Loading...
13050033I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: I0684 RANDY LN CONTRACTOR: LEGEND BUILDERS INC PERMIT NO: 13050033 OWNER'S NAME: DINESH SHAHANE 2735 SAND POINT DR DATE ISSUED: 09/05/2013 OWNER'S PHONE: 4087716224 SAN JOSE, CA 95148 PRONE NO: (408) 592-8563 21 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL. License Class Lic.# � 12��- CONSTRUCT A ONE STORY ADDITION (479 SQ FT) AND A COVERED PORCH (94 SQ FT'); REMODEL DINING ROOM, Contractor a _ t "�atel I 2 �{ - 3 E Y AND BATHROOM (188 SQ FT). I hereby affirm tat I am licensed under the provisions of Chapter 9 CHANGE FRAMING DETAIL FOR FOUNDATION AT (commencing with Section 7000) of Division3 of the Business & Professions R PROPERTY - ISSUED 10/24/13 Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Codc, for the Sq. Ft Floor Area: Valuation: $69000 rforrnancc of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 31602069.00 Oeeupaney Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED Correct. I agree to comply with all city and county ordinances and state laws relating WITHIN ISO DAYS O RMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS T CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against fiabif ities, judgments, costs, and expenses which may accrue against said City in consequence of the �by:-�Date: d 2 granting of this permit. Additionally, the applicant understands and.will comp with all non-point source regulations per the Cupertino Municipal Code, Sec 9.18. ATIo_ l Signator aka `{ 3 RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. OWNER-BUILDER DECLARATION Signature of Applicant: Datc: Thereby affirm that 1 am exempt from the Contrpctor's License Law for one of " the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to NAZARDOYS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued, will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this t y Owner or authorized agen : \ _ Date `1 permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must 1 hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked, work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name AkPLICANT CERTIFICATION Lender's Address 1 certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequenoe of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10684 RANDY LN CONTRACTOR- &BE PERMIT NO: 13050033 ED OWNER'S NAME: DINESH SHAHANE DATE ISSUED: 0910512013 O ER'S PHONE: 4087716224 PHONE NO: JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALD LICENSED CONTRACTOR'S DECLARATION License ClassLic. # 2 1 8 S . CONSTRUCT A ONE STORY ADDITION (479 SQ FT) AND A COVERED PORCH (94 SQ FT); REMODEL DINING ROOM, Contractor Date ENTRY AND BATHROOM (188 SQ FT). I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and That my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: 1 have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sg. Ft Floor Aren; Valuation: $69000 of the work for which this permit is issued. Eartce will maintain Worker's Compensation Insurance, as provided for by of the Labor Code, for the performance of the work for which this APN Number: 31602069.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws gelating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DJJOM LAST CALLED INSPE;;N. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the -f granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signatur ti = ....�= _ c — l 3 All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (See.7044, Business & Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 2S505, 25533, and 25534. 1 will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 15532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should 1 use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District 1 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9,12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner iI ' S r permit is issued. o la agett _ nn ---� I certify that in the performance of the work for which this permit is issued, I shall -�'�-'- not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must 1 hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to Comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the 1 understand my plans shall be used as public records. granting of this permit. Addilionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date 1 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building cu pertino,or ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION DEFERRED ORIGINAL PERMIT #_J_.? Orb 0 3 3 PRorEcraDDtiFCC +r,r c7 h ti� APxa J%Z OWNER NAME I/l l " / l . � 10* /2 PHONE D� _ , E-MAIL STREET ADDRESS n