08070211CITY OF CUPERTINO
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BmLDING DIVISION PERMIT
BUIL 10, RES
�T'A ICENIC BLVD
CD ROOFING
PERMITNO.
08070211
OWNER'S NAME:
PERMIT ISSUE DATE
SFIOENI'IAER RICHARD T AND
383 HUCKLEBERRY DR
07/30/2008
O:n u n n n
SANITARY NO. CONTROL NO.
(408)898-6605
ARCHITECT/Ef1GINEER:
BUILDING PERMIT INFO
'BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
9
Job Description
P
1 hemby affirm that I am Iiccuecd under provisions of Chapter (commencing
with section TOM) of Division 3 ofma Business and Prof..ssmas Code,L my licenmu
RE—RF T/O WDSHK APPLY OSB ADD 50YR LNDMK CLS A
in full farce and efhtt 9' N j
License clue (✓ Lis. O
2 5 SQ CNTRY GREY
Contractor
Dam ARCHITECTS DECLARATION
7/30/8 CD ROOFING RENWD BSL
1 understand my Plans shall be teed u public mrnrds
Liconsed Profcesional
OWNER -BUILDER DECLARATION
I hereby Affirm Nal I am exempt from the Contractor's Licenac Law for Inc
following Mason. (Section 703 1.5, Business and Professions Code: Any city M county
which requires a permit m ...vett alms, Improw, d oralish, or repair any swan.
prior m its issuance, also requires the Applicant(orsuch permit m file aligned sulemenl
to do of the Contractor's Lkcaam Law (chapter 9
Sq. Ft. Floor Area
Valuation
that M is licensed pursuant provisions
(commencing with Section 7000) W Division 3 of the Business and Professions Code) or
$7000
Oat he u exempt therefrom and On burs for tiro alleged exemption. Any violation of
pyo Number
35702005:
Occupancy Type
P Y yP
Section 7031.5 by any applicant for a Permit subjects me applicant w a civil penalty of
neem.. man Bw hundred doliera(M).
VV'
1, u owner of the property, m my employes with wages az their sole compensation,
Required Inspections
will do me work. And she aborcome is An, Enameled o,.if ..d formic (Sec. 704.1, Business
And Professions Cade: The COntrecwr's License Law does rot apply w an Owner of
property who builds or i mprova thereon, and who does such work himself or through his
awn employees. provided that such improwments am not insentient oroQereci for We. if.
howemr, me building m improvement is sold within ane year of completion, the owner-
buildm will have the burden of proving Wt Ise did net build or improw for purpose of
LIeJ.
❑ 1. a owner of the property. am exclusively contracting with licensed eman nors b
construct me pmfeel (SCC 7044. Business and Professions Cade:) The Danlracturb LI-
,
cram Law dmet not apply m an owner of property who Wilds or Improves thereon, and,
who contracts for such projects with a conlracco (s) licensed pursuant w me Contrmwr's
Liceaue Law.
I am exempt under See .B@P C for this Masan
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury arc of she fallowing declarations:
I haw and will maintain a Certificale of Conserv to self-insum far Worker'sCompen-
sation, az provided for by SCNon 3700 of me Labor Code. for me performs. Of the
week for which this permit u issued.
0 1 haw and will maintain Worker's CompenLtion Insurance, az mquimd by Section
37110 of the Labor Code. for the performance of the worts forwhich this permit is issued.
My Worker'. Compensation Wlalaance canner And Policy number Am:
Cartier. < T ft TF t J,� Policy NO.: -?- e S W 0 3 0
_
16
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu aecuon need not le completed If un permit is forone hundred dollars ($100)
or less.)
,
1 cMd y mat in me performance of me work for which this Permit is issued. I shall not
employ aoypermn In my maancr m a w become subject to the Workc& Compensation
'
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: IL after making this Cenifica , of Exemption, You should
become subject m the Worker's Compensation provisions of th. Labor Codc, you mute
comply with such previsions of this permit shall We deemed rooked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that mem is a construction lending agency for the Performance of
the work (ter which tills permit is issued (Sec. 3097, Civ. C.)
