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08050127 (2) CITY OF CUPERTINO �*,� yrr BUILDING DIVISION• PERMIT tCONTRACTORINF,OI.tMA.'fI(Ql g BUIIDN IJ FSS' PERMIT No. i8g9� S BLANEY AVE TBD – TO BE DETERMINED 08050127 rNER'S NAME: PERMIT ISSUE DATE ABERG HENRIK E AND FARANGIS 05/15/2008 PHONE!" SANITARY NO. CONTROL NO. ARCHITECUPNGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 uOp LICENSED CONTRACTOR'S DECLARATION lob Desert tion 4 U F 1 bereby affirm that I am licensed under innwianes of Chap=9(commercing P wmSc.don7(Xah.fDi,ism 3ofthall nesaaMPm'05f "ov;ode,aMm rcmanis RE–RF, RMV EXTNG RF& INSTL 1/2"CDX n in fall force aM Sq= Lice.:n — uv.. PLYWD–INSTL36"30" Date cxrrEcrsD�b1 LBS ASTM FLT, INSTL CRTEEED PRESDTL FIBRGLS f � undersand my piano"I W usW as public rerorth S HNGLS oau s G Licensed Professional 3 OWNER-BUILDER DECLARATION iE I hereby a1Erre that I am acmpl from the ConuacmYs License Law for the 00 following won.(Section 7031.5,Busincu and Pmressivns Cade:My city ter county $ which requires a Permit an cnwnct,ahem.imimm,s.demdhah,or repair any sound. prior to its issuance.also requires;Ne applicant forsuch permit en file a signed sbamcni < that Wislicensed Pur,namwthe provisions ofLam conu:mraLxerenLaw(Chapter 9 Sq.Ft. Floor Area Valuation �s (commencing with Sesdot700o)of Dwivm.3 of the Buslrcv and Profwimu Code)Or $18000 `i this W I.mutant Nccofmm and the but,for Ne alleged..pd..My vbd d m or section 7031.5 by arty spplltlm for a permit sobjeN the applicNl to a civil penally of Ay Number not.dwnfi.nhundreddolws(S5fOccupancy 0n 36932061 P Y Type Q L u mmer of the property,m mY eoPlayw with wages u thev sok emnpcwtion. w m the wart and the,mnnnre u outdedded Or offered far ads(Sec.70".Buaiess and Pmmssions Code:The Contravenes Limme Law does not apply to an owner of Required Inspections property who wiles ter improv,theman,and who nonesuch went himself ter through his awe cmployw.povlmd that such imPo urmo s are Out irmnded mo0am forsake.If. kawewe the building or impmwmrst Is Bald within one year a(completion.the owner. Wilder wiB haw the burden Of moving that W did Out Will a impow for purpoz of rale.). Q 1,as Owner of the popes,,am exclusively contracting with Ecensed contractors to cmuwn me project(Sec.7004,Business,add Po(essiou Code:)The Costumers U, mean Law does not apply N an owner of property who Wild$or improv themon,and who comae,for scale projems with a contractor(s)licensed pmsunt In the ConuauMs License law. Q lam exempt under See ,B ink P C forthis reason W Data WORKER'S COMPENSATION DECLARATION 1 Wromy afrim under penalty O(perjury one of the following declarations: e Thaw andwlcud For nb SuCcrdfi7M ofCe Labor self-huurtfm WarkdaCofthe shoe,r maw;xd ren mi is isrn na or the Labor cam.ren the perrarmuee or the work for which Nu Permit is iauN. ❑I haw aM will mainuin Workers Compensation Insurance,as tubed by Section 37M.fthe labor Code,for the penformaceof Ne walk for which this permit Is issued. ' My Work aCompeua'on lnsumce,carrier and Policy number Carni Polity Na.. CERTIFICATE Ofy An0lNEMPTION FROM WORKERS' COMPENSATION INSURANCE , (hisseedan need net he com icam Ulan,permit is foronebundsed mRan(glOD) or leas) 1 certify Nat in sic performance of the work for which this permit a Inste-d,l shall non employ any peso.in any manner sin as W Ismomc subject to Ne Woulacy Comperamm. Laws of CallreWa.Dab Appliam NGnCE TO APPLICANT:IL after making this Condition of Eacreption.You should baome tubjw in me workers Compenaimn provisions of the LAbor Code,you mus .,O fmNwith comply with such pmHsioo m NU permit shall he camel rooked. z ""' CONSMUCGON LENDING AGENCY F 4 Ihereb a M.dart siert u a..ties kMin^ r g. mor the penrmmame or C' the work for which sit,permit 4 lamed(Sec 3097,Civ.C.).)z Lenders Name ::l �z IendehMdw U O 1 carer,that 1 haw mW Wa application and ffib dead the show in(mm.don U II. ^' eortect 1 agree o comply with all city and county oNimocen and vas laws minting in C)CSR^ building construction.and hereby mNoriu mpmunlauw of Nu city in order upon Nc dell .hove-mentioned popery fm inspection pm-P. gy (We)agree to saw,indemnify and deep harmless tle City of Calandra agaiml Cf/1 liabilities.judgments.toss and expcoses which may in any way ucoc agalmt said City ,),'L mconsal f ft granting of Wspermh. ^ APPLICA NDERSTANDS AND WI COMPLY LL NON-POINT Issued by:. Date SOUR GULATIONS. Re-roofs �— Si uuu of AppliaHAZARa:enr D HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building ottvpantarem