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08070226 (2) CITY OF CUPERTINO BUILDING DIVISION. PE �IcQt\:1�GaTOR�IPT.EO�RMATI�N z BUILDING ADDRESS: PERMIT NO. 1 .1568 COPPER SPRING CT CASTILLO' S ROOFING 08070226 OWNER'S NAME: PERMIT ISSUE DATE NLAVELI:r GEOFFREY ET AL 1703 CATHAY DR 07/30/2008 NE: SANITARY NO. CONTROL NO. ARCHITECTIENGiNEER: BUILDING PERMIT INFO RE-RF RMV RF& INSTL#30LB BLDG ELECT PLUMB MECH O O O O u o ij LICENSED CONIRACIDR'S DECLARATION 1 nemby affirm tat I am lixand ander provisions of Chapter 9(rnmmcrcing ...... of Description whin S.Om'OW)of Division 3.film Beat.and Proomiosts Code,and my license is n in full forte and effect j License Clusa ( Lk,g 30 •�(OJ '-r=p Date Can ' J37W ARCHRECI'S DEC TION m 1 undcnund my plans shall he used as public to JyU & y Licensed Professional OWNER BUILDER DECLARATION iC I hereby.(bore Ines I am exempt from Ne Conuacm oa e:An x Law for Inc p o whicfollowing tams a Permit t 8131.5.Business and Professions Code:Any city or county nctum which myuim a permit m construct,alter,apmve,dcmolbh,or mpoh any swc,um licensed e,almmtotha provisional of the Contractor's arae aw(Cha mml Emttatomenci &wit pama•nt some of Division of oft Conusiness and Prvcaw(Oupxr9 Sq.Ft. Floor Area Valuation '1-0 Oat he inc exempt therefrom and of Divbion l of al Business exe and Professions Cade)of y`<$ that k u exempt therefrom and Oe baso far uta alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant In a civil penalty of APN Number Occupancy e not more Ian Bus bandied dollars,(SSW P Y TYP 1,as owner of the property,or my employee,with wage as Weir sok campensation, will do Oe wort and tax,structure is not Wlended o offered for sale(Sm.70m.Businew, and Pm(essions Code The Ommcmh Littme Law dam rot apply x an owner of Required Inspections pmpeny who milds o im provesthereon.and wee dots ruin work himself or though his own employees,provided than such improvements art not intended mo@red forsale.If, however,the building or improvement is sold within ane year edcomple max.did owrcry . builder will ave the bads of moving Oat k did rot Isuld or improve for purpose of sob.} C]1.as owner of the property.am reclusively embossing with licensed conmcmn b construct We project(Sec.70th,Business and Pm(essions Code:)Tic Conuacbfs U. cane law docs not apply he an owner of Propcny,who builds m impmm thereon.and who contracts for such pmjecu with a conaactm(s)licensed pursuant to the Conummh License law. ❑I sum exempt under Sec ,B&PC for Wu reason Owner Dau WORKER'S COMPENSATION DECLARATION I kmby anion Over penalty of perjury res of the following declarations: 1 have and will maintain a Certfhcate of Coronet to selRinsum for Workees Compen. sa,ion,as provided for by Section 37M of the IaWr Code.for Oe peAom ane of the work far which this permit is issued. eve and will maintain Warkces Compensation Ineannm,as required by Section 3700 of WC labor Coe,for the performance of the work for which this Permit is issued. My Worker/Corm ensstion Insunnca n 'er end POHcy number a :: 1-,, q �Jp Carrier. J n Policy No.: 2 0 a / // CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need ren W co.pleud if the Permit is foam hundred dollars($I00) or Ina) 1 cutiry that in the performaxe of On work for which this permit u issued.l shall no employ,say peMn I.my..Mr.as ka became subject to the Wafters.L'arrpmeassion Laws of California Dox Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should became sobj¢t x the Warkca's Compensation pmvisiau of the labor Cade,you most ,J O forthwith comply with such Provision or this permit shall k d re deemeoked. 