CITY, STATE, ZI�j FAX CONTACT NAME JK Ti f 7 rrt NS l� PHONE E-MAIL. STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER 110 -BU LDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME r yI M I, 1) C tLkI LICENSE BER LICENSE TYPE BUS. LIC H COMPANY NAME }�(�j?, jD r f , n V� ltl Ill/ Ll(J E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECfIENGINEER NAME LICENSE NUMBER BUS. LIC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATF_ ZIP PHONE DESCRIPTION OF WO HAW 4 ►r- I- R � f Pie 401 J 10 0 ' /1 - V Jx b V uo �, t,E nl �/ S 5 2 EMSHNGUSE PROPOSED USE CONSTR.TYPE 11STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODEL AREA PORCH AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH [7KARFA ❑ATTACH 4 DWELLING UNITS: IS A SECOND UNIT ❑YES SECONDSTORY []YES BEINGADDED? ❑NO ADDITION' []NO PRE -APPLICATION [)YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YTS 4REC - - UATION: PLANNINGAPPLO ONO PLANNING APPROVAL LETTER EICHLERHOME? ❑NO � , By my signature below, I certify to each of the following: I am the property owner or authorized agent o act on th r rty owner's behalf. I have read this application and the information 1 have provided is correct. I have read the Description of Work and verify it is ac c. I agree to comply with all applicable local ordinances and state laws relating to building construction. ifautborize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplieanUAgent: Date: SUPPLEMENTAL N REQUIRED _ MAN CHECK TYPE'_ w . ROUTING SLIP U 'OVFR-TIIE-C0UNjR � ' ,� � D BUILDING`PLANREYIEW New SFA or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building ' permit for new building. "�' i xP ss : 0 -PLAN'NIN`d- iri RE`VJ, W _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure b-S'AN?i) iq 0 •ri_IBL_ 1C WORX-S � - form if any Hazardous Materials are being used as part of this project.; ` ❑ LARGE, = IFIRE DEPTH , _ Copy of Planning Approval Letter or Meeting with Planning prior to i �+ evlloR ] D $A`iITARYSEwERt)iSTRIC submittal of Building Permit application. 0 FNVIRONMENTALI3EALri1x BldgApp_2011.doc revised 06121111 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingPcuperlino.org /30_!�_0e �3 ❑ NEW CONSTRUCTION M ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDR M' Y LA APN# OWNER NAME i)I.l� A SA(1 ��+ii�f i t+%1,wroy PHONE �p 622 E-MAIL STREET ADDRESS d lD CITY, STATE, ZIP � � n CX FAX CONTACT NAME IV ` �C[ Y j ��I PHONE ^O_ (� Q - E•/MAEL60 STREET ADDRESS N CITY, STAT, IP`Q / FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT )� ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CON OR NAME LICENSENUMBER LICENSETYPE BUS. LIC 9 COMPANY NAME E-MAIL t FAX STREET ADDRESS CITY, STATE, ZIP PHONE lEN 1NEER NAME LICENSE NUMBER BUS. LIC n lc L COMPANYNAME ` -� n ! M E-MAIL ffl�4< ab FAX �LCJV ���C� STREErADDRES a SC() �31,V T� CITY, STATE, ZIP S PHO - 6 2 (DIffRIPTION OF WORK .� .. _ vKo 0-1 &hwt, Kl l/ &L EXISTING USE PROPOrS� USE CONSTR. TYPE N STORIES v USE OCC, SQ.FT. VALUATION (S) EXISTAREA AREA OR AREA 1 SS TOTAL NErAREA �J y �'5 JTYPE BATHROOM REMODELARFA CHEN RFMODELAREA rsti OTHER REMODEL AREA r-7 PORCHAREA DECKAREA TOTALDECKIPORCHAREA GARAGEAREA: DETACH v� ATTACH # D LING UNITS: IS A SECOND UNIT ❑ YES SECONDSTORY ❑ YES BEING ADDED? J2NO ADDITION? P'NO l PRE -APPLICATION [:]YES IF YES, PROVIDE COPY OF PLANNINGAPPLO []NO PLANNING APPROVAL LETTFR IS THE RLDG AN ❑ YES EICHLER11061E? JaNO R CVVED B 1 ��� V TO�e "L} N: bm • By my signature below, I certify to each oFthe following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description OF Work and verify iL is accurate. I agree to comply with all applicable local ordinances and state laws relating to build' ction. ] au rite representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicandAgent: Date: t� SUPPLEMENTALTI QUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OYER -THE -COUNTER ❑ BUILDING PLAN REVIEW New SFD Or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PIAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ ❑ LARGE FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to 1-1nwOR 1-1SANITARYSEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL I[EALTII BldgApp_1011.doc revised 06121111 M e4 �- &�4 CITY OF CUPERTING FEE ESTEVIAT®R - BUILDING DIVISI®N ADDRESS:4fandy In TYPE OF CONSTR. DATE: 05/0612013 REVIEWED BY: larrys APN: BP#: dd,3 3 'VALUATION: $69,000 *PERMIT TYPE: Building Permit II-B'111-B,IV,V-B PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: p $1,549.00 2nd Unit? Yes No OTC? Q Yes GNo PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK addition 479s ftadd porch 94 sq ftinterior remodel 