08030032 (2) CITY OF CUPERTINO � �
BUILDING DIVISION PERMITaRACQRIIORMeTIt3N
° �5's- qa " ''�•dl't+Nwe'l.`Nil�^4'�''"�`Wk 1�'�'«
BUILDTN44 ADDRESS: PERMIT No.
2U694 CELESTE CIR AAA FURNACE & AIR 08030032
OWNER'S NAME: PERMIT ISSUE DATE
KERSI DARUWALL 1712 STONE AVE 03/07/2008
NE: SANITARY NO. CONTROL NO.
ARCHITECr7ENGINEER: BUILDING PERMIT INFO
REPLACE FURNCE 80, 000 BTU MECFI
0 0 0 0
�oa LICENSED CONTRACTOR'S DECLARATION IOb Description
1 lex mby alarm that 1 Am licensed under provisions of Chapter 9(commencing P
Z wide Socuon 70(mrs'DlNdun 3 of dee Surfaces and Prefapom Code,mail my licenwb
n< in tali fortem
' foo 12
�: L e�—Le.. A
z Dam Convector T/
oil
AR HnELTS DEC A 0
I undewnJ my plans WII he used u Public rerordr
g o Licensed PwfuSian.l
b OWNER-BUILDER DECLARATION
Communes
a i I hereby.(Swat Net I I. exempt from the Cosmos o e:LicconseMy c Law for the
O O following moon. emit t RInstr Business mO Prove.de ioli Coda:My city m county
S�' which reguima a permit m cmstnwt alcor,improv,demolish,At mpeir ay structure
'
bissu
wiWox its ancebse re
.Am the applicant fm such Permit co File A Signed comment�< that(commencing
pursuant rote of Division
of dteCBusinesa Liamclaw(C odc)or Sq.Ft. Floor Area Valuation
(commandngwiWSrdion to7001Hthe p(Divionsof fthenaeinusand cmcLaiw( hAre)oI
tet M la exempt Jmm(rom and the bull for the Alleged exemption.My Mol W,on of
Section 7031.5 by Any,applicant fm a permit eabjecu the Appllome W.civil penalty of APN Number Occu ane e
cwt more clue fire hundred dolbn(55001. P Y ZYP
I,uownerof Jmproperty,mmywpla mwirewgautheiraleampcmdm,
will da Newark and the swcture b not immnded m offered(Daub(5®.7044,B"max,
and prolamines Cade:Tete Contrsnora License law doe,ant apply m an wmer or Required Inspections
property who bailout or impmwts timman,and whodoessuch work himWrmthmugn his
Own cmploym,Provided Jut each improvements Am ext inmrWed reoffered(mala IL
however,the building or Improvement is mid whom arm yea ofcompledm.the owner-
builder will ban the perch of moving Nu he did not 1mW or improve(or purpose or
tam.).
❑I.as ower a the property.Am uelucvly conuaming wide licensed ceewmcors w
convrect we project(Sec.7044.Business and Patient.Cada)The Contractor,Li.
coma law does not Apply to an owner of property who Wilda or immune Jmom .ad,
who contracts for such pmjecu wit A coMaetor(s)licensed mussel to Ne Conu eemes
License Law.
❑Issnaemptundes See .Bl PCfmtbmama
owner Dan
WORKER'S COMPENSATION DECLARATION
1 hereby am=under porosity of perjury arc of the following trslanumc
Q lhaveaM will matnWna CeNBote of Canxntwxl(-loam fm WarkerSCmnpen-
radon,as provided for by Seal=37M of the labor Code.for dee performance of the
wok for which this permit is issued.
I haw and will maintain WmkeYi Compensation Insurance.a required by Section
3700 of Jw labor Code.far ma Performance ofthe work fmwhicjc Jus persons;Issued. '
my Workers Campeuation Wrrursna carrier sed w
Policy number :
Coder.,*f 4e �/i,A Poliry No.� -0
,.CATEO EMPIION FROMWORKERS'
COMPENSATION INSURANCE
(lhtsxecOm eased cwt he cwplemd if tie permit is(oranchunted dollars($100)
or leu)
1 certify than in the Performance of the work fm Which this permit is issued.I Nall nm
employ any person in any maearre As In becama abject to the Wodmrs'Compensation
of Calif2i Dam
APplinnt qJ z -`--
NcameOIIC sTO�Po the .1.Comafter pentl i this Ccsions or of Exemption.You Nauta
become momp y to Worker's Compensation permit
the labor,Code,you muss
vJ O forthwith comply with tueh provisions m this pennil ahatl rd deemeo revoked.
