Phone: 818-368-3561 - Facsimile: 818-366-2455

P. O. Box 7817 - Northridge, CA 91327-7817

CONTRACTORS SUPPLEMENTAL QUESTIONNAIRE

PART A (Completion required by ALL 90000 series classified contractors)

Applicant: ________________________________________________
Address: _________________________________________________________
________________________________________________________________
Phone No. __________________ Fax Number:____________________

  1. Contractor's State License Number _________ Circle Licenses Held: A B C______
    (ENTER C LICENSE NUMBERS IN BLANK ABOVE)
  2. How many years has this specific business entity operated under current name?_______
  3. Predecessor business name (if any) operated by this entity's principal (s): ________________________________________________________
  4. How many total years experience in this type of contracting business does current management have? ________
  5. What percent of your receipts are derived from your work as a:
    General Contractor ________% Artisan or subcontractor ________%
  6. What percent of your work is: Residential _________% Commercial _________%
  7. What percent of your work is: New Construction ________% Remodeling_________% Renovation / Redecorating _________% Repair / Maintenance __________%
  8. Current number of : Employees (other than owners) ________% Owners/Partners/Officers:_______%
    Of the total number of employees, how many are: Full time:_______ Part-time:_______
  9. During the past: five years, have you or your SubContractors performed any work over two stories?
    [ ]Yes [ ]No If yes, describe:____________________________________
  10. Provide the following information:
Year Total Payroll Total Costs Subbed Type of Work Total Receipts
1998        
1997        
1996        
1995        

 

PART B (COMPLETION REQUIRED ONLY BY CONTRACTORS INVOLVED WITH THE FOLLOWING DISCIPLINES (whether performed by self / own employees / or sublet to others:

Carpentry (all classifications), Concrete Construction, Door/window installation, Excavation, Grading, Irrigation or Drainage Systems, Landscape / Gardening, Masonry, Metal Erection (all Classifications), Roofing (Including tear-off work), Sheet Metal work (including gutter installation), Underpinning, Waterproofing (all kinds).

  1. During the past 5 years, have you ever been involved in the original structural construction or the remodeling of town houses, condominiums, row houses, tract homes, or developments of 15 or more unattached single family houses? [ ]Yes [ ]No
    Do you anticipate getting into this kind of work? [ ]Yes [ ]No
  2. During the past 5 years, have you constructed (a) footings or foundations? [ ]Yes [ ]No
    (b) Slab or monolithic floors? [ ]Yes [ ]No
    (c) Chimneys? [ ] Yes [ ] No
    (d) Retaining Walls? [ ] Yes [ ]No
    (e) Underpinning or piers? [ ]Yes [ ]No
    Do you anticipate getting Into this kind of work? [ ] Yes [ ] No
    Comments / explanations:______________________________
    __________________________________________________

Signature of Applicant ________________________ Date ________________

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Please print a copy of this form, complete it, and fax it to 818-366-2455
We will call you if we need more information.

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