08040131 (2) CITY OFTINO
I
�UPER
No DIVIS14,1I.I?
BUILD[ PERNHT XMPI
BUILDING
RESS: PERMIT NO.
W)5 MERRIMAN RD BLUE MOUNTAIN AIR 08040131
OWNERS NAME; F&U.MISSUISIDATE
HONG TONY N AND YVONNE TRUSTEE 707 ALDRIDGE RD STE B 04/18/2008
NE: SANITARY NO. CONTROL NO.
ARCHITECITE1,1G]WEER: BUILDING PERMIT INFO
REPLACE AC 4 TON 13 SEER, BLDG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLARATION FuFdtAef! 88 ft B
I hereby affland that I am licensed under provisions of Chapter 9(commencing ^^^ Yoh Description
MLhSd.70f10).fDIAsion3aftheBusi..WPmf.W.Cade addrayli,muci.,
i full form n _>0 C 1� 5 4r 6.6
RZ U am !Dem _ —
Con
A CHrrECrq DECLARATION V
I madenamal my plans mail no used as public racarris
Licensed Pruffessli...I
OWNER-BUILDER DECLARATION
I kmb,.frm War IS.mantoln from the contramm's License Law fa,the
ZQO following reassion.(Section 7031.5,Business and Profession Codc:Any city Or county
IRE! which required a permit in centuries,sher,remove.demolish,or mi sir any immune
Prior M its itiminec.&130 Icahn=do applicant for Such permit to rid A Signed SAICTOCTIL
dual he is licensed paramount to the provisions of thes Contractor's Licems,Law(Chapter 9 Sq.Ft.Floor Area Valuation
(commencing with Section 7000)of Division 3 of and Business and Professions Coucl or
Nat he is mussold therefroon and the boost for dive alleged cooro ptioni Any violation of
Section 7031.5 by any applicant for a permit subjects,the applicart,to a civil penalty of APN Number Occupancy Type
.1..m than five hundred dollars(SM
0 1,is winter of did pmpcny.Or my croplumics wait"M as their sols ccurparesiders.
will did dim.,it,and thermancome I.not inticarded or offered to,Sam( ic.7014,Business
and Professions Code:The Commandoes License Law does an,apply in an Owner of Required Inspections
propanywho builds err inprom thereon,and who does such work hanatelforthrough his
mad andeplaysm.pronided that Such Improvements are non,intended orofficrodi for ask,If.
Somme.ds building Or Improvement is Said within oro Your ormandidatiod.the awrover.
builder MR have the burdledi of proving that he did Out build or Imparmard for purpose Of
zaflic.}
F]1,Sir awass,or ans property,am misciusively contracting with licensed coneriumes W
construct the martinet.(sac.7014,Busindmi Sam professorial coce)The comencises u-
ancest,Law it=not apply us an cramer of property who builds or Wpmm thanam,and
who contracts for such prejacts wits.camiscuou(s)licensed parsucaurit to the Comossion's
License
I...
C3 larnexcuripturaderSec _,B&PCfarthisnuound
Owner Data_
WORKER'S COMPENSATION DECLARATION
I hereby driand under penalty of puler,W of the following disclandemser
Mm and will main am a Cartificatim'Canada to self-insure far Washers Crimson.
ralton,as provided for by Section 3700 of ds Labou,Code.far Re performance of the
M&to,which N.permit 1.Issued.
0 1 have and will maintain Warler's Conspandidamor Insurance,ar required by Scedon
3700 of the Labor Code,for the c3foranducce of the work for which this North is lacial.
My We Carder -a Compensation Imm.carrier and Policy number and:
6-1:! Policy N.:L')C'-�16 f 0(9
c4e &AE11"TION nom WORKElts,
COMPENSATION INSURANCE
(Thor section Sent ran toccompleuml if ft Permit is forces hundred dallarts(SIM)
or IIAL)
I cartify that In the performance of the work for which this permit IS humid.I"I not
employ any patient in any mannose u in bcomen,subject in the Workers'Comporealum
L..of Cadiforah.Data
Applicant
NOTICE TO APPLICANT.If,.11cr making this certificates of Exemption,you Amid
bacourc subject in the Waftes Compensation provisions of the Latin,Code you a=
z forthwith comply with Such provision or this permit mail W decumod mated.
z 0
V1 CONSTRUCTION LENDING AGENCY
I thereby allbrot that there ist a construction binding agency for the performance,of
the wants far which this Permit is issued(Sac.3097.CN.C.)
