . . . . . . . . . : 1938 OLD MIDDLEFIELD WAY
CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94043
TELEPHONE . . . . . . . . : (650) 961-8922
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
IBSEISMICR VALUATION 9, 000 . 00. 0 . 90 0 . 00 0 . 90 0 . 00
1REROOFRES SQ FEET 22 . 00 286.. 00 0 . 00 286 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 286 . 90 0 . 00 286 . 90 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 286 . 90 MC
---------------
TOTAL RECEIPT 286. 90
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
�o s 00.5 7
-� CITY OF CUPERTINO
REROOF
• OF
CUPERTINO PERMIT APPLICATION
APN # Date:
2�9?, o/ /s/off
Building Address: -�/
�a 6t,%4Wa
Owner's Name: Phone #:
L5:( CY 4V •S
Contractor: Phone #: (�10 56 C_ $iZ Z
C_ ��M`.i Fax #: 9a/ - 2-y 0
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles )C Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings a Provide I.C.B.O. Report #
o To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: / _ V��
1'� e Ql�c�e tJ Flo y r how.. Pb ckv A
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: ^OO�
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
•
�g
a, -
CITY OF CUPERTINO
REROOF
CITY OF
*CUPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
IBSEISMICO Seismic Commercial B
IREROOFRES Re-roof Residential B 1SFDWLROOF
22--
/ IBSEISMICRE Seismic Residential B
IREROOFMRES Re-roof Multi-Family B 1MFDWLROOF
IBSEISMICRE 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.
Q
Homeowner's Name: �L Y- lti t--\. 5 J;
Job Site Address: 7(o ✓ . 1ti (.y 1 ,
Roofing Company Name: C 4 l+u 49�0 L
Applicant's Signatu aDate: 6 �O
• Greg Casteel
Building Official
Revised 11/2/04
Green Building Plan Check
rIndex 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 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 POINTS 40 points
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.
A.Site
E
le Job Site Const uct on&Demolition Waste
point;75%= 2 points;80%=4 points up to 4 Resource pts 0
e 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 Stormwater Practices 2 Resource pts y=yes 0
7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0
B.Design Resource-Efficient Landscapes and Gardens 4 Resource pts y=yes 0
9.Reuse Matedals/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 0
C.Structural Frame
1 1 1
Sewn Lumber with Engineered Lumber 3 Resource pts y=yes 0
F.Subs'�tuteSorld
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
B.Use Finger-Jointed Studs for Vertical Applications 2 Resource pts y=yes 0
7.Use Engineered Studs for Vertical Applications 2 Resource p!s y--yes p
8.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes p
9.Use Structural Insulated Panels(SIPS)
a.Floors 3 Energy pts y=yes
I b.Wall 0
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 Resourceis
p . y=yes 0
a.Subfloors i`J
1 Resource pt y=yes 0
• b.Sheathing _ 1 Resource pt y=yes
1 1 1
D.Exterff imsh
!1.Use Sustainable Decking Materials
a.Recycled content j 3.Resource pts y=yes 0 e
1 b.FSC Certified Wood 3 Resource pts y=yes 0
�2.Use Treated Wood That Does Not Contain Chmmium/Arsenic 1 IAQ/Health pt y=yes 0
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 Hester Jacket 1 Energy pt y--yes 0
2.Insulate Hot and Cold water Pipes 2 Energy pts y=yes 0
3.Retrofit all Faucetsand 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 IAO/Hsalth 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
B.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes D
1 1 1
r-.rreccrmar
1.Install Compact Fluorescent Light Bulbs(CFLs)
(6 bulbs=2 points,l0 bulbs points,l2 bulbs=4 points) Up to 4 Energy pis. 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 nature,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 !
G.Appliances
1.Install Energy Star Drish;;iiheF 1 Energy pt y--yes 0
2,Install Washing Machine with Water and Energy
Conservation Features 1 Energy pt y=yes 0
3.lnstall Energy Star Refrigerator 1 Energy pt y=yes 0
4.Install Built-In Recycling Center 3 Resource pts y=yes 0
w_.—_ __-_— 1 1 1
H.Insulation
1.Upgrade Insulation to Exceed Title 24 Requirements
a.Wallis 2 Energy pts y=yes 0
b.Ceilings 2 Energy pis 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 3 IAQ/Health pts y=yes 0
4.Use Advanced Infiltration Reduction Practices 2 Energy pis 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 D
o.cenings 4 Resource pts y=yes 0
1 1
Windows
;7.Install Energy-Efficient Windows - I
. i a.Double-Paned 1 Energy pt y--yes 0
b.Low-Emissivity(Low-E) R 2 Energy pts y=yes 0
a.Low.Conductivity Frames _ _ j 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
F.Use Duct Masticon All Duct Joints - 2 Ener is
� 9Y P Y=Yes 0
2.Install Ductwork within Conditioned Space 3 Energy pts y=yas 0
3.Vent Range Hood to the Outside 1 IAQ/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 Eneroy pts Y--yes 0
B.Install Sealed Combustion Units
a.Furnaces 3 IAQ/Health pts y=yes p
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_y es 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 stovesfinserts 1 lAQ/Health pt y=yes 0
b. Install/Replace Dampers 1 Energy of 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/Health pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health 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-VJre 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=16 points) Up to 16 Energy pts 0
j6:Select Safe and Durable A-0-0fi ng Mate als �� 1 Resource pt y=yes 0
7 Instal)Radiant Barrier 3 Energy pts y=yes 0
1 1
L.Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy pts y=yes p
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 p
1 1 1
M.Indoor Air Qua ity and Finishes 1
ri.Use Low/No-VOC Paint _ _ __ _ _i 1 IAQ/Health pts y--yes 0
Z.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y--yes 0 •
rr3.Use Lowl—No VOC Adhesives _ 3 IAQ/Health pts y=yes
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61A0/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
L3eal all Exposed Pa t cleboa d or MDF �; 4 IAQ/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 3 IAO/Health pts y=yes 0
1 { 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
r Use Rapidly Renewable Rooring Matedals _L t 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 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 1301 57
Total Points Project Received: / 01 01 0 •
G:datarprogslgreenbuilSngguidelinestremodelerslgreenpointsfinal212.04prmealed.zls
•
• Community Development
a 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
•CUPEI�TINO
Building Department
JOB ADDRESS: PERMIT # O� 7
7Y ` ��
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: y L FAX #
I am not using any subcontracto -
Siat
gnure Date
Please check applicable subcontractors an 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
Owner/Contractor Signature Date