08060105 (2) CITY OF CTJPERTINO - �. =A.��•�trS-i;:i�"E�' � �Ls�+'�''.< :
BUILDING DIVISION' PERMIT ML
-'•'
BUILDING A DRESS: PERMIT NO.
/856 MC CLELLAN RD PRINCIPLE ROOFING & 08060105
OWNER'S NAME: PERMIT MUE DATE
XUMIN WU 10160 STERN AVE 06/16/2008
NE: SANITARY NO, CONTROL NO.
(408) 898-7298
ARCHTIECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O p LICENSED CONTRACTOR'S DECLARATION O O O O
1 thereby of irem thm 1 am licensed under Provisions of Chapter 9(commencing Job Description
m�s vied Satan 7g111)ofD;vivon3of the Badness aM Aofcssiom Code,and mylkc�u RE-RF RMV EXSTNG WDSHK& INSTL OSB 40YR CLS A
fall f road 2 Liumc Class aR .Uct
>,'qacy- �3 6 COMPSHNGL 26SQ
a„
Data Gon EC ECTS DECLARATION
understand my plans&ME NN W used As public rtcoN,
J�U
b o r^ Licensed Pmfessionnl
3 OWNER-BUILDER DECLARATION
C 2 0 I hereby a1Trm that I I. oaesin from oc Cssions o :Any c taw for the
s following mason Permit
a 7 commS.onest.
Business and Prome.dcoum Code:Any my or county
which its iism•pemil meonumm,Wm.improve,damoril b me a sig anystructure
=` prim w,Hearted
eart dpursuant to rts theApplicantfor Contractor',
file Loao(mlemcm
MAL(commencing
Sq.Ft. Floor Area $8000 Valuation
e;R (commencing with section7")an theb Division r the
the Busaged axe pt Praon.Any vi Code)or 8 0 0 0
.. S et Section
u campy thertfrom and the beer for the dkgcd exemption.to Any l pennon of
Sermon 7031.5 five
any applicant for•permit mbjecss the applicant to a civil penalty of Number Occupancy Type
�mtmamwnnKhnndmdewlan(ssoo>. 35903002 WP Y YP
D(.Ua ofdiepmpmy,mmymploymwio"rAmthebmlc o pemdos,
will do the weak,end dte atmmure u ret intended ar offered for ask(Sec.7064,Business
and Pm(emimu Code:The Cmure mr,I.iaxse law dm Out apply or an owes of Required Inspections
property who build,or improvoa therms,and whodoca each wmk hhmelfor through his
own employer.pmNdcd that such improvemma art mtintended aralfertd fmsale IL
however,the building or improvement is mid within one yeenof completion,the owner.
Wilder will haw the burden of pmving that he did tet build or improve far purpose of
earn.).
0 I.as ower of the property.sen exclusively conuscling with Gamed conuw.ws m
comaact she p ajem(See.7044.Business and Prefessimes Code)The Cmuaemrs U.
cense Law dm not apply An an owner of property who bui1N or impmwa dtemon,and
who conusaw for such prejecu with a mnuxwr(s)licensed purseam An the Convenors
License law.
0 l am exempt under See ,B&P C for this mann
Ower Date
W ORKER'9 COMPENSATION DECLARATION
1hertbyaffimunderpm tyofperjuryteteofthefolb ngdeelamdow:
❑1 haw and will maintain aCertiOum ofCommmt m wif-meare forWmkcrsCompen-
swim,as provided for by Section 3700 a the Lab,Code,for the perfomenco of 1W
work for which this permit is issued. - t
law And will maimaln Workers Compensation Imuranu,as required by Section
3'roo m the labor Code,for the performance of the wmk for which that pem;t la hssud.
My Workers Compensation Wurance Gamier and Policy number me-
Canier. �AOt�wTiaw-.'t__ Polity Na.: �3'✓n)l!,-�71t',>
CD 11 TEO(A FFEXEMPTONFROM WORKERS'
COMPENSATION INSURANCE
(This section rand set Inc completed if the,Permit I$ferone hunoaddeBN(SI W)
or ksa)
I certify that I.On perfomeme of the work far which this marsh is issued.l ME sat
employ any person in any manner an as As became subject rode Workcn'Compensation
laws of California Dale
Applicant
NOTICE TO APPLICANT.If,after making oat Certificate of Exemption,you mould
bceonte subject As the WerkrYs Compenuuo t pro isiw of the labor Code.You muR
0 O foMwith comply with such prenimmu m this permit"I W dct nted mmked.
zr7 CONSTRUCTION LENDING AGENCY
f~ l hereby mfm tMt dtert is a ndl(mc.construction lending Agency lm the performance of
(Yi > the dark rte which this permit k issued(Sm.3097.civ.C.)