188 sq ft nonew roof only re 'r re [ace 1 SCOPE window. \ A6 Aieft_ 1&4 412—r0%r,-j V AA - r t OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B'111-B,IV,V-B 573 $2,468.00 1R3PLNCK $1,549.00 1R3INSP F;lec. Insp. Fee: Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ' C'onsfl-uctlon Tax., Adrninlistrative Fee: Q E) Work Without Permit? Q Yes (D No $0.00 Advanced Planning Fee: IPLLONGR TOTALS: 573 1 $2,468.00 1 $1,549.00 $6.90 MECH, SOURLY © Yes 0 No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY ()Yes, No fifeclr. Plan Check Plumb. Plan Check Elec. Plan Check 1lfech. Permit Fee Plumh. Permit Fee: Elec. Pernril Fee: Orher Afec•h. Insp. Ocher Plumb Insp, Other Elec, Insp. ;Meth, lisp. Fee: Plumb, busy. Fee: F;lec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta). These fees are based on the nrelinunary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS fFee Resolution I VOS3 Eff 7/1/12) FEE QTYIFEE MISC ITEMS Plan Check Fee: $2,468.001 �8 s.f. Remodel, Other $400.00 IREMRESOTH Suppl. PC Fee: Q Reg. d OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 1 # Window / Sliding Glass Door $400.00 1WINREP Replacement Permit Fee: $1,549.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ' C'onsfl-uctlon Tax., Adrninlistrative Fee: Q E) Work Without Permit? Q Yes (D No $0.00 Advanced Planning Fee: IPLLONGR $74.49 Select a Non -Residential G Building or Structure Q i I-m,el Documentation Fees: Strong Motion Fee: IBSEISACCR $6.90 Select an Administrative Item . Bldg Stds Commission Fee: 1BCBSC $3.00 SUBTOTALS: $4,101.39 $800.00 TOTAL FEE: $4,901.39 Revised: 04129/2013 CITY OF CUPERTINO Ifni EEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District etc). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'I info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) ADDRESS: 10684 RANDY LN DATE: 10/2312013 REVIEWED BY: MELISSA xfech. Permit Fee; APN: 316 02 069 BP#: *VALUATION: Iso PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration 1 Repair PRIMARY SFD or Duplex USE: Plueuh. hrsp. Fee: PENTAMATION 1GENRES I PERMIT TYPE: WORK REV # 1 - CHANGE FRAMING DETAIL FOR ADDITION AT REAR OF PROPERTY SCOPE Suppl. Insp. Fee -.Q Reg. Q OT NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District etc). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'I info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) Neele. Plan Check- Phemb, Plur1 Check- Elec. Plan Check xfech. Permit Fee; Plumb. Permit Fee: flee. Permit Fee: Other Afech. Insp. Oilier Plumb Insp.Lj Other Elec. 1n1p. Hech. hap. Foc: Plueuh. hrsp. Fee: Elee. 1usp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District etc). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'I info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTYIFEE MISC ITEMS Plan Check Fee: Hourly Only? () Yes, Q No $0.00 2 hours Plan Check, Hourly $278.00 ISTPLNCK Suppl. PC Fee: Q Reg. OT 0.0 hrs. $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -.Q Reg. Q OT 4,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee-,,: Q 0 Work Without Permit? O Yes (F) No $0.00 Advanced Planning Fee: $0,00 Select a Non -Residential E) Building or Structure O Trove:! Documentation Fees: Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $278.00 TOTAL FEE: $27$,40 Revised: 10/01/2013 CUPERTINO CONTRACTOR / SUBCONTRACTOR AST Building Department City OrCupertirro 10 300 Torre Avenue Cupertino. CA 95014-3255 Telephone: 408-777-3229 Fax; 408-777-13;1.1 JOB nuuxESS: p �l�t l� la_ I PrRr4I-r # X �5 1 0 I:t> 0 0 5-�5 O\YNi:ft'S Nr1sVIL ^1 �� -- PHONE :f e -O 5V GENERAL CONTRACTOR: [���� ��'� ,�� BUSINESS LICENSE 4. nDDRL'SS: • Qat, cITY}'ZIPC[3171:: �I t,t "0111- municipal cnrlc r•cgnircS all bWAIMSSC5 ti 01-IdTig in fire city 14) 11.11T a City 111 Cupertino business liecusc. ,NO IMILDING 114 -NAL Olt FINAL. 0(:CLlY,, iN(.'1' IN5PLiurrON(S) NVILL BE' SUIEl)L)1. EA) t6NT11. GriNT-RAL CON'rE2Acmit AND AL1, SU3tO,NTRACT0RS,llAVL 011TAENED A C1TY Or CUPI'lul-IN0 BUSINESS LICENSE. 1 ;1111 1101 using ant• Nil lacontractor:s: — - - - — — -- signantre Dale Please check applicable~ subcontrilctors and compleic the 1'ollawing fnrornt:ltion: Otitef Cnntt•actor Signarure S --iLl —tLk Date SUBCONTRACTOR _ BUSINESS NAN-Hi' BUSINESS LICENSE 4 Cllbiuclsf N1illwclri;..�_.'__ cement Fi111Sltilll, Electrical — - Excavation - ��'��GaCb`_+e - --- q rj Z - _Z� Z Z Fencino Hoaring I Carpeting Linoleum 1 W00d Glass I Glazing - _ Herring Insulation Landscaping Lathing _ Masonry 11ainling! Wallpaper - Paving Plastering Plumbing Roofing Scplic Tani: _ x Sheet Metal _ Sheet stock Otitef Cnntt•actor Signarure S --iLl —tLk Date