01100060 CITY OF CUPERTINO '
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
ON:
BUILDING ADDRESS: PERMIT NO.
1054 COLONY HILLS LA CHEROKEE CONTRACTING CO. 01100060
OWNER'S NAME: APPLICATION SUB DATE
JOHNSON ALAN K AND BETTY J 1220 COLEMAN AVE 10/10/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 727-9850
µ
]OO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
F w- BLDG ELECT PLUMB MECH
sip —I O IU L'7
S4a 1herebyeRlrmor5;DmliceON.RAdrode,PDECovofChapter9(commencing TION lob Description
i=�0 W with Section 7")of Division 3 of the Business and Professions Code,and icease INSTALL CLEAN OUT.
isin Nll force and ffetta,
'OSs,V Licence close%=�
3 B au y Dam I�'�" Conttanor
RCHITECT'SDECLAR N
a 1 unJeaand my plans shall be used as p.1th mann
' of
s O O Licensed Professional
Oat I am exeLDEIImpt
DECLARATION
y
1 hereby.idem on 11. exempt from the Cessions r s c:LicenseAry c Law for the
following reason.(Section]031.5,Business and Professions Cade:Any city or county 0 0 0
$,CS which regmres a perm t I Imct,eh r pro tlemohsh,or capon any sw t -- - _ _ _ - -
a3� "'pnonoslicenadpurl req Theeppppf mf hpemmuo BleasLw stat I• --- - - ---- -- - -. ....... $1000
.._
that he is ncensed pu uldf t Ne pmvlsion f me Contractors License Law(Chapter 9 Valuation
mammenemg with Sent n]p00)of Division 3 fine Busionaeand Prufepsmns Cod) ! '$.} F)L,
or that he ii exempt Nerefrdm and the basis for On alldged exemption.Any violation
of Section 78316 by any applicant for a permit subjects the applicant to a civil penalty
mf not name than rive hundred doll=(5500). AIN 1 Occupancy Type
106 - hWh & WATER
❑I,'ascrof the property,-,my emees ploywith wages as inch wlecompemader.
'will do the work,arm he an enta is not intended or offered for-sale(Se,.1844. _
Business and Professions Code:The Contnctm'a License Law does not apply ton 301 - ROUGH PI WI�'4�(I1'speetions
owner of property Who build,or improves macron,and who does such work himself i
loaned-for sidelLis own howearcdieWildingorthat
mprovcomaip'ssold thinon.>`aroi - ..302. —....TUB. .&. OR SHOWER ! .. _. _.,.. . _ . . .,
- . _ - r. _ _ ._..
c
o pieton,tnoownrWilderwdohavetheburdeno(provnfithrbedidnorWilda, 502 - FINAL PLUMBING ENERGY "
I mp f p pose faal ) 506 GAS, TEST.
_ _._. .. _.._. .
❑I'as owner oIt.he p Seedy, Business
vela o wctiag w W I enscd eontmnom to 507 - FINAL PLUMBING ' ^
License the project(Sec IDda Business and Proproperty
who b Cade:)The ves tracmr'a
License Law does fi apply to sj owner of property who builds se improves thereon, 1
_aod.wnor's Lice for.such pmjeca.wiN.a contractar(s)liwrued pursuem.ia the. __._. ..,.....__ __ -,-._._. . ... _... .. ... ._ - _...5, ....... ... ... _. __
Contractor's am axe License Lew. -
❑tam exempt under 5 ) 'B&PCf rtnis mason
Det ..
WORKER'S COMPENSATION DECLARATION F I IN A L E
I hereby atTrm underpenalty ofppuuryoneofthefollowingdeclamtions: ern
o I have end will mchn'tan a'Cenificou of Consent to nelf-inam,for WndmYs OCT 2 4 2001
Compensation, sa,provided for by Section 3700 of the Labor Code, for The
_ Performance of the'work for which chis Parodi is usuedf, p
❑1 m d 11-m t W u ke x Co pemad n hsurzhce es reyo sed by Section BUILDING
k t hien tb puma
pis a M W Work
Com ^sat o s re a cam d P l cY mbar rc
3100 f th Isbo Cod fw the performance of Ne
Y. ...... K _..
n� ..._ .. ., ..._ ...,.._.-�_. ._. .._.
