08090021 (2)uW'
OpF
�ZuZ�
=Z
iq
of-yC�
�to
5.0�
C
�0C
IRE
_2>
CITY OF CUPERTINO
L�����sa,,��T
'►Qa�,�S�x.T�.tF}yO lYy �AVii
BUILDINGDIvISION Pl`.S�1Y111
waC�t\ull�l4
BULKING''
..I off hR:rDGE PARK CT
CASTILLO'S ROOFING
PERMIT NO.
08090021
OWNER'S NAME:
PERMIT ISSUE DATE
!',NGEI.RAN PNINA AND ELI
1703 CATHAY DR
09/04/2008
Ng
(408)251-3565
SANITARY NO, CONTROL NO.
ARCHI ECTYENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
- OeSCrIp
Ib Description
1 hereby affirm that 1 am licensed under Provisions prompter 9 (commencing
with Section 7") ofDivision 3ofdte Business and Professions Code, and my license is
RE -RF 'RMV OLD RF & INSTL $30LB FLT&GAF COMP
th full force and efree -9
License Clau
SHNGLS
Dam - CHTBCTSDEC` yN
CLS A 19SQ
I undersand my pWs sl I M ound as pts tic Ida
.
Licensed Profeaiona
OWNER -BUILDER DECLARATION
1 hereby M. that 1 am exempt from the Contraeroes License Law for ale
following mason. (Section RD 1.5, Business and Profeasuns Cole: My city or county
-
which nequires •permit an construct, alun. improve. demolish. M repair any suucturd
! priorm its issuance, also requires theapplicant formch permit to rile a signed summcns
that he is licensed pursuant to the provisions of the Comsmmri UmMc Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 70(30) of Division 3 of the Business and Prorrsions Coda) M
$9500
that he is exempt thamrmm and the bases for she alleged uemptim My Halation of
36652051 fiff Number
Occupancy P y 1Ype
Secton 7031.5 by any applicant for a porous subjects the applicant to a civil penalty of
nos more man five hundred dollars ({5)0).
ofnd pressruc Mmy wpmycm Or wgnasthe'San. a
Lo
'
.Beams
will dothesict. andt ran ContisnmmmndedMaw clo Tartanpply race, Beams
thewo offered
and ons Cost Tm ContrmmYi License Law dam ms apply m an awMr
Required Inspections
arty wh Mthmu{h his
propertywhobuilds insphaseschicon,andwm anusstilt work is
oroffi
awn rte, provided seas such improvements am not intended oroRmed fns
i
ver. th owner.
or wide did one Weld ofimproefarmeowner-
buwder,
inbuildinguimprovementg
milGr win have the burden of proHng mat Ins did not beim M improve far purpose of
uk.).
❑ 1. as owner or tiro prurient, am exclusively contracting with Rcan ed mnummrs m
srortsms-s the project (Sec. 1000, Business and Rogesdons Code) The Ccauacm/s Li-
.
cumse Law cons Out apply m an owner of property who builds or improves thereon, and
who contracts for such pmjcm with a conhrmmr(s) [!caused purstant m the Contrames
License taw.
❑ Iammemprunder See .R&PCfmmiswon
Owner Data
WORKERS COMPENSATION DECLARATION
1 thereby afRm under penally of pecjusy one of the following declarations:
.
love and will maintain a Cmificeleof Consent to self-lmum for WmYees Cout
, as provided for by Section 3100 of the Labor Code. for the performance of the
wort for which this permit is issued.
❑ 1 have and will mainWn Worsens Compensation I... u required by Section
3700ofthe Labor Code. to, the performanceafthe were for which this pcmtit is issued.
'
MY Wahefs Compensation Iwrance cash aM PWlry number Ita�e: �y5 /�
Camcn._!: gf 1--ynQ Policy No.��A DI1 r/T T
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thusectmn need not be completed if the permit is foroac mndrad dollars (SIM)
1 certfy ems to the performance W the work for which this permit is issued, [ shall apt
employ anypenon in my manner¢ as to become subject to the Workers' Compensadon
laws of Califoroit Data
Appfisam
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker! Compensation provisions of the laser Cade, you am
ermwith comply with such Proviso. or this permit c1W I he decmW revoked.
