08040183II '.
BUILDING DIVISION PERIVII'I'T�kCO1VTRACTGTR
URMA4�IOIV'
IM
BUT I GA DRESS:
PERMIT NO.
1�1 FOREST AVE
DO NOT USE-DUPLICATE 19307
08040183
OWNER'S NAME:
PERMIT ISSUE DATE
MATSUKI ALFRED AND ATSUKO
825 CAMDEN AVE
04/25/2008
E:
SANITARY NO. CONTROL NO.
(408)866-1800
ARCHRECT/ENGiNEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED COMRACDOWS DECLARATION
Job Description
I hnaby affirm that 1 w ilamed under provisions of Chapter 9 (commencing
wind Section ttm)arDivivan 3.fft Business and ProfeaLons Code, and my license is
REROOF—T/O (E)SHAKES,INSTALL 1/2'PLYWOOD.INSTALL
m full fame and eB Z i8
License Cl Li,. 0
30LB FELT UNDERLAY.LANDMARK PREMIUM COMP "A" 30
Dam
ARCNffECI-S DECLARATION
St, RS,
1 mddemund my plans NMI bis used as public records
Licensed Pmfessioul
OWNER-BUILDER DECLARATION
I hereby calm that I am exempt from the Conuacmh License Law for the
following maxim. (Section 7031.5, Business and Profession, Code: Any City sur county
which inquires a l much to construct, Iter. hnpmw, demolish, or repair any sutaum
prior to its issuance. also requires the spplieal rorsuch Permit to rile a signed suumenj
Mt he u licensed mthe of tide Contractor's Ucense Law(Chapor 9
Sq. Ft. Floor Area
-.
Valuation
puraunl Provisions
ndn
(cmaadng with Section 1000) of Division 3 Of the Business and Prorrssions Canoe) m
$15000
that he ts exempt Merchant and Ne basis for Mn alleged assumption. My vio man Of
Number
Occupancy Type
any applicant for a Permit $A*13 Me applicant to a civil Penalty of
Section 1031.5 byBw
not mNhuodmd
am en r 5500).
316 3 3 0 71 .'d�CjN
0 1, as awns of Me property, a my moployw with wages as Neo sole compensation,
Required Inspections
will do Me work, and Ma,uucture ts rot Nu Bled oro@cod far axle (Sec. 7044. Business
ad Poefcasions Cade: Tho CanuamMs I men, Law does a1 apply m an owner of
.
property who buildsorimpmw s thereon,and whodasa eta work WouctfserNmugh his
owe employ as, pmvidead Nat such impmwmenu are not inmndrd oroBemd rental. If.
howasv, Ne building or impmwmml is sold within ane year of completion, the owner.
builder will how the burden of proving Mut he did mat build m improv fm purpose of
ale.).
Q 1. as coarser of the property. am mmla hely cmoruting with Banual conusesen to
comnmcl Me project (Sec. T(dd. Business and Profassiaru Code:) The Co mocu's U.
comes Law does not apply an an amor of Property who builds or improves Neuron, ad ,
who contacts for such projects MN acontractors) licensed pursuant o the Conusctor's
License Law.
❑ I am exempt under See .B h P C for this cum.
Owner Dau
WORKERS COMPENSATION DECLARATION
1 hereby groan under perWly of perjury ane of the following deelandonc
ham end will nod.win a Coofiau of Consent to self-moune for WartNa Compen-
sedan. u provided fa by Section 3100 of the labor Cad. for the perforrom. of she
work for which Nis Permit is issued. .
RO1 haw and will maintain WorkersInsomnia. Compensation Inco a. as mpdoxi by Section
Oof Me Labor Code. for Me performance of Me was for which this permit is Weed.
'
My Wmime. Compensation Insurance carrier and Policy number see:
Cartier. Slat t AVA.0 Policy No.: 'DeA D(a11—
.
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
Into sectlw need set ba completed lithe permit Isrorome hundred elegant (2100)
or toxo)
1 certify Mut in Me performance of Me wars for which this permit ts blued. I shall na
employ any person in my mamrso as to become subject to Me Wohal Compensation
Laws of Califomia. Dam
Anil.
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to Me Worker's Compensation previsions or Ne IaWr Code, you mum
forthwith comply with such previsions or this permit shall be assured rewked.
CONSTRUCTION LENDING AGENCY
I lumby mMon Nat there la • consuucsian One ing agmey fm the pmformmex of
Me work rm which this permit Is blued (San. 3091, Civ. C.)
