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08070117 CITY OF CUPERTINO �Y*,� «&- *'+ .t-�q7,� - BUILDING DIVISION- PERMIT CONTRAC�»TOR�INFORMATION` PERMITNO. BUILt�.I�coR}sF�NNINGTON LN BLAIR ROOFING 08070117 - OWNER'S NAME: PERMIT ISSUE DATE 11AEHNEL ROBERT B AND BARBARA 1664 CIROSS WAY 07/16/2008 IrNB; (408) 1 295-6557 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO 'BLDG ELECT PLUMB MECH trapLICENSED CONTRACTOR'S DECLARATION JbDDescription Z C 1 hucby anion that I am liceved under Provisions of Chapter 9(mmOeSCrIP mcncing <t� with Section 70f1U)of DiHilonlaftM Buvnae�and Pra(cuioru Code.and myliceucu RE-RF RMV WDSHKS INSTL 1/2" OSB INSTL LFTM WRNT afull fans,and effc9 Z Lkaaua Is.R CMPSHNGLS CLS A 21SQ ` p Dem A CHITF.CT'S DECLARATION a LC 7W7W 1 uMemand my Plaws mall be count u public woods JyU kC Licanud Pmfcuional c OWNER-BUILDER DECLARATION I MrebY sRm that I em ucmpt from the Contrmars Liernse law for the p o following mason.(Section 11171.3,Business and Profassinu Cods:Any city or county 5$ which requires a permit m construct.alkr.Improw,demoilm,or repair my swcturo 2i r^"wiuissuance.alsomquimtoapplicantforsuchpermitwrhkasigmdsukmmt pp c that ran is liccmed Pumsmtto the pmvisiou of tiro conuumra Liaxnac law(Chapn9 Sq.Ft.Floor Area Valuation Y (commencing with Session 7000)of Division 7 alum Businessand Prowasions Cade)air $95OO Q $ Nat he is eampt theefrom and the buss for the ailegod ctemptian Any violation of Section 7031.5 by airy applicant for a Permit wbjats the-VPOcatn m a Civil pwity Of A,t�T Number Occupancy rot more than five hundred dollars($500). 36203032 .•CIV' T'Pe 01,uawnsoftieproprny.mmYemployeewithveruuthakwkmm =dm, will m the wvrk-and Neswcuue u mtimended..ff.W fmaak(Scc.7 .Bu bass and professions Code The Contacmrs Lune Law door Out appy to an owner of _ Required Inspections propeny who bu ilda a improve thermn,and who does such wank himwl r ar through his Own employes,provided that Inch Impmvemmts art rot kuhwed moRemd(orsak.if. haven r.to building orimpmwmmn amid within one year of.platicn,tlm awmr- Wildm will have the Mumu of proving Nat M did Out budld Or improve for purpo ,or saw I. 0 1.as owner or the proRrty.w ea dusiwly contracting with licensed mmracmrs to muwct the project(Sec.7060.Business and Profestau Cotler)Tic Cmtnctors Li- ceue law ones not apply b an owner of property who builds or improves thermn,and, who contracts for such ,*=with aconuacbr(I)Oaued .at to the Contractors Issue law. - 0lunaemplundersco. .B&PCrmthisreawn Owner Dae WORKERS COMPENSATION OECLARATLON I hereby aRim under Notary of Perjury one of the following decimations: I have and will maintain a CettiBcaea(Consent m self-inure for workers Compere noon,u provimA for EY Bacton 1700 of the labor Cade.fm tiro peRomahh¢of tiro work for which this permit is issued. 0 1 have and will maintain Workers Corrpruation I..as tryuind by Sawn 7700ofthe labor Code.for to peffomame oftha work fawown this pemit u issued. ' My Workers Compensation luureneccartier and Policy number are: Candor. X77 OT 'I Policy Na.: O O O U 57 CERTIFICATE OF EXEMPTION FROM WO ERS COMPENSATION INSURANCE (TU.ectim toad mtbecamplexd if flan permit is froom hundred dollars($100) orku) I codify that in the perfmmanee of the work for which this permit Is Wood.l shall rot - employ any Peron in my manmfw Is to become subject m the Workers'Compeuadon Laws of Calif.run.Dau Applicant NOTICE TO APPLICANT:If,afar making this Cenirmau of Exemption,you should Wcome subjm as the Workers Compensttion provision a do labor Code,you moat .J z forthwith comply with such Provisions or this permit Nall be decmrL rewkcd. zaO CONSTRUCTION LENDING