'Z " CONSTRUCTION LENDING AGENCY `� F W.by which soh Permit isarnmlmc.3M.ding agenry sur tax performan¢of 6i the rook fur which This permin b iasuW(Scc.3f19'1,Civ.C.) QLender's Name � z Lender's Address f�Q 1 st rtify Oat I have mad Dia application and sou the,the me,o farmauon u - tT. F comm l agree W comply with all city and county ominamv and fuse laws relating W QU building construction,and hereby anthons represenutim of this city to enxrup.n the G21 above-m=nuoned pmpc set ex far henion puryuxa ,y'Clr (We)agree to save,indemnify and keep ha males the City of Cupertino egilust l,, liabiliues,Judgmenu.cosu and expenses which may any waymrnxagilnst a id City UZ in consequence of Oe&taming of this permit. v-r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REG TIONS, �� !' / L Re-roofs Signa of Ap rcarrUConuacmr Dim HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will tie pplicennor futom Wilding occupantmore uraMle hmamous maxnal as defined by the Calamine Municipal Code,Chapur 9.12.and Oe Health and Safety Cade.Section 25532(.)? Dyes rslB✓ All roofs shall be inspected prior to any roofing material being installed. Will thea a.nt of future holding occupant ax m If a roof is installed without first obtainingan inspection,I agree to remove pp g p ey proem w Jcvimi which P Divncanm I, it u/�aOncd by the Bay Area Air Quality Manegemcnt all new materials for inspection. ❑Yes BTu I have mad the narardeusmaxriilsrtquirememsunderCapmr6.95 of the Califon nix Health&SxIeYCade.Sctiohts25505,23533 and 25534.larNnvmd thanifurc building dam not commonly have a mores.than it u my responsibility b Mary the aeupant of We mqui hiahmaRb<mcipnaW an«.isCeltficaxaromaPaney. Signature of Applicant Date n 3a oP wmef a= met rete All roof coverings to be Class'n"or better CITY OF CUPERTINO • 2 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . 1 . : 36654053 . 00 DATE ISSUED. . . . . . . : 07/30/2008 RECEIPT # . . . . . . . . . : BS000005637 REFERENCE ID # . . . : 08070226 SITE ADDRESS . . . . . : 11568 COPPER SPRING CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : FLAVELL GEOFFREY ET AL ADDRESS . . . . . . . . . . : 11568 COPPER SPRING CT CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4157 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 7, 500 . 00 0 . 80 0 . 00 0 . 80 0 . 00 1REROOFRES SQ FEET 19 . 00 247 . 00 0 . 00 247 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 247 . 80 0 . 00 247 . 80 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 592 . 50 #15233 --------------- TOTAL RECEIPT 592 . 50 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 CITY•CUPEr�TINO PERMIT APPLICATION APN # ✓/ / S L/O 5 3 , D� Date: n /\ Building Address: P /J lJ & Owner's Name: q V Phone #: � i mr� om_ I q� l - Coo Contractor: Phone #: gS I Dj Sb b S 11 l Lp S '12U15 ) Fax #: Cupertino Business License #: Contractor License #: (7 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ sphalt Shingles �sphalt Shingles �' Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.B.O. Report# o/To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: YYIU� �t3D 3 p /, 1;e I + Gt Y)Cr rand any on -6h�no�les Gf c(TA / 5 Residential ff 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: applicable, include in plan set & the sheet index. Valuation: I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: • SKaW Revised 6/16/08 CITY OF CUPERTINO REROOF CUPER,TINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Commercial B /9 1RER00FRES Re-roof Residential B 1SFDWLR00F 1BSEISMICRE Seismic Residential B 1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B Revised 6/16/08 • 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 minimum of 1/ " 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: �(y( � us N r/(oy-eL Job Site Address: �. 