z0 CONSfRUCfIONLENDINGAGENCY
Eo I Mmhy alarm Wt tem luta coN
nnrunn leedingagonc,far dee norormancear
> the work for which this permit b issued(Su.3097,Civ.C.)
aQ landef,None .
z ease.Address,
U Q 1 certify that I ban toad this application and state that the above information is
{L.E coven.I agree m comply with all city and county ordinances and saw lave mating in
O building contraction.and hereby autMm representatives of this city In enter upon the
W above-motioned property for inspection pmpowa
0. (We)agree to an,indemnify used keep harmless the City of Cupertino aj airm
(A liabilida,Jedgmenw,cuts and expenses which may in my way am=agaiexl mid City
t.1 7 in comequmce of to granting of tis permit.
c1- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date i" —
SOURCEREGULATIONS.
4
— ro a"J D
S/gn Data o Ar�pp numtar l i Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de applicant m Name building actepmtmom m handle havrdou mamrad ,
As defrmtl by than,Cupertino M.AWIl Code.Chapter 9.11 ad we Holt and Safety
Cade.Session 25533417 All roofs shall be inspected prior to any roofing material being installed.
❑Yu
NMI]to Applicant.1froome building occupant use equipment or devim,which If a roof is installed without first obtaining an inspection,.I agree to remove
..It haardau ffi cenumiexnty As darned by to Bay Amo Air Oulicy Mmagcment all new materials for inspection.
Out
❑Yes No
v
lhareadte twsmucriatsmquimmenuunda ChpWr6.95ofte Califor.
rob HesltkSafclyCeda Ssuou25505.25533a n5M.1andcmmdtatirJwbolding
docs cot..Ady in.A wnaL that It b my mapomiEility,m mury tie occupant of dee
reimlre a richmupbe
metpdarmiaoatweoraCerulwumafOccupency.�Jq�JqSignature OfApplicant Date
0 ororauthowada cal -'D;; All roof coverings to be Class'%r'or better
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
PERMIT INVOICE OPERATOR: SylviaM
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32659998 .94
INVOICE DATE. . . . . . : 03/07/2008
REFERENCE ID # . . . : 08030032
SITE ADDRESS . . . . . : 20694 CELESTE CIR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KERSI DARUWALL
ADDRESS . . . . . . . . . . : 20684 CELESTE CIR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
CONTRACTOR . . . . . . . : RANDO, JIM LIC # 8050
COMPANY . . . . . . . . . . : AAA FURNACE & AIR CONDITIONING
ADDRESS . . . . . . . . . . : 1712 STONE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408)293-4717
FEE DESCRIPTION --------- DUE FOR AMOUNT DUE PAID BALANCE
• ------------------ ---------------- --------- ---------- ----------
SEISMIC RESIDENTIAL PRINTING PERMIT0. 50 0.50 0. 00
ELEC PERMIT ISSUANCE PRINTING PERMIT 40.79 40. 79 0 . 00
MECH PERMIT ISSUANCE PRINTING PERMIT 40.79 40.79 0 . 00
RES MECH REPAIR/ALT/ADD PRINTING PERMIT 61 .19 61. 19 0 . 00
PLUMBNG PERMIT ISSUE PRINTING PERMIT 40 .79 40.79 0. 00
TRAVEL & DOCUMENTATION FEE PRINTING PERMIT 40 .79 40.79 0. 00
-------- ---- ----------
224 . 85 224 . 85 0. 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- ------ -- --------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
•
CITY OF CUPERTINO
a
FURNACE/AC
CUPERTINO PERMIT APPLICATION FORM
03M&
APN# Date:
02-U 5 qq (
Building Address:
D69s/ (2e (2; c /e
Owner's Name: Phone#:
s1 ��. w 4 -� zed-
Contractor: Phone#y-9v-d 9x' yJ/J
/v O ,Q //X C r Fax#:
Contractor License#: 9.10 Cupertino Business License#:
iPa f�
Conttact: . �— Phone#: </ad' ',7qJ
pfdIV Fax 4:
Building Permit Info:
Elect ❑ Plumb ❑ Mech
Residential ❑ Commercial H.
Job Description:
i(eP/ece. �uYAoccr �G Qov Q7v
For Residential Installations:
Attic ❑ 151 floor LEr 2"a floor ❑
Adhere to minimum setback requirement ❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installatiori Planning Approval Required ❑
Cost of Project: Type of Construction(Usage Class):
pt D y"O Qo
Strapped ❑ On Platform ❑ Bonded New Location ❑ Replacement'
• Valuation:
aD J D.Qo
Green Building: Must attach Green Building Checklist to this application
CT.
