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08090088 CITY OF CUPERTINO BUILDINGDiVISION. PERMIT fkCOIVTJ[2A.CTQR INFQRMA.TION BUI INC A44DRESS: PERMIT NO. �750b SHADOWHILL LN STONERIDGE ROOFING 08090088 OWNER'S NAME: PERMyy ISSUE DATE GREGORY ROBERT M AND PAMELA J 2798 GLENFIRTH DR 09/16/2008 NE: -(408) 729-5101 SANITARY NO. CONTROL NO. ARCHLTECTENGUIFER: BUILDING PERMITINFO BLDG EIFCf PLUMB MECH u sea a LICENSED CONTRACTOR'S DECLARATION Job Description 4 U 1 hereby aRrm that I am limed under pmritimu of Chapk,9(mmmeming P with Sntion 7IXNB of Divisonlof the Busnw and Profcssiuns Cade,ars mylicanset RE-RF T. /O WDSHK INSTL 1/2 IN RAD OSB 30LB FLT a'�n in full fonx and eft ;pz License lea - Lie.B // CLS Date ARCHRECsS DECLARATION r A 50YR CMP 31SQ e I undearm my plans shall bo used as Public records 6 y0� Lk:raued Professional - N3 OWNER-BUILDER DECLARATION coaT10N �f 1 hetcby sMrm than 1 em exempt from the Cmvaeora License law for the COO following moan.(ECCdon 7(D I.S,Business and Profassimas Code:Any city a,county 9 9! which requires a permit to emuWc4 alk,,impmw,demullsh,en repos(any stratum, _2r micruie lssuseac.also requires the applicant for such permit to file a signed sumracnt E�G that he is licensed pursuant m din pmvieans of the Contractors liar law(Gaptm 9 Sq.Ft. Floor Area Valuation 5 (commencing with Section 7000)W Division 3 of f Business and Proktaions Cattle)or 10600 (�$ that ha it exempt therefrom and the buts for the alleged exemption.Any violation of Section 7031.5 by arty applicant far a permit anbjecu the applicant 10 a Civil penalty OfNumber Occupancy m1,a,than five Mmdred dollars M50T. 362300951YPe ❑I.uawurof the pmpmy,enmy employees with,gnu Ne"v sok mmpewtion, will at,thework and thnawctu.Is mtinmMed mortared fersak(Sec.70W,Business and Pmfctsmu Code:The Cmme mY,License law don Out apply m an awmr of Required Inspections Property who With mimpmwstheaem,and modoessuclt went himself,through WE awn employes,provided thatmelt improvement am not intended oroRered formic.a,. _ however,Ne building or impromncnt is sold within am year of completion.the owner- WikWc will law thus hard,of proving that bo did cot With or improve for purpose of sale.). ❑1.as owner of the property ma acambri,contrecting with licerued conatitma to construct the project(Sec.70sa,Business aM Profwiou Code:)Tbo Contractor's U. Cane law does not apply to an owner of property who Wilds or improve themon;and, who comncu for such gaieeu with a commaums)Rommel putwnt m use Contactors License law. ❑Ism uempu undo See .BRPCfenthisromen Owner Dau WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury ane of then following declarations: 41i haw and will maintain•Car ficate of Gnseu to selbinanre for Workers Compen. i Co.as provided far by Section 37W of the tabor Code.for the perfamana of the work for which this permit is isuM. ❑1 have and will maintain Walkers Compensation resonance,as required by Section 3700 of de tabor Code,far Ne pcsformancc of th,wort forwhich this permit is issued My Wartese.comixCuesm.lrwran¢artier and Polity numbs are; tarsier. �'/.T CIERTIFIC43'E hOF PoliNty FROM RO_IWORKERS' COMPENSATIONINSURANCE (Q (Thtacctim and cot he Comple"lithe Permit is foram hunNCd deBan(5100) or less) 1 unify then in Ne Per(amaKC of the work far which this Permit is Wood.I shall am employ any Korn in any manmrm u to becumc subject to the Workers'Compeuadon Lams of CallfOmia.Date Alpheus NOTICE TO APPLICANT:IL after making this Certificate of Exemption.you should become subject m the Workers Compensation previsions of Ne Labor Cade.you muco .J O forthwith comply with each me,t ems en Nis permit shall be deemed,caked. 'Z 7) CONSTRUCTION LENDING AGENCY - - [-i 1 berehy affirm that these to construction lending icacy for de pefformsocvof 0.! the work far which this permit tissued(Scu.3097,Civ.G) W�Q Landers Name . z Ltnde'sAddom U Q I certify Nu 1 haw mad this application aM sum that the above bormandan is "E Correct.I"ma m Comply with di City and County Ordinances and utak laws misting On .O SU^ Wilding canstuctim.and hereby anNariae,prnenutives of this city m cover upon Ne ProperIg7 ahavo-m.judgm judgments.cam fen inspection purposes (We)agree to ave,indemnify and keep harmless the City of Cupertino against ti N in f the Swung may in any my acme against aid City (,)z A cPLICANT of the granting of Nu)Cita. