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12080278 CITY OF CUPERTI.NO BUILDING PERMIT BUILDINGADDRESS: 10122 BANDLEY DR, RACTOR:LB COMMERCIAL PERMIT NO: 12080278 r530 TRUCTION INC :M OWNER'S NAME: ARINA PLAZA LLC. WRENCE EXPWY STE 406 DATE ISSUED:11/14/2012. OWNER'S PHONE:.4154683800. SUNNYVALE,CA 94085 PHONE NO:(408)844-8299 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL LJ COMMERCIIAAI License Class_ Lic.# 138560 SHENGKEE BAKERY-COMMERCIAL TENANT IMPROVEMENT IN Contractor 1A (dWO EKC441+404n. Date 61 • ` 2013 EXISTING BAKERY(1265 SQFT);INCLUDES NEW WALLS, I hereby affirm that I am licensed under the provisions of Chapter 9 NEW CEILING,SHELVES,CASES c&KITCHEN EQUIPMENT- (Commencing QUIPMENT(commencing with Section 7000)of Division 3 of the Business&Professions AND Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: REVISION#I-COMM.T.I OF BATHROOM AREA 496 SQFr,ADD . I have and will maintain'a certificate of consent to self-insure for Worker's NEW WIND SCREEN AT BAKERY SALES AREA-ISSD 1/I5/13 Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$160000 I 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:32634066.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED D correct.I agree.to comply with all city and county ordinances and state laws relating WITHIN fl80 DAYS®F PERMIT ISSUANCE 09to building construction,and hereby authorize representatives of this city to enter uponthe above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the G� granting of this permit. Additionally,the applicant understands and will comply Issued by: � l Date: / f with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. � II RE-ROOFS: Signature Date �� °.f�" �� 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. ❑ OWNEWBUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following,two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as their sole compensation, will do the:wOrk,and the structure isnot intended or offered for sale(Sec.7044, Business.&Professions Code) I,as owner of'the property,am exclusively contracting with licensed contractors to HAZARDOUS 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. 11will 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 Owner or authorised agent: Date: 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 I 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence 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 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10122 BANDLEY DR CONTRACTOR:LB COMMERCIAL PERMIT NO:12080278 CONSTRUCTION INC OWNER'S NAME: MARINA PLAZA LLC 530 LAWRENCE EXPWY STE 406 DATE ISSUED: 11/14/2012 OWNER'S PHONE: 4154683800 SUNNYVALE,CA 94085 PHONE NO:(408)844-8299 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT' PLUMB License Classj Lic.# 18)lb 976 d � [_ MECgII RESIDENTIAL r— COMMERCIAL Contractor L , t:dlN,Of=M f(L 6AN516ete •2 2- I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIP'T'ION:S14ENGKEE BAKERY-COMMERCIAL TENANT (commencing with Section 7000)of Division 3 of the Business&Professions IMPROVEMENT IN Code and that my license is in full force and effect. EXISTING BAKERY(1265 SQFT);INCLUDES NEW WALLS, NEW CEILING,SHELVES,CASES&KITCHEN EQUIPMENT;AND 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 Code,for the performance of the work for which this permit is issued. I 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 permit is issued. Sq.Ft Floor Area: Valuation:$150000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:32634066.00 Occupancy Type: 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, PERMIT EXPIRES IF WORD IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Dated 10— Issued by: 47�f Date: ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: . All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 1 have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. T will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owne thorized a e t: ! I 20 1 S Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CONSTRUCTION PERMIT APPLICAMON COMMUNITY aDING 10300 TORRE AVENUDEVELOE-CUP RTINO,CA 95014 3121 e�D VISIU�r�� OUPERTINO (408)777-3228°FAX(408)777-3333°buildingLcuoertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/Tt FZr REVISION/DEFERRED ORIGINAL PERMIT# ®� PROJECT ADDRESS (0 1 n,2 ���P r p� 9 6+ P�11`�✓tl�� PP, OWNER NAME �'I.las�� trot='� a[c�pp� PHONE 1 I5-o Oro V 1q, E-MAIL STREET ADDRESS 1 t,1:&2 CITY,STATE,ZIP �ae� Rl p n I FAX CONTACT NAME `- PHONE �. EMAIL STREETADDRESS VOC 5:-(W 6" WA A Af� CITY,STATE, ZIP S FAX 0 e ° Z ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER ®� LICENSE TYPE BUS.LIC# COMPANY NAME COOK. �. E-MAIL meM �cy° e (.0m FAXL8 1~616CAft- ° �I STREET ADDRESS 0� CITY,STATE,ZIP W �� PHONE ° o 8� ARCHITECT/ENGINEER NAMEG LICENSE NUMBER I BUS.LIC 4 ® r COMPANY NAME E-MAIL FAX STREET ADDRESS CITY STATE,ZIP PHONE 4. DESCRIPTION OF WORK 5W( OF ft&4 ® New WIN17 _C-C T Rig( 'S f * EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES /�/ p & .+ ��UUSE�/ TYPE OCC. SQ.FT. VALUATION(S) EXIST NEW FLOOR AREA G�6.P� AREA AREA LS, NET 6�� 17f�.�+0 �� _ b M y9� BATHROOM KITCHEN OTHER REMODEL AREA / REMODEL AREA I yt REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY DYES BEING ADDED? �NO ADDITION? JZNO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVEg.BY• TOTAL VAI I I A-1. PLANNINGAPPL# ONO PLANNING APPROVAL LETTER EICHLER HOME? ®NO `jN 5� OGD By my signature below,I certify to each of the 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 it is accurate. I agree to comply with all applicable local ordinances and state laws relating to lAtlding construction. 1 authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: b 10 M SUPPLEMEN AL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ,--❑ EXPRESS �j PLANNING PLAN REVIEW __Commercial Bldgs: Provide a completed Hazardous Materials Disclosure y6I STANDARD G❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE 'If-FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doe revised 06/21/11 ` -Z.o� 0 � CON'STR CTION f ERNT APPUC ATM COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE- CUPERTINO,CA 95014-3255 CUP66tTINO (408)777-3228- FAX(408)777-3333- building@cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION u ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS APN# 6 121 PA740L P9 Urf-KTINb 5D OWNER^NAME Y n PHOE r - 4&( m E-MAIL STREET ADDRESS CITY, STATE,17�P b� FAX 201 S. MILL D2 . FRI Sg/ia�E � I 7 CONTACT NAMEPHON E-MAIL � JD IS 96�- 313 bo STREET ADDRESS CITY STATE, ZIP FAX Z 5 I I_L R SSPE eh I �i S,BA-rJF 60tit 605 OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ;7— LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# 0 - 3150 COMPANY NAME E-MAIL FAX cv �I a? arrr �► b��l .c,�m 0$- 9 Z STREET ADDRESS CITY,STATE,ZIP PIIO E DESCRIPTION OF WORK wo K Lr1(,u4')F-S W-0 WkLLS NP—W *P-A VF5S lfife,,5:�S /PJ0 tTF-Quer,. IrA-101 k0iA-L EXISTING USE PROPOSED USECONSTR.TYPE #STORIES " M z�, —gy ,_ USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR fes`'-"`' DEMO TOTAL AREA I n /T AREA AREA NET AREA 1 6 5 i 1 5,/so ' vo . BATHROOM O7 KITCHEN OTHER- ✓7,��"''- 1 V fJ V V REMODEL;ZAA� REMODEL AREA i b REMODEL AREA PORCH AREA DECK AREA TOTAL DE-CK/PORCH AREA GARAGE AREA: DETACH ATTACH H DWELLING UNITS: 1S A SECOND UNIT ❑YES SECOND STORY ❑ BEING ADDED? 00 ADDITION? \0 PRE-APPLICATION []YLS IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES J�.CEIVED. Y: ;. T AL VALUATION: PLANNING APPL# <0 PLANNING APPROVAL LETTER EICHLER HOME? �jNO � By my signature below,I certify to each of the 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 ibis accurate. I agree to comply with all applicable local ordinances and state laws relating to uilding construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent. Date: Aub• a 2p 12- SUPPLEMEN AL INFORMATION REQUIRED -TYPE - RouT►NcsLIP New SFD or Multifamily dwellings: Apply for demolition permit for 1 OVER-THE-COUNTER BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. L 7 ExPREss PLANNINGPLAN,REViEIV-' Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD, 0.,rusuictivoRKs. form if any Hazardous Materials are being used as part of this project. [] LARGE (`., -FIRE D"T - _Copy of Planning Approval Letter or Meeting with Planning prior to .MAJOR SANITARY SEWER DISTRICT submittal of Building Permit application. ENVtRONME'NTAL HEALTH BldgApp 2011.doc revised 06/21/11 cCffTY OF cCUP EIERTffNO FEE (ESTIMATOR— BU111C BING INVESEON A DDRESS: 90922 BpaRl®BEV®P2 IIDATE: 12/07/2012 REVIEWED BY: SEAN Al N: 1B1P#: 12080278 '�AILUJATIION: $0 PE: Building Permit PLAN CIIIIECUC TYPE: Addition PRIMARY SFD or Duplex 2nd Unit? Yes o No PENTAMATIION 1R3SFDADD USE: OTC. 0 Yes GNo PERMIT TYPE: WORK REVISION#1: TENANT IMPROVEMENT OF BATHROOM AREA 496 SQ FT •ADD NEIN WIND SCOPE SCREEN AT BAKERY SALES AREA. OCCUPANCY TYPE: TYPE OF 1FLR AREA PC(FEES PC(FEE R D BP FEES BP FEEID CONSTR. s.f. R-3(Custom) II-B,111-B,IV,V-B 496 $1,512.00 IADDPLCK $1,230.00 JADDINSP TOTALS: 496 $1,512.00 $1,230.00 MECH,HOURLY 0 Yes ( No PLUMB,HOURLY 0 Yes 0 No E1LEC,HOURLY Q Yes E)No Xfech. Plan Check77— Phunb. 