m lundlc huallou maoriW defined by sic Cupertino Municipal Calc.Chapter 9.11.and sic Health and Safety . Cl Y.23531(x)? All roofs shall be inspected nor to an roofing material bei. Cl Y. d P P Y g g installed. If a roof is installed without first obtainingan inspection,I agree to remove Will u a air ci ant or us defining by ft B y A equipment or derive which P emit hvaNnns air conaminsn—u�u�/mfiad by Ne Bay Arta Air Quality Management all new materials for inspection. Diwima 1Y1O P QYo I haw mal the Wood.mamrials o p,m mems under Chaper695 oftheCalifm- maHeal"Saf yebdn Swdw235o5,25533a 25534.1undcmatl NaifNe budding tae net cu haw a mount,that it no maponsibil1 b 'fy de occupant f the require des must L cmc of c ear Signature of Applicant Date Owner or authamcd1 Dae I 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 . . . . . . . . : 36932061 . 00 DATE ISSUED. . . . . . . : 05/15/2008 RECEIPT #. . . . . . . . . : BS000004783 REFERENCE ID # . . . : 08050127 SITE ADDRESS . . . . . : 10275 S BLANEY AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . OWNER . . . . . . . . . . . . : ABERG HENRIK E AND FARANGIS TR ADDRESS . . . . . . . . . . : 10275 S BLANEY AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3188 RECEIVED FROM . . . . : BAY AREA RE-ROOFING CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , . TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY . AMOUNT PD-TO-DT THIS REC NEW BAL ------- -------- ---------- ---------- ------- -------- ---------- 1BSEISMICR VALUATION 18, 000 . 00 1 . 80 0 . 00 1 . 80 0 . 00 1REROOFRES SQ FEET 32 . 00 416 . 00 0 . 00 416 . 00 0 . 00 TOTAL PERMIT 417 . 80 0 . 00 417 . 80 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 417 . 80 #09221 --------------- TOTAL RECEIPT 417 . 80 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF • CITY OF CUPERTINO RECEIPT NUMBER: BS000004782 RECEIVED BY: PATRICIAG PAYOR: BAY AREA RE-ROOFING TODAY' S DATE: 05/15/08 REGISTER DATE: 05/15/08 TIME: 08:21 1 BUSINESS LICENSE TAX BAY AREA RE-ROOFING BSL $110 . 00 ---------------- TOTAL DUE: $110 . 00 CHECK $110 . 00 REF NUM: #09220 TENDERED CHANGE $110 . 00 $ . 00 • • W105 0/.27 CITY OF CUPERTINO ;(C., REROOF kUPERT - INO PERMIT APPLICATION APN # 3 03 � 0 J 1. O v Dat Bu'Idin Address: c0 �G Owner's Name: Phone #: W-2f.�_ /- z Contractor: � Phone Fax # Cupertino Business License #: Contractor License # Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles s�Asphalt Shingles ood 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: R2�;(�1/257 4A55</� �, �'+vyid� L43�1 rf3711w � Gu�''iE1 LL Residential Commercial Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the there are any restrictions: ❑ application or if applicable, include in plan set & the sheet index. Valuation: • I Have Read, Un tand and Will Comply with Cupertino's Tear-Off Policy: Signature CITY OF CUPERTINO - REROOF CITY OF �CUPERTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1RER00FC0M Re-roof Commercial B 1COMMLROOF IBSEISMICO Seismic Commercial B ,L IREROOFRES Re-roof Residential B ISFDWLROOF 1BSEISMICRE Seismic Residential B 1REROOFMRES Re-roof Multi-Family B IMFDWLROOF IBSEISMICRE Seismic Residential B I 1BUSLIC Business License B 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 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: Job Site Address: Roofing Company Name: Applicant's Signature: Dat �y� V • 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 ^* Y 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. Enercly Star Refrigerator, (No te/Spec. A-3 1 point P. Other 1 1. List Green Features on Plans A-1 1 point TOTAL POINTS1 40 points Z�s r Qr % • 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. A.Site F65% ycle Job Site Construction&Demolition Waste 1 point;75%= 2 points;BOV°=4 points � up to 4 Resource pts 0 . age 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 6.Implement Construction Site Stormwater Practices 2 Resource pts y=yes 0 7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0 R.Design Resm rce-Efficient Landscapes andGardens i7 4 Resource pts y=yes 0 9.Reuse Materials/Use Recycled Content Materials for Landscape Areas 2 Resource pis y=yes . D 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 Flyashin 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 D 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. p 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 p 7.Use Engineered Studs for Vertical Applications 2 Resource pts y--yes 0 B.