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /S SOURCE REGULATIONS. 44.t- 16'01' Re-roofs HAZARDOUS LS S MATERIADISCLOSURE Data Type of Roof WiBden Cupertino (mum Wildinge.Obaatawemand ft Health and Safety m,Sec by tic Cupertino Municipal Cade.Chapter 9.13.and the Health and Safety Code,QTn 35532(a)7 No All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future Wilding accvpam use equipment a devices;which If a roof is installed without first obtaining an inspection,I agree to remove it havaoaus air contaminants as defimd by tie Bay Aro Air Quality Management all new materials for inspection. 7 ❑Yn C]No I have read the hormones makriat nomthmcnt muck,chapter 6.95 of the Calif.. -is F ME co SafetyCode.AtcCvonsg5503,2myr33 sm17553q.I undersfMthuifdk Wilding GJ�,SO �yJ[7Li'� /�n don cot Sof et have•tenant.Ne h. 55 rapaui5i4.1 to notify rma ft d enirds, of tie requirement whlep must de met prior m issuaek of a Cmtificate of O,copmry. 'S(f"q R'/ bl��ii�, J-1G_08 Signatu(e of Applicant Date owner th�misa sgwi Dale 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 . . . . . . . . : 36230095 . 00 DATE ISSUED. . . . . . . : 09/16/2008 RECEIPT #. . . . . . . . . : BS000006092 REFERENCE ID # . . . : 08090088 - SITE ADDRESS . . . . . : 7506 SHADOWHILL IN SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER GREGORY ROBERT M AND PAMELA J ADDRESS . . . . . . . . . . : 7506 SHADOWHILL IN CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5052 RECEIVED FROM . . . . : SERGIO GONZALEZ CONTRACTOR . . . . . . . : SERGIO GONZALEZ LIC # 25625 COMPANY . . . . . . . . . . : STONERIDGE ROOFING ADDRESS . . . . . . . . . . : 2798 GLENFIRTH DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95133 TELEPHONE . . . . . . . . : (408) 729-5101 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 10, 600 . 00 1 . 10 0 . 00 1 . 10 0 . 00 1REROOFRES SQ FEET 31 . 00 403 . 00 0 . 00 403 . 00 0 . 0.0 ---------- ---------- ---------- ---------- TOTAL PERMIT 404 . 10 0 . 00 404 . 10 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 404 . 10 #0957 --------------- TOTAL RECEIPT 404 . 10 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF • 0,�Oq ooss CITY OF CUPERTINO REROOF CITY OF 4UPERTINO PERMIT APPLICATION APN # 3 (ea3 0 0 9-:5 , 0 o Date: / 6- Building Address: 9,SO6 S Owner's Name: Phone #: Y9.9 -25 S - y�Z U f 1 Contractor: Phone #: Fax #: Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles vKsphalt Shingles ❑ Wood Shakes ❑ Wood Shakes uWood 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: 3z sy 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: to p� I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: • S ge5j& f��h9dlP 7 Sign re Revised 6/16/08 1 CITY OF CUPERTINO Cda- REROOF ITY OF CUPERTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1RER00FC0M Re-roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Commercial B / 1RER00FRES Re-roof Residential B 1SFDWLROOF 1BSEISMICRE Seismic Residential B 1RER00FMRES 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 Raid before another inspection can be scheduled IMPORTANT: 1. Flat roofs must have a minimum of I/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: S1 eMiJ AI&SII d Job Site Address: �/)� Roofing Company Name: I-)ZsP Applicant's Signature: E 4ggii &, 76lc4 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 y Plans See below v 4i^ 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. Enerqv Star Refrigerator, (Note/Spec. A3 1oint 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. INPUT Resountes Energy IAQ/Heafth A.Site (1.Recycle Job Site Construction&Demolition Waste ^i 65°6–1 point;75%= 2 points;80%=4 points up to 4 Resource pts 0 2.Salvage 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 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 8.Design Resource-Efficient Landscapes and Gardens ___ j 4 Resource pts y=yes 0 9.Reuse Matenals/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 1 1 1 C.Structural frame - F-1 Suist tute 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 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 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 8.