08040135 (2) CITY OF CU��RTINO -
BUILDING DIVISION PERMIT. CONTRACTC3R I�ATFO�MATI
BUILDING ADDRESS: PERMITNO.
11792 TRINITY SPRING CT CASTILLO' S ROOFING 08040135
OWNER'S NAME: PERMrf ISSUE DATE
RAYMOND & CECILIA WONG 1703 CATHAY DR 04/18/2008
leNE: SANITARY NO, CONTROL NO.
ARCHrrECTIENGINEER: BU1 NG PERMITINFO
REMOVE EXISTING WOOD SHAKE, O O O O
�oo LICENSED CONTRACTOR'S DECLARATION .JOh..DeSCrI VOA
1 hemby affirm mAr 1 am lk and under pmvisiou of Chaper 9(commeming -•-^ - -1 ••^ ^^••^ P
with Scedon 7OM)of DiviAion 3af ma Business end PofcWun�n/Coda,and my license is
^ in full fume and effect.
Licence Clue 3 / LA.11
Dae contrera
ARCell So
N
I uMcnuml cor PIs^s[hell W usW u public ncom
y tad Licensed Profession.
OatNEmBUILDER DECLARATION
+�a 1 resume.
.(S m o n 1 am exempt from the Conu¢mh Licence taw for me
is p O following moon. er it t 7031.5.ommu B slun. p P.ft.ns Com:Any rily Structure aumy
S$ width its Am•pemit m cAoneL alter.Meow,mermit m repair ed =an,
PriAmiucensedq Numgo the theApplicanttheohpermil W file Uccaab signedw(cammmt -
€< (Own that comma licensed pSem,m m We of Division
nr dxw Business ad
mn wanton Cook)9 $q.F[. Floor Area Valuation
$ that M is exgwit Section7")ndtheliviwiofraflMeged canendon.Any
Cook)or
Net he u ezemPt mere(rom and de buts far the alleged eumpdon.Any viWadOn of
Section 7031.5 by any applicant for a Permit Subjects An applicant to a civil penalty of APN Number Occupancy e
con It.come New hundred dollars(35001 P Y�'P
L u owner of 0e popertr,a my empl^yeu with wage u dae'v sole mnpewtion,
ann�e`�,`cam-Thee Ian La mss se ply�'Buticom
momear of Required Inspections
property who buildsorimpvw flu eooatd whodommueh wet himselfotiuough his
awn employees,provided thatach Improvements Arco not inendad Antlered for ale If.
however,the building or Improvement mold within ane you of completion.the ower-
builder ME have As burden of paving Nn An did rot build A improve for purpose of
ASIA.).
. ❑I.As wan of the property.w euluively conuading Aida llavd anvucmn to
ceomet tie pojen(Sm 7044.Business and ProicsalON Code)The Co iscus'A U
ova law does not apply AS an owner of property who WHO or improves daemon.ad
w W canuacts far such projects with A cantmentr(s)licensed puraom to own Contractors
License law.
❑lamaemptederSee ,Bk PCfAdatsnaam _
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hemby of low under Penalty a(peejAy,are of the following decia atinns:
hive and will coalnuin aCerdOcam of Cmmm.t m self-insurefa WorkersCampen-
on,As provided for by Section 37M of the Lalmr Cade.fm ma peeformanm of t e
7C ' .wNch anis permit is laud.
[-I'1 hew ad will maintain Walker's Compensation momenta,AS Acquired by Section
37M of we rather CTM,for As peRmmana of me wort for which this permit u issued. '
My Woruers Compvadon Insummm artier end Policy number Are:
ca Jen Sfs�/e Goner/ policy No.: enol ff
CERTIFIGRA .� EMPTON FROM WORKERS'
COMPENSATION INSURANCE
md.section oed athe compleed If me petit Is Mane hundred dollen($100)
or lane.)
I century that in Are perfonnsnce of the work for which anis ppmit Is Issued,l"I no
employ any pram in my maocran AS An become abject rode WorkAs'Compensation
""of California.Dam
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should
become Subject m the Workeh Compensation provisions of An IahA Codc.you mus
.0 O forthwith comply WN such ravtmns A mu permit shall W accrual revoked.Z" CONSTRUCTION LENDING AGENCY
(•+ aforthereby which Airlines Wtmem isacmwnc.30 len ding apoyfortha perfmmana of
0u woh for which Lia permit b isaod(Sec.31197,Civ.C.)
W� Q Landes Name ,
z LnWers Address
UO I arufy mat I have read this applicafm W mm the the above information is
is, ^. comet.l seam[m comply Aim Jm I city ucourtly on ivnca and sum Iowa miming m
O rV' Wilding communion,ad hereby Andaman represaudwa of this city In new upon the
t7" y [have-mendaucd property for inspection purposes
(We)agree m aw,indemnify ad kap homeless me City of Cupertino sgJvt
�^ h Liabilities,judgmenW cos,and expenses which may In any my Aran against Said City
U 7 In conaqueve of me grating of this permit.