CITY OF CUPERTINO
FURNACE/AC
CUPEkTiNO 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 Cormnercial 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 41
this code:
1MCSUSHTR Commercial Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1PGASCOM 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 ¬ incl in an appliance
permit,
1BSEISMICO Commercial Seismic B
1NIRRAA 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 41
suspended heater,recessed wall htr, or
floor mounted unit heater.
1MRAPPVNT Residential for the install/relocate/ or M
replacement of ea appliance vent
install ¬ incl in an appl permit.
CITY OF CUPERTINO
FURNACE/AC
CITY FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1PGASRES Residential for ea gas piping system of P
1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
1BSEISMICR Residential Seismic B
1MECPLNCK Mechanical Plan Check M
1MFR=<100 Furnace Syst<=100k BTU install or M
relocate ea forced-air/gravity type
•
furnace/burner, incl.ducts/vents
attached to such appliance up to and
include 100,000 Btu/h
1MFRN>100 Furnace Syst> 100k BTU install or M
relocate ea forced-air/gravity type
fnrnace/burner, incl ducts/vents
attached to such appliance over
100,000 Btu/h
/ IEPERMITFEE Electric Permit Fee , E
1MPERMITFEE Mechanical Permit Fee M
r
1PPERMITFEE Plumbing Permit P
ITRAVDOC Travel Documentation B
1BUSLIC Business License B
CITY OF CUPERTINO
0FURNACE/AC
CUPEKFINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
1BCA.IRHAN Commercial A/C Units <= l0k CFM B
1MCRAA Commercial Mech Repair/alt/add M
IBSEISMICO Seismic Commercial B
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
-1PG7ASRES -Resiaenfial-for ea gas piping em--P— —"
of 1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet. Comm/Resid
1BREIvIAIRHAN Residential A/C units <= l0k CFM B
1MRRAA Residential Mech Repair/alt/add M
1BSEISMICR Seismic Residential B
lEPERMITFEE Electric Permit E
1MPERMITFEE Mechanical Permit M
1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
1BUSLIC Business License B
•
Single Family GreenPoint Checklist date: 7- Build It Greeri
The GrearrPoiM Checklist is based on the various green features incorporated Into the home and is the Smart Solutions From The Ground Up
basis for the GraenPoinl Rated program.A home can be considered green It It fulfills the prerequisites,
• Hams at least SD points,and meats the minimum points par category:Energy list
of Indoor d Teen y/
Health(5),Resources(6),and Water(B).Please comaq Build It Green for a Ilst of qualified GreenPoint
Raters if you are Interested in pursuing third-party varilIcation.
The green building prectices listed below are described in the New Home_Construction Green.Building
Guidelines,available at 15 mouldingrearnor2.
PROJECTENTER
C
Af SITE." '0 ... .0,_- .: _. .' _._, '., '•-`..7 Points A6allabla Per Measure..
1.Pro ct Topsoil and inimF*Disruption of Ezlsting P inh ree
Ts
a.Protect Topsoil from Erosion and Reuse atter Commuctien 0 1 _ 1
❑ b.Unfit and Delineate Construction Fool for Maximum Prele0tl0n 0 1
2 Deconstruct Instead of Demolishing Existing Buildings On Site 0 3
S.Recycle Job Site Construction Waste(Including Green Waste)
❑ a.Minimum 50%Waste Diversion by Weight(Recycling or Reuse)-Required 0 R
❑ b.Minimum 65%Diversion by Weight(Recycling or Reuse) - 0 2
E] c.Minimum e0%Diversion by Weight(Recycling or Reuse) p
4.Use Recycled Consent Aggregate(Minimum 25%)
❑ e.Walkway and Driveway 0 3
❑ b.Roadway Base 0 1
Total Points Available In Site=12 0
B.FOUNDATION.,. Points Available Per Measure
1.Replace Portland Cement in Concrete with Recycled Flynn or Slag
—❑ a.Mlinimum 205;Il Ill Slag— 0
❑ b.Minimum 25%Flash or Slag 0 1
❑ 2 Use Frost-Proiectad Shallow Foundation in Cold Areas(C.E.C.Climate Zone 16) 0 i• 3
❑ 3.Use Radon Resistant Construction On At-Risk Locations Only) 0 f 1
4.Design and Build Structural Past Controls
❑ a.Install Tennis Shields B Separate All Extortor Wood4o-Concrete Connections by Meal or Plastic Fasteners)Dividers 0
b.All New Plants Have Trunk,Base,or Stem Located At Least 36 Inches from Foundation 0 1