CONSTRUCTION LENDING AGENCY
1 ser Wr them u c lemm�{ agertry fns Ins pertomarice of
whaRrm
work for which Thu pemhit is issued (Sec. 7WT, Civ. C.)
s d (Sce. 30
,
Lo
Ltnder's Name
Lender Address
1 cenlfy that 1 have mad :his applicuion and sum tha the above information is
COMCL I asma On comply with all city and county ordinances and sole laws relating to
Wilding coruvecton. and thereby authpriae representatives of this city to on= upon the
above-mantoMd property fm inspection purymea
(we) agree to cent, indemnify and hicp harmless the City against
Wgmenu cents and eapcusm which may in any way aarntagairm std City
n e Mainst l
in
in cortstyuence of the {tantin{ of Nu permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -PO
SOURCEREGU
Issued by: Date
Re -roofs /
of pelican Canusehor Da
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof .�/
the applicans or future Wilding aeupml Mie M mMk haysdom materia
U derived by the Cupertino Mtenciipal ode. Chapter 9.11. and the Health and Safety
Cale, Schon 25531(x)+
El Yu
All roofs shall be inspected prior to any roofing material being installed.
Will thea Brent or rut It Id' or devices which
pp pant use equipment
Avardpm
If a roof is installed without first obtainingan inspection, I agree to remove
P g
al, emumimn a d br ale eat Aroaar owny Management
Qu
all new materials for inspection.
aT
❑Yrs ❑No
,
I have road the hvandwsmaeriaumquimmmuunderCmpler 6.95 ofthe Caifen.
vis Hmldh&Safety Com. Smater 355W, 25533 and 25530.1 undcrsund thaif ale building
dons rapt currency ha a anL der, it u my unporsbilitY m entry cele nectpanla Ule
mquhcmerus whit bedletpriM o!a 'Txale of
y
Signature of Applicant Date
All roof coverings to be Class'W' or better
Owmcr1(atA1h22fd.gcm1 Date
2 :ITEMS OF 2
•
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36652051.00
DATE ISSUED.......: 09/04/2008
RECEIPT #.........: BS000005995
REFERENCE ID # ...: 08090021
SITE ADDRESS .....: 11652 BRIDGE PARK CT
SUBDIVISION .......
CITY CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
OWNER ............:
ENGELMAN PNINA AND ELI
ADDRESS. ..........:
11652 BRIDGE PARK CT
CITY/STATE/ZIP ...:
CUPERTINO CA, 95014-5100
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
IBSEISMICR VALUATION
9,500.00
1.00
0.00
1.00
0.00
IREROOFRES SQ FEET
19.00
247.00
0.00
247.00
0.00
TOTAL PERMIT
----------
248.00
----------
----------
0.00
----------
248.00
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
248.00
---------------
248.00
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
REFERENCE NUMBER
--------------------
#15316
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
' ; too
TY OF
•FUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION
0$Oq C)C),-�,(
APN #
Date: ,
Building Address: ' I S n
Owner's Name: a
Phone #: / p / Gf
l �a kX % vQ "
U� O /
Contractor:
C ���
Phone #:
N L S
Fax #:
Cupertino Business License #:
Contractor Li ense #:
3� S�
Type of Roof Covering:
Existing: Proposed:
❑ Built -Up Roof ❑ Bui t -Up roof
Shingles
�o phalt sphalt Shingles
ood Shakes o Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Nu�b er of existing coverings o Provide I.C.B.O. Report #
g/T o be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:-, k
Q-eX e- o I CL P_U-0 __Tn�' IJ�b FE_ i
J
1 Zf
Residential Commercial
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: El
applicable, include in plan set & the sheet index.
Valuation:
and Will Comply with Cupertino's Tear -Off Policy:
Revised 6/16/08
CI OF
CUPEkTINO
CITY OF CUPERTINO
REROOF
FEESCHEDULE •
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
1RER00FC0M
Re -roof Commercial
B
1COMMLROOF
1BSEISMICO
Seismic Commercial
B
1RER00FRES
Re -roof Residential
B
1SFDWLROOF
1BSEISMICRE
Seismic Residential
B
1RER00FMRES
Re -roof Multi -Family
B
IMFDWLROOF
1BSEISMICRE
Seismic Residential
B
1BUSLIC
Business License
B
Revised 6/16/08
J
•
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 2007 IBC Standards
and manufacturers specifications on re -roofing. All roofs are Class "A" per Cupertino
municipal code 16.04.080.