Leadice.Name
n z Lander's Add.
U 0 1 cestify that I have mad this application and=in use the,me.i.fowmakm 4
VL i— cannot.I attims to comply with 411 city and county aNinmae and made tam misting to
0 Wilding constructroa,and humby sandamons,npinceirmadvas of this city in cracr upon the
LLl banne-racroksmad!prairceny for Inspection pturpicans.
(We)agais,to save,indemnify and lump hanaless the City of Cupertino against
(A liabilidesJudgments.com and expenses which may in any my Scenic against Wit City
I.Immasquarom of the&.ties of ROSS parich.
Ai UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
0 REGULATI S.
A Irit4 Re-roofs C7
7 :a fi'�"Jp
sismadme drAppicia.111COMmalm— Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant in future building occuponamic Or handle huallow material
as defend by dic Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
0yn
vin,,'t applicant building Occupant um equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mr,ma7
ir taminants at defload by the Day Am,Air Quality Management all new materials for inspection.
[]Y. 0
/o
I have and die,hicadidusf.1.nemiummormis under ChaincriS.93 ofths CLlifor,
us licad"SaletyCods,Sccum n5D5,25533 wd25534.I undcomand thouffulue Wilding
Jona armill
nipt which in am to issuance or a ccouricia,or oc-paracy. Signature of Applicant Date
Owner or mahmincel govt Dam be Class'n"or better
CITY OF CUPERTINO
® 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34229056 . 00
DATE ISSUED. . . . . . . : 04/18/2008
RECEIPT #. . . . . . . . . : BS000004518
REFERENCE ID # . . . : 08040131
SITE ADDRESS . . . . . : 10485 MERRIMAN RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HONG TONY N AND YVONNE TRUSTEE
ADDRESS . . . . . . . . . . : 10485 MERRIMAN RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2680
RECEIVED FROM . . . . : EDWARD GREGORY
CONTRACTOR . . . . . . . : GREGORY S. OWEN LIC # 29600
COMPANY . . . . . . . . . . : BLUE MOUNTAIN AIR
ADDRESS . . . . . . . . . . : 707 ALDRIDGE RD STE B
CITY/STATE/ZIP . . . : VACAVILLE, CA 95688
TELEPHONE . . . . . . . . : (707) 451-8111
® FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- --- ---- ---------- ---------- ----------
19SEISMICR VALUATION 6, 350. 00 0 .70 0. 00 0 .70 0 . 00
1EPERMITFE FLAT RATE 1. 00 40 :79 0. 00 40 .79 0. 00
1MFRN>100 UNITS 1. 00 122 .38 0. 00 122 .38 0 . 00
1MPERMITFE FLAT RATE 1. 00 40.79 0. 00 40 .79 0. 00
1MRRAA UNITS 1. 00 61.19 0. 00 61 .19 0. 00
1PPERMITFE FLAT RATE 1. 00 40.79 0. 00 40 .79 0. 00
1TRAVDOC FLAT RATE 1. 00 40.79 0. 00 40 .79 0 . 00
---- ------- ---------- ----------
TOTAL PERMIT 347 .43 0. 00 347 .43 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 347 .43 MASTER CARD
---------------
TOTAL RECEIPT 347 .43
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- --------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
FURNACE/AC
OF
• CUPERTINO PERMIT APPLICATION FORINT
i?o N613
APN# �( Z Q�^ Date:
Building Address: J [�
iOwner's Name: i Phone #:
i Contractor: / n ^�/ I Phone :Tp 7, 51XI 00/!/
�A/J
/ut, p 6,a R,%t i4i/' C 7,J 7 /7702(7
Fax #:
Contractor License#:_ . _i Cupertino Business License —I-
3 � � 6� � i 2aYOD i
Contact: Phone #: h 7
( ' e 6 --C,C 4 Fax #: 7o1�- lrv17-� 76
Building Permit Info:
Elect ❑ Plumb ❑ Mech ❑
Residential Commercial
Job Description: 4- eX / G
Tam 54..te
�?D k 6 T LJ 9 2
For Residential Installations: !
Attic ❑ I"floor � 2nd floor ❑
I
Adhere to minimum`"setback requirement
For Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Plamdng Approval Required ❑
Cost of Project: b 3 Sa Type of Construction (Usage Class):
Strapped On Platform Bonded New Location Replacement
Valuation: b 3
Green Building: Must attach Green Building Check list to this application
CITY OF CUPERTINO
FURNACE/AC
CUPERTINO 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 ptr outlet.