tiW Q Lander',Name
Z z lenders Address
U O 1 mMfY oat I have road this application tib sate that the above information u
IL entree l agree or comply with all day and county umins^^•and stmt Laws rtlating in `
.0 building consuuction,and hcrtby suthari,e mpmmumdvm of-this city te mm,upon the [_]t\�t�(/yam'//
show-mentieMad property for inspection which ms
F a (We)agree m saw,indemnify and kap hamless the City of Cupertino against
h intliabilities utuargmcnh,command expessawhich may in any way accra ageimuatd City
U,'� A APPLICANT
or the UNDERSTANDS
of this D WILL
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE R3EypULATIONS. /
Signmmc of pphoas omecmr n�. , Doh Re-roofs —
ata
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Win the applicant or In,=building acupanlmom or hattme hmallow material
As defined by the Cupemno Municip ode,Chapter 9.11.AN the Health and Safety
Cale,Sauon 15531(e)?
❑Yet Ne All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
..it hazardous at,cmum;nanu ss mal by the Bay Arta Al,Quality Management all new,materials for inspection.
Oisui.7
DYoa Nu
I have rted the hvarom,materials rtgdmmcma under Chapter 6.95 of the Califon
ma Haelo&Safety Code.Sachem 15505.25533 and 25534.1 understand thal ifthe building
does not currently have a¢mane oro it is my mponsibility m Madly the occupant of the �j d
mulmmenhkimuune met priormissuanu oft CutiGcemof(kcupancy. Signature of Applicant Dae
6i«boa
owne,m mthmt xd agem D,a' All roof coverings to be Class An"or better
CITY OF CUPERTINO
• 2 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35903002 . 00
DATE ISSUED. . . . . . . : 06/16/2008
RECEIPT # . . . . . . . . . : BS000005116
REFERENCE ID # . . . : 08060105
SITE ADDRESS . . . . . : 7856 MC CLELLAN RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : XUMIN WU
ADDRESS . . . . . . . . . . : 78,c6 MC .CLELLAN RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : DERECK LOI
CONTRACTOR . . . . . . . : DERECK LOI LIC # 27564
COMPANY PRINCIPLE ROOFING &
ADDRESS . . . . . . . . . . : 10160 STERN AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (408) 898-7298
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--------- ------- ----- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 8, 000 . 00 0 . 80 0 . 00 0 . 80 0 . 00
1REROOFRES SQ FEET 26 . 00 338 . 00 0 . 00 338 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 338 . 80 0 . 00 338 . 80 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS _ 605 FINAL REROOF '
•
CITY OF CUPERTINO
REROOF
OCUPEIt,TINO PERMIT APPLICATION
APN # ?59 O D CD Date:
Building Address:
7556 MC
Owner's Name: Phone #:
)G 1,2.A-t 1 hw
Contractor: p � c ,^� , , Phone #:.
Fax #: (qoy 5-13-
Cupertino Business License #: Contractor License #:
8/ 6� �
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ t-Up roof
❑/asphalt Shingles 5K Asphalt Shingles
d Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
a Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report #
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: Jfitiy� syr
Co AI SL ( �iLA s S 4 26
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: 2.
Odd �
• I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
CITY OF CUPERTINO
`'p� REROOF
*cuPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
6 1RER00FRES Re-roof Residential B 1SFDWLR00F
1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
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: k1,14- /l4" V/tl
Job Site Address:
Roofing Company Name:
Applicant's Signature: Date:
• 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
z . f
B. Site 9. Install H.E. Irrigation, (details/spec)' L-1 7points
11. Permeable Paving, Note L-1 C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2 5. Use Truss with heels, (detail) S-2 6. B. OSB Sheathin detail S-2
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. Energy Star Refrigerator, (Note/Spec. A-3 1 point
P. Other 1. List Green Features on Plans A-1 1 point
_ TOTAL POINTS 40 points
U
0
enol s t Nnr
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.