Poli
Car%rl CERTIFlCATION El(EMPI'ION FROM WORKERS . ,.k Jortii 'nV_`@iv x.t � . .a''y�r'iA,bF }qJy: , . ' 'alit
',v r n- COMPENSATION INSURANCE .,...;_ _
(Th s senion need nog be compietW if the permit is for one hundred dollars
f5100)nlmaJ
FF y th p K once f me h far which Nis pent s issued 1 I
C pe soon Lawny person in any manna so es to,zeame subjen to the W k '
'NOIIC9TOAPPL1 of California,Dafe
P Y
-A .cent - .- n. .... .. .. .. .. . . . . .. _ ..- . . .. _._ - .., . _
CANT If,after making this Celli tate of Exemption,you should
OZ f^amenobject 16the W kat Compensation proinions of rhe Lancer Code,you most
Q ply with such provisions or It,permit shall be deamed revoker.
CONSTRUCTION LENDING AGENCY - - - s -- rr -
1 thereby firm that there is a consimn on 1<d ag g my forme peH rmatice I
a' sus of the workfor which this pnrnt sissued(Sec 3091'C .C7
s 0.'Q Lender'sName
... ..�. ... . ... ....._..,. _.._. ._ _ __ _. . _.. , .. .. ..._ ...... .._
=;z Lcdrs Address .r
V' 1 artily that 1 have mad this application mM slate that the above inuondim is
LL:Fy curreccl agree m comply,wlm all city and county ordinances and smm laws relating
O;V to building construction,-and hereby authorize iepressmatives of this city to enter upon
;;q-W the above-mentioned progeny for inspection purposes..
I.-0. (We)agree to save,indemnify end keep harmless the City of Cupertino against
.UV) liabilities,judgments,costa and expenseswhich may in any way sane against said
z City in consequence of the grunting of N¢pemal. - ,
APPLIC�'r UNDERST D$ANDWB "COMPLYWITHALLNON-POINT ISSuedb
sbuRggaeetc��.x�T1on \ �', 5 y:
Date
Sign hi v mAppl a o/C iu enter t, 11Re-roofs
HAZARDOUS MATERIALS DISCLOSURE I -k
Wdl N Pel cant fun holding a«npa t t r handlenmaiiJaas material Type of Roof, .. ,
as defined by the Cupertino Municipal Code Chapter 9.12.and the Health and Safety t
"qp t P � P Y g
i Will thea li l o future building ocru t use equipment o devices i t,: ! i ig
va t g , ..All roofs shall be ms acted I prior-to, roofing patenal..being installed., ___..... .__
de$act n 25532(-) i a l f tri pp Ii p 3 i
❑Yes ❑No 1 s S_ pa
whim If a roof Is Inetalled'without first obtaining an ms action;I'agree ao'remove
emu nazerdous air co a ass defined by thea AreaArQ altYManagement
o strict, Y _all new materials for.inspection, Applicant understands:and will,comply,with _
Q oy ❑No r; all non- oin[source re ulations.; , , •'
4� P g
1 have read-4he hazardous mamnak regwremenis'under Chapter 6.95 of Ne
Califomis Hea11h&Safety Coda,Sections 25505,25533 and 25534.I understu rd that'
if the building does'^tcurrcnaveet - rtnat it is my responsibility to notify the '-
ace p t f the q tie a h¢h a,'
bamxnprmno nm.r f a C rtificate of -
°y�no,.� � ^ t Signature of Applicant Date
-" _
n or nuummed agent - ' ,, Date All roof coverings to be Class "B"or better -
`-t OFFICE