113SETSMICR Residential Seismic B
1MECPLNCK Mechanical Plan Check M
1MFR=<100 Furnace Syst<=100k BTU install or M
relocate ea forced-air/gravity type
fuinace/bumer, incl.ducts/vents
• attached to such appliance up to and
include 100,000 Btu/h
1MFRN>I00 Furnace Syst> 100k BTU install or M
relocate ea forced-air/gravity type
fumace/bumer, incl ducts/vents
attached to such appliance over
100,000 Btu/h
1 EPERMITFEE Electric Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
IBUSLIC Business License B
CITY OF CUPERTINO
FURNACE/AC
CRY OF
CUPErRTiNO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FLTRNN"AC
1MCRAA Conunercial-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_ofe.ontrols_regulatedb_y_this
coue.
1 MCREPALT 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.
IMCSUSHTR Commercial InstalI/Relocate ea M
suspended lneater,recessed wall htr, or
floor mounted unit heater.
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
IBPGAS For each gas piping system of 5 or P
more per outlet.
IMCAPPVNT Conunercial for the install/relocate/ or M
replacement of ea appliance vent
installed ¬ incl in an appliance
permit.
IBSEISMICO Commercial Seismic B
IMRRAA Residential Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
/ cooling unit,absorption unit,or ea
I/ heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by
this code.
® IMRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1 MRAPPVNT Residential for the instalI/relocate/ or M
replacement of ea appliance vent
install & not incl in an appl permit.
CITY OF CUPERTINO
FURNACE/AC
• CUPEIIaTIN0 FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
1BCAIR2A.N Commercial A/C Units <= l0k CFM B
1MCRAA Commercial Mech Repair/alt/add M
1BSEISMICO Seismic Commercial B
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
IPGASRES -Resid-ential-for ea gas pipin y eni P
of 1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet. Comm/Resid
IBREMA KHAN Residential A/C units <= 10k 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
IBUSLIC Business License B
•
Single Family GreenPoint Checklist date: �-� Build If Greeiri
The GrearrPoim Checklist is based on the various green ivaheac incorporated Into the home and is the Snap Solmiad From the Ground n
basis for the GreenPoint Rated program A home can be considered green N 0lulfilis the prerequisites. I—�
earns at least 60 pces' and meets the minimum points per Build
11 Green
Energy(t of Indoor Air amen tyf F n FI
Health(5),Resources(6),and Wafer(g).Please contact Builtl II Green for a list of quallnetl GreenPoint
• Raters d you are interested in pursuing third-parry,verification.
The green building pramices listed below are dascribad in the New Home Construction Green Buildin
Guidalms,available w nnyAiMggO n.oro. o A'�z,ENTE �✓L
v PROJECT
e a
MM
A.SITE . Points Available Par Measure
1.Protect Topull and Minindze Disruption of Existing Plante a Trees
❑ a Protect Topsoil tram Erosion and Reuse after Construction _ 0 __ 3
❑ b.Umll and Dallasite,Construction Footprint for Madmum Protection 0 7
2.De..um t Instead of Demolishing Existing Buildings Des Site 0 I ', 3
3.Recycle Job Site Construction Waste(including Green Waste)
❑ abfinumirn 0%Waste Dwersian by We'Bht(Recycling or Ruse)-Requimd 0R
❑ b.Minimum 65%Diversion by Weight(Recycling or Rause) 0 _ 2
❑ c.Minimum 80%Diversion by Weight(Recycling or Rause) p --_ —_z--
4.Use Recycled ConLmt Aggregate(Mminnum 25•:)
❑ a Walkway and Diweway 0
❑ a Roadway Base D 1
Total Palms Avalable in Site=12 0
E.FOUNDATION Points Available Per Idessure
