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05040130CITY OF CUPER'fINO °�.ax<'� BUILDING DIVISION PERMIT €CONTRACTOR INFORMATION•. BUILDING ADDRIiSs: CHEROKEE CONTRACTING CO. PERMIT NO. 05040130 OWNER'S NAME: PERMIT ISSUE DATE INE: SANITARY OL NO. ARCHITECTIENGINEEN: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION )Ob DeSC(IPI100 1 hereby &form'hat I am licensed under provisions of Chapter 9 t}nmmencing With Section )IXMB of Division 3 ofthc Business and Professions Cndc. and my he... is o mB fmca and effgS) 3 $ 5!e /S LicenseClasa�Lie.« PROPERTY LINE C/O Date a-/ / L i o C Conlrnor %7 ✓e — IPv— ARCHITECTS DECLARATION I undersand my plans shall be tend AS public .emus Licensedinstal OWNER BUILDER DECLARATION Ihereby affifo that 1 exempt from Nc Cmm�s License Lew for the no Code: Any city ser couoy following I Co lecNun )IDIS, Busincss and Pre. demolish. ser repair any suucnre which requires & permit In construct. alter, impo de rens a m, th for also Ino ssigned state(Chapter print LLlslcensd Sq. FL,Floor Area aluau he nt toinion of the ConrCrmllnice that haisRmnudptelction7 orbit(Divintr�fineca^naaannR<nnl.onsCodtCr9 p (commencingwith Section 700(b of Division3 of the Business and Professions Code) or eged Any thea he is exempt therefrom and the basis for the alleged exemption. Any vinhtion of 3.A AN A.l.,y«16er00 9 Occupancy Type Section 2031.5 by any applicant fon permit subjects the applicant o a civil penalty of nm more Nan rove hundred dollar. (SSW). 9'J 25 �Y11t 1, AS owner of the property, or my employees with wages u their ole compensation, Required Inspections will do the work, and use structure is not intended or offend for Sale Sec. )041, Busidmss : The Contractor's License Law daowner of and Professions coxacdam not apply to an property who baud& in improves thereon. and who docssuch work himselfor through his Own employees, provided that such Improvements are not intended or offered for Bile. If, however, no building or improvement is sold within one year ofcompletion. Are owner - builder will have the burden of proving that M did not build or Improve for purpose of salt.). 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the proket (Sec. 71X4, Business and Professions Code) The Conu¢mr's Li - Come Law does not apply to an owner of progeny who builds or improves daemon, and who contracts for such projects with a contnnor(s) licensed pursuant to She COAMA,W'6 License Law. lam eaImpt under See. ,B& P C for this reason Own Dal WORKER'S COMPENSATION DECLARATION 1 hereby attrm under penalty of perjury, one of the following declarations: I neve and will maintain s Certificate of Consent to selFlnsum for WorkehCOmpen- salion, As provided for by Section 3700 of Ne Labor Code, for the performance of the work for which this permit is issued. 71 1 have and will maintain Worker's Compensation Insurance, As required by Section 37M of the Labor Code. for the pedormance of the work for which this permit is issued. My Worker's Compensation Insurance causer and Policy number art: ! Cartier. A.T A /�i9-9'G.er , Policy No.: % — t ' O% CERTIFICATE FEKEMPf10NFROM WORKERS' ' COMPENSATION INSURANCE (Onssection need not M completed if Ne Munk im fnr one hundred dollaos SI W) or leas.) 1 eenify that in the performance of the work for which this permit Is issued, I shall not employ anypenun in any manner o as to become subject to the Workers Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you Should Income subJcct to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this Permil shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm most Ncm is s(elinn lending agency Int the Performance of ' the work for which this permit is sanered (See. 3(19), Civ. CJ LCn'M`A Namc Lender's Address 1 cantly that I have read this application and sure that the above information is ' CmmeL I agree to comply with all city and county ordinances and sum laws mining to building construetion, and hereby suthonm repremenutives Of this city to enter upon the have mentioned property for inspection purposes. (We) Agree to save, indemnify and keep harmless the City of Cupertino against j liabilities, judgments, costs and expenses which may in any why aceom Against Said City A i t in consequence of the Starting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. Re -roofs - 9igmmm of Appl' actor Dem enU ZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant star, or handle hazardous materiel AS defined by the Cupertino Municipal Cox, Chapter 9.12. and the Health and Safety code,sares zssu(.)p ❑ Yes [a+r All roofs shall be inspected prior to an roofing material beim Installed. P P Y g g If a roof is installed without first obtaining an inspection, I agree to remove Will IhcapplIi's !mune building occupant use equipment or devices which it harardnus air cnnlaminants ss x0ncd by the Bay Area Air Quality Management all new materials for inspection. nrinP ❑Yes it I have mal dm hanMousmamrials mquimmenu under. Chapterfi.95 of Ne Califon ma HcaBh&SafnyCde,Stcuom25505.2553J am125534. 1 unxrnam Nadda, Wilding does not currently have a MASAI, that it is my responsibility 10 nearly IM occupant of AMC requirements which mum be at poor As issuance of a Certificate of Occupancy. Signature Of Applicant Date - L-,oS, All roof coverings to be Class "B" or better orizcd a • Date :2® I am not using any subcontractors: z z -CI-5 �S' — ature Date Please check applicable subcontractors and complete the following information: 60 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 Tile Owner/Contractor Signature Date 4 - Ll 9 CRY OF CUPERTINO CITY OF CUPERTINO REPIPE/SEWERS/MAIN SERVICE PERMIT APPLICATION FORM �`f° 110 APN # Plumbing Permit Issuance PLUMBING Date: ,3`75,3'e'oas PLUMBING BPERMFEE y- z z -os Building Address: BPFIXTURE Pbl . Fixture PLUMBING 05 Main Water Service BPSEWER Owner's Name: PLUMBING BPSEWAGE Phone #: 5R ku 2,o ' Yoh -PSS- OJ77 Contractor: License #: /Phone: Contact: Phone: Cupertino Business License #: ,,Tl," vee L10f--1�`>-lv 916 Z 70z Building Permit Info: Bldg ❑ Elect ❑ Plumb ©� Job Description: Residential Commercial ❑ Cost of Project: 'g, UO Qty. if ADDlicable Fee TD Frr tiPc�ri nfinn PPERMI'1'FEE Plumbing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPERMFEE Bldg. Permit Fees BUILDING BPFIXTURE Pbl . Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Dis oral PLUMBING BUSLIC Business License BUILDING ' s J. i -r-