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 p 3 Energy pts y=yes 0 10.Apply Advanced Framing Techniques 4 Resource pts y=yes D 11.Use Reclaimed Lumber for Non Structural Applications l 3 Resource pts y=yes 0 aOSB ----- - --,- . I a.Subfloors 1 Resource pt y=yes p b.Sheathing _ 1 Resource pt y=yes 0 1 1 1 D.Exterior Finish i-1. se Sustainable becking Materials a.Recycled content 3.Resource pts y--yes 0 b.FSC Certified Wood 3 Resource pts y--yes 0 J 2.Use Treated Wood That Does Not Contain Chromium/Arsenic i 1 IAD/Health pt y--yes 0 3.Install House Wrap under Sidng f 1 IAQ/Health pt y=yes 0 4.Use Fiber-Cement Siding Materials 1 Resource pt Y_-Yes 0 1 ! 1 E.Plumbing l Install Water Heater Jacket 1 Energ _ J y of Y=Yes D 2 Insulate Hot and Cold Water Pipes _ _ 2 Energy pts y=yes 0 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) J Up to 3 Resource pts. 0 5.Install Chlorine Filter on Showerhead 1 IAQ/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 S.Install On-Demand Hof Water Circulation Pump 4 Resource pts y--yes 0 1 1 1 r-.riecrrmcar 1.Install Compact Fluorescent Light Bulbs(CFLs) i • (6 bulbs=2 points,10 bulbs point212 bulbs=4 point's) Up to 4 Energy pts. D 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 Calling Fans with CFLs (1 point each,up to 4 points) Up to 4 Energy pts. 0 1 1 1 G.Appliances 1.install Energy StarDishwasher 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 Refdgerator 1 Energy pt y=yes D 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_-Yes 0 b.Ceilings 2 Energy pts y=yes 0 2.Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0 3.Install'RecycledContent,Fiberglassatlon w lnsulith [NoAddedFormaldehyde _ ) 31AQ/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-y,es 0 • b.Ceilings 4 Resource pts y=yes 0 6.Alternative Insulation Products(Cotton,spray-foam) a.Walls 4 Resource pts y=yes 0 D.Cemngs 4 Resource pts y=yes 0 1 1 INPUT Resources Energy I.WIndDws 1.Install Energy-Efficient Windows _ E a.Double-Paned 1 Energy pt y--yes D b.Low-Emissivity(Low-E) 2 Energy pts Y--yes 0 c.Low.Conductivity Frames 2 Energy lots y=yes 0 2.Install Low Heaf Transmission Glazing 1 Energy pt y=yes D 1 1 1 J.Heating Ventilation and Air Conditioning (1.Use Duct Mastic on All Duct Joints _ _ 2 Energy pts y=yes D 2.Install Ductwork within Conditioned Space - 3 Energy pts y--yes 0 3.Vent Range Hood to the Outside 1 IAQ/Health or y--yes 0 4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 0 5.Install Solar Attic Fan 2 Energy pts y=yes 7 0 6.Install Attic Ventilation Systems 1 Energy pt y=yes 0 7.Install Whole House Fan 4 Eneray pts Y--yes 0 8.Install Sealed Combustion Units a.Furnaces 3IAQ/Health pts y--yes 0 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 D •. 13.Retrofit Wood Burning Fireplaces a.Install EPA certified wood stovesrinseds 1 IAQ/Health 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 D 15.Install High Efficiency Filter 41AQ/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 p 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 Select Safe andDurabie Roofing Matenals 1 Resource pty=yes D 7.Insta l Radiant Barrier 3 Energy pis y=yes 0 I 1 1 L.Natural Heating and Cooling 1.Incorporate Passive Solar Heating 5 Energy pts y=yes 0 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 0 • 1 1 1 M.Indoor Air Qua rtyand finishes ,1,lJse LowMo-VOC Paint _ _ _ _� 1 IAO/Health pts y--yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Heallh pts y--yes 0 �3.Use LcwRJo VOC Adhesives __ 3 IAO/Health y=y _ , _ _ — _ pts es 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 IAO/Health pts y=yes 0 7.9ed all Exposed Padicleboa d or MDF, 4 IAQMealth,pts y=yes 0 8.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 4*," 1 1 N.Flooring 1.Select FSC Certified Wood Flooding _ 8 Resource pts y=yes 0 2.Use Rapidly Renewable NO,6nng 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 IAQMealth 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 ! ! Total Points Available-11 1 Available-11 1 1401 1301 57 • Total Points Project Received: 1 01 01 0 G:datarprogsJgmenbuildngguidelineshemodele:srgmenpointsfinxl27 204pmte7el.xls • Community Development 10300 Torre Avenue ff k/ Cupertino CA 95014 Telephone(408) 777-3228 �UPERTINO Fax(408)777-3333 Building Department JOB ADDRESS: PERMIT # o�oso�a D � OWNER'S NAME: PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Kate Please check applicable subcontractors and complete the followin 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 Owner/Contractor Signature Date