08090147CITY OF CUPERTINO+#
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BUDDING DIVISION PERMIT
CONTRACTOR IAiFQRMATON
BULLRING ADDRESS:
PERMIT NO.
L1111 STEVENS CREEK BLVD
TBD - TO BE DETERMINED
08090147
OWNER'S NAME:
PERMIT ISSUE DATE
CUPERTINO CITY OF
09/22/2008
NE:
SANITARY NO. CONTROL NO.
ARCHI ECUENGINEER:
BUILDING PERMIT INFO
BLDG ELECT FLUME MECH
0 0 0 0
LICENSED CONTRACTORS DECLARATION
Job Description
1 kmby affirm that 1 am IicevN umler provisions of Cbspur 9 (commencing
with Section 7IX ) of Division 3 of NC Business and Professions CocC.,fd my lironm is
REPLC EXTNG PACKG UNIT
in full forte and erzm
Licenm Clan t
Dau Co.
TSDECL
ARCHrIECf3 DECLARATION
1 understood my Punts anal k used u public rtmrds
-
Liccnmd Pmressianal
OWNER -BUILDER DECLARATION
1 kreby affirm Nat I am exempt from the Canuanroh luenm law for the
fallowing mason. (Section Yin L5, Business and Professions Code: Any city or county
which requires a permit W com=L alcor, improve, demolish, or repair my suucum
prior W its issumsc. also mmAns, Ilex applicant for such permit w fhlc a sillocd stlmmem
the ConuacuesLiameLaw (Chapw9
Sq. Ft. Floor Area
Valuation
that kuliccnsedpurmantbfprovisbtuaf
(commencing with Scion7000)ofDiviion3ofOnBusinessand ProfessionsCnda)or
$14000
Nat k u tempt tbcmfmm and On basis for the alleged esempuon Any violation of
Number
Occupancy Type
Section 7031.3 by M pplicam for a permit mbjzu 0u applicant W +civil penalty of
tot mom Nan five Modred dollars (55004
32629022 .'`
01,uownerofthepmpcny.amyctoplOYcewithwg utubolecompemton,
Required Inspections '
da Ile e u nal Wmndsl o 7060, Buaner
node:
ono Out a(Sec.
he Co law Out apply W rt owner of
and ons Code: The Law
profession
and Ry,
uch
propertywho Wildsorimprovu Nemon,andwho roamsuch wok hutselforIknude his
wh ms Otmors and
Own ids for
is mid wide ors,InfirouMeaoortemd
owempuym,p in gar mpm mid within one)ear of completion, the awmuL
however. On killingtuden
ase of
builder will kw On buAm of proving Nat k did rot duW a improve for purpose of
of proving;
sale.).
.
Q I. as ow. of the propmrtY. ,m eselusively conuuting with liarued contractors; u
consume Ile pojen (Sec. 7010, Bnsinm atd Pmf Sim. Code:) Tk Commis ses U.
acre law doer not apply b an owner of property who Wads or improve Nemon. and .
who contacts for such projects with a commovor(s) Ikensed poswm u Ne Conuactoss
LiceLa law.
❑ I atm exempt undo Sec�� B & P C for this mown
Owner /!!fi' Dau
ERS COMPENSATION DECLARATION
I hereby drum under penally of perjury ore of the following dsclan mal
I have aid will manuin a CouEam of Co.., in self-insme for WmImesComRn-
satan, u provided for by Section 3'100 of the labor Code. for the performm¢ of Ne
work for which Nu permit is issued.
1 have and will mountain Workefs Compemauon I..e. u mgdmd by Section
3700.fft labor Code. for the performance of the work for which Nu permit is utero.
'
My Worker's Compemauon lmunc artier and Policy numkr are:
Carer: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORREAS
COMPENSATION INSURANCE
(This suction heed ml k completed ifft p:mhit is foam chundmd dollars (SIOU)
or lc.)