Total Points Available in Foundation=B 0
C.LANDSCAPING :''i ' Points Available Per Measure,
1,Construct Resource-Efficient Landscapes
• ❑ a.No In ive Species Listed by Cal-IPC Are Planted _ 0 _-
❑ b.No Plant Species Nil Require Hedging 0
❑ c.75%of Plants Are Droughl-Werant California Nanies,Mad'nanansan,or Other Appropriate Species 0 -�- 3
❑ 2 Use Fire-Safe Landscaping Techniques 0 1
3,Minimize Turf Areas in Landscape Installed by Builder - -
❑ a All Turf Will Have a Water Requirement Less than or Equal to Tell Fescue(SO.B plant factor! 0 2
❑ b.Tull Shall NM Be Installed on Slopes Exceeding 1D%or in Areas Less than 6 Feet Woe 0 2
❑ c.Turf is S33%of Landscaped Area(total2 points) D ! 2
❑ it.Turf is S10%of Landscaped Area(total 4 points) �--�..0 I ! 2
❑ 4,Plant Shade Trees 0) 1 3
77 S.Group Plants by Wmor Needs(Hydrazoning) 0 !' 1 j 2
6.Install High-Efficiency Irrigation Systems
❑ a.System Uses Only Low-Flow Drip,Bubblers,or Low-flow Sprinklers Lam- 2
E] S System Has Small Controllers L 0 i. 3
❑ 7.Incorporate Two Inches of Compost in the Top 6 to 12 Inches of Soil =0 ! 3
❑ B.Mulch All Planting Bstls to the Greater of 2lnehes or Local Water Ordinance Requirement 10 ! 2
9.Use 50%Salvagetl or Recycled-Content Materials for 50%Of Non-Plant Landscape Elements i0 1
❑ 10,Reduce Light Pollution by Shielding Fixtures and/or Directing Light Downward ��>•'10 Llf"!
Tonal Points Available in Lands:10119 4411, U 0
D.STRUCTURAL FRAME&BUILDING ENVELOPE "(' Points Available Par Measure'
1.Apply Optimal Value Engineering \ Ji
❑ a.Place ReXers and Studs at 24-Inch On Center Framing
❑ b.Size Door and Wmdow Headers for Load
❑ c.Use Only Jack and Cdpple Studs Required for Load 0 1
2.Use Engineered Lumber fl
❑ a,Beams and Headers 0 I
❑ b.Insulated Engineered Headers p — T
❑ c.Wood 4Joisis or Web Trusses for Floors
❑
it.Wood I-Joists for Roof Rafters r Ir VV Il LLp VI^1 II 11 p ! —f
❑ e.Engineered or Fnger-Jointed Studs for Vertical Applications _ 0}'s`�1LV.r�J.1Ld'
❑ I.Oriented Snand Board for Subfloor MAR
q p ! 1
❑ g.Grunted Strand Board for Wall and Roof Sheathing '- MAR 077008 0
3.Use FSC-Cerlified Wood
❑ a.Dimensional Lumber,Studs and Timber.Minimum 40% -yf 0 _I_ Z _
•' ❑ b.Dimensional Lumber,Studs and Timber.Minimum 70% JL 0 _T l 7
El c.Panel Products:Minimum 40% 0 1 _
❑ J.Panel Products:Minimum 70% 0 1 i 1
02007 Build It Green Single Family GraenPoinl Checklist 2DD7 Version Page 1 of 4
ENTER
PROJECT NAME
MUGHUR
4.Use solid Well Systems includes SIP&,ICFs,a Any Nonl Frame Assembly)
❑ e.FID= 0 2 1 7
❑ b.Wells D 2 2
❑ c.Rooth D 2 2
S.Reduce Pollution Entering the Home from the Geroge
❑ A Tightly Seal the Air Beller between Damage and Living Area 0
❑ h.Install Garel Exhaust Fen 08 Build a Detached Garage 0 ! 1
6.Dain Energy Heels on Theme(75%of Adds Insulation Haight a Outside Ede of Extortor Well) 0 1
[7—T Desi n Root Trusses to Accommodate Duchsork ' 0 1
e.Use Re oled-Cenlent Steal Studs for DD%of Interior Well Framing 0 1
S.Thermal Mas Wells:5M-Inch Drywall on All Interior Wells or Wells Weighing more then 40Ib/Du.tL 0 1
10.Install Dverhangs and Gutter&
❑ e.Minimum 1 Inch Overhangs and Guests D 1
❑ b.Minimum 24-Inch Overhangs and Gutters 0 1 1
Total Points Avallahls In Structural Building Frame and Envollia=36 D
E.EXTRMOR PINIBH Points Avallable Par Measure
LJ 1.Use Recycled-Content(No Virgin Media)or FSC-Cord6ed Wood Docking 0 2
2.Install a Rain Sawn wag System 0 2
3.Use Durable and Noncombusdble Siding Materials 0 1
4.Select Durable and Noncombustible Feeling Materiels 0 2 1
Total Points Available In Exterior Finish=7 0
P.INBDLATION Points Avallable Per Measure
1.Install Iwuletion with 75%Recycled Content
❑ A Wells and/or FlDDrS 0 1
—E b.Cellin s 0 -——— —i—t——
2,Install Insulation that is Low-Emitting(Certified Section 01350)
❑ a.Walla and/or Floor - 0 _ 1
❑ b.Callings 0 1
❑ 3.Inspect OURIly of Insulation Installation before Applying Drywall 0 1
Total Points Avallahle In Insulation 5 0
G.PLUMBING Points Available Per Measure
1.Distribute Domestic Hot Water Efficiently(Maximum 7 Points).