1.Replace Portland Cement in Concrete with Recycled Flyah or Slag
❑--e.Minimum 20%Fyasn m Slag D j j
❑ a Minimum 25%Fyash or Slag 0 T 1 1
LJ 2 Use Froct-Protamad Shallow Foundation in Cold Anes(GEC.Climate Zone 16) 0 3
El 1 Use Radon Resistant Construction On AI-Risk Locations Only) - D 1
4.Design and Build Structural Pest Controls "
❑ A.Install Turns SNelds A Separate Al Exterior Wu:Ht Cenoele Connections by Metal or Plastic Fasten aDividars p 1
b.Al New Plants Have Tnmk Base,or Slam Located At Lease 36 Inches train Founduon 0 1
TDlal Po ds Avallabe in Fourdatim= 0
C.LANDSCAPING - ) Points A.H.H.Per Mansura
1.Construct Resu ur Efgciem Landscapes
❑ a No evasive Species Listed by CxHPC Are Planted 0
• ❑ b.No Plard Species Will Require Hedging
❑ e 755'%of Plants Ave DmughFtderam Cmilomlx Natives,Medta.anean,m Omer Appropriate Species p ! 1
2 Use Fire-Sale Landscaping Techniques D 1
3.Minimize Tud Areas In Landscape localletl by Builder
❑ a All TW Wig Have a Water Requirement Less than or Equal to Tall Fescue(SU plant factor) D
❑ b.Turf Shag Not Be Installed on Stopes Exceeding 10%ar In Amax Len than 0 Feet Wide D i z
❑ C.Tud Is 533%of Landscaped Area(total2 paints) 2
❑ dTud is 510%of Landscaped Area Octel 4 paM5) 0 2
4.Plant Shade Trees 0 3
El a Group Plants by Water Needs(Hydremnin ) 0 Z
6.Install High-Efficiency Irrigation Systeme
❑ a System Uses Only,Low-Flow Delp,Bubblers,or Lox-1tow SprbJJers 0
❑ b.System Has Smad Councilors D 3
Lj 7.Incorporate Two Inches of Compos(in the Top 6 to 12 Inches of Soil p 3
❑ 6.Mulch All Planting Bad,to me Greater of 2lnches or Loral Water Ordinance Requirement D j j 1 2
a Use so%Sal"guld or RMchmi-Convect Materiels for 50%01 Non-Plant Landscape Elements D 1
10.Reduce Light Pollution by Shielding Fixtures andfor Directing Light Downward p I I I i
ToW Poin6 Available in Landscaping=31 D
D.STRUCTURAL FRAME;R BUILDING ENVELOPE I Points Available Per Mecum
1.Apply Optimal Value Engineering
❑ a Place Rafters and Suds of 24-Inch On Cancer Framing 0
❑ b.Size Dom and Window Headers for Load - 0
❑ c.Use Only Jack and Uipple Studs Required for Load 0 I 1
2.Use Engineered Lumber
❑ a Beams and Headers p 1 1g r
❑ b.Insulated Engineered Headers —
❑ c.Wood 1-Jorsls or Web Tosses for Fleas U
❑ Ii.Wood Wo6b for Roof Ratters p — -7 _--
❑ e.Engineered a Finger-Joidsd Studs lor Vertical Appications
❑ f.Oneht5tl Strand Board Ire Subnom 0
❑ g.Oriented Stand Board for Wal and Rod Sheathing o
3.Use FSCAedifiod Wood
❑ a.Dimeneional Lunder,Studs and Timber.Minimum 40% 0 iZ
• ❑ b.Dimensional Lumber,Studs and Timber.Minimum 70% p_ __
❑ C.Pants Products:Minimum 4D% 0
❑ it.Panel Products:Minimum 70% D 1 1
07DD7 Ruild 11 Gran. Sul Family GreenPoint Checklis12007 Version P.,e e
PROJECTENTER NAME
1.Use Sofid Wal Systems(Inelutles SIPe,ICFs,8 Amry Non3fick Frame Assembly)
• ❑ b.Walls p 2 2 _—
❑
C.Foods 0 2 2
5.Ratio=Pollution Entering the Home from the Gerald
❑ a TgMly Seal the Ah Berler bervveen GossipendsLiving Area 0 1
❑ b.Insts Gamgo Exhaust Fan OR Build a Dotached George 0 1 I
77 6.Design Evary Healer on Trusses(?S%of Attic Insulation Height at Du stdo Ede of Exterior Well) 0 1
❑ 7.Design Rodf Trustee t Axommad=Ductwork D' 1
S UP Recyctad-ContentSteel SWtle for 90%of Interior Wap Framing 0 1
0.Thermal Maes,Welt,Stanch Drywall on Ali Interior Wept or Walls Weighing mora than 4016neu.fL 0 1
10.Install Overhangs wd Guardia
❑ a.Minimum 16axh Overhangs and Gutters 0 I
❑ b.Minimum 244reh Overhangs and Gutters D
Total Points Available in Smxluial Building Frame and Envelops,:35 0 .