I comfy that in Ne performanee of Ne work for which Nis permit is broad. l shall not
alb kenmmmMfCel l�p tC Wmlot COO,isnytpl
cmployanypermoinany M!=
t
L. ws of caifomia Da 1L2 c�� ZrCsB
Appltem 7
,
NOTICE TO : If, alum making Nu CcNOcau of Facmptioni you should
ct an IN Worker's Cmmpcn
bcconm subject most
pmvisiom of Ile lm Cade you must
y it this
forthwith comply with such proviaons m Nu permit shall k dimmed mnkd.
d
CONSTRUCTION.IsacLENDINGAGENCY
I kr by that Nem is a
3M.. Ch. agency for ton performs calf
which ed (Sec.
ton won for which ids permit u ivued (Sec. 3(197, Cir. CJ
Name
Undefs
lcndefs Address
I cenirr that I have mad this application and two that Ile akw womudon is
conttL I agree u comply with all city and county ordinances and sum laws miming W
building construction, and kmby autborim mprescnuuvcs of this city W cnmr upon Ile
+leve-mcnudgm
(an inspection purpowhich
propertycosts
(Wt:) agmc to save. indemnify antl loop barmlm Ne City of cuperno against
ms
cxwoms may in any way a¢rm against said City
inconses. quence fLkgrstsmd
ofmisXwbtcM
Aconsequence of UNDERSTANDS
AND WILL APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Z
SOURCE
Date
REGULApoNS.
Re -roofs
'�19 d
Signature ori or Good
HAZARDOUS MATERIALS DISCLOSURE
Type Of Roof
Will tk applicant or fuum building acuPmluom orhandle h,vrdam materia
r donned by to Cupcnino Municipal Cada. Chapter 9.17, and ton Health and Safety
code. cotton zss3z(n7
❑Wm pns
All roofs shall be inspected nor to an roofing material beim
P P Y g g installed.
If a roof is installed without first obtaining an inspection, I
Will tic applicant or comm banding occupant um equipment o devim which
g agree to remove P
it I mth.mr
a. air eamarines doIle med by Bay A. Air Quality Mamg.mem
all new materials for inspection.
uia7
❑Yes aw—
.
Ikon mal Ilebmadonsmwdi mWImm.ntsunderClupmr6.95of Nouifor.
nie Health & Sdety Code, Sc 6. n5D5, 25513 W M530.I mdcretmd thatifda: Wilding
docs not currently hem a taunt that it u my mtimumbilby W notify the occomml of the
regoimmrnmw'hmtan k met photo irmnaeofa ccmiricamoracopm.y.
Signature of Applicant Date
��4 �IDoz,
All roof coverings to be Class'W'
g Or better
owns on rvsd exam Dam'
CITY OF CUPERTINO
FURNACE/AC
I OF
:CUPERTINO PERMIT APPLICATION FORM
L
09090/Y7
APN # 3 o as O
Dater /Z v 0
Building Address:
2-1111 S �,—_ s (.4 F
Owner's Name:
Phone #:
Cr - Qt
c a 3Z� Z
Contractor:
Phone #:
/V E
Fax#: 1050
Contractor License #:
Cupertino Business License #:
Pg 358
Contact:
Phone#: (4�a— ? 3 3-�t/�3
PXLIL
Fax #:
Building Permit Info:
Elect Plumb [�� Mech
Residential Commercial
Job Description:
Rr A= Is c S i •�t/6 .6-C ,4 Or-- ✓�
ui`i-
For Residential Installations:
Attic ❑ ]s` floor ❑ 2nd floor ❑
Adhere to minimum setback requirement ❑
For Commercial Installations:
Replacement same weight 1� kJ Additional weight (structural c_alcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction (Usage Class):
iy, o00.- A3
Strapped On Platform Bonded El New Location Replacement
Project Size: Express ❑ Standard Large ❑ Major ❑
Valuation:
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set & the sheet index. �r
u
Revised 6/16/08
CITY OF CUPERTINO
aOF
FURNACE/AC
CUPErINO FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee
Permit Type
Group
FURNACE
FURN/AC
1MCRAA
Commercial-Repair/Alteration/Add to
M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system;incl
installation of controls regulated by this
code.
