01100152 TY
CI
BUILDING G DIIV�'ISSIIONNOPERMIT CONTRACTOR INFORMATION:
'
BUILDING ADDRESS: PERMIT NO.
10793 W ESTATES DR CHEROKEE CONTRACTING CO. 01100152
OWNER'S NAME: APPLICATION SUB DATE
am IGNAITIS JOSEPH AND ELIZABET1 1220 COLEMAN AVE 10/30/2001
PHONE:
I (408) 727-9850 SANITARY NO. CONTROL NO.
O MMI ARCHITECT/ENGINEER:
b O O BLDG ELECT BUILD�G PERMIT INFO MECH
ut
<s.
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O m Z LICENSED CONTRACTOR'S DECLARATION Job Description
5 Z_C hereby affirm nha 1 am licensed under provisions of Chapter 9 fcommcncing
„fro semina]lxro)-rDi.�irmn3onheBnainerrandPmfessmnrcale.anamYlmense REPLACE SEWER LINE WITH
5'1iw of tone and Ila,.
EAw Ieenx claha — Lica 5'�'•%FIS 4 " ABS PIPE.
7 O a O Date Contract -
3 F ARCHITECT'S DECLARATION
"O 1 understand my plans shall be used as public records
e�Y
O Licensed Pr-fessionol
_wi a OWNER-BUILDER DECLARATION
_av, 1 hereby M.,hitt 1 A.1. exempt from the Cessions is License Law for the
following mason.(Section]831.5,Business and vet de professions h,or Any tiny or county
M which requires a profit no con.amn,alter.improve,demolish,-r repair any structure
� �.prionoi¢iswarre,olx rcquircs the applicam fa such permit-Bleasigned sammem- -- - -
(hm he, I snstE p e Gra-me pro f Nc t Ho tuts hens law IChnper 9 S, [, F100 tyre
(commencing mesa, ]nm)orD J of anTmers and Pr-r r nr code) {_ 4It. T�a Valuation
or S ,1 em pt nh -r and the ba.'. f theis h applicant
t Ani v o natty
of Section]031.3 by any applicant for a permit subjects the appliam,o a civil penalty
of not more than five hundred dollars($50(l). APN Number i"t .''.r Occupancy Type
. m
DL,as owner of the propeny,or my employees with wages As their sole compensation, _ �7
, will do the work,-and the s, ctum is not intended or offered for sale(Sec.70,14.- �T�,Irp�U
rATEJ
Business nM'Pofessions CodLi
Code:The Conbacmr's cense Law does no,apply 2 0 2 - UNDERFLta`•
no an 9" I[��
�&jibj9:
owner of propeny Who builds m improves thneon,and who does such work himself 1
m through his own employees.provided than such improvements am not intended or _ __ 3 01 - ROUGH PLUMBING_
--offi -d for sale.IL however,the buildingrovemeni is sold within one e --— - -- - - -- _—_--.the aror 302 - TUB & OR SHOWER`S
omplaion,the owner-builder will have the burden or proving What he did not build or '` • ''
improve for purpose of sale.). 502 - FINAL PLUMBING ENERGY
- -- "tuft ". ' - nt 506 - .-GAS TEST -. . . - .. _
❑Lasawnernf,he property,am Business
road contracting with contain-ton° "-'-" --:;LL:F iv:R�..moi., :
construct the does
no(Sec. to an
owner
prtl Professions Code:)mr Contractor's i ..,, i�.t r„ 't f•1' rr, l
e - L'
an-wnaof acontrwho Wildese puranathto me - PLUMBING .
