01100153 C),BUILDINGUDPERTONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
937 BROOKGROVE LA CHEROKEE CONTRACTING CO. 01100153
OWNER'S NAME: APPLICATION SUB DATE
JENNIFER PRESLEY 1220 ' COLEMAN AVE 10/30/2001
PHONE: (408) 727-9850 SANITARY NO. CONTROL NO.
O O O ARCHITECUENGINEER: BUILDING PERMIT INFO
aU BLDG ELECT LU MECH
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Gt-oa
o'm i LICENSED CONTRACTOR'S DECLARATION Job Description J z_O I hereby((arta that 1 am.f1mcd,iacr provisions of chapter Code,
(commencing [y
,.I[-w with ron]0oo)ar oivismn3nnne Buaness arta Professionscoae,arta my aortae REPLACE LATERAL C.O.
i-5� ice' run fureeaad t I
`0w< cenasCla Lice
i 3y
counts off
u as
O ARCHITECTS DECLARATION
'
Y 1 understand my plans shall be used as public records
I n O Licensed Professional
try OWNER-BUILDER DECLARATION
so I hereby aRrm that I am exempt from the Contractor's License law for the
?< following mason.(Section 7031.5,Business and Professions Code:Any city or county $200
x D Win cM1 requires a permit t construct,alter,improve
demolish,or repair any sou Lure
i3°_°' Pri tot 'ssuance,also requirestite applicant fh permitto file asignedstatement, ___.. _..._ . __�.. . ...._... _._. ._ ...... ... _.'..
thathe I dpls a itothep t fth t t t L le on,Code)
P• % Tt r a Valuation
(em g 'Ins ri pooan IDivision'- 3 fm BusinessviudP�f - acgd) i f:},. a3,'�u3 �w�C4,yv.NI ���'y,4..'a�. {
or Nat he is 703 IS
by
Iberefrnrn and the bass far the alleged exemption.Any violation � -
of Section]031.5 by any applicam far a permit nbjeds the applicam to a evil cenuhy'
iof mtptore than five hundred ao1fors(s500)' 106APN Ngli &R & WATER ,'0�'y tf' Occupancy Type
❑eas owner of the property,or my employees with In,a a mei...le eompcnonsm, 202 - UNDERFLOOR PLUMBING
will do the work,and the smrctare is not intended or-offered for sale(Sec-]oaa, 3 O l - ROUGH P nAT�(C�
'Business and Professions Code:The Contractor's License tadoes w not apply to an I r�BJQspectlons o "
own
er of property Who builds or improves thereon,and who does such work himself
or 3 0 2 - TUB & OR SHOWER
through his own emloy
pees.provided that such improvements ere not intendedor t
offered for Sale.If,however,the building or improvement is sold within she year of "- -502 "-- FINAL -PLUMBING -ENERGY, -'- -.-a: •;". - - "--` - "
iompletion,the owner-builder will have the burden of proving that he did not build or
mprove fa,purpoae of sine.). 5 0 6 - GAS TEST
❑I nn ' - rt w:;,el' - ' - .507 = ' FINAL -PLUMBING t - - -----
P ce Y y convoning with 1 ceased controach to - - I'., _
License
et the project(See an a Business,and Professions Cods:)The Commcmr s : i '
.. c ._....
License Law dos not apply to an owner of procenY who builds or Improves thereon,
and who contracts for h projects with a contractor(s)licensed pursuant,o the
Cot t L nsc L ---
❑1 a.exi,
mls mi '- ' ;B&P C for this reason
Ow Date '
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of he following declarations:'
❑ 1 have and will maintain a Cenificate of Consent to self-insure for Worker's �/ O
Compensation.as provided for by Section 37M of the Labor Code, for the /
performance of the work for wM1ich Ibis permit is issued.
❑I have and wi11'mainmin worker's Cnmpetisaion Inatimove,as required by Section
37W of the Labor Code;foe the perrormanee of the work for which mia permit is
MyW k C pe t I .ur c carrier ,d Policy / Cerare
's5m11`. .. 'RTIFICATION,OF,EXEMYPiIO�FROM WORKERS L.14 t:.a_.15 J[E s.xv`v Ul" .I1. A C•`.. _.._ �'{ I .,, : __ .._.-
COMPENSATION INSURANCE
--
Pdrumerless.) p permit isf'onehundred tlallars "t � t _, •:1
..i .. . ..... ..... ..._ ........ .
1
onto that in or Performance (tit k( which u ct ,e ismed I
shall not icraft]o pe on in any manner so as to become subject to me Workers I>f•.I(t'Il I ' '
Compcnsation Laws California.Date'
1,
Applicata „, ...; ,. ..
'
NOTICE TO APPLICANT
bee ub t t Inc 0.o k C tpc t p ,ions of tit lobo Cod you must I
O Q forth itM1 comply with inch Provisions or h porma hall be decoundows.ked,
.e,t?ti
-' "t "CONSTRUCTION LENDING AGENCY
......
of In lothtin oast l do agency mpcoimaace
kfor
which tit � t' .sed(S J )ad rs Ne - " . - ,h
t7'z Lcndu sAedress "
c.UQ'nFw-yt:5 SVtFry] t[m ria h ili pylic t o d t tn
W 'ndo1c gcetM1 c y antsd state 1 oinggWegconstnii ananeretiyaathb semaYves fth' city memer uponhe aboeproperty inspection neuroses
a' (we)agresim.a e ' domxyandk phn harmless theCity fCupertino
h liabilities,judgments,costs d expenses which y any y at against saidZCity
an consequence of tham jimmiq of dik'permi, l'
APP 'ANT UNDER TANDS AND vILL COMPLY WITH ALL NON-PRI,INT'' /y ,_O/
so Ec n s Issued by: Date
n . . 10130 0
nature bf Appheanvcbutractnr.. •:, ...Dare Re-roofs
HAZARDOUS MATERIALS DISCLOSURE - '
�.. Will tit applicant 1 future Wilding ex pant surn or.h dle haiard'tia material ..Type of Roof- . . r_. .... _ ._.._.. . _.._ ..
as defined by fire C Pm o Municipal Cod Chapter 9.12.and tit H IIh and Safety --
CWe S t 25532(a) _ ff .}4, p i '?"#
❑Y `'pN i ,.5 h 1 u 2t JI
AD roofs shall.be inspected pnor_to,any_roofing material being.installed.
tW II the uppbca ,or ans a Wilding cupant use ea i ordevicps wn'eh If a roof is installed without fust obtaining an inspection;I'agree'toSremove
emitict, d 'coin a t a fined by tit Bay AreaA Qu 1tyM nagcment g
District, [IN. - all new materials for inspection. ,Applicant understands and will comply with
t all non point source regu]a[ions
:,. '
I ha iiread then d -materials'requirements underChapter 695 of me
Calif Halm&Safety Cd S'ctians 2550525533 and 25534.(understand that
if tn buddmgdoesnot currently have a tenant,train is my responsibility to notify me
p t f th 'equlreme u h'ch'most b t priorto issuance of Certificate of
Y.
V r 6 30 61 Signature.of Applicant Date _
Win uminaeaagent
Da,e., All roof coverings to be Class B or better '
' -- - �' E OFFICE - '- -