AGENCY (—h.N. 1 hereby Mr.Out them is.consugenethe uctimt lending ay fm parfoar O rmaf 01 the work for which this pemtit u mond(Sec.7(19'1,Civ.C.) W�Q Lentos Name =z Lendeh Address U C 1 cmtify that I lave road this application and sou that to above infomatiun u Ly cortacL I agree m comply wit all city and county ordinamxs and sum laws relating to C) building construction,and bereby authoua mpreenutiwa ofthis city to tour upon flu r[rd ahove.mmtioned pmpeny fan iupectia which ns f's y (We)ague to ave.indemnify and keep Nsmlett the City of Cupc dno against N ii Cadsawowmumenu,costs and ea penwswhichmgin any way¢true agilutsaid City U z mcomequrnec OftM granting of the permit. ^ APPLICANT UNDERSTANDSOL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE RE�tlt�T10�. l f Signuurt of App hcmVC r Re-roofs Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Willtoapplicant or towns ni buildinge.Chaptroremand Hasdousmaurial u mOned io the 32(.)Cupertino Municipal Code.Llupmr 9.13.and the Health and safety cam,o m zss7zfa)? All roofs shall be inspected prior to any roofing material being installed. Yes No 41Will the mi,lkan fume Wilding Oavpant=cquipmeat air mN¢s which If a roof is installed without first obtaining an inspection,I agree to remove tit huvdaus air inmu u relined by the Bay Area Air Quality Management all new materials for inspection. District? P Dy. O I haw read the har3rdaus min iaumquiamcw unmrChapmrd.95oftu Califor- nla Health&Safctyeadc,Scctiou 25305, 125371.1undcnwd WcJ17Lcbuilding does rot currenfly haw a unanL that it' my uihiliry m mtifY the aro91 t of the requimmantswhwh a"o" rmamar Signature of Applicant Date Owner on anth nrcdagent D as + All roof coverings to be Class's{v or better CITY OF CUPERTINO • 3 ITEMS OF 3 PERMIT. RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36203032 . 00 DATE ISSUED. . . . . . . : 07/16/2008 RECEIPT #. . . . . . . . . : BS000005485 REFERENCE ID # . . . : 08070117 SITE ADDRESS . . . . . : 1022 PENNINGTON LN SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . .. HAEHNEL ROBERT B AND BARBARA J ADDRESS . . . . . . . . . . : 1022 PENNINGTON IN CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4771 RECEIVED FROM . . . . : MICHAEL BLAIR ROOFI CONTRACTOR . . . . . . . : MICHAEL BLAIR LIC # 25712 COMPANY . . . . . . . . . . : BLAIR ROOFING ADDRESS . . . . . . . . . . : 1664 CIROSS WAY CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : (408) 295-6557 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL --- ------------- ---------- ---------- ---------- ---------- ---------- 1_BSEISMICR VALUATION 9, 500 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BUSLIC FLAT RATE 1 . 00 110.. 00 0 . 00 110 . 00 0 . 00 I.REROOFRES SQ FEET 21 . 00 273 . 00 0 . 00 273 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 384 . 00 0 . 00 384 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 384 . 00 #9086 --------------- TOTAL RECEIPT 384 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF • CITY OF CUPERTINO REROOF •CUPERTINO PERMIT APPLICATION APN # O U �� \ Date: I o Ad�s� Building � I U U U Owner's Name: Phone #: p g- � Contractor: _ M � � Phone #: X3 2 hod � rJ�. Fax M F Cupertino Business License #: �� ' Contractor License #: 5o TSD3 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ 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. Job Description: 1R�(MC)V�_2 W QO D O .S. B > UNVAAZ W_rVtn IY coM p 'zSWr--;G L& Residenti aVLJCommercial Lj 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: �OOuo • I Have Read, Understand and 1Will CompI with Cupertino's Tear-Off Policy: —, Signature Revised 6/16/08 CITY OF CUPERTINO REROOF