08090043 CITY OF CUPERTINO ,zr v
BUILDrNb D3vlsioN PERMIT CCSNTRACTO MIiMt1TIO,N .
PERMIT NO,
BLBLp1hycg3gD,EFsJOHNSON AVE TBD — TO BE DETERMINED 08090043
OWNERS NAME: PERM11T LSSUEDATE
JAMES C ATCHISON JR TRUSTEE 09/09/2008
NE: SANTrARY NO. CONTROL NO.
ARCHr1ECT(ENGINEER:. BUILDING PERMIT INFO
fil ELECT PLUMB MECH
0 0 0 0
0 0 LICENSED CONTRACTORS DECLARATION
I demby affirm that I am licensed under provisions or Chapter 9(commencing Job Description
_ wiNSeetion)00U)ofDivision3aftheButirkvandProfcssio om,andmylkcrmis RE—RF T/0 BLT—UP & REPLC W/MODFIED BITUMEN CLS A
m N n full fame am cffat pp r
j�iZ Licence ass Lam' fY.a O 20SQ
n
� D.m ARCHITECT'S D CIARATION a **PRO 'TECH ROOFING PD FOR NEW BSL 9/9/8
U 1 uMersund my plans shall be used as public research ., -
gd
L O Ix'mad PNfeSSlaml
3
OWNER-BUILDER DECLARATION
ContrON
E F 1 hmasu .Rite that 1 am eampt from the fes l..Cw License law for the
E po following mason. erten t )0313,Buri•er. and w.de oli h.or MY city or county
m�+
which require a permit re cores the slier,improv,demolish,or repair any structure _
REprior.its censed pursu require thovisio antsof for smhpermit nice.signed shap=9
< NuhcislleenseJpurmantathcpmrisionsafthe Cantncar'allcenseLaw(CTaPm9 Sq.F[. Floor Area Valuation
xis (mmmencingwithSemon)1KIm)dt)ivWon3ofineBu:tne.� Pmre�ioeCade)or $8000
r3.- that he u b
exempt therefrom and themu To,Ne alleged emmptioe Any violation of
Section 703M by any applicant for a permit mbiccts de,epplkmt a a MAI penalty of Number Occupancy
not mart than IT.hundred dollars ane s(M). 37530024 P Y Type
❑Las owner of the property.a my moployces with cages a their sok eampenution,
wad Prtheloom,ane the heComusrotksendede awdo Tarek(Sit.RMS,wourev
and ernkasinbu ease:The conuemon.came Law Sae not apply an an owner,of _ Required Inspections
pro em lodeduildsulimprm'a dveon,andwho dossued lockhimrlfmthough his
own employoouiprovlmd that such impm sold
within
not intendedoroRergd for sale If.
builder me building or improwmrntumidwithinot yearormmovefortheowner-
ask.). will haw terns burden of pvrina dui k did rot htild or Improve for puryoae of
ask.).
❑1.as awmr of tic property.w emleinly contracting with Bccmed matracmrs to
comtmct the pmject(sec.70,15.Business and Professions Code:)The Contractor's U.
sense law dose cot apply in an oloner of property who builds or improv themon,and
whocantricu for such projects with s lcmuneror(s)licensed Pleasure to the Convene/s
Lkcex Law.
❑Iamexwptunder See ,B&PCfnrdusreasan
Owner Date
WORKERS COMPENSATION DECLARATION
I barely affirm under penalty of perjury out of dm following declamtionc
L ban and will maintain a Cnrtificataof Conan to self-usum fa WorgeYscompen-
sedan,as provided for by Section 3700 of the fader Code,for the,perform.of the
...{, work,for which this Permit is imuea.
1 ban and will maintain Worhe/s Compenution Insurance,as required by section
]00 or the labor Coke.for tic Kdomtance of the wort for which this permit u issued
My Wa s ompe rrtion lnmmrSR ami rend Polley nu D(me,
lacy e-I (
ERTIFlGMOM
- ,
Camkr. Q A FROO
OF EXEMPTION M w'ORKEA5
COMPENSATION INSURANCE
(Thu seetim reed not be cmnpkted if the permit u forme hundred dollen(SIM)
or leu)
1 curtly that in the performance of the with for which this Permit is issued.I shall nw
ernPloy any person in airy manoorm as b became subject in the Worgen'Compmuation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after malting this Cenifiam of Exemption,you abmk
become subibet in the Workles Compensation provisions of the Labor Code.you muse
.,O forthwith amply with such pm'amms w the permit shall he doomed unsold.za vy CONSTRUCTION LENDING AGENCY
[-r Thereby affirm that then is a construction lending agency for the Performance of
IY the loam for which the Permit is issued(sit.3097.Cir.C.)
ip L<nmrh Name
z L<ndersAaamss
U O 1 certify mut 1 In.mad this application and some muss the elan information is
W^ cmmct.I egrte in comply with all city and county unimar xs and sum laws mlmng in
0 lrJ' building construction,and hereby mo der n,mprraentadws of this city Is enter upon the
alavmmenuoned pmpeny for ie pecum Porch may
H y (We)agree to saw,indemnify and Imcp harmless the City of Cupertino against
Uh lialllimu,Judgments.casu and expenses which may In any wyamueaaaimtadd Cap
ane aegmn earmeam nog acro emit. Issued by: Date
► AP (CANT DERSTANDS AND WILL COMPLY WITH A L ON POINT
SOXR TIONS.