1MCREPALT
Commercial for the repair of alt/add to
M
ea heating appliance,refrigeration
unit,cooling unit,VAV boxes,
absorption unit or ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code.
1MCSUSHTR
Commercial Install/Relocate ea
M
suspended heater,recessed wall htr, or
floor mounted unit heater.
IPGASCOM
Commerical for ea gas piping System
P
1-4 outlets
113PGAS
For each gas piping system of 5 or
P
more per outlet.
1MCAPPVNT
Commercial for the install/relocate/ or
M
replacement of ea appliance vent
installed & not incl in an appliance
permit.
1BSEISMICO
Commercial Seismic
B
1MRRAA
Residential Repair/Alteration/Add to
M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by
this code.
1MRSUSHTR
Residential Install/Relocate ea
M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1 MRAPPVNT
Residential for the install/relocate/ or
M
replacement of ea appliance vent
install & not incl in an appI pennit.
Quantity
Fee ID
Fee Description
Fee
Permit Type
f
17J
CITY OF CUPERTINO
agns,
FURNACE/AC
:CUPEkTINO FEE SCHEDULE
•
Quantity I Fee ID Fee Description Fee Permit Tvne
Group
FURNACE
FURN/AC
1PGASRES
Residential for ea gas piping system of
1-4 Outlets
P
IBPGAS
For each gas piping system of 5 or
more per outlet.
P
IBSEISMICR
Residential Seismic
B
1MECPLNCK
Mechanical Plan Check
M
1MFR=<100 .
Furnace Syst <=100k BTU install or
relocate ea forced-air/gravity type
fumace/bumer, incl ducts/vents
attached to such appliance up to and
include 100,000 Btu/h
M
1MFRN>100
Furnace Syst > 100k BTU install or
relocate ea forced-air/gravity type
fumace/bumer, incl ducts/vents
attached to such appliance over
100,000 Btu/h
M
IEPERMITFEE
Electric Permit Fee
E
1MPERMITFEE
Mechanical Permit Fee
M
1PPERMITFEE
Plumbing Permit
--p-
1TRAVDOC
Travel Documentation
B
IBUSLIC
Business License
B
•
Quantity I Fee ID Fee Description Fee Permit Tvne
10-f
CUPERTINO
CITY OF CUPERTINO
FURNACE/AC
FEE SCHEDULE
0
•
0
Group
AIR
CONDITIONING
FURN/AC
1BCAIRHAN
Commercial A/C Units <= lOk CFM
B
1MCRAA
Commercial Mech Repair/alt/add
M
1BSEISMICO
Seismic Commercial
B
1 PGASCOM
Commerical for ea gas piping System
1-4 outlets
P
1 PGASRES
Residential for ea gas piping system
of 1-4 Outlets
P
1BPGAS
For each gas piping system of 5 of
more per outlet. Comm/Resid
P
1BREMAIRHAN
Residential A/C units <= I Ok CFM
B
1MRRAA
Residential Mech Repair/alt/add
M
1BSEISMICR
Seismic Residential
B
IEPERMITFEE
Electric Permit
E
1MPERMITFEE
Mechanical Permit
M
1PPERMITFEE
Plumbing Permit
P
1TRAVDOC
Travel Documentation
B
1BUSLIC
Business License
B
0
•
0
.0
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
Dints
C.
Foundation
1.
Use 15 % Flyash Concrete, (note)
S-1
--?-P
5 paints
D.
Structural
3.
Uses Wood I.loist, (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__?joints
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 Dints
G.
Electrical
4.
E. Ceiling Fans, (Note/Sp6c.)
A-3
4 points
H.
Appliances
1.
Energy Star Dishwasher, (Note/Spec.)
A-3
1 point
3.
Energy Star Refrigerator, Nate/S ec.
A-3
1 Dint
P.
Other
1.