'
Lenders Name
,
Landers Address
I certify Nat I haw mad this application and sum Mu the show Information is
cxrnamn� I agree m Comply with all city and Cowry confinement and sass law, missing to
'
Wilding caatmcMan, and hereby mthodu reprexnudws of Nu city to we,. tie
Neve-mentioned property for Inspection proposes. .
(We) agree to saw. indemnify and keep hatmless the City of Cupertino against
�/ ✓✓ 11 v .
IisbiiiMes.ju agmen W eoms ad expenses which may In any way acrnu gaWtaid City
in consequence or the greening of this rah.
r�
pe
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Type of Roof
,tr
�1 Ap �1I
signature of ApplianMCon err Date
Dole
HAZARDOUS MATERIALS DISCLOSURE
Will Me applicant or future building occupant mom orhandle ha-rdoa material
as dcfimM by Me Cupertino Municipal Code. Chapter 9.12. and the Health and Safely
Cade. Section 25532(a)i
All roofs shall be inspected to any roofing material being installed.
❑Ya $We
prior
If a roof is installed without first obtaining an inspection, I agree to remove
WIII Na applicant or future building occupant use equipment Or daises which
h ,. air camrninsnts u defined by Ne Bay Am�Air Quality Management
all new materials for inspection.
stric0
❑Yo O.N.
1 hew mad the ha»Noua materials requirements under Chapter 6.95 afta Califor-
niaHmilhkSarctyCod.Smjans23505.25533md25534.1wdermmd NaifMm Wilding
dean an, currently hew a mond, Mut It u my responsibility to notify the mcupmt of Ne
requirements which mum be met priorm Wuace ora CM
Signature of Applicant - Date
�`�`� 4-HW Serer--127�Ui
All roof coverings to be Class'W' or better
ownerana Date
drad.gent
• 2 ITEMS OF 2
0
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 31633071.00
DATE ISSUED.......: 04/25/2008
RECEIPT #.........: BS000004584
REFERENCE ID # ...: 08040183
SITE ADDRESS .....: 20151 FOREST AVE
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: suew
COPY # : 1
OWNER ............: 14ATSUKI ALFRED AND ATSUKO
ADDRESS ..........: 20151 FOREST AVE
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-2008
RECEIVED FROM ....: PAUL HORSAGER
CONTRACTOR .......: PAUL HORSAGER LIC # 23342
COMPANY ..........: DO NOT USE -DUPLICATE 19307
ADDRESS ..........: 825 CAMDEN AVE
CITY/STATE/ZIP ...: CAMPBELL, CA 95008
TELEPHONE ........: (408)866-1800
FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
---------- ------------- -------------------- ---------- ---------- ----------
1BSEISMICR VALUATION 15,000.00 1.50 0.00 1.50 0.00
1REROOFRES SQ FEET 30.00 390.00 0.00 390.00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 391.50 0.00 391.50 0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT
AMOUNT
---------------
391.50
---------------
391.50
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
REFERENCE NUMBER
__q -----------------
mc
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
A
,t
J
C TV OF
•CUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION co
APN # 3 l lv 33 b 7
Date: z 0 8
Building Address:
Lk
Za SIF
QA_9-SE A M, Ca
N L
Owner's Name:
Phone #:
Contractor: � �
Phone #: Ljo%C- 8 (oQ-- 12u c)
—
Fax #: '10o�—
Cupertino Business License #: 2`z,3 `{ Z
Cp88 �o�icense #: G
�l
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
o Built -Up roof
❑ Asphalt Shingles
%_ Asphalt Shingles
*- 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.
JobDescription: eA4- d P F r S44A )coz u S L L 11 I� W uoA 01.
/21 Sl1Pu �, ._-_t-A.s,gi/ ZoL3S
Residential LA,
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:
S 00 ^
I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy:
Signature
CITY OF CUPERTINO
REROOF
CITY OF
•CUPERTINO FEE SCHEDULE
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
1REROOFCOM
Re -roof Commercial
B
1COMMLROOF
1BSEISMICO
Seismic Commercial
B
3d
1REROOFRES
Re -roof Residential
B
1SFDWLR00F
1BSEISMICRE
Seismic Residential
B
1REROOFMRES
Re -roof Multi -Family
B
1MFDWLROOF
1BSEISMICRE
Seismic Residential
B
1BUSLIC
Business License
B
0
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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: 43--'FAzA
Job Site Address: Z.(DI S (
Roofing Company Name: &010 vh. 4
L
Applicant's Signature_ - h Vim\ C Date: �� U
Greg Casteel
Building Official
Revised 11/2/04
�J a 1 LA-• q ro) +
4
L
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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 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 oints .