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 mirumum of I/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:�.Ar? G} -I-
Job Site Address: ZI 6 S_oZ 13 tI p(� jaGv� C
Roofing Company Name: /tf % l &Z_0_1
• Applicant's Signature Date: �— U
Greg Casteel
Building Official
Revised 07/30/08
•
U
Plan Review Process Work Book Page -12-Revised 3/25/08
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
2 points
11. Permeable Paving, Note
L-1
2 points
C.
Foundation
1.
Use 15 % Flyash Concrete, (note)
S-1
5 points
D.
Structural
3.
Uses Wood I -Joist, (See Spec.)
S-2
2 points
5.
Use Truss with heels, (detail)
S-2
2 points
6.
B. OSB Sheathing, detail
S-2
2 points
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.
Ener Star Refrigerator, (Note/Spec.)A-3
1 point
P.
Other
1.
List Green Features on Plans
A-1
1 point
TOTAL POINTS1
40 points
•
U
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.
114PUT Resources Energy IAG/Heafth
A. Site
Vit. Recycle Job Site Construction & Demolition Waste
65%=1 point; 75%= 2 points; 60%= 4 points
+ up to 4 Resource
;2_ Salvage Reusable Building Materials _
4 Resource pts
y-
3. Remodel for Mixed Use, Adaptive Reuse, and
2. Use FSC Certified Wood for framing
.'
Historic Preservation
4 Resource pts
y=
4. Protect Native Soil
2 Resource pts
y-
5. Minimize Disruption of Existing Plants & Trees
1 Resource pt
y=
6. Implement Construction Site Slormwaler Practices
2 Resource pts
y=
7. Protect Water Quality with Landscape Design
2 Resource pts
y=
(B. Dzsign Resource-tfficiantL_ capes and Gardens _
4 Resource pts
y=
9. Reuse MatedaWUse Recycled Content Materials
2 Resource pts
y=yes
for Landscape Areas
2 Resource pts
y=.
10. Install High-Eficiancy Irrigation Systems
2 Resource pts
y_
11. Provide for On -Site Water Catchment / Retention
2 Resource pts
y=
B. Foundation
3 Energy pts
y=yes
1. Incorporate Recycled Flyash in Concrete
4 Resource pts
y=yas
25% Recycled Flyash = 2 points; Add 1 point for every 10%
3 Resource pts
y=yes
• increase of flyash, up to 5 points
up to 5 Resource
2. Use Recycled Content Aggregate
2 Resource pts
Y=1
3. Insulate Foundation/Slab before backfill
3 Energy pts
yq
C. Structural Frame
(1. Substitute Solid Sawn Lumber with Engineered Lumber -
3 Resource pts
2. Use FSC Certified Wood for framing
.'
y=yes
(For every 10% of FSC lumber used = 2 points, up to 10)
up to 10 Resource pts.