Signature of Appli=VCon DDam Re-roofs
11=10 ATERIAL9 DISCLOSURE Type of Roof
Will the applicant or rte 'Iding occupant same or handle heard..mamrial
asdeRmd by the Cupertino M cipal Cam.napmr 9.13.and the Heaith and Safety
cam,Section
es p,I Na
zss32(.))
❑Ye All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or lot=building oceupsnt use equipment m mesas which If a roof is installed without first obtaining an inspection,I agree to remove
�hvaMe air cmtamium s as defined by the Bacs? y Arta Air Quality Management all new materials for inspection.
�jk
'Lady haercmu materials mquimumms underChaper6.95ofthe Caiifor.
am,Satires LS505.25533 and25534.T undersand thaifine holding
n a tonna,that it u my rcrypmihilify be or,dear pant of mm
artmmetprioranialanaof.Cerdecalof� p�T Signature of Applicant ate
agent Olt coverings to be Class'%{."or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37530024 . 00
DATE ISSUED. . . . . . . : 09/09/2008
RECEIPT # . . . . . . . . . : BS000006032
REFERENCE ID # . . . : 08090043
SITE ADDRESS . . . . . : 10840 JOHNSON AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JAMES 'C ATCHISON JR TRUSTEE
ADDRESS . . . . . . . . . . : P 0 BOX 698
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : PRO TECH ROOFING
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 8, 000 . 00 0 . 80 0 . 00 0 . 80 0 . 00
1REROOFRES SQ FEET 20 . 00 260 . 00 0 . 00 260 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 260 . 80 0 . 00 260 . 80 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CASH 260 . 80
---------------
TOTAL RECEIPT 260 . 80
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
Okay � uy�
Rix
OF CUPERTINO
Oddix REROOF
.CUPEkTINO PERMIT APPLICATION
APN # 3-75 3 o O,? ' / I 00
Date:
Build' Address: `�
lob Z-) cz\j
Owner's Name• Rhone #:
q �S _ ' t �3 C�
`-t
7Oh� ift C_5
Contractor: c�, n Phone #: �.qu 910-39/ 7 g
\k J 2C� 1 c��r vl — I `� Fax #:
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
Al—Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) K, Other(Specify)t U,j..i' _e� _�; N 0
Number of existing coverings ❑ Provide I.C.B.O. Report #
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Descri ti n:
Residentia Commercial ❑
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation:
I Hav Read, Un erst d and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 6/16/08
Sm
CITY OF CUPERTINO
REROOF
OF
CUPEfiTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
IREROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
2 0 1RER00FRES Re-roof Residential B 1SFDWLR00F
1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08
•
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 2007 IBC Standards
and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino
municipal code 16.04.080.
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/ "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: �nh�
Job Site Address: 109,40
Roofing Company Name: Qw
Applicant's Signature: q Date:
• Greg Casteel
Building Official
Revised 07/30/08
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 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 oint
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
t
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.Srte
1.Recycle Job Site Construction&Demolition Waste i
65%=1 point;75%= 2 points;80%=4 points - up to 4 Resource pts p
,2.Salvage Reusable Building Materials _ 4 Resource pts y--yes p
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=yas 0
S. Implement Construction Site Stormwater Practices 2 Resource pts y=yes 0
7. Protect Water Quality with Landscape Design 2 Resource pts y=yes 0
- --— -
18_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 p
2.Use Recycled Content Aggregate 2 Resource pts y=yes p
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yesl;;F 0
I 1 1
C.Structural Frame
(1.Substitute Solid Sawn Lumberw th Engineered Lumber J 3 Resource pts y=yes p
2.Use FSC Certified Wood for framing
(For every 10%,of FSC lumber used=2 points,up to 10) up to 10 Resource pts. p
3.Use Wood(Joists for Floors and Ceilings 2 Resource pts y=yes 0
4.Use Web Floor Trusses 2 Resource pts y=yes p
5.Design Energy Heels on Trusses 6°or more 2 Energy pts y=yes p
6.Use Finger-Jointed Studs for Vertical Applications 2 Resource pts y=yes p
7.Use Engineered Studs for Vertical Applications 2 Resource pts 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
b.Wall 3 Energy pts y=yes p
3 Energy pts y=yes p
c.Roof 3 Enercy pts y=yes p
10.Apply Advanced Framing Techniques 4 Resource pts y=yes 0
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes p
12.use OSB — -- '
a.Subfloors , 1 Resource pt y=yes p
• It.Sheathing 1 Resource of y=yes p
! 1 !