Sde
1.Recycle Job Site Construction&Demolition Waste
65°A=1 poinT 75°h= 2 points;80%=4 points up to 4 Resource pts 0
2.SaHage 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
B.Design Resource-Efficient Landscapes and Gardens 4 Resource pts y=yes 0
9.Reuse Matedals/Use Recycled Content Materials
for Landscape Areas 2 Resource pts y=yes 0
10.Install High-Efnciency Irrigation Systems 2 Resource pts y--yes 0
11.Provide for On-Site Water Catchment/Retention 2 Resource pts y=yes 0
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 yryes p
3.Insulate Foundatior>/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 0
7.Use Engineered Studs for Verticai Applications 2 Resource pts yryes 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 D
b.Well 3 Energy pts yryes 0
3 Energy pts y=yes D
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
112.Use OSB –
• a.Subfloors 1 Resource pt y=yes 0
b.Sheathing 1 Resource
L – -- -- — -- --- -- pt Y=Yes D
1 1 1
INPUT Resources Energy IA07HEalth
D.Fxtenor Fims -
1.Use Sustainable Decking Materials } •
a.Recycled content 3 Resource pts y--yes D
b.FSC Certified Wood 3 Resource pts y=yes 0
2.Use Treated Wood That Does Not Contain Chromium/Arsenic j 1 IAO/Health pt y=yes 0
3.Install House Wrap under Siding s 1 IAO/Health pt y--yes 0
4.Use Fiber-Cement Siding Materials 1 Resource pt y=yes D
E.Plumbing
1.Install Water Heater Jacket ( 1 Energy pt y=yes 0
2.Insulate Hot and Cold Water Pipas 2 Energy pts y=yas 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 Tallest with Ultra-Low Flush Toilets
(1 point each,up to 3 points) Up to 3 Resource pts. 0
5.Install Chlorine Filter on Showerhead 1 IAQ/Health pt y--yes 0
S.Convert Gas to Tankless Water Heater 4 Energy pts y=yes D
7.Install Water Filtration Units at Faucets
(2 points each,up to 4 points) Up to 4 IAQ/Heallh pts. 0
6.Install On-Demand Hot Water Circulation Pump 4 Resource pts y--yes 0
1 1 1
r.trecuncai
1.Install Compal Fluorescent Light Bulbs(CFCs)
(6 bulbs=2 poin1s,10 bulbs points,12 bulbs=4 points) 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 Ceiling Fans with CFLs
(1 point each,up to 4 points) Up to 4 Energy pis. 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.lnstall Energy Star Refrigerator -- 1 Energy pt y=yes 0
4.Install Built-In Recycling Center ! 3 Resource pts y=yes 0
1 1 i
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
�u.�Install Recycled�onlent,Fibe�glasslnsulation with
0
No Added Formaldehyde _ 3IAQ/Health pts y=yes
4.Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes 0
5.Use Cellulose Insulation
a.Walls 4 Resource pts y=yesD •
b.Ceilings 4 Resource pts y=yes 0
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
D.uemngs 4 Resource pts y=yes 0
1 1 1
I.Windows
• 1.Fnstall Energy-Efficient Windows 1
a.Double Paned 1 Energy p y=yes 0
b.Low-Emissivity(Low-E) 2 Energy pts y=yes 0
c.Low.Conductivity Frames 2 Energy pts y=yes D
2.Install Low Heat 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 0
2.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0
3.Vent Range Hood to the Outside 1 IAQ/Health pt y=yes 0
4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yss 0
5.Install Solar Attic Fan 2 Energy pts y=yes 0
6.Install Attic Ventilation Systems 1 Energy pt y=yas 0
7.Install Whole House Fan 4 Energy pts y=yes 0
B.Install Sealed Combustion Units
a.Furnaces 3 IAQ/Hsalth 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..1nstall AC with Non-HCFC Refrigerants2 Resource pts y=yes D
12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts Y--yes 0
• 13.Retrofit Wood Burning Fireplaces
a.Install EPA certified woodstoveslnserts I IAQ/Health pt y--yes D
b. Install/Replace Dampers 1 Energy pt y=yes 0
c.Install Airtight Doors 1 Energy pt y=yes D
14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0
15.Install High Efficiency Filter 4IAQ/Health pts y=yes D
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAO/Health pts y=yes D
17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts =yes 0
1 1 1
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar Water Heating 4 Energy pts Y--yes D
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 18 Energy pts 0
6.Select Safe and Durable Roofing Metenals _ _ 1 Resource pt y=yes 0
7.Install Radiaht Barrier 3 Energy pts y=yes p
1 1
L.Natural Heating and Cooling 1
1.Incorporate Passive Solar Heating 5 Energy pts y=yes p
2.Install Overhangs or Awnings over South Facing VMindows 3 Energy pts y=yes D
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes p
• 1 1 1
M.Indoor Air Quality and Finishes
r1.Use LowMaVOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low—VO—C, ,Water-Based Wood Finishes 2 IAD/Health pts y=yes 0
13,Use Low/No VOC Adhesives i 3lAQMealth 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 61AQMealth pts y--yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Seal all Exposed Particleboard or MDF —� 4IAQ/Health. 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
! 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Matenals 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:1 1 140 130 57 •
Total Points Project Received:1 1 01 01 0
G:da;erpmgslgreenhuildingguidelines�remodelers�greenpoin+sf❑a121204pro1ededxls
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CIN OF Fax(408)777-3333
*UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
-nAlm eo (S'01 OS
OWNER'S NAME: z4,-L cy„v tyw PHONE #Cavi(
GENERAL CONTRACTOR: /Ivn Gi o FAX #
I am not using any subcontractors: 6r/dl
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
0WzlgyG$
Owner/Contractor Signature Dilate