08090178CITY OF CUPERTINO&.,w�+x
RACTORINFORM'A% N
BUILDING DIVISION PERMIT
y kC x
BulL.gdttc�QDRFsT
TRINITY SPRING CT
CASTILLO' S ROOFING
PERMIT NO.
08090178
OWNERS S NAIMEL:
PERMIT ISSUE DATE
LI TOMI T AND TERESA H
1703 CATHAY DR
09/26/2008
NE:
SANITARY NO. CONTROL N0.
(408)251-3565
ARCH=fENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O O
j LICENSED CONTRACTOR'S DECLARATIONm
Job DesCTI tion
P
1 hereby aM that I mum, n licenced uudprovisions; of Chapter 9 (commencing
3 wi,b Scene. 74M) fDiOaic- 3 of the B-ai— and Prefiessims Code and my licerom 13
RE RF T/O EXT SHK APPLY 30LB FLT INST CLS A GAF
infull
ciao eerrw 9 seg 3U
CMPSHNGLS 18SQ
Dale Conucros
ARCHTIECTS DEC
1 undeanJ my plans.hall he uaud u public records
rs
' liemand Professional
S OWNER -BUILDER DECLARATION
E I lurch, aRrm that I am cxcmpl from dm Communes License law far the
ifollowing mason. (Section 7031.5, Business and Pmftwom Code: Any city or county
which ripiiru a Permit to construct alter, improve, demolish. or mpoir any structure
a prior us its muamKe.,lsa requlrs da,pllcam retouch permit us file,llgned 92mmnml
that W is licensed pursusntto We"visimu of the Committees license Law (Cbaper9
Sq. Ft. Floor Area
Valuation
(commewing with Section 7") of Division 3 of dm Busincurand Profusions Cwc) w
$8000
.- dict he is exempt therefrom and the hunts for the alleged caemylion Any violation of
Occupancy Type
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil Penalty ofNumber
not mom dam five hundreddollars(Ss00)
366530451
I, a owner of the pmpery, car my wployees with wages u there sok campcwdon,
Required Inspections
will do the wort, and demo mm Is not Intended OfaQemd rofaile(gee. 7W. BusineO
and prefessious Code: Tia Comeames Liceme law does an, apply to in owner of
proponty who builds crimproes Nueoe. and wMdouauclm wast hineuirorWmu66 his
.
owo employees, provided that such Improvements art not Intended cautioned forst e. If.
however. the building or improvement is sold wattle oma year of completion. the owner.
builder will have f burden of proving that he did rot build or improve for purpose of
a e.).
❑ 1. es awwr or the property, am exclusively contracting with lbewe mntrct u s to
consuscn die project (Sec. 7060. Business and Professions Cade:) Tic Conmemra U.
,
were Law does not apply to an miner of property who builds or improver thereon, and,
who contracts; for such projects with a contratmr(s) licensed protean to the Canucmrs
Licence Law.
O l am exempt under See , B k P C for this mason
Owner Dam
WORKER'S COMPENSATION DECLARATION
I herby aBim under pttWty of perjury, etc of the fallowing dwluatiane
haw and will maintsin a CeniOoteof Cousent m self-imme for Wortees Comped-
sadna, as provided for by Section 3700 of the Labor Code, for the Performance of the
work for which this permit is burned
❑ 1 have and will maintain Workers Compensation luswanm, as requited by section
-
for which this hermit is ued
3700 of use Labor Cade. for the paRormanwof am wort ia
,
My WorkersC mlteneation Wumumu and Policy number am:
Cae/a—�kM Policy Na:.2 Oele 31
CERTIFICATE OP ILKEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Doris secdw wed not bis completed if the Permit is foram buudred dollars (5100)
or kis)
1 conafy that in We pmforma ee of the rah for which this Permit is issued, 1 shall net
employ any person in any marecr so as to become mbjeet to the Wortmi Compensation
Laws of California. Dam
Applicant
_
NOTICE TO APPLICANT: IL after making Nu Cervi iicate of Esmnption, you should
become subject to the Workers Compensation provisions of the labor Code. you most
>. forthwiih comply with such provisions or this permit shall be deemed raked.
CONSTRUCTION LENDING AGENCY
ON10NLENDINGAGENCYj
2
I herchyaNthi Wu them aa cten lending agery for thprfortnan¢ of
Lao wrk for which Nis permit u issued (Sec.. 31197, Civ, C.)