3. Use Wood I -Joists for Floors and Ceilings
2 Resource pts
y=yes
4. Use Web Floor Trusses
2 Resource pts
y=yes
5. Design Energy Heels on Trusses 6" or more
2 Energy pts
y=yes
6. Use Finger -Jointed Studs for Vertical Applications
2 Resource pts
y=yes
7. Use Engineered Studs for Vertical Applications
2 Resource pts
y=yes
B. Use Recycled Content Steel Studs for Interior Framing
2 Resource pts
y=yes
9. Use Structural Insulated Panels (SIPS)
a. Floors
3 Energy pts
y=yes
b. Wall
3 Energy pts
y=yes
c. Roof
3 Energy pts
y=yes
10. Apply Advanced Framing Techniques
4 Resource pts
y=yas
11. Use Reclaimed Lumber for Non Structural Applications
-—
3 Resource pts
y=yes
12. Use CSB -
a. Subfloors
1 Resource pt
y=yes
b. Sheathing
• _ _
1 Resource of
Y --yes
1. Use Sustainable backing Materials
a. Recycled content
3. Resource pts
y=yE
b. FSC Certified Wood
3 Resource pts
y=yE
12. Use Treated Wood That Does Not Contain ChromiurNArsenic
1 IAQ/Health pt
y=yf
I3. Install House Wrap under Siding
1 IAQ/Health of
y=yE
'I4. Use Fiber -Cement Siding Materials
1 Resource pt
y=yes
E. Plumbing
1. Install Water Heater Jacket - - -
2. Insulate [Tot and Cold Water Pipes
sul
'3. Retrofit all Faucets and Showerheads with Flow Reducers
a. Faucets (1 point each, up to 2 points) i
b. Showerheads (1 point each, up to 2 points)
4. Replace Toilest with Ultra -Low Flush Toilets I
I(1 point each, up to 3 points)
5. Install Chlorine Filter on Showerhead
6. Convert Gas to Tankless Water Heater
7. Install Water Filtration Units at Faucets
(2 points each, up to 4 points)
S. Install On -Demand Hot Water Circulation Pump
r. trecmcar
I1. Install Compact Fluorescent Light Bulbs (CFLs)
(L6 bulbs—_2 points, 10 bulbs =3 points, 12 bulbs = 4 points)
2. Install IC -AT Recessed Fixtures with CFLs (1 point each, up to
5 points)
3. Install Lighting Controls (1 point per fixture, up to 4 points)
4. Install High Efficiency Ceiling Fans with CFLs
(1 point each, up to 4 points)
1 Energy pt
2 Energy pts
Up to 2 Resource pts.
Up to 2 Resource pts.
Up to 3 Resource pts.
1 IAO/Health pt y=yes
4 Energy pts y=yes
Up to 4 IAQ/Health
4 Resource pts y:
Up to 4 Energy pts. 0
Up to 5 Energy pts. 0 •
Up to 4 Energy pts. 0
Up to 4 Energy pts. 0
1 1
G. Appliances
it. Install Energy Star Dishwasher - -
y 1 Energy pt
y=yes
I2. Install Washing Machine with Water and Energy
Conservation Features
1 Energy pt
y=yes
I3.Install Energy Star Refrigerator
1 Energy pt
y=yes
�4. Install Built -In Recycling Center
3 Resource pts
y --yes
H. Insulation
1. Upgrade Insulation to Exceed Title 24 Requirements
a. Walls
b. Ceilings
2. Install Floor Insulation over Crawl Space
!3. Install Recycled -Content, Fiberglass Insulation with
!No Added Formaldehyde
4. Use Advanced Infiltration Reduction Practices
5. Use Cellulose Insulation
a. Walls
b. Ceilings
6. Alternative Insulation Products (Cotton, spray -foam)
a. Walls
o. uemngs
2 Energy pts y=yes
2 Energy pts y=yes
4 Energy pts Y_—Yes
31AQ/Health pts
2 Energy pts
4 Resource pts
4 Resource pts
4 Resource pts
4 Resource pts
•
1. Install Energy -Efficient Windows
i a. Double -Paned 1 Energy pt
• b. Low -Emissivity (Low -E) 2 Energy pts
c. Low. Conductivity Frames 2 Energy pts
2. Install Low Heat Transmission Glazing 1 Energy pt
J. Heating Ventilation and Air Conditioning
'1. -Use Duct Mastic on All Duct Joints
2. Install Ductwork wthin Conditioned Space
3. Vent Range Hood to the Outside
4. Clean all Ducts Before Occupancy
5. Install Solar Attic Fan