List Green Features on Plans
A-1
1 point
TOTAL POINTS
40 points
.0
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 ReMurces Energy 1ADII-leafth
.Site
Fl. Recycle Job Site Construction & Demolition Waste
65%=1 point; 75%= 2 points; 60%= 4 points
J up to 4 Resource pts
12. Salvage Reusable Building Materials —
4 Resource pts
y=yes
3. Remodel for Mixed Use, Adaptive Reuse, and
y=ye:
2 Resource pts
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
(8. 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 is
-
B. Foundation
1. Incorporate Recycled Flyashin Concrete
. 25% Recycled Flyash = 2 points; Add 1 point for every 10%
increase of flyash, up to 5 points
2. Use Recycled Content Aggregate
3. Insulate Foundation/Slab before backfill
C. Structural Frame
!1. Subsfltute Solid Sawn Lumber with ine
Engered Lumber
2. Use FSC Conifed Wood for framing
(For every 10% of FSC lumber used = 2 points, up to 10)
3. Use Wood l -Joists for Floors and Ceilings
4. Use Web Floor Trusses
5. Design Energy Heels on Trusses 6' or more
6. Use Finger -Jointed Studs for Vertical Applications
7. Use Engineered Studs for Vertical Applications
8. Use Recycled Content Steel Studs for Interior Framing
9. Use Structural Insulated Panels (SIPS)
a. Floors
J. Wall
c. Roof
10. Apply Advanced Framing Techniques
11. Use Reclaimed Lumber for Non Structural Applications
12. Use OSB
a. Subfloors
• b. Sheathing _
V y -yes
up to 5 Resource
2 Resource pts y=
3 Energy pts y='
J 3 Resource pts y=ye
up to 10 Resource pts
2 Resource pts
y=ye,
2 Resource pts
y=ye,
2 Energy pis
y=ye:
2 Resource pts
y=ye:
2 Resource pts
y=ye:
2 Resource pts
y=ye;
3 Energy pts
y=ye:
3 Energy pts
Y --Ye:
3 Energy pts
y_=ye=
4 Resource pts
y=yee
3 Resource pts
y=ye;
1 Resource pt y=yes
1 Resource pt y=yes
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1. Use Sustainable Decking Materials
1 Energy pt , y=yes
2. Insulate Hot and Cold Water Pipes
a. Recycled content
3 Resource pts
y=yE
b. FSC Certified Wood
3 Resource pts
y=yE
;2. Use Treated Wood That Does Not Contain Chromium/Arsenic
1 IAQ/Health pt
y=yE
3. Install House Wrap under Siding
1 IAOMealth pt
y=yE
14. Use Fiber -Cement Siding Materials
1 Resource pt
y=yes
E. Plumbing
0. Install Water Heater Jacket
1 Energy pt , y=yes
2. Insulate Hot and Cold Water Pipes
2 Energy pts y=yes
�3. 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.
I b. Showerheads (1 point each, up to 2 points)
Up to 2 Resource pts.
14. Replace Toilest with Ultra -Low Flush Toilets
Up to 4 Energy pis.
i(1 point each, up to 3 points) _ _ _ _ _
_ Up to 3 Resource pts.
5. Install Chlorine Filter on Showerhead
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.
B. Install On -Demand Hot Water Circulation Pump
4 Resource pts y=yes
r. eiectricai
It. Install Compact Fluorescent Light Bulbs (CFLs)
1. Upgrade Insulation to Exceed Title 24 Requirements
;(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
2 Energy pts
5 points)
Up to 5 Energy pts.
3. Install Lighting Controls (1 point per fixture, up to 4 points)
Up to 4 Energy pis.
4. Install High Efficiency Ceiling Fans wi h CFLs
4 Energy pts
(1 point each, up to 4 points)
Up to 4 Energy pts.