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0 9.Use Structural Insulated Panels(SIPS) a.Floors 3 Energy pts y=yes 0 b.Wall 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 Resource pts y=yes 0 I a.Subfloors 1 Resource pt y=yes 0 b.Sheathing • L _-- _- ---- -- — --- _ _—___-- -- 1 Resource y=yes p 1 1 1 _30 zterior Finish 1.Use Sustainable Decking Materials a.Recycled content 3 Resource pts y--yes 0 to FSC Certified Wood 3 Resource pts y=yes 0 • 2.Use Treated Wood That Does Not Contain Chromium/Arsenic 1 IAO Health pt y=yes D 3.Install House Wrap under Siding 1 IAQ/Health pt y=yes 0 4.Use Fiber-Cement Siding Materials 1 Resource pt Y--yes 0 ' E.Plumbing ri.-Install Water Heater Jacket _ __ J 1 Energy pt y=yes 0 2.Insulate Hot and Cold Water Pipes - 2 Energy pts y=yes 0 3.Retrofit all Faucets and Showerheads with Row 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 i 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 i t IAO/Health 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 6.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0 1 1 t r.tiecmcar 1.Install Compact Fluorescent Light Bulbs(CFCs) (6 bulbs 2 pbints,l0 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 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.Install Energy Star Refrigerator 1 Energy pt y=yes 0 4.Install Built-In Recycling Center 3 Resource pts y=yes 0 ---- '- -- 1 1 1 H.Insulation 1.Upgrade Insulation to Exceed Title 24 Requirements a.walls 2 Energy pts y=yas 0 b.Ceilings 2 Energy pts y=yes 0 2.Install Floor Insulation over Crawl Space 4 Energy pts y--yes 0 3.Install RecycledConsent,Fiberglass Insulation with No Added Formaldehyde _ _ ( 31AQ/Health pts,y=yes 0 4.1 Advanced Infiltration Reduction Practices 2 Energy pts y=yes 0 5.Use Cellulose Insulation a.Walls 4 Resource pts y==yes 0 b.Ceilines 4 Resource pts y=yes 0 6.Alternative Insulation Products(Cotton,spray-foam) • a.Walls 4 Resource pts y=yes 0 n.cenings 4 Resource pts y=yes 0 1 1 1 INPUT Resources Energy M0711ealth rM_nc1oow_s_ 1.Install Energy Efficient Windows a.Double-Paned 1 Energy pt y=yes . 0 • b.Low-Emissivity(Low-E) 2 Energy pts y=yes 0 c. Y--yes Low.Conductivity Frames _ _ _ 2 Energy pts es 0 2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 0 1 f 1 J.Heating Ventilation and Air Conditioning 1.Use Duct Mastic on All Duct Joints _ j 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 IAO/Health pt y=yes 0 4.Clean all Ducts Before Occupancy 2 IAO/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 0 S.Install Sealed Combustion Units a.Furnaces 3IAQ/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--yes 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 stoveslnserts 1 IAOMealth pt y=yes 0 b. Install/Replace Dampers 1 Energy pt 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 41AQ/Health pts y=yes 0 16.Install Heat Recovery Ventilation Unit(HRV) 51AQ/Health pts y=yes 0 17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes p . 1 1 K.Renewable Energy and Roofing 1 1.Pre-Plumb for Solar(Nater Heating 4 Energy pts y=yes p 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 16 Energy pts 0 I6.Select Safe and Ro Durable ofing Materials - _ _ 1 Resource pt Mes p 7.Install Radiant Barrier - 3 Energy pts y=yes p 1 L.Natural Heating and Cooling 1 1 1.Incorporate Passive Solar Heating 5 Energy pts y=yes TO -1 2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes3.Plant Deciduous Trees on the West and South Sides 3 Energy ps y=yes 1 1 1 • INPUT ResDurtes Energy 1�011­iealth M.Indoor Air Qualdy and Fmrshes ' F.Use LowMo-VOC Paint 1 [AD/Health pis y=yes 0 2.Use Low VOC WWater-Based Wood Finishes _~ 2 IAQ/Health pts y=yes 0 i3_Use Low/No VOC 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 F.Seal all Exposed Particleboard or MDF _ _ 4 IAQ/Health pts y=yes 0 S.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 D 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 1 t 1 N.Flooring 1.Select FSC Certified Wood Flooring 6 Resource pts y=yes0 2.Use Rapidly Renewable Flooring Materials _ _ 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 1 Total Points Available: 1401 1301 57 Total Points Project R 1 0 0 0 • Gaat3/prooslgreenbuildngguidzlinzsrremodeleygreenpointsfina1212.D4protaMzd.ds • Community Development 10300 Torre Avenue i kms:/ pe Crtino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 4f.UPERTINO Building De artment JOB ADDRESS: PERMIT # OWNER'S NAME: j PHONE # GENERAL CONTRACTOR: / FAX # I am not using any subcontractors: c 7—,--09� nl iyffz —T Signature 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 `e.l i �sih2l l y/6-g8 —Owner/Contractor Signature Date