S. Install Attic Ventilation Systems
7. Install Whole House Fan
S. Install Sealed Combustion Units
a. Furnaces
b. Water Heaters
2 Energy pts
y=yes
3 Energy pts
y=yes
1 IAQ/Health pt
y=yes
21AQ/Health pts
y=yes
2 Energy pts
Y --yes
1 Energy pt
y=yes
4 Energy pts
y=yes
31AQ/Health pts
31AQ/Health pts
9. Replace Wall -Mounted Electric and Gas Heaters with
Through -the -Wall Heat Pumps 3 Energy pts
10. Install 13 SEER/11 EER or higher AC with aTXV 3 Energy pts
11. Install AC with Non -HCFC Refdaerants 2 Resource pts
12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace
2 Energy pts
y=yas
13. Retrofit Wood Burning Fireplaces
3. Pre-Nrre for Future Photovoltaic (PV) Installation
4 Energy pts y=
• a. Install EPA certified wood stoves4nserts
b. Install/Replace
1 IAQ/Health pt
y=yes
Dampers
1 Energy pt
y=yes
c. Install Airtight Doors
1 Energy pt
y=yes
14. Install Zoned, Hydronic Radiant Heating
3 Energy pts
y=yes
15. Install High Efficiency Filter
4 IAQ/Health pts
y --yes
16. Install Heat Recovery Ventilation Unit (H RV)
5 IAQ/Health pts
y_=yas
17. Install Separate Garage Exhaust Fan
3 IAQ/Health pts
y=yes
K. Renewable Energy and Roofing
1. Pre -Plumb for Solar Water Heating
4 Energy pts y=
2. Install Solar Water Heating System
10 Energy pts y=
3. Pre-Nrre for Future Photovoltaic (PV) Installation
4 Energy pts y=
4. Install Photovoltaic (PV) System
(1.2 kw = 6 points, 2.4 kw =12 points, 3.6 kw = 16 points)
Up to 16 Energy
6. Select Safe antl Durable Roofing Materials_ _
1 Resource pt y=
_ _ _
7 Install Radiant Barrier
3 Enerov ots V=
L. Natural Heating and Cooling
1. Incorporate Passive Solar Heating 5 Energy pts y=yes
2. Install Overhangs or Awnings over South Facing Windows 3 Energy pts . y=yes
3. Plant Deciduous Trees on the West and South Sides 3 Energy pts Y --yes
L J
1. Use Lciw&o-VOC Paint - _
1 IAQ/Health pts
y=yes
2. Use Low VO—C, Water-Based Wood Finishes
2 IAQ/Health pts
y=yes
'3. UseLowMo VOC Adhesives -
_ 3 IAQ/Health pts
y=yes
4. Use Salvaged Materials for Interior Finishes
3 Resource pts
y=yes
5. Use Engineered Sheet Goods with no added Utea
Formaldehyde
61AQ/Health pts
y=yes
6. Use Exterior Grade Plywood for Interior Uses
1 IAQ/Health pts
y=yes
7. See all Exposed Particleboard or OF
41AQ/Health pts
y=yes
B. Use FSC Certified Materials for Interior Finish
4 Resource pts
y=yes
9. Use Finger-Jointed or Recycled-Content Trim
1 Resource pts
y=yes
10. Install Whole House Vacuum System
3 IAQ/Health pts
y=yes
N. Flooring
1. Select FSC Certified Wood Flooring
B Resource pts
y=yes
i2. Use Rapidly Renewable Fldoring Matenal-s
- 4 Resource pts
y=yes
3. Use Recycled Content Ceramic Tiles
4 Resource pts
y=yes
4. Install Natural Linoleum in Place of Vinyl
51AQ/Health pts
y=yes
5. Use Exposed Concrete as Finished Floor
4 Resource pts
yges
6. Install Recycled Content Carpet with Low VOCs
4 Resource pts
y=yes
Total Points Available:
Total Points Project Received:
•
1401 130 57
01 0 0 •
Com- Gi- D
G:daarpmgsrgreen lildingguidelineslremodelersrgmenp�inlsfinal2.12.04pro7ecled.ds
0
4
CITY Of
�UPEkTINO
I 41
JOB ADDRESS:
OWNER'S NAME:
GENERAL CONTI
Buil
a r? r
I am not using any subcontract/
Please check anolicable subcontractors
De artm
PERMIT #
PHONE#
FAX #
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
nt
�CoS'- F319
SI'�SCos
rmmnlPta tha fnllnwino infnr ma nn -
Date
Owner/ Contractor Signature
Date
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
'e
Owner/ Contractor Signature
Date