P1CUPEI,TINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Commercial B 2( 1REROOFRES Re-roof Residential B 1SFDWLR00F IBSEISMICRE Seismic Residential B 1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF 1BSEISMICRE Seismic Residential B IBUSLIC 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 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 Y4 " 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: . OT Job Site Address :Po )r ) (tj Roofing Company Name: s l �,J a, tCo p Applicant's Signature: Date: • Greg Casteel Building Official Revised 11/2/04 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 MR!IMMIM B. Site 9. Install H.E. Irrigation, (details/spec)' L-1 2 points 11. Permeable Paving, Note L-1 2 oints C. Foundation 1. Use 15% Flyash Concrete, (note) S-1 5 points D. Structural 3. Uses Wood Waist, (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 cints F. Plumbing 1. Insulate all H.W.'pipes, (Nate/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.) AJ 1 point 3. Enerqv Star Refrigerator, Note/Spec. AJ 1 oint P. Other 1. List Green Features on Plans A-1 1 point TOTAL POINTS —li' 40 points Plan Review Process Work Book Page-12-Revised 325/08 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 1.Recycle Job Site Construction&Demolition Waste 65%=1 point;75%= 2 points;80%=4 points up to 4 Resource pts 0 2.Salvage Reusable Building Materials f 4 Resource pts y_-yas D 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 Stormwaler Practices 2 Resource pts y=yes 0 7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0 IB eD sign Resource-Efficient Landscapes and Gardens 4 Resource pts y=yes D 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 D 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 pis 0 2.Use Recycled Content Aggregate 2 Resource pts -y=yes 0 3,Insulate Foundation/Slab before backfill 3 Energy pts y=yes 0 1 1 1 C.Structural Frame 1.Substitute Solid Sawn Lumber with Engineered Lumber 3 Resource pts y=yes 0 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 kJoists for Floors and Ceilings 2 Resource pts y=yes D 4.Use Web Floor Trusses 2 Resource pts y=yes 0 5.Design Energy Heels on Trusses 6°or more 2 Eneroy pts Y--yes p 6.Use Finger-Jointed Studs for Vertical Applications 2 Resource pts y=yes 0 7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes 0 B.Use Recycled Content Steel Studs for Interior Framing 2 Resource pis y=yes D R.Use Structural Insulated Panels(SIPS) a.Floors 3 Energy pts y=yes 0 b.Wall 3 Energy pis 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 Resource pis y=yes 0 • a.Subfloors t 1 Resource pt y=yes D b.Sheathing 1 Resource t `---- — ------ t P y--yes 0 1 1 1 IlMIjT ReB%rces Energy [AP/Health D.Extenor mra R Use Sustainable Decking Materials % • a.Recycled content 3.Resource pts y=yes 0 b.FSC Certified Wood 3 Resource pis y--yes 0 2.Use Treated Wood That Does Not Contain Chromium/Arsenic ( 1 IAO/Hsalth pt y=yas 0 3.Install House Wrap under Siding 14 1 IACgHealth pt y--yes 0 4.Use Fiber-Cement Siding Materials i 1 Resource pt y=yes 0 E.Plumbing 1,Install Water Heater Jacket 1 Energy pt y=yes 0 2.Insulate Hot and Cold Water Pipes 2 Energy pts y=yes D 3.Retrofit all Faucets and 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 IAQ/Haalth pt y=yes 0 6.Convert Gas to Tanklass Water Heater 4 Energy pts Y--yes 0 7.Install Water Filtration Units at Faucets (2 points each,up to 4 points) Up to 41AO/Health pts. 0 S.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0 1 1 1 r.riecmcar 1.Install Compact Fluorescent Light Bulbs(CFCs) (6 bulbs=2 points,10 bulbs 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. 