G. Appliances
!1.Install Energy Star Dishwasher
1 Energy pt y=yes
I
12. Install Washing Machine with Water and Energy
4. Use Advanced Infiltration Reduction Practices
(Conservation Features
1 Energy pt y=yes
'3.lnstall Energy Star Refrigerator
1 Energy pt y=ye=.
4. Install Built -In Recycling Center
3 Resource pts y=yes
H. Insulation
1. Upgrade Insulation to Exceed Title 24 Requirements
a. Walls
2 Energy pts
y—yYes
b. Ceilings
2 Energy pts
y=yes
2. Install Floor Insulation over Crawl Space
4 Energy pts
y=yes
13. Install Racgcled-Content, Fiberglass Insulation with
No Added Formaldehyde
3 IAQ/Health 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. Alternative Insulation Products (Cotton, spray -foam)
a. Walls
4 Resource pts
y=yes
I). Uailincs
4 Resource pts
y=yes
E
l J
•
1. Install Energy -Efficient Windows
• I a. Double -Paned
b. Low -Emissivity (Low -E)
c. Low. Conductivity Frames
2. Install Low Heat Transmission Glazing
J. Heating Ventilation and Air Conditioning
'1.'Use bud 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
8. Install Sealed Combustion Units
a. Furnaces
J. Water Heaters
9. Replace Wall -Mounted Electric and Gas Heaters with
Through -the -Wall Heat Pumps
10. Install 13 SEER/11 EER or higher AC with a TXV
11. Install AC with Non -HCFC Refrigerants
12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace
13. Retrofit Wood Burning Fireplaces
a. Install EPA certified wood stovesMserts
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, 2A kw =12 points, 3.6 kw =18 points)
8. Select Safe and Durable Roofing Materials
7. 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
1 Energy pt
2 Energy pts
2 Energy pts
1 Energy pt
2 Energy pts y=yes
3 Energy pts y=yes
1 IAQ/Health of y=ye_
21AQ/Heallh pts y=yes
2 Energy pts y=yes
1 Energy pt y=yes
4 Energy pts y=yes
31AQ/Heallh pts
31AQ/Health pts
3 Energy pts
3 Energy pts
2 Resource pts
2 Energy pts
1 IAO Health pt
1 Energy pt
1 Energy pt
3 Energy pts
41AQ/Health pts
5 IAQ/Health pts
31AQ/Health pts
4 Energy pts
10 Energy pts
4 Energy pts
Up to 18 Energy
1 Resource pt y=
3 Energy pts y-
5 Energy pts y=yes
3 Energy pts , y=yes
3 Enerov ots v=ves
,1. Use Low%No-VOC Paint
2. Use Low VOC, Water -Based Wood Finishes
'3.Use Cow/No bOC'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 tiposed Particleboard or MDF
B. Use FSC Certified Materials for Interior Finish
9. Use Finger -Jointed or Recycied-Content Trim
to. Install Whole House Vacuum System
N. Flooring
1. Select FSC Certified Wood Flooring
i2. Use Rapidly Renewable. Flooring Materials
3._
3. Use Recyclzd Content Ceram--lo—Til-es-
4,
icTiles4, Install Natural Linoleum in Place of Vinyl .
5. Use Exposed Concrete as Finished Floor
6. Install Recycled Content Carpet with Low VOCs
Total Points Available:
Total Points Project Received:
1 IAO/Health pts y=yes 0
21A0/Health pts y=yes 0
31A0/Health pts y=yes 0 •
3 Resource pts y=yesH 0
61A0/Health pts
1 IAO/Health pts
41A0/Health pts
4 Resource pts
1 Resource pts
3 IAO/Health pts
8 Resource pts
y=yes
4 Resource pts
y=yes
4 Resource pts
y=yes
5 IAO/Health pts
y=yes
4 Resource pts
y=yes
4 Resource pts
y=yes
1401 130®
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CITY OF
ioM TINO
F
Buildine D
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
artment
JOB ADDRESS: PERMIT #
Zelll/ a d eo?;0�, Lc
OWNER'S NAME: f Or— PHONE # pg Z& ZS
GENERAL CONTRA OR:^/,=,roniu,0Al !/eni; n4l FAX #
I am not using any subcontractors: n;z6
Signature Date
Please check applicable subcontractors and complete the following information
64
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
Z2
Date