04070096CITY OF CUPERTINO�.+�nss"^e':>t
BUILDING DIVISION
CONTRACTOM NFORMATION
^�.'.: Yr�.R%hC� . '�4'.gv.S. L•.�
BUILDING ADDRESS:
CHEROKEE CONTRACTING CO.
PERMIT N904070096
10336 E EaTATFS DR
OWNER'S NAME:
PERMITLSUEDATE
ANDREW GROH
1220
ONE:
SANITARY NO. CONTROL NO.
(408)727-9850
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDGELECr PLUMB MECH
0 t E
LICENSED CONTRACTOR'S DECLARATION
I Mosby affirm that I am licensed under provisions or Chapter 9 (commencing
Job Description O�n
�/ t�
with Saban 700gpo1Division 3ofthe Basi ficsrimu Corck, anderyliccnxm
Or sun m a if
CLEAN OUT
Liao Lie.' J
✓VC
Dau Contras
_%G \/
ARCHHECPS DEC N
1 undecorated my plans shall k used as public reanrda
v
Q
p v
• �4
QUI
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby .(Sere our 1 exempt from Ne Comnerols License Law far the
s�
1. Cods: city Of County
following¢uoa (Section 7fn LA Business; and
se. deruu ..1Any
which requires permit ler alar, impose. demoRN, sir repair any
n prim,construct, tamcure
applicant for such Permit mfile asigned naumem
priormits issuance,aimntto
FL Floor Area
Valuation
the pr Llaoxcomas Law
thmkis licensed pursuanttothe provisions of the
Sq.
Capxl9
Sation7(100) of Division, of theeusinuaand Pfaferx vi Codd of
(commencing he Business
the k is exempt therefrom and the buss far the alleged exemption. Any violation of
that ne I, pt
et0 0
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicaot to a civil penalty of
not more Nan five hundred dollars (5500).
I,uo =ofth pmpwy.mmyemploy=wiNwMuftFwlemmpcnauon,
Required Inspections
will do the work and thcewcwm 0 not inuMed ofoffcnd tarsale (Sec. 7044, Beaircss
and Profusions Cade: The Con ercmr's Liranx Law does not apply to an owner of
propenywho buildsorim 'micas Ihenon, and who does such work himself or through his
own employes, provided that such improvements tee not intended oroRered for We. If,
however, the building or imperv=ment is sold within one you of completion, the owner -
builder will have the thunders of proving that he did not build or improve for purpose of
sale.).
CD h as sinner of din property, am exclusively contracting with licensed contractors to
construct the project (See. 7044, Business and Professions Code:) The Contracwr's L;-
_
cense taw does not apply in an owner of progeny who Wilds or improver Merton, and
who contracts for such projects with a eonuactor(s) licanxd purauam w the Commiserates
License taw.
-
❑ 1 am exempt under Sec. . B & P C for this mason
Owncr Dale
WORKER'S COMPENSATION DECLARATION
1 kreby affirm under penalty of perjury one of Ilse following decorations:
I have and will maintain a Certificates of Consent to elf -insure for Worker's Compcn-
Wion, as provides for by Section 3700 of the Labor Cade, for the pantomimic of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the labor Code, for the paformatict, of the work for which this permit is issued.
My War aCom gsato I surence carter and Policy nundi a,=
a, icy
CERTIFI A Xi AiPIION WORKERS' - a,g•l
,
COM NSATIONINSURANCE 6 I `
(This satire( need not he completed if tk permit is for one hundred dollars (SIM)
or I..)
1 coney that in On performance of the work for which this permit is issued. l shall not
employ anyperson in any manner so a to become subject o the Workers Compensation
Laws of California. Dau
Applicant
NOTICE To APPLICANT: If, after making this Certificate of Exemption, you should
become subject in tk Worker's Compenssuon provisions of the labor Code. you main
roMwith comply with such provisions or Nu permit shall be dammed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby off thi that iss Construction lending agency for the perfarmance of
ethem
ed
the work for which this permit is issued (See. )097, Co, CJ
Lender's Name
tender's Aatlress
j I certify that I have mad this application and sum Net the aWve information is
'
' comm. I agree in comply with all city and county ondmorams and sum laws minding to
building co wsction. and hereby authome ¢prescnutivics of this city to enter upon the
I about -mentioned I. ortysave rinemnify and
npumpsha against
(s ju agree s. Chin, indemnify and kap harmless w City accrue
and .which may in anyway accrue againstsold City
j lncmities,jumc
of the
to of thO of this permi'.
of this
UNDERSTANDS
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
APPLICANT
Issued by: Date
CE R G ATIONS.
Re -roofs
Type of Roof
_ b2 d (i
;S1
ore ofApplicandContrect�~� Dau f
HAZARDOUS MATERIALS DISCLOSURE
Will One applicant or future Wilding occupant store or handle hazardous melena]
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
cotle. section zss3z(a)7
Yes
All roofs shall be inspected prior to any roofing material being installe .
If a roof is installed without first obtaining an inspection, I agree to remove
Will thea Beam sir future builmn t can equipment or deviaa which
pp dbytheB
Prior harardnus sit c^numinanu az dc0ncd by the Bay Arca Air Quality Management
all new materials for inspection.
District? \
❑Yes Lya4�
1 have mad the haaandnus materials requirements under Chapter 6.95 O1 the CaSfnr-
^ia Hcelth &Safety CWd , Sceuou 25N15,25533 and 25534.1 undcmund thm if tk Wilding
Jars nal emsemly haves a icrunl, that it n my rcaponsibility w navy Inc aeupmt of tk
regain 0 warm be, iasuan=eoraceniecateoroccupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
o eraraumari sere^t Daw
i
CITY OF
�UPEkTINO
JOB ADDRESS:
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
PERMIT
OWNER'S NAME: r.,2o k I PHONE # Z�7� �9 $
GENERAL CONTRACTOR W " 4I7. _ 1 FAX #
I am not using any subcontractors: K- tom- +u% t is /jr
Signature —� Date
Please check applicable subcontractors and complete the following information
eri�/Con Signature
/ /�/a
Date
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
eri�/Con Signature
/ /�/a
Date
4
•
CITY OF CUPERTINO 0 y, 76074
qw REPIPE/SEWERS/MAIN SERVICE
CUPERTINO PERMIT APPLICATION FORM
APN3# 9 U ?v
g
Dat --7111 /
Building Address:
Re i e of Fixtures
PLUMBING
BPERMFEE
Bldg. Permit Fees
BUILDING
Ow sI e:
E�
Phone #:
5