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 point each,up to 4 points) Up to 4 Energy pts. 0 1 1 1 G.Appliances 1.Install Energy Star Dishwasher 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 D 1 1 1 H.Insulation 1.Upgrade Insulation to Exceed Title 24 Requirements a.Walls 2 Energy pis y=yes 0 b.Ceilings 2 Energy pts Y--yes 0 2.Install Floor Insulation over Crawl Space 4 Energy pis y=yes 0 (3.Install Recycled-Conte`nt,Fiberglass-Insulatio`nwith—' � INo Added Formaldehyde 3 IAO/Health pts y=yes 0 4.Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes 0 5.Use Cellulose Insulation a.Walls 4 Resource pts y=yes0 b.Ceilings 4 Resource pts y=yes 0 • 6.Altemative Insulation Products(Cotton,spray-foam) a.Walls - 4 Resource pts y=yes 0 o.uenings 4 Resource pts y=yes 0 iNPUT Resources Energy 1AWHealth I.Windows • i.Install Energy-Efficient indows — a.Double-Paned 1 Energy pt y=yes 0 b.Low-Emissivity(Low-E) 2 Energy pts Y--yes 0 c.Low.Conductivity Frames y 2 Energy pts y=yes 0 2.Install Low Haat Transmission Glazing .1 Energy pt Y=yes 0 1 1 1 J.Heating Ventilation and Air Conditioning IT—Use Duct Mastic on All Duct Joints 2 Energy lots Y=Y es 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 D 4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 7 0 5.Install Solar Attic Fan 2 Energy pts y=yes 0 6.Install Attic Ventilation Systems 1 Energy pt Y_-Yes D 7.Install Whole House Fan 4 Energy pts y=yes 0 8.Install Sealed Combustion Units a.Furnaces 3 IAD/Health pts y=yes D b,Water Heaters 3 AQ/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 1 D.Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y=yes 0 11.Install AC with Non-HCFC Refrigerants _ 2 Resource pts Y--yes D 12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y--yes D • 13.Retrofit Wood Burning Fireplaces a.Install EPA certified wood stoves/inserts 1 IAD/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-Wire 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=18 points) Up to 18 Energy pts 0 6.Select Safe and Durable Roofing Materials I 1 Resource t y=yes L__.�------------- P Y-Y 0 7.Install Radiant Barrier 3 Energy pts Y_-Yes 0 1 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 D • 1 1 1 INPUT Resources Energy Aq/Health III . ndoor Air Qua rty and Finishes L: N 'Use Lowo VOC Paint i 1 IAQ/Health pis y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 • 3 OiJ e.Low//NoV00Adhesives ___ __ 31AQ/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 pis y--yes 0 6.Use Exterior Grade Plywood for Interior Uses _ 1 IAQMealth pts y=yes 0 [7.Seal all Exposed Particleboard or MDF ,_ _ 4IAO/Health. pts y--yes D B.Use FSC Certified Materials for Interior Finish J 4 Resource pts y--yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes D 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 t 1 1 N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 2. Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes D 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts yl—es 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 D { 1 1 Total Points Available: 1 1401 1301 57 • Total Points Project Received: 1 01 0 0 G:data/pmosrgreenbuildtngguidelinesr;emodeleNgmengoimsfma1272Nprmecledxls • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 #UPEkTINO Building De artment JOB ADDRESS: PERMIT # l b Z P l.1-t 1tN) C 7 OWNER'S NAME: PHONE # p I— L6 SZ �� CONTRACTOR: ZL FAX # 20 olr l lac � �1-6�12�'Sb7 S03 I am not using any subcontractors: ' Signature Date Please check applicable subcontractors and complete the followinginformation: 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 bin Roofing Septic Tank Sheet Metal Sheet Rock Tile • —�. � , o Owner/Contractor Signature Date