•7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date L -
SOUR(3ERE8ULA1�N3. _
� ��'/o �j/9a�
Re-roofs
41(rgu)cof Apptiaanm Dem
HAZARDOUS MATERIALS MCUP LAOMoDISCLOSURE Type of Roof
WIII dm applicant m(Arturo building ocupatuom m handle huudou material
u de0ned by de Cupertino Mun'a' 1 Code.Chapter 9.12,'no the Health and Safety
cam,ration zss3x(e)7
Ely" No All roofs shall be inspected prior to any roofing material being installed.
Will me apph con nr comm W' Ing o cup,m ale cogmpmaI m m.+aa which If a roof is installed without first obtaining an inspection,I agree to remove
CL? tar canuminanu Ood by the Be,Ana Air Quality Management all new materials for inspection.
tT
❑Yv No
I have and the hLammsomerWs mrommau mulrChapan6.95 oram i i/_/
nu HcalmkSafoy Cade,Sections 25505,25533 And!x5534.1'udwrsad muifmc 'Wing l� P- �
data not curmrtdr have A urenanc that It ts my mparded ii m n^tifY dao gaup of m O
nami. nu be et prior to I. ceof.Cord r $ig atureofApplicant Date
0 at or umne
ardsgem DamAll roof coverings[o be Class'1?"or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36653043 . 00
DATE ISSUED. . . . . . . : 04/18/2008
RECEIPT #. . . . . . . . . : BS000004524
REFERENCE ID # . . . : 08040135
SITE ADDRESS . . . . . : 11792 TRINITY SPRING CT
SUBDIVISION
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER RAYMOND & CECILIA WONG
ADDRESS 11792 TRINITY SPRINGS CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5146
RECEIVED FROM . . . . : CASTILLO'S ROOFING
CONTRACTOR. . . . . . . . : JOSE CASTILLO LIC # 25850
COMPANY CASTILLO'S ROOFING
ADDRESS 1703 CATHAY DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95122
TELEPHONE . . . . . . . . : (408) 251-3565
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 7, 000. 00 0 .70 0. 00 0.70 0. 00
1RERO0FRES. SQ FEET 18. 00 234 .00 0. 00 234 . 00 0. 00
`--------- ---------- ---------- ----------
TOTAL PERMIT 234 .70 0. 00 234 .70 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ---------------------
CHECK 234 .70 15056 ..
---------------
TOTAL RECEIPT 234 .70
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
605 FINAL REROOF
1 CITY OF CUPERTINO
C REROOF
•
C U kilCTI'NO PERMIT APPLICATION
APN # L0L0 5-3 043 Date:
Building Address: I
Trino S ren
Owner's Name: Phone #:
1 A mon � CcLA Vel on 40$- a51-55s
Contractor: Phone #: 3S'Y-'
OAS-�d �.IDSD� 'r � Fax #:
Cupertino Business License #: Contractor License #:
3 5
Type of Roof Covering:
Existing: Proposed:
o Built-Up Roof ❑ Built-Up roof
❑ /Asphalt Shingles u✓Asphalt Shingles
r/ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
N tuber of existing coverings ❑ Provide I.C.B.O. Report #
V To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: `p-emove eos-h nqJWoo6, Shal� ,�r 1S- II �� b • �e 1'�
frnc� A So Y2 . Com� . shi no� IQ .
Residential Commercial Lj
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, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signa re
J
CITY OF CUPERTINO
REROOF
� Of
CUPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type.
Squares Group
1RER00FC0M Re-roof Commercial B ICOMMLROOF
IBSEISMICO Seismic Commercial B
1REROOFRES Re-roof Residential B 1SFDWLROOF
1BSEISMICRE Seismic Residential B
1RER00FMRES 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 notready,
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 ktated policy on re-roofing.
Homeowner's Name: /� Y17(JYL
�(Q
job Site Address: I I 1 `/I�Z_ J (-I � 1 Til 5 p� r 1 na 4
Roofing Company Name: ` 6tj�I '�s �Oa f I p" ► ,` /Q /�
Applicant' -Signattue• 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
B. Site 9. Install H.E. Irrigation, (details/spec)' L-1 72points
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
M&MOMMI TOTAL POINTS1 40 points
•
•
Plan Review Process Work Book Page-12-Revised 3/25/08
74
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.