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
I.,
List Green Features on Plans
A-1
1 point
TOTAL POINTS1
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.
1. Recycle Job Site Construction & Demolition Waste
3 Resource pts y=
2. Use FSC Certified Wood for framing
65%=1 point; 75%= 2 points; 80%= 4 points
up to 4 Resource pts
2. Salvage Reusable Building Materials
I 4 Resource pts
y=yes
3. Remodel for Mixed Use, Adaptive Reuse, and
2 Resource pts y=
5. Design Energy Heels on Trusses 6' or more
Historic Preservation
4 Resource pts
y=yes
4. Protect Native Soil
2 Resource pts
y=yes
5. Minimize Disruption of Existing Plants & Trees
1 Resource pt
y=yes
6. Implement Construction Site Stormwater Practices
2 Resource pts
y=yes
7. Protect Water Quality with Landscape Design
2 Resource pts
y=yes
6. Design Resource -Efficient Landscapes and Gardens
4 Resource pts
y=yes
9. Reuse Materials/Use Recycled Content Materials
for Landscape Areas
2 Resource pts
y=yes
10. Install High -Efficiency Irrigation Systems -
2 Resource pts
y=yes
11. Provide for On -Site Water Catchment / Retention
2 Resource ots
v=ves
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
2. Use Recycled Content Aggregate 2 Resource pts y=yes
3. Insulate Foundation/Slab before backfill 3 Energy pts y=yes
C. Structural Frame
11. Substitute Solid Sawn Lumber with Engineered Lumber
3 Resource pts y=
2. Use FSC Certified Wood for framing
(For every 10% of FSC lumber used = 2 points, up to 10)
up to 10 Resource
3. Use Wood I -Joists for Floors and Ceilings
2 Resource pts y=
4. Use Web Floor Trusses
2 Resource pts y=
5. Design Energy Heels on Trusses 6' or more
2 Energy pts y=
B. Use Finger -Jointed Studs for Vertical Applications
2 Resource pts y=
7. Use Engineered Studs for Vertical Applications
2 Resource pts y=
B. Use Recycled Content Steel Studs for Interior Framing
2 Resource pts y=
9. Use Structural Insulated Panels (SIPS)
a. Floors 3 Energy pts
b. Wall 3 Energy pts
c. Roof 3 Energy pts
10. Apply Advanced Framing Techniques 4 Resource pts
11. Use Reclaimed Lumber for Non Structural Applications 3 Resource pts
a. Subfloors 1 Resource pt
•It. Sheathing 1 R=
v'
1. Use Sustainable Decking Materials
a. Recycled content
3 Resource pts
y --yes
b. FSC Certified Wood
3 Resource pts
y --yes
2. Use Treated Wood That Does Not Contain ChromiumrArsenic
1 IAO/Health pt
y --yes
3. Install House Wrap under Siding
1 IAO/Health pt
y=yes
4. Use Fiber -Cement Siding Materials
1 Resource pt
y=yes
E. Plumbing
2 Energy pts
1. Install Water Heater Jacket
1 Energy pt y:
2. Insulate Hot and Cold Water Pipes
2 Energy pts y:
3. Retrofit all Faucets and Showerheads with Flow Reducers
1 Energy pt
a. Faucets (1 point each, up to 2 points)
Up to 2 Resource
b. Showerheads (1 point each, up to 2 points)
Up to 2 Resource
4. Replace Toilest with Ultra -Low Flush Toilets
31A0/Heallh pts
(1 point each, up to 3 points)
Up to 3 Resource
5, Install Chlorine Filler on Showerhead
1 IAO/Health pt y:
6. Convert Gas to Tankless Water Heater
4 Energy pts y:
7. Install Water Filtration Units at Faucets
a. Walls
(2 points each, up to 4 points)
Up to 4 IAO/Health
8. Install On -Demand Hot Water Circulation Pump
4 Resource pts y:
r. eiecmcai
2 Energy pts
1. Install Compact Fluorescent Light Bulbs (CFLs)
1 Energy pt
(6 bulbs=2 points, 10 bulbs =3 points, 12 bulbs = 4 points)
Up to 4 Energy
2. Install IC -AT Recessed Fixtures with CFLs (1 point each, up to
1 Energy pt
5 points)
Up to 5 Energy
3. Install Lighting Controls (1 point per fixture, up to 4 points)
Up to 4 Energy
4. Install High Efficiency Ceiling Fans with CFLs
31A0/Heallh pts
(1 point each, up to 4 points)
Up to 4 Energy
G. Appliances
2 Energy pts