15 (0 Roofing Company Name: L(rS � Applicant's Signatur I Date: ` )v b • Greg Casteel Building Official Revised 07/30/08 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 R= B. Site 9. Install H.E. Irrigation, (details/spec)' L-1 2 points 11. Permeable Paving, Note L-1 2 oints 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 oints E. Ext. Finish 1. Composite Decking, (Note/Spec.) A-3 2 points 4. B. Fiber Cement Siding, (Note/Spec.) A4 2 oints 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 oints 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 oint P. Other 1. List Green Features on Plans A-1 1 point TOTAL POINTS1 40 points • • 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. A.Site — INPUT Fe�ulces Energy IAQlHeahh 11.Recycle Job Site Construction&Demolition Waste 65%-1 point;75%= 2 points;BD%=4 points ! up to 4 Resource pts 0 2.Salvage Reusable Building Materials _ _ 4 Resource pts y=yes D 3.Remodel for Mixed Use,Adaptive Reuse,and Historic Preservation 4 Resource pts y=yes D 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 6.Design Resource-Efficient Landscapes and Ga dens 4 Resource is es — — — �— P" Y=Y 0 9.Reuse Materials/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 D 1 I 1 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 y=yes 0 3.Insulate Foundation/Slab before backfill 3 Energy pts y=yesl;;F 0 1 1 1 C.Structural Frame 1.S( ubstitute Solid Sawn Lumber with Engineered Lumber 3 Resource pts y--yes p 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 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 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 3 Ener is 9Y P Y=Yes b.Wall D 3 Energy pts y=yes 0 c.Roof 3 Energy pis y=yes 0 10.Apply Advanced Framing Techniques 4 Resource pts y=yas 0 11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes 0 12. a.Subfloors 1 Resource pt y=yes 0 • i It.Sheathing — 1 - 1 Resource pt y=yes 0 1 I D.Eztenor Ftmsh , INPUT ReSDUNCES Energy U0111ealft 1.Use Sustainable Decking Materials a.Recycled content 3_Resource pts y=yes 0 • J.FSC Certified Wood 3 Resource pts y=yes 0 �2.Use Treated Wood That Does Not Contain Chromiurn/Arsenic 1 IAQMealth of y=yes D 13.Install House Wrap under Siding 1 [AD/Health pt y=yes 0 14.Use Fiber-Cement Siding Materials 1 Resource of y=yes 0 1 1 E.Plumbing 1.Install Water Heater Jacket -� - - — -— - -- - J 1 Energy of Y=Yes D 2.Insulate Hot and Cold Water Pipes 2 Energy pts Y--yes 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. D 4.Replace Toiled with Ultra-Low Flush Toilets r (1 point each,up to 3points) — Up to 3 Resource pts. D 5.Install Chlorine Filter on Showerhead 1 AQ/Health of y=yes 0 6.Convert Gas to Tankless Water Heater 4 Energy pts Y--yes 0 7.Install Water Filtration Units at Faucets (2 points each,up to 4 points) Up to 4 IAQ/Health pts. 0 8.Install On-Demand Hot Water Circulation Pump 4 Resource pts y--yes D 1 1 1 r.trecmcar (( 21.Install Compact Fluorescent Light Bulbs(CFLs) 6 bulbs= t points,l0 bulbs=3 points,l2 bulbs=4 points) Up to 4 Energy pts. 0 --- •2.Install IC-AT Recessed--- Fixtures with CFLs(1 point each,up-to- 5 p 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. D 4.Install High Efficiency Ceiling Fans with CFLs (1 point each,up to 4 points) Up to 4 Energy pts. 0 1 1 1 G.Appliances (1.Install Energy Star Dishweshe� �l 1 Energy of y=yes 0 (f2.Install Washing Machine with Water and Energy Conservation Features 1 Energy pt y=yes 0 13.Install Energy Star Refrigerator 