INPUT ReSDUFCeS Energy IAO/Heatth
ite
1.Recycle Job Site Construction 8 Demolition Waste i
65%=1 point;75%= 2 points;80%=4 points up to 4 Resource pts 0
2.Salvage 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 C
5.Minimize Disruption of Existing Plants 8 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
8.Design Resource-Efficient Landscapes and Gardens _� 4 Resource pts y=yes 0
9.Reuse Mater als/Use Recycled Content Materials
for Landscape Areas 2 Resource pts y=yes 0
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
B.Foundation
1 1 1
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 p
2.Use Recycled Content Aggregate 2 Resource pts y=yes 0
3.Insulate Foundation/Slab before backfill 3 Energy pts
Y=Yes 0
C.Structural Frame
1 1 1
1.Substitute Solid Sawn Lumber with Engineered Lumber —] 3 Resource pts y=yes i 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. 0
3.Use Wood IJoists 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 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
b.Wall 3 Energy pts y=yes 0
c.Roof 3 Energy pts y=yes C
3 Energy pts y=yes 0
10.Apply Advanced Framing Techniques 4 Resource pts y=yes 0
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes
Pp
12.Gse OSB
a.Subfloors 1 Resource pt y=yes 0
b.Sheathing i 1 Resource pt y=yes p
1 1
• 1 1 1
r'
INPUT ROSDUICOS Energy
. xter or n s
1.Use Sustainable Decking Materials
a.Recycled content 3 Resource pts Y--yes0 •
b.FSC Certified Wood 3 Resource pts Y--Yes 0
2.Use Treated Wood That Does Not Contain Chromium/Arsenic 1 IAQ/Health pt y--yes 0
3,Install House Wrap under Siding 1 IAQ/Health pt y=yes 0
4.Use Fiber-Cement Siding Materials 1 Resource pt Y_-Yes 0
1 1 1
E.Plumbing
1,Install Water Heater Jacket 1 Energy pt Y_—Yes0
2.Insulate Hot and Cold Water Pipes 2 Energy pts yryes 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 pis. 0
4,Replace Toilest 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
6.Convert Gas to Tankless Water Heater 4 Energy pts Y--yes 0
7.Install Water Filtration Units at Faucets 0
(2 points each,up to 4 points) Up to 4 IAQ/Health pts.
B.Install On-Demand Hot Water Circulation Pump 4 Resource pts Y--Yes 0
r.wecmcar
1.Install Compact Fluorescent Light Bulbs(CFLs) 0
(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
Up to 5 Energy pts. 0
5 points)
3.Install Lighting Controls(i 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.Install Energy Star Refrigerator 1 Energy pt y=yes 0
4,Install Built-In Recycling Center 3 Resource pts y--yes 0
1 1
H.InsuleUon
1.Upgrade Insulation to Exceed Title 24 Requirements 0
a.Walls 2 Energy pts y yes 0
b.Ceilings 2 Energy pts y--yes
2.Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0
3.Install Recycled-Content,Fiberglass Insulation with 0
No Added Formaldehyde 3 IAQ/Health pts y=yes
4.Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes 0
5,Use Cellulose insulation
a.Walls 4 Resource pis y--yes 0
b.Ceilings 4 Resource pis y=yes 0
6.Alternative Insulation Products(Cotton,spray-foam) •
a.Walls 4 Resource pts y=yes 0
D.cesings 4 Resource pts y=yes 0
1 1
'z-
r
114PUT Resources Energy
riclows
1.Install Energy-Efficient Windows y
a.Double-Paned 1 Energy pt y=yes 0
It.Low-Emissivity(Low-E) 2 Energy pts y=yes 0
c.Lbw.Conductivity Frames 2 Energy pts y=yes 0
2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 0
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=yes 0
5.Install Solar Attic Fan 2 Energy pts y=yes 0
6.Install Attic Ventilation Systems 1 Energy pt y=yes 0
7.Install Whole House Fan 4 Energy pts Y--yes 0
8.Install Sealed Combustion Units
a.Furnaces 31AQ/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 0
13.Retrofit Wood Burning Fireplaces
• a.Install EPA certified wood stovestinserls 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,Hydropic Radiant Heating 3 Energy pts y=yes 0
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 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 Materials 1 Resource pt y=yes 0
7.Install Radiant Barrier 3 Energy pts y=yes 0
1 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
r
MOhleafth r
. n oor r ua tty an n s ea
1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 S
3.Use Low/No VOC Adhesives 3 IAQ/Health 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 61AO/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAO/Health pts y=yes 0
7.Seal all Exposed Particleboard or MDF 4 IAQ/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 0
10,Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2,Use Rapidly Renewable Flooding 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 IAQ/Health 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=yesl 0
1 1 1 ii
Total Points AvaXaFej 1 1401 1301 57
Total Points Project R 1 0 0 0 e
G:data/progsrgreenbuildngguidelines/remodelerdomenpointsfinal2.12.edprotected.ds
' Community Development
ot
' � C
10300
ertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
CUPEkTINO
Buildin De artment
JOB ADDRESS:
-Tr It) I PERMIT #
Cl
ri n eta /-3s-
SIMM6
OWNER'S NAME: won
GENERALCONTRACTOR: }i to oa�i FAX #
I am not using any subcon c
Signature Date
Please checka licable subcontractors 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
Q�vner/Contractor Signature Date