1. Install Energy Star Dishwasher
1 Energy pt
2. Install Washing Machine with Water and Energy
y --yes
Conservation Features
1 Energy pt
3.lnstall Energy Star Refrigerator
1 Energy pt
4. Install Built -In Recycling Center
3 Resource
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. Install Floor Insulation over Crawl Space
4 Energy pts
y --yes
3. Install Recycled -Content, Fiberglass Insulation with
No Added Formaldehyde
31A0/Heallh 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. Altemative Insulation Products (Cotton, spray -foam)
a. Walls
4 Resource pts
y=yes
o. Uemngs
4 Resource pts
y=yes
E
1*
1 Install Energy -Efficient Windows
® a. Double -Paned 1 Energy pt
b. Low -Emissivity (Low -E) t 2 Energy pts
`c. Low. Conductivity Frames 2 Energy pts
.2. Install Low Heat Transmission Glazing 1 Energy pt
J. Heating Ventilation and Air Conditioning
2 Energy pts
1. Use Duct Mastic on All Duct Joints
2 Energy pts
2. Install Ductwork within Conditioned Space
3 Energy pts
3. Vent Range Hood to the Outside
1 IAQ/Health pt
4. Clean all Ducts Before Occupancy
2 IAQ/Health pts
5. Install Solar Attic Fan
2 Energy pts
6. Install Attic Ventilation Systems
1 Energy pt
7. Install Whole House Fan
4 Energy pts
8. Install Sealed Combustion Units
3 IAQ/Health pts
a. Furnaces
3 IAQ/Health pts
b. Water Heaters
3 IAQ/Health pts
9. Replace Wall -Mounted Electric and Gas Heaters with
Through -the -Wall Heat Pumps
3 Energy pts
10. Install 13 SEER/11 EER or higher AC with a TXV
3 Energy pts
11. Install AC with Non -HCFC Refrigerants
2 Resource pts
12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace
2 Energy pts
13. Retrofit Wood Burning Fireplaces
• a. Install EPA codified wood stoves/inserts
1 IAQ/Health pt
b. Install/Replace Dampers
i Energy pt
c. Install Airtight Doors
i Energy pt
14. Install Zoned, Hydronic Radiant Heating
3 Energy pts
15. Install High Efficiency Filter
41A0/Hea1th pts
16. Install Heat Recovery Ventilation Unit (HRV)
5 IAQ/Health pts
17. Install Separate Garage Exhaust Fan
3 IAQ/Health pts
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, 2.4 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 Barder 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 pis . y=yes
3. Plant Deciduous Trees on the West and South Sides 3 Energy pis y=yes
0
1. Use Low/No-VOC Paint
2. Use Low VOC, Water -Based Wood Finishes
3. 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 Padicleboard 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
2. Use Rapidly Renewable Flooring Materials
3. Use Recycled Content Ceramic Tiles
4. Install Natural Linoleum in Place o1 Vinyl
5. Use Exposed Concrete as Finished Floor
6. Install Recycled Content Carpet with Low VOCs
Total Points Available:
Total Points Project Received:
1 AQ/Health pts y --yes 0
21A0/Health pts y=yes 0
3 3 Resource pts yy1AQ/Health pts y=yes 0
as 0
61AO/Health pts y=yes
1 IAQ/Health pts y=yes
41AQ/Health pts y=yes
4 Resource pts y=yas
1 Resource pts y=yes
3 IAQ/Health pts y=yes
8 Resource pts
y=yes
4 Resource pts
y=yes
4 Resource pts
y --yes
5 IAQMealth pts
y=yes
4 Resource pts
y=yes
4 Resource pts
y=yes
1401 1301 57
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®-- — •��
G:data/pmgslgreenbuilCmgguidelines(mmodelem/greenpointsfnal2.12.obpmtectedxls
4
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Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS: �-o (
v L4-
PERMTr # - G�/`O/��
0
OWNER'S NAME: „\,Q
PHONE
GENERAL CONTRACTOR: r,
FAX #-(a✓s- los
O �
I am not using any subcontractor 2
T Signature Date
Please check applicable subcontractors and complete the following information:
c
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
c
Owner/ Contractor Signature �— Date