05050024 CITY OF CUPERTINO *' '°•' . z "' ° ''` "'�"^°' �•'
BUILDING DIVISION PERMIT C0NTRACT0 INFORMATION x:
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BUILDmc ADUREss: CHEROKEE CONTRACTING CO. PERMIT No05050024
749 nPAK7 CT
OW NER'S NAME: PERMIT LSSUE DATE
NE: SANITARY C OL NO.
ARCHITEC'VENGINISM: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
CJ � 0
LO1LICENSED CONTRACTOR'S DECLARATION Job Description
C I thereby affirm Nm 1 am licensed under previsions of Chapter 9(rommcaing
t' with Suuon70(g)of Division 7 of the Box.shut Professions Code.md ar,her.is
I.
rota and er L -2-SG, IS _ REPLACE SEWER LINE
j Z Lianw CI 5 Lie.p �_
a^p Date cmimor LL L
R!i ARCHITECTS DECLARATION
U I understand my plans shall he used as public recordsSm
O
ti Licensed Pmfcssional
3 OWNER-BUILDER DECLARATION _ J
'<F I kmby affirm dol I am exempt from the CONRCIor]License law for the
el O followingreason.(Section 711]L5.Business and Pwasuzo s Cade:Any city or county
k
%9 which ayuires A permit to consumer.alter,impmae.demolish,or arbor any Structure
�ZY prior rat its issuance.also requires the applicant for Such pemlil to file a Signed xUlconni
< that heisliccnsedpunuantat She provisions ofNeContrxtur'sLicense Law(Chapmr9 Sq.Ft. Floor Area Valuation -
sFC
that
onefrot(And0 basisofrnf Alleged
Isssand...Anyaa autumn
of
y`<� Net k u exempt therefrom and Ne baso for Ne alleged exemption.Any vialatirn of �,�SwnM,.ova{,
Section 7071.5 by any applicant for a permit Subjects the applicant to a civil tonally of 3 191VJft6ero 0 Occupancy Type
not more Nan five hundred dollars($500).
D 1,u o mr of the pmpcny,or my employcu with w gu u lktr sole compenvuon•
will dotestark.andthe he Commodes
LMedo Law
not wrier Of
aria Profession Wilds or
The C swore rs License law dace or apply if an Owren is Required Inspections
Own enywho Wildsorimpmasckmon.andwno da souchwork himmlfor througM1 his
employees.provided pr such improvementsArt not tendedoraQertd tha ofornic.r-
b iRchor ,the building or den of pmenl is that
within one year of comticvon.Nc oose of
builder will nave Ne burden of proving Nat k did nm Wild or improve for purpose of
talc.).
D 1,as owner of She lumpeny,am exclusively contracting with licensed contractors to
emstmet the project(Sec.7044.Business and Professions Cade:)The Comracmes Li-
case law docs not apply In an owner of property who Wilds or improass common.and,
who contracts for such pmjccu with a contractor(S)licensed pursuant in the Comaclors
License law.
D 1 am exempt under Sec. .B k P C for this mason -
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury arc of the fallowing declarations:
730701
ham and will maintain aCcrufieam of Consent m air-insure for Workers Compcn-
n,u pmvidW far by Section 3900 of Ne lakr Code.for the pcsfmmwce of the
for which this permit is issued.
have and will maintain Worker's Compensation Insurance,az required by Section
of Ne labor Code,far the perommnce of the work for which Nis pcmtit is issued.
Workels Com nsauo//n�yInwmna canter and Palley numberer. 5 l0-Nn aN ' Polity No.'7�3/sn,H-6s 7/
CERTIFICATE EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need trot k completed if the permit is foram hundred cinllars(5100)
or less.)
I ecrtify Nat in in.performance of Ne work nor which this permit is issued,1 Shall not
croployanypcmuninanyman,grTIS L`trh�ubjectm Ne Waricea Compensation
Laws of calif"• + n,.I91T I r
Applicant�,ILy� 7�
NOTICE TO APPLICANT:If,after making Ni ni0cae of Exemption.you should
became subject to She Worker's Compensation pmvisiom of the Gkr Code.you mus
Z faMwiN comply with Such previsions or this Permit hall W deemed revoked.
? O CONSTRUCTION LENDING AGENCY
I hereby aRsm that there is a construction lending agency nor the performance of
(r Ne work for which this permit is issued(Sec.3094.Civ.C.)