Nam.
'
Laoder't Address
1 certify mat 1 Mw read this application and stew that me above information u
I agree w comply wish all city and county ordinances and soon laws relaung lo
building construction, and herby mmoim reprommatiws of this city to enter upon the
ahave-monudgm property for inspection ms
(We) agree to Lw, indemnify And keep harmless the City of Cupertino against
and expenses which may in any way accrue againslsdd City
which
&
incoiva,jonce of ecornng
APPLICANT eUNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
-�
Issued by: Date
SOURCE REGqCA_TIONS.
N ? 1? � oX
Re -roofs �y
Signature of Applian✓Contrmwr
De
HAZARDOUS MATERIALS DISCLOSURE
Type Of Roof
Will the applicant or future building accupLlswre or handle naardous material
az defined by tee Cupertino Municipal Code. Chapmr 9.13, and the Health And Safety
Cade, Section 25533(a)?
❑Yrs t1Tj.No
All roofs shall be inspected prior to any roofing material being installed.
Will rho applicant or future building occupant use or devices which
If a roof is installed without first obtainingan inspection, I agree to remove
P g
it hvsNous air cantaminanu a defined by the Bay AMA Air Quality Managemem
A AJI Qu
all new materials for inspection.
District?
❑Yea ON.
-'
1havemalshe Was m=6aumquimmenuunderChapnr6.95ofineCalifor-
th=the WE
niaHntCkUndYhaw1tenam,
don't
dor not cuncnuY hew a nnLr, that it u MY mspouiniliry w notify tee pccapent of Nc
annoul34.1 Mnadir OfCIg
requirements which masa le at Our to issuance of a Ccrtif am of Occupancy.
Signature of Applicant. Dale
i^^/ 71-1 06
All roof coverings to be Class
g OC better
Owner Or amhor'vcd assesban,
• 3 ITEMS OF 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35702005.00
DATE ISSUED.......: 07/30/2008
RECEIPT #.........: BS000005627
REFERENCE ID # ...: 08070211
SITE ADDRESS .....: 10285 SCENIC BLVD
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT
AMOUNT
---------------
435.70
---------------
435.70
VOICE ID DESCRIPTION
-- ----------------------------
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
r�
REFERENCE NUMBER
--------------------
#1018
VOICE ID DESCRIPTION
----- ----------------------------
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
OWNER ............:
SHOENHAIR RICHARD T
AND MARGAR
ADDRESS ..........:
10285 SCENIC BLVD
CITY/STATE/ZIP ...:
CUPERTINO CA, 95014-2717
RECEIVED FROM ....:
CD ROOFING COMPANY
CONTRACTOR .......:
CHARLIE DUONG LIC
# 28245
COMPANY ..........:
CD ROOFING
ADDRESS ..........:
383 HUCKLEBERRY DR
CITY/STATE/ZIP ...:
SAN JOSE, CA 95123
TELEPHONE ........:
(408)898-6605
•
FEE ID
----------
UNIT QUANTITY
-----------------------
AMOUNT PD -TO -DT
THIS REC
NEW BAL
1BSEISMICR
VALUATION 7,000.00
------- -------
0.70 0.00
----------
0.70
----------
0.00
].BUSLIC
FLAT RATE 1.00
110`.00 0.00
110.00
0.00
1REROOFRES
SQ FEET 25.00
'•325.00 0.00
325.00
0.00
TOTAL PERMIT
---------- ----------
435.70 0.00
----------
435.70
----------
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT
AMOUNT
---------------
435.70
---------------
435.70
VOICE ID DESCRIPTION
-- ----------------------------
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
r�
REFERENCE NUMBER
--------------------
#1018
VOICE ID DESCRIPTION
----- ----------------------------
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
OF
•CUCIPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION
OJ070� /
APN #
5 ?UoZ00J CSU
Date:
,
7 oe9 0
Building Address:
10 4 Sc 1C
Lv._0
Owner's Name:
Phone #:
1 C H A lz--b 9 h10 -/✓
-6" j,-
0 - a-7- 9 c 73
Contractor:
Phone #: .+ 0 �s _ '96 & - 66 0
Q- .D R o 0 -F i tv'
Fax #:
Cupertino Business License #:
Contractor License #:
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
)i( Asphalt Shingles
Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑r 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: T A K E n F r
w o o ib st-14\Kc, APPLE 0S 8� PO i
W -D M -A I; k
� c o v N rP- y
" c L RsS -ft
Residential
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:
—1000 . 0 0
I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy:
•-
Signature
Revised 6/16/08
'��"
CUPEI,TINO
CITY OF CUPERTINO
REROOF
FEESCHEDULE
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
1REROOFCOM
Re -roof Commercial
B
1COMMLROOF
1BSEISMIC0
Seismic Commercial
B
2
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
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 reroofing
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: 9- A F -Dg fi o N +/ f}
Job Site Address: f X S S c t N i <_ V .b
Roofing Company Name: o, .D 7-p o P i N
Applicant's Signature: Date:
• Greg Casteel
Building Official
Revised 11/2/04
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 Paints Categories that must be
shown and referenced on the Project
Plans See below
.a
u ri
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 Roint
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.
h. Recycle Job Site Construction & Demolition Waste
65%=1 point; 75%= 2 points; 80%, = 4 points
up to 4 Resource
I2. Salvage Reusable Building Materials _
l 4 Resource pts
y
3. Remodel for Mixed Use, Adaptive Reuse, and
- - -
2. Use FSC Certified Wood for framing
Historic Preservation
4 Resource pts
y=
4. Protect Native Soil
2 Resource pts
y=
5. Minimize Disruption of Existing Plants & Trees
1 Resource pt
y=
6. Implement Construction Site Stormwater Practices
2 Resource pts
y-
7. Protect Water Quality with Landscape Design
2 Resource pts
y=
�r ---- La -
. Design R—esource-Efficient ndsca-pes and Gardens
4 Resource pts
y=
9. Reuse Materials/Use Recycled Content Materials
2 Resource pts
y=ye
for Landscape Areas
2 Resource pts
y=
10. Install High -Efficiency Irrigation Systems
2 Resource pts
y-
11. Provide for On -Site Water Catchment / Retention
2 Resource pts
yu
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
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1. Substitute SolidSawn Lumber with _EngineeriA Lumber
3 Resource pts
- - -
2. Use FSC Certified Wood for framing
y=Ye
(For every 10% of FSC lumber used = 2 points, up to 10)
up to 10 Resource ptE
3. Use Wood I -Joists for Floors and Ceilings
2 Resource pts
y --ye
4. Use Web Floor Trusses
2 Resource pts
y=ye
5. Design Energy Heels on Trusses 6' or more
2 Energy pts
y=ye
6. Use Finger -Jointed Studs for Vertical Applications
2 Resource pts
yye
7. Use Engineered Studs for Vertical Applications
2 Resource pts
y=ye:
S. Use Recycled Content Steel Studs for Interior Framing
2 Resource pts
y=ye
9. Use Structural Insulated Panels (SIPS)
a. Floors
3 Ener is
9Y P
Y=Ye�
b. Wall
3 Energy pts
y=ye;
c. Reoi
3 Energy pts
y=yeE
10. Apply Advanced Framing Techniques
4 Resource pts
y=ye!