ContactAero hn �unse Law. rojen.wim a contractor(s)licensed Dorsuam no the.
creµe Law doer nota l t�. �„ - . .
apply
such
OI p ,B&P C_for this reason
_ Owner n ..,:' tt. Dam
WORKER'S COMPENSATION DECLARATION j
Ihertby AM.under pcnahyof perjury one of the following dalarai-ns: J_
I ❑ 1 have and_will maintain'a Certificate of Consent in self-immer for Worker's O�
Compensation, as provided for by Section 3780 of the Labor Code, for ,he
performance i f the work for which,his permit is issued..,
❑ ave and will mtiiniain woiker's C-mpmaaiion Insurance,m mquimd by Stttion
-B'of,he Libor Code,for the perforations,of the work'for which this permit is
d
so My Workit's Compensation: 1 Ir y number ra c and Poo
r 1 Sf f T,.' . t PolicyNo.7/3 Luu�GS71 t i:s`, 142 >?h 1`0 is `F? u.i,t.
t ,)- CATION OF,E%EMPnON M WORF'1 - KER1S j
' COMPENSATION INSURANCE' ` " ' ,
fS188 (Thes tt&ion ntt4 not be completed if the permit is for one hundred dollars ^f1�\' �,'ll:'Obe:E �' „ !);.L ll)i'l.1 -!\i)C ------
o .)
l certifyLoy n,n theperformancef thk ha which thisPermit 5 uedl
shall ,employ any Demon m any ate x es io become subject to the Workeri f�' U ' 'r ' ,"1 •,,
Compenso,ion laws of California.Date'
.Applicant -.,.: r . ....,, .,.
ng
m.
ld
'NOTICE sujctt6APPLICANT:If.Com,eRsation thisCertificatebf of Labor lodes you must -
Z beatomo subject y the Worker's Compenwthis provisions of one labor Code,you must
z 0 fonhwiJi comply with such provisions or this permit shall be deemed revoked.
FZI k''s!� s - " `CONSTRUCTION LENDING AGENCY - - - - -, '-- -
n...
1 hereby firm thin me" ss mued(S on Iendmg agency for the performance' `y t
Lender's
work for which this perm, issued is J89] Cry C) "
r� Z Leve s N
Leader's Aad •:
U
cb, I certify that L rhave read this application and state that above information is
.� E•' mecv:b agree to comply with all city and county ordinances and state laws relating
!U to building construction,and hereby mulmze rrpre natives-(this city to cnmrup-n
the abovememioned property for impatmrs purposes.
j ,,
� 6 (WA)agree no save:indemify nand keep harmss
lethe'Ciny"of Cvpenioo'against
y liabilities,judgmems,costs and expenses which may in any way accme against said
U Z Cit n o s q ecce of meg t gofthis
OUH�EtGQLAE` ANDS AND WI ONPLYWTTHALLNON-POINT
Issued by: Date
8^a '.. I, PP'' HAZARDOUS MAT . ..
^ , fA Ica VC n n y Date Re-roofs
MATERIALS DISCLOSURE
:?" W II the appl cont or f art W Id' g omvpa t Bo hem hazard-s m m`i Type of Roof
11111 led Cupertino municipal Code Chapter 912 dtheH Health and Safety s -
cedd oyes 2ss3n.�+ t)r Nos :, k -5a. h li '' - - g • `�` j _S'� `,Y ,'` t '�=
D n All roofs shall.be inspected pnor.to any roofing material being installed.
• W'lltheapDlicamo fuwrcbuldmga upanwsccgmp en�orpe�eerwhen If a roof is iAs[alled'withou[first obtaining an inspection;I'agree[o iemove
emit heard s a contaminants as defined by me Illy A Ai Quality Management
Dist i,m , all new materials for inspection.- Applicant understands and will comply_with all non-point sburce regulations: . ;
h e rtad,,he h ard us'maienals iequ emend code Chaps 6.95 of Ne >—
C ata Health&Safety Code:Sreuona 25585,25533 and 25330:1 understand that
' t helsu led ns otcurrentlyh a th tenant, Y .tymea tiny to o,fy.nhe - -- - - -- - - _ _
cc nnfth requirements h e rx
h thtp o to nssm eof a,Cinifcaac.af -
Signature of Applicant Date
own: a I i=ea age, D,e All roof coverings to be Class "B"or better - t
OFFICE . . .. . ... -