1 1 Eneroy pt y=yes 0 �4.Install Built-In Recycling Center 3 Resource pts Y=yes 0 1 1 1 H.Insulation 1.Upgrade Insulation to Exceed Title 24 Requirements a.Walls 2 Energy pts Y_-Yes D b.Ceilings 2 Energy pts y=yes 0 2.Install Floor Insulation over Crawl Space 4 Energy pts Y=yes D IS.Install ReWaled-Conte6t,Fiberglass Insulation Willi' ll No Added Formaldehyde _ 1 3 IAQfHealth pts y=yes 0 4 Use Advanced Infiltration Reduction Practices 2 Energy pts y yes 0 5.Use Cellulose Insulation a.Walls 4 Resource pts Y=yes 0 b.Ceilings 4 Resource pts y--yes 0 • 6.Alternative Insulation Products(Cotton,spray-foam) a.Walls 4 Resource pts Y=yes - 0 D.cemngs 4 Resource pts y=yes 0 1 1 INPUT Resources Energy IAQIHealth I.Windows 9 Ahistall Energy-Efficient Windows • a.Double-Panad 1 Energy pt Y--yes 0 1 b.Low-Emissivity(Low-E) 2 Energy pts y yes 0 c.Low.Conductivity Frames 2 Energy pts y=yes 0 2.Install Low Heat Transmission Glaiing 1 Energy pt y=yes 0 1 1 1 J.Heating Ventilation and Air Conditioning it.Use Duct Mastic on All Duct Joints _ _ 2 Energy pts yryes 0 Z.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0 3.Vent Range Hood to the Outside 1 IAQ/Health of y=yes p 4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 0 S.Install Solar Attic Fan 2 Energy pts y=yes 0 6.Install Attic Ventilation Systems 1 Energy of y=yes 0 7.Install Whole House Fan 4 Energy pts y=yes 0 S.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)Fumace 2 Energy pts Y--yes 0 13.Retrofit Wood Burning Fireplaces • a.Install EPA certified wood stoves/Inserts 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,Hydronic Radiant Heating 3 Energy pts y=yes 0 15.Install High Efficiency Filter 4 IAQ/Health pts y--yes 0 16.Install Heat Recovery Ventilation Unit(HRV) 51AQ/Health pts y=yes 0 17.Install Separate Garage Exhaust Fan 31AQ/Health pts y=yes D 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 C 3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0 4.Install Photovoltaic(PV)System (1.2 kw=6 points,2A kw=12 points,3.6 kw=18 points) Up to IS Energy pts p 16.Seleafe and Durable Roofing Materials __ _ _ 1 Resource pt y=yes 7.InstRadp Tin—still ian( r 3 Energy pts Barriey=yes ci Sp 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 Windows 3 Energy ptsy=yes p 3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0 1 1 1 • M. ndoor Air Quality and Finishes INPUT ResDurres Energy 5AD/HerilttZ, Ft.Use LOWIND-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAO/Health pts y=yes D • i3.Use LowNo VOC Adhesives 3 IAQ/Health pts y=yes D 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y--yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 6IAQ/Health 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 B.Use FSC Certified Materials for Inte or Finish 4 Resource pts y=yas 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 1 N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 2.Use Rapidly Renewable Flooring 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=yes 0 1 1 1 Total Points Availa le: 140 130 57 Total Points Project Received: 01 0 0 • G:daWpmgslgreenbuildingguidellnesrremodalersrgreenpointsfinal27 2.g4protected.xis Community Development 0 Torre Avenue CuOpertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 #UPEkTINO Building De artment / JOB ADDRESS: I 1 G r PERMIT # �,v-?G Z2 6 OWNER'S NAME: PHONE # S I'3 SCoS GENERAL CONTRACTOR: S JJt 6 1,�- f , 3 FAX # 2�' I am not using any subcontractor ' Signature Date Please check applicable subcontractors and complete the followin information: 66 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 T' C/ Owner/Contractor Signature Date