11. Use Reclaimed Lumber for Non Structural Applications
3 Resource pts
y=yeE
12. Use OSB
a. Subfloors
i 1 Resource pt
y=yes
• b. Sheathing _
1 Resource pt
y=yes
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1. Use Sustainable Decking Materials
Up to 4 Energy pts.
i1. Install Water Heater Jacket - _ l
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 Chromium/Arsenic ;
1 IAQ/Health pt
y --yes
13. Install House Wrap under Siding
1 IAQ/Health pt
y=yes
14. Use Fiber -Cement Siding Materials,
1 Resource pt
Y --yes
E. Plumbing
Up to 4 Energy pts.
i1. Install Water Heater Jacket - _ l
1 Energy pt y --yes
2. Insulate Hot and Cold Water Pipes
2 Energy pts y --yes
P. Retrofit all Faucets and Showerheads with Flow Reducers
Up to 4 Energy pts.
a. Faucets (1 point each, up to 2 points)
Up to 2 Resource pts.
b. Showerheads (1 point each, up to 2 points)
Up to 2 Resource pts.
4. Replace Toiled with Ultra -Low Flush Toilets
(1 point each, up to 3 points)
Up to 3 Resource pts.
5: Install Chlorine Filter onShowerhead
1 IAQ/Health pt y=yes
6. Convert Gas to Tankless Water Heater
4 Energy pts y=yes
7. Install Water Filtration Units at Faucets
1 Energy pt y=yes
(2 points each, up to 4 points)
Up to 4 IAQ/Health pts.
6. Install On -Demand Hot Water Circulation Pump
4 Resource pts y=yes
r. eiecmcai
1. Install Compact Fluorescent Light Bulbs (CFLs)
(6 bulbs=2 points, 10 bulbs =3 points, 12 bulbs = 4 points)
Up to 4 Energy pts.
2. Install IC -AT Recessed Fixtures with CFLs (1 point each, up to
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0
5 points)
Up to 5 Energy pts.
3. Install Lighting Controls (1 point per fixture, up to 4 points)
Up to 4 Energy pts.
4. Install High Efficiency Ceiling Fans with CFLs
(1 point each, up to 4 points)
Up to 4 Energy pts.
G. Appliances
1.1. Install Energy Star Dishwasher
1 Energy pt y=yes
2. Install Washing Machine with Water and Energy
!Conservation Features
1 Energy pt y=yes
i3.Install Energy Star Refrigerator
1 Energy pt y=yes
14. Install Built -In Recycling Center
3 Resource pts y=yes
H. Insulation
1. Upgrade Insulation to Exceed Title 24 Requirements
a. Wells
b. Ceilings
2. Install Floor Insulation over Crawl Space
3. Install Recycled -Content, Fiberglass Insulation with
INo Added Formaldehyde
4. Use Advanced Infiltration Reduction Practices
5. Use Cellulose Insulation
a. Walls
b. Ceilings
6. Altemative Insulation Products (Cotton, spray-foan)
a. Walls
D. uenings
2 Energy pts
2 Energy pts
4 Energy pts
31AQ/Health pts y=yes
2 Energy pts y=yes
4 Resource pts
4 Resource pts
4 Resource pts
4 Resource ots
E
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31AQ/Health pts y=yes
2 Energy pts y=yes
4 Resource pts
4 Resource pts
4 Resource pts
4 Resource ots
E
•
1. Install Energy -Efficient Windows
• i a. Double -Paned
b. Low -Emissivity (Low -E)
c. Low. Conductivity Frames
2. Install Low Heat Transmission Gla_zj g
J. Heating Ventilation and Air Conditioning
1. Use Duct Mastic on All Duct Joints
----------- ------ -- — —'
2. Install Ductwork within Conditioned Space
3. Vent Range Hood to the Outside
4. Clean all Ducts Before Occupancy
5. Install Solar Attic Fan
6. Install Attic Ventilation Systems
7. Install Whole House Fan