xtenor Ffmsh n
1.Use Sustainable Decking Materials
a.Recycled content 3.Resource pts y=yes 0 .
b.FSC Certified Wood 3 Resource pts y=yes 0
12.Use Treated Wood That Does Not Contain Chromiurn/Arsenic ? 1 IAO/Health pt y=yes 0
I3.Install House Wrap under Siding 1 IAO/Health pt y=yes 0
14.Use Fiber-Cement Siding Materials 1 Resource pt y=yes 0
E.Plumbing
L,Install Water Heater Jacket J 1 Energy pt Y_—Yes 0
2.Insulate of and Cold Water Pipes 2 Energy pts Y--yes 0
13.Retrofit all Faucets and Showerheads with Flow Reducers
a.Faucets(1 point each,up to 2 points) Up to 2 Resource pts. 0
J.Showerheads(1 point each,up to 2 points) f Up to 2 Resource pts. D
,4.Replace Toilest with Ultra-Low Flush Toilets
((1 point each,up to 3 points) Up to 3 Resource pts. 0
5.Install Chlorine Filler on Showerhead 1 IAO/Health pt y=yas 0
6.Convert Gas to Tankless Water Heater 4 Energy pts y=yes D
7.Install Water Filtration Units at Faucets
(2 points each,up to 4 points) Up to 4 IAO Health pts. 0
B.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
1 1 1
r.trecmcar
11.Install Compact Fluorescent Light Bulbs(CFLs)
1(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. D
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 Slar Dishwasher 1 Energy pt y=yes 0
12.Install Washing Machine with Water and Energy
IConservation Features 1 Energy of Y--yes D
13.lnstall Energy Star Refrigerator 1 Energy pt y=yes 0
14.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 Cra\%d Space 4 Energy pts y=yes 0
�3.Install Racycled-Content,Fiberglass Insulation witli
:No Added Formaldehyde 3 IAO/Health pts y=yes D
•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 pis y=yes D •
S.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
o.t;emngs 4 Resource pis y=yes 0
1 1
indows
1.Install Energy-Efficient Wir dows
• 1 a.Double-Paned 1 Energy pt y=yes D
b.Low-Emissivity(Low•E) 2 Energy pts y yes 0
c.Low.Conductivity Frames 2 Energy pts y=yes 0
2.Insta l Low Heat Transmission Glai ng 1 Energy pt y=yes D
1 1 1
J.Heating Ventilation and Air Conditioning
1.Use Duct Mastic on ATI Duct 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/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 Energy pts y=yes D
B.Install Sealed Combustion Units
a.Furnaces 31AQ/Health pts y--yes 0
b.Water Heaters 3 IAQ/Health pts y--yes D
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 D
11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yes D
12.Install 9D%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts Y--yes D
13.Retrofit Wood Burning Fireplaces
• a.Install EPA certified wood stoves8nserts 1 IAQ/Health pt y--yes 0
b. InstalUReplace Dampers 1 Energy pt y=yes 0
c.Install Airtight Doors 1 Energy pt y=yes 0
14.Install Zoned,Hydmnic Radiant Heating 3 Energy pts y=yes D
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 Fai 3 IAQ/Health pts y=yes D
1 1 1
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar Water Heating 4 Energy pts Y--yes D
2.Install Solar Water Heating System 10 Energy pts y=yes D
3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes D
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 0
6.Select Safe and Durable Roofing Materials 1 Resource of y=yes 0
7.Install Radiant Barrer 3 Energy pts y--yes. p
11
I 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
•
INPUT Resources Energy la()Mezilth
]M. n oor Air Qua ity and imshes .
;1.Use-LOW/ND-VOCPafnt - - 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes D .
3.Use CoWI146VOC Adhesives 3 IAQ/Health 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
J.Seal all Exposed Particleboard or MDF 4 IAQ/Health pts y--yes 0
6.Use FSC CertKed Materials for Intenor 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 IAQ/Health pts y--yes D
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring B Resource pts y=yes 0
(2.Use Rapidly Renewable Flooring male—nals _ _ 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 IAO/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 Availab e: a'�C 140 130 57
Total Points Project Received: —7�, ft �l �� L 0 0 0 •
G:daarprogsigmenb�ildngguidelines/rvmodelersJgreenpointsf na1212.04prmecled.xls
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY Of Fax(408)777-3333
46UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
QJLro
OS09onq
OWNER'S NAME: --S--Oh PHONE # 10
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Si tune 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
a
R �
Owner/Contr tgnature Date