W 0 Lender's Name
d Lenders Address
VQ I certify that 1 have read Nis application and tum that the above information At
D. t-' comrL I Agra m comply with all city and county on inances and sum lam relating to
O U building construction,and hereby authorize¢pmxnmiss of this city to crier upon the
r W akvcmentiamni property for inspecum pogrosea
(We)agree to save,indemnify and kap harmless the City of Cupertino agmns
F'h liabilities,judgments,costs and expenses which may in any way accmc against said City
U Z in consequence of the granting of this permit.
^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU S.
14LAI g
Signature of AppfcanVf ouonroseloor T�' S 1 f!lD Re-roofs
ta
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding Occupant store or handle huaNau maerial
as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
Ocit
e.Section 25572(.)? �� All roofs shall be inspected prior to any roofing material being installed.
Dy.
will the applicant or(brute building acapant use equipment or devices whim I If a roof is installed without first obtaining an inspection,I agree to remove
hvardaus air contaminans u defined by On Bay Area Air Gouty Management all new materials for Inspection.
District?
D Yea 6+�
1 have mad Ne hvaNtws maerialsmyvirtmcnu under Cnapmr 6.95 of the Glifor-
nia Health a SafetyCode Savors 25505.25511 and M534.1 undersand Nat fare building
Jars not cumemly haw a terant Nat it is my responsibility on nouly to Occupant nfthe
mut rty�aL.w��mmmu�atWmetpnory}aaan�eor.cardfcateofaapaney. Signature of Applicant Date
KtkJA tiF n • {( t• 2 SA tldog- All roof coverings to be Class"B" or better
Owner or amhorisd agent Dam
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
OU
PEI�TINO
Building Department
J07ADDRESS: PERMIT #
97q2- I--- b
OWNS 'S NAME: 14 h B g o ry PHONE # k1 -9 ,i�-O
GENERAL CONTRACTOR: ( b r z n FAX # p pSC
I am not using any subcontractors: � +^� ��,`Z_ !:;:Wo
,!;—
Signature Date
Please check applicable subcontractors and complete the following information:
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 a !Z S,S 07SZZ2 103
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/ ontracto e Date
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE �S �S�
CUPECiINO PERMIT APPLICATION FORM
APN #_ Dae^:
? J (.% -
Buildipg_ddress:
��f
Owner's NPhone #:
/ 41 ) O g�n� 6-073
C ract Phone: License#:
S lS'
Cont t:Phone/:: Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb IJJ
Job scripti n:
1� C'� P� S �( J Z l 'n C� lf � `Y) 1�ca1 R�l'1�
Residentia ❑ Commercial ❑
Cost of Project:
Qty. if
Applicable Fee ID Fee Description Fee Group
PPERMITFEE 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 Disposal PLUMBING
BUSLIC Business License BUILDING
MAY-19-2005 16:38 MARK THOMAS CUP 4082535173 P.01i01
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DISTRICT MANAGER-ENGINEER oW BOARD OF DIRECTORS
MARK THOMAS&COMPANY,INC. 6a WILLIAM A.BOSWORTH
® DAVID E.ROSS DR.JOSEPH F.BROWN
JOHN M.GATTO
DISTRICT COUNSEL fp %t��
qg�1$N k0 N CURTIS B.HARRISON
ATKINSON•FARASYN,LLP
W ENDELL H.KERR,JR.
HAROLD S.TOPPEL 20833 STEVENS CREEK BOULEVARD,SUITE 104
CUPERTINO,CALIFORNIA 950142154
(408)2537071 PHONE a (40812538173 FAX
File: CuSD—MOP
Building Dept. —Cupertino
City of Cupertino
Attn.: Building Department
10300 Torre Ave.
Cupertino, CA 95014-3202
Subject: Residential Remodel/Additions
Name: Charles Thompson
Address: 19742 Drake Court
APN: 316-32-015
Permit No. 05050024
Videotape and Property Line Cleanout inspected.
No additional conditions/requirements by the District.
Inspector: George Santos ...............................I...........Gs'
Date; ...5-18-200.5................... Sanitary Sewer Location:
cc: Homeowner
SUPvrcING SANITART SEWERAGE Suvias Fm CITY OF CUPERTINO, PORTIONS OF THE CITIF5 OF SARATOGA, SUNNPYAIE, LOS ALTOS AND SURROUNDING UNINEORPDRATEO AREAS
www.rupe rrin osonif Ory0s trier.(Om
TOTAL P.01