It. Install Sealed Combustion Units
a. Furnaces
b. Water Heaters
9. Replace Wall -Mounted Electric and Gas Heaters with
Through -the -Wall Heat Pumps
10. Install 13 SEER/1 t EER or higher AC with a TXV
11. Install AC with Non -HCFC Refrigerants
12. Install 9D% Annual Fuel Utilization Efficiency (AFUE) Furnace
13. Retrofit Wood Burning Fireplaces
• a. Install EPA certified wood stoveslnserts
b. Install/Replace Dampers
c. Install Airtight Doors
14. Install Zoned, Hydronic Radiant Heating
15. Install High Efficiency Filter
16. Install Heat Recovery Ventilation Unit (HRV)
17. Install Separate Garage Exhaust Fan
K. Renewable Energy and Roofing
1. Pre -Plumb for Solar Water Heating
2. Install Solar Water Heating System
3. Pre -Wire for Future Photovoltaic (PV) Installation
4. Install Photovoltaic (PV) System
(1.2 kw = 6 points, 2.4 kw =12 points, 3.6 kw =1 B points)
ti. Select Safe and Durable Roofing Materials
T Install Radiant Barrier
L. Natural Heating and Cooling
1. Incorporate Passive Solar Heating
2. Install Overhangs or Awnings over South Facing Windows
3. Plant Deciduous Trees on the West and South Sides
is
1 Energy pt
Y --yes
2 Energy pts
y=yes
2 Energy pts
y=yes
1 Enerev of
v_wes
2 Energy pts
3 Energy pts
1 IAQ/Health pt
21AQ/Health pis
2 Energy pts
1 Energy pt
4 Energy pts
31AQ/Health pts
31AQ/Health pts
3 Energy pts
3 Energy pts
2 Resource pts
2 Energy pts
1 IAQ/Health pt
1 Energy pt
1 Energy pt
3 Energy pts
41A0/Health pts
5 IAQ/Health pts
31AQ/Health pts
4 Energy pts y --yes
10 Energy pts y=yes
4 Energy pts Y --yes
Up to 1 B Energy
1 Resource pt y=
3 Energy pts y_
5 Energy pts y=yes
3 Energy pts . y=yes
3 Energy pts y=yes
1. Use Low/ND-VOC Paint
1 IAO/Health pts
2. Use Low VOC, Water-Based Wood Finishes
2 IAQ/Health pts
Use Low/No VOC Adhesives _
3 IAQ/Health pts
4. Use Salvaged Materials for Interior Finishes
3 Resource pts
5. Use Engineered Sheet Goods with no added Urea
4 Resource pts
Formaldehyde
61AQ/Health pts
6. Use Exterior Grade Plywood for Interior Uses
1 IAQ/Health pts
,7. Seal all Exposed Particleboard or MDF
4 IAOJHealth pts
8. Use FSC Certified Materials for Interior Finish
4 Resource pts
9. Use Finger-Jointed or Recycled-Content Trim
1 Resource pts
10. Install Whole House Vacuum System
3 IAQ/Health pts
N. Flooring
1. Select FSC Certified Wood Flooring
8 Resource pts
L2. Use Rapidly Renewable Flooring Materials
4 Resource pts
3. Use Recycled Content Ceramic Tiles
4 Resource pts
4. Install Natural Linoleum in Place of Vinyl
5 IAQ/Health pts
5. Use Exposed Concrete as Finished Floor
4 Resource pts
6. Install Recycled Content Carpet with Low VOCs
4 Resource pts
Total Points Availab e:
Total Points Project Received:
1401 1301 57
Z7 0 0 0 •
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Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
1 0ozg J c cr/t C�, g L✓ -
PERMIT #
a
OWNER'S NAME: R f c,H -A w - jt-, t+ o c N ii -A i'?-,
PHONE # 4 o g - g - G 6 0
GENERAL CONTRACTOR:
FAX #
I am not using any subcontractors: U '. -2,5 1 0
Signature Date
Please check applicable subcontractors and complete the following information:
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
Owner/ Contractor Signature
Date