1'lun Check Elec:.Plan Check fLfec,h. Permit Fee: Plumb.Permil Fee: li12c. Permit Fee: Otlrcr;tleeh.Insp. =_�_ Other I'lumh Insp. E:]� !� Other Elec.Insp. 0 /tech. Insp..('ee: Ph nrh.Insp.Fee: Elec.Insp. Fee: NOTE:This estimate does not includeJees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc . TheseLees are based on the prefimiina information available and are only an estimate. Contact the Dept Lor addn'l in o. ]FEE ITEMS (Fee Resolution 11-053 Eft. 71f ,1/12) FEE QTYNE]E MIISC ITEMS Plan Check Fee: $1,512.00 Select a Misc Bldg/Structure Suppl. PC Fee: (D Reg. 0 OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $1,230.00 Suppl. Insp.Feer Reg. 8 OT 0 0 hrs $0.00 EPME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction:Tax: E] Administrative F(,e: Work Without Permit? Yes E) No $0.00 Advanced Planning Fee: 1PLLONGR $64.48 Select a Non-Residential Q Building or Structure Travel Documentation Fees: a' Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $2,806.48 $0.00 TOTAL FEE: $2,806.48 Revised: 10/01/2012 CI[TY Off' CUP Efl$TM EEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10122 Bandley Dr DATE: 08/28/2092 R VIEWED BY: Sean APN: 1BP#: *VALUATION: 1$150,000 *PIERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1B'I'I USE: PERMIT TYPE: WORD Tenant improvement in existing bake 1265 s ft SCOPE OCCUPANCY TYPE: TYPE OF 1FLR AREA PC FEES PC FEE IIID BP FEES BP FELE 1(D CONSTR. s.f. B (Tenant Improvements) II-B,III-B,IV,V-B 1,265 $1,999.00 IBTIPLNCK $1,182.70 /BTIINSP TOTALS: 1,265 $1,999.00 $1,182.70 MECH,HOURLY 0 Yes (F) No PLUMB,HOURLY .H 0 Yes Q No ELEC,HOURLY Q Yes No ;14'ech.Plan Check Plumb.Plan Check Elee..Plan 1£ech. A!nrril Frte: Plumb. Per7nil Fee: Elec. Pertnit Other rlleclr. Imp. El Dlirer Plumb Insp. Other Elec.Insp, .11c"12.Insp.Fee: Plumb.Insp.Fee: Elec.Insp.fee: NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc . TheseLees are based on the relimina information available and are onl an estimate Contact the Det or addn7 info. FEE ITEMS(Fee Resolution I1-053 Eff. 7/1/111 FEE QTY/FEE ly RSC RT1EMS Plan Check Fee: $1,999.00 Select a Misc Bldg/Structure Suppl.PC Fee: 0 Reg. 0 OT 0,0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $1,182.70 Suppl. Insp.Fee-.0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ConstructionTax: Adininistr ative.Fe e: Work Without Permit? 0 Yes ID No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential � Travel Documentulion FceS: Building or Structure Strong Motion Fee: IBSEISWCO $31.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $6.00 SUBTOTALS: $3,219.20 $0.001 TOTAL FEE: $3,219.20 Revised: 07/01/2012 , 26/2013 16:31 0 PAGE 01/02 B uRdnnng Depzrttmmnl City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 ce a D Ga3T fkl® Telgphooe: 408-777-3225 Fax:408-777-3333 JOB ADDRESS: - PERMIT OWNER'S NAME: PHONE# GENERAL CONTRACTOR: !', ,.F n,/i,",r --(. l a L i 7�'�rt, ' "BUSMSS LICENSE# �- ADDRESS: 2C> �s,'r::�l +: v��;" _? �' CITY/ZIPCODE: Gi -� �., c d 1 *Our municipal code.requires all(businesses worRdng W the!city to leave a Cky-off Cupertino bushiess Hcense. NO BUIL[DUgG IF][111AL OR FINAL .00CUPANCY I NSIPIEC71ON(S) WIIILL B E SCHEDULED NN7CIIlt, 7C1FIl5E GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUMERTI[NG BUSWIESS LICENSE. I am not rasing any subcontractors: ftnature Date :]Please,cheek.applicable sanlbcoatractor§ and compRete the.following Wormmfion c> SUBCONTRACTOR BUSINIESS NAME BNSl[SS LICENSE# Cabinets&Millwork gqp 3,q 7 +/ Cement Finishing Electrical � Q Excavation Fencing Flooring/Carpeting Linoleum/Wood IJ Glass/Glazing VA Pleating Iztsulation Landscaping Lathing >J/A Masomy P,1/A Painting!Wallpaper . Paving Plastering M . a P, - p r� ""alp Plumbing 5xf-1P Roofitag Al Septic'Tank ?Ij . Sheet Metal � A Sheet Rock tQ yTk Tile D / 12— ' Owner/Contractor Signature Date