E.EXTERIOR FINISH Points Available Par Measure
1.Use Reryelod-Coment(No Virgin Plastie)or FSCLar ified Wood Decking 0 2
2 Install a Rain Screen Wag System 0 m 2 m
3.Uses Dumb,and Noncombustible Siding Materials D I
a,Smmrct Dureble antl Noncombusb3le Reading Materials 0 I 2 m
Total Points Available in Exterior Finish.7 0
F.INSULATION Points Available Per Measure
1.Instep Insulation with 75%Recycled Content
❑ e.WAIN enNor Flmrs 0 1 1
—O—b:Celin -- 0 —
I Instal Insulation that is Lov Emitting(Cedified Section 01 sso)
❑ a.Walls antllo Plant 0
❑
It.Cefingie 0 _—
❑ 3.Inspect Ouapty of Insulation Installation before Applying Drywall 0 1 1
Total Palms Available In Insulation.5 0
G.PLUMBING Palms Avallabla Par Measure
1.Distribute Domestic Hot Water Elfidently(Maximum 7 Points)
❑ a.Insulate HM Water Pipet man Water Healer t Kitchen D
❑ h Nsulate Ail Hal Wales Pipes _ 0
❑ t Use Engineered PareIIN Piping
• El d Use Engineered Parole]Piping MM Demand Controlled Circulation Loo?
El 9.Use Sbucened Plumbing with Demand Consoled Circulation Loop 0
❑ 1.Use General Core Plumbing0 1 m 1 2
❑ 2 InMll Only High Efficiency Toilet(DuatRush m S12a gilt) 0 1 4
Total Points Avapabb In Plumbing=Total 12 0
H.HEATING.VENTILATION R AIR CONDMONING i Points Avallabla Pet Measure
❑ 1.Design and Instal HVAC System to ACCA Manuel J.D,and S Recommendations 0 4 m
1,Instal Sealed Combustion Unit
a Formosa 0 2 I
b.Water Heathers 0 m 7
3.Install Zxnetl,Hydrooic Radiant Heating with Slab Edge Insulation 0 1 1 1
L Install High Eftidenry Ab Conditioning with Environmentally Responsible Refrigerants D 1
5.Design end Inslaff ENective Ducbmrk
❑ e.Install HVAC Unit and Ductwork within Conditioned Space D 1 3
❑ b.Use Dud Mastic on Al Died Jointer and Seems 0 I
❑ c.Install DucMork under A&Insulation(Buried Duct) 0 I
❑ d.Pressure Selma the Ductwork System 0 ]
❑ e.Prmect Duch during Construction and Clown Al Duch helms Occupancy oS.install High Eficienry HVAC Floor(MERV&) 0
❑ 7.Don't Install Fireplace or Install Sealed Gas Fireplaces with Efficiency Rating Not Less Than G07. ]
using CSA Standards 0
IL Install Ef oadve Exhaust Syseams in Bathrooms and IGlulmns
❑ a.Instal ENERGY STAR Belhmom Fans Varittl to the Outside 0 1
❑ b.AN Bathroom Fans Are on Tuner or Hurridstet D
❑ e.Install Kitchen Range Hood Variant to the Outside p I
a.Instal Mechanical Ventilation System for Cooling(Maximum 1 Point)
❑ a Instal ENERGY STAR Caping Fans a Light Kgs in Living Areas a Ballrooms
E] b.Insist While House Fan wIM Variable Speeds 0 1
❑
C.AdomeOptly,Comnilad Integrated System - D -- .._i
❑ d.Automatically Controlled Integrated System with Variable Speed Conal 0 3 i
10.Install Mechaniml Fresh Air Ventilation System(Maximum 3 Point)
❑ a.Any Whole Hale VenMapon System Thai Meets ASHRAE 62.2 0
❑ b.imstall Air10-Ak Heal Exchil that meek ASHRAE 622 0 I 1 2
• tet.Install Carbon Monoxide Alarms) i1
Total Points Available In Heaft Vemblalion and Air C cfitkx mp.30 0
Community Development
I 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
46UPERTINO
Building Department
JOB ADDRESS: #
�o Y8s K d PERMIT6 S-a b 13 /
OWNER'S NAME: 7o�% O PHONE # ~— ZS7-Z Z6 d'
GENERAL CONTRACTOR: FAX # _ yY6_ Zp Z&
I am not using any subcontractors: y elf ZcD;>
Signature V 0 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
2C Heating L
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signatf6e Date