❑ a.Insulate Hot Water Pipes from Water Heater he Kitchen 0 1 1
❑ b.Insulate All Hot Water Pipes _ 0
❑ c.Use Engineered Parallel Piping 0
❑ d.Use Engineered Parallel Piping with Demand Controlled Clmulabn Loop D
❑ e.Use Structured Plumbing with Demand Controlled Clmulatlon Loop 0-
❑ 1.Use Central Core Plumbing 0 1 1 2
❑ 2.Install Only High Efficiency Tallest Dual-Flush or 51.28 pp 0 4
Total Pointe Available in Plumbing=Toth 12 0
FL HEA.TINO VENTILATION&AIR CONDITIONING Points Available Per Measure
1.Design and Install HVAC System to ACCA Manual J,D,and S Recommendations 0 1 4
2.herself Sealed Combaatlon Units
❑ a.Furnace& D 2
❑ b.Water Headline 0 i 2
3.Install Zoned,Hydrants Radiant Heating with Slab Edge Insulation 0 1 1
77 4.Install High Efficiency Air Conditioning with Environmentally Responsible Refrigerants 0
5.Design and Install Effective Duetwork
❑ a.Install HVAC Unit and Ductwork within Conditioned Space 0 3
❑ b.Use Duct Meads an All Dust Joints and Shame 0 1
❑ c.Install Ductwork under Alto session(Buded Dues) 0 1
❑ d.Pressure Balance the Ductwork System 0 _ 1
❑ e.Protest Ducts during Centra lion and Clean All Ducts before Occupancy 0 1
S.Install High Efficiency HVAC Filter(MERV it) 0 1
❑ 7.Don't Install Fireplace or Install Sealed Ga Flreplam with Efficiency Raring Not Leas Than 60% 0 I 1
using CSA Standards
e.Install Effective Exhaust Systems In Bathrooms and Kitchens
❑ a.Install ENERGY STAR Bathman Fane Vented to the Outaide 0
❑ b.All Bathroom Fans Are on Timm or Humldistat 0 T—�-
❑ c.Install Klhhen Range Hood Vented to the Outside 0 1
Q.Install Mechanical Ventilation System for Cooling(Maximum 4 Pointe)
❑ A.Install ENERGY STAR Calling Fans A Light Kits In Living Area a Bedrooms 0 _� 1
❑ b,Install Whole House Fan with Variable Speeds 0
❑ c,Automatically Controlled Integrated System 0
❑ J.Automatically Controlled Integrated System with Variable Speed Control 0 3 r 1
10.Install Mechanical Fresh Air Validation System(Maximum 3 Points)
❑ a.Any Whole House Ventllation System That Mata ASHRAE 522 0 _� 2 _
Elb.Install Air-to-Air Heat Exchanger that meets ASHRAE 62.2 0 1 ; 2
11.lestsll Carbon Monoxide Alarms) 0 1
Total Points Available In Heeling,Ventilation and Air Condltionin :3D 0
®2007 Build It Green Sinole Family GreanPolnt Checklist 2DO7 Version Pace 2 of 4
_ - r
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPE(�TINO
Building De artment
JOB ADDRESS: PERMIT(?eq 3 00 3 Z
o?O
OWNER'S NAME: ES- PHONE # s-
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
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 w' C �o f�
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
ti
Owner/Contractor Signature Date