Lenders Name
� Lancer, Aadrcn
1 modify that 1 have nad this, application and sum this the show information is
'
coma. I agree to comply with all city and county ordinarmes and sale Int robbing in
building construction, and hereby and odor mpree adws of this city to enter upon We
.boas-muntiowd property for impectime purposes
, indemnify and hornless dm CITY or Cupenn agaiusl
(We) agree be Lw, ud tropin
n
liabiliisa.judgments. toss and upmuu which may in any'w'ay aeonue agmul said City
in comegwwe or the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE R TI S. 261�e�
SZ=Re-roofs
Type of Roof
nammo App onlramor Data
HAZARDOUS MATERIALS DISCLOSURE
Will dm applicant or future building weup,nt sore or handk hamdau material
u defined by thiCuponino Municipal C . Cluplef 9.12, aM die HesIN cud Sdtty
Code. suien 25532(,)P
❑ Yu o
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection, I
Will thea leant an rami Wilding oxer ant tete
PP g p equipment car devices which
agree to remove
P g
t ha'.? m . air cem�imnts u defined by the Bay Area Air Quality Mamgemenl
all new materials for inspection.
O /
❑Yes O�
Lha e road Lk crusu.luChapter G93afdc Gla(
SafoyCdaSd n5W.5533r umfmmmde WildingUy
dosbutmarafctYCve-hism, 2
yAy/
it is mysW2s331.1
responsibility occupfftant
w nobly dr arupwt of do
does trot emrenay have ,mmol this It u myermine
mquircments whit run be r'Cl.priarteiurmancc aracemfiS,a�tm`OcSppwm�
C
[�Pgnature' of Applicant Date
All roof coverings to be Class 'Rv or better
gainer ora thorvcd arc Dale -
• 2 ITEMS OF 2
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36653045.00
DATE ISSUED.......: 09/26/2008
RECEIPT #.:.......: BS000006206
REFERENCE ID # ...: 08090178
SITE ADDRESS .....: 11812 TRINITY SPRING CT
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
OWNER ............: LI TOMI T AND TERESA H
ADDRESS ..........: 11812 TRINITY SPRING CT
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-5146
RECEIVED FROM ....: CASTILLO'S ROOFING
CONTRACTOR .......: JOSE CASTILLO LIC # 25850
COMPANY ..........: CASTILLO'S ROOFING
ADDRESS ..........: 1703. CATHAY DR
CITY/STATE/ZIP ...: SAN JOSE, CA 95122
TELEPHONE (408)251-3565
• FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
------------------------------------- ------------------------------
1BSEISMICR VALUATION 81000.00 0.80 0.00 0.80 0.00
1REROOFRES SQ FEET 18.00 234.00 0.00 234.00 0.00
TOTAL PERMIT : 234.80 , 0.00 234.80 0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT
AMOUNT
---------------
234.80
---------------
234.80
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
REFERENCE NUMBER
--------------------
#15371
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
;(t.
CITY OF
•CUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION
oe09 J/7?
APN #3 � 6,, S3 O y S a6
Date:
Building Address:
[ r'ini
c—
c� j2 r- r) C .
Owner's Name:
Phone #:
I
q
Contractor:
Phone #:
II
Fax #:
Cupertino Business License #:
t
Contractor License #: .
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
VAsphalt Shingles
dir Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings
❑ Provide I.C.B.O. Report #
w�`To be Removed
❑ Provide Mfgr. Installation Specs.
Job Description: ---TSA 'F -qE
fi �z� � �, �Np Pa y 36 Ib pe r
,
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: 3. ( R J(J F\�
i� l
I Have Read, filnderstand and Will Comply with Cupertino's Tear -Off Policy:
Revised 6/16/08
gamul-,
O
CUPEkTINO
CITY OF CUPERTINO
REROOF
FEE SCHEDULE
0
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
1RER00FC0M
Re -roof Commercial
B
1COMMLROOF
1BSEISMICO
Seismic Commercial
B
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
0
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/a " 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:
Job Site Address:
Roofing Company Name:
Applicant's Sign
• Greg CasteeiL
Building Official
Revised 07/30/08
Date:
is
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
2 points
C.
Foundation
1.
Use 15 % Flyash Concrete, (note)
S-1
5 points
D.
Structural
3.
Uses Wood ]-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.
A4
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 nt
P.
Other-
1.
List Green Features on Plans
A-1
1 nt
Epo
MMMMUM
TOTAL POINTS
40nts
is
Plan Review Process Work Book Page -12-Revised 3/25/08
i 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.
11. Recycle Job Site Construction & Demolition Waste
1. Substitute Solid Sawn Lumber with Engineered Lumber
65%= 1 point; 75%= 2 points; BO%= 4 points
up to 4 Resource pts
2. Salvage Reusable Building Materials
4 Resource pts
y=yes
3. Remodel for Mixed Use, Adaptive Reuse, and
2 Resource pts y:
4. Use Web Floor Trusses
Historic Preservation
4 Resource pts
y=yes
4. Protect Native Soil
2 Resource pts
y=yes
5. Minimize Disruption of Existing Plants 8 Trees
1 Resource pt
y=ye=.
6. Implement Construction Site Stormwater Practices
2 Resource pts
y=yes
7. Protect Water Quality with Landscape Design
2 Resource pts
y=ye=-
S. 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=ye=.
11. Provide for On -Site Water Catchment / Retention
2 Resource pts
y=yes
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
1. Substitute Solid Sawn Lumber with Engineered Lumber
3 Resource pts y:
2. Use FSC Certified Wood for framing
y=yes
(For every 10% of FSC lumber used = 2 points, up to 10)
up to 10 Resource
3. Use Wood I -Joists for Floors and Ceilings -
2 Resource pts y:
4. Use Web Floor Trusses
2 Resource pts y=
5. Design Energy Heels on Trusses 6' or more
2 Energy pts y=
6. Use Finger -Jointed Studs for Vertical Applications
2 Resource pts y=
7. Use Engineered Studs for Vertical Applications
2 Resource pts y:
6. Use Recycled Content Steel Studs for Interior Framing
2 Resource pts y:
9. Use Structural Insulated Panels (SIPs)
a. Floors
3 Energy pts
y=yes
b. Wall
3 Energy pts
y=yes
c. Roof
3 Ener is
Energy
y=yes
10. Apply Advanced Framing Techniques
4 Resource pts
y=yes
11. Use Reclaimed Lumber for Non Structural Applications
3 Resource pts
y=yes
T( OSB
a. Subfloors
1 Resource pt
y=yes
• b. Sheathing __
1 Resource pt
y=yes
a. Recycled content
b. FSC Certified Wood
Use Treated Wood That Does Not Contain Chromium Arsenic
Install House Wrap under Siding
Use Fiber -Cement Siding Materials
3 Resource pts
y=yi
3 Resource pts
y=yi
1 IAQ/Health pt
y=y(
1 IAQ/Health pt
y=yi
1 Resource pt
y=yes
E. Plumbing
1. 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
2 Energy pis
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 Toilest with Ultra -Low Flush Toilets
3.Install Energy Star Refrigerator
j(1 point each, up to 3 points) _ _
Up to 3 Resource pts.
5. Install Chlorine Filter on Showerhead
1 IAO/Health pt y=yes
6. Convert Gas to Tankless Water Heater
4 Energy pts y=yes
7. Install Water Filtration Units at Faucets
4. Use Advanced Infiltration Reduction Practices
(2 points each, up to 4 points)
Up to 4 IAQ/Health pts.
8. Install On -Demand Hot Water Circulation Pump
4 Resource pts y=yes
- t-. r:recmcai -- - -
F. Install Compact Fluorescent Light Bulbs (CFLs) ,
y=yes
(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 pis
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
3.Install Energy Star Refrigerator
(1 point each, up to 4 points)
Up to 4 Energy pts.
G. Appliances
1 Energy pt
y=yes
1. Install Energy Star Dishwasher
I2. Install Washing Machine wth Water and Energy
a. Walls
2 Energy pis
y=yes
Conservation Features
2 Energy pis
1 Energy pt
y=yes
3.Install Energy Star Refrigerator
y=yes
1 Energy of
y=yes
4. Install Built -In Recycling Center
i 3 Resource pts
y=yes
H. Insulation
1. Upgrade Insulation to Exceed Title 24 Requirements
a. Walls
2 Energy pis
y=yes
b. Ceilings
2 Energy pis
y=yes
2. Install Floor Insulation over Crawl Space
4 Energy pts
y=yes
3. Install Recycled -Content, Fiberglass Insulation with
No Added Formaldehyde
_j 3 IAQ/Health pts
y=yes
4. Use Advanced Infiltration Reduction Practices
2 Energy pis
y=yes
5. Use Cellulose Insulation
a. Walls
4 Resource pis
y=yeE
b. Ceilings
4 Resource pts
y=yet
6. Alternative Insulation Products (Cotton, spray -foam)
a. Walls
4 Resource pts
y=yep
o. Cewngs
4 Resource pts
y=ye:
ll
t
i
•
4 . windows
I1. Install Energy -Efficient Windows
a. Double -Paned 1 Energy pt
b. Low -Emissivity (Low -E) 2 Energy pts
c. Low. Conductivity Frames 2 Energy pts
f Install Low Heat Transmission Glazing 1 Energy of
J. Heating Ventilation and Air Conditioning
2 Energy pts
y=yes
j1. Use Duct Mastic on All Duct Joints --
y 2 Energy pts
y=yes
2. Install Ductwork within Conditioned Space
3 Energy pts
y=yes
3. Vent Range Hood to the Outside
1 IAQ/Health pt
y=yes
4. Clean all Ducts Before Occupancy
2 IAQ/Health pts
y=yes
5. Install Solar Attic Fan
2 Energy pts
y=yes
6. Install Attic Ventilation Systems
1 Energy pt
y=yes
7. Install Whole House Fan
4 Energy pts
y=yes
8. Install Sealed Combustion Units
3 IAQ/Health pts
y=yes
a. Furnaces
31AQ/Health pts
y=yes
b. Water Heaters
3 IAQ/Health pts
y=yes
9. Replace Wall -Mounted Electric and Gas Heaters with
Through -the -Wall Heat Pumps
3 Energy pts
y=yes
10. Install 13 SEERM 1 EER or higher AC with a TXV
3 Energy pts
y=yes
11. Install AC with Non -HCFC Refrigerants
2 Resource pts
y=yes
12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace
2 Energy pts
y=yes
13. Retrofit Wood Buming Fireplaces
a. Install EPA certified wood stoveslnserts
1 IAQ/Health pt
y=yes
b. Install/Replace Dampers
1 Energy pt
y=yes
c. Install Airtight Doors
1 Energy pt
y=yes
14. Install Zoned, Hydronic Radiant Heating
3 Energy pts
y=yes
15. Install High Efficiency Filter
41AQ/Health pts
y=yes
16. Install Heat Recovery Ventilation Unit (HRV)
5 IAQ/Health pts
y=yes
17. Install Separate Garage Exhaust Fan
3 IAQ/Health pts
y=yes
K. Renewable Energy and Roofing
1. Pre -Plumb for Solar Water Heating 4 Energy pts
2. Install Solar Water Heating System 10 Energy pts
3. Pre -Wire for Future Photovoltaic (PV) Installation 4 Energy pts
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
[!_Select Safe and Durable Roofing Materials —� 1 Resource pt y=yes
7. Install Radiant Barrier 3 Energy pts y=yes
L. Natural Heating and Cooling
1. Incorporate Passive Solar Heating 5 Energy pts y=yes
2. Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes
3. Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes
E
1`UseLow/No-VOCPeint
11AQ/Health pts
y=yes
2. Use Low VOC, Water -Based Wood Finishes
2 IAQ/Health pts
y=yes
Use Low/tJo VOC Adhesives
3 IAQ/Health pts
y=yes
4. Use Salvaged Materials for Interior Finishes
3 Resource pts
y=yes
5. Use Engineered Sheet Goods with no added Urea
5 IAQ/Health pts
y=yes
Formaldehyde
61AQ/Health pts
y=yes
6. Use Exterior Grade Plywood for Interior Uses
1 IAQ/Health pts
y=yes
7. Seal all Exposed Particleboard or MDF
4 IAO/Health pts
y --yes
8. Use FSC Certified Materials for Interior Finish
4 Resource pts
y=yes
9. Use Finger -Jointed or Recycled -Content Trim
1 Resource pts
y=yes
10. Install Whole House Vacuum System
3IAQ/Health pts
y=yes
N. Flooring
1. Select FSC Certified Wood Flooring
8 Resource pts
y=yes
2 Use—Rapid y Renewable Flooring Materials
4 Resource pts
y=yes
3. Use Recycled Content Ceramic Tiles
4 Resource pts
y=yes
4. Install Natural Linoleum in Place of Vinyl -
5 IAQ/Health pts
y=yes
5. Use Exposed Concrete as Finished Floor
4 Resource pts
y=yes
6. Install Recycled Content Carpel with Low VOCs
4 Resource pts
y=yes
Total Points Avalla le:
Total Points Project Received:
AQ/HeaHh
r
1401 1301 57
01 01 0
G:datalpr Slgreenbuildingguidellneslremodelerslgreenpoimsfinal2.12.04proleded.xls
Is
Community Development
10300 Torre Avenue
-fl"�' Cupertino CA 95014
Telephone (408) 777-3228
CITY OF Fax (408) 777-3333
•CUPER,TINO
Building Department
is
JOB ADDRESS:
I M2- Trini-} Sprinscf,
PERMIT #
Okc 2 O / %,t'
OWNER'S NAME: -T-c- r e S n L;
PHONE #(40&)..2,5 -3 S
GENERAL CONTRACTOR: 5 1 1 LL S O i
FAX #
I am not using any subcon s:
Signature Date
Please check applicable subcontractors and complete the following infnrmaHnn-
Owner/ Contractor Signature
e? —C;) C)vLY
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
Tye
Owner/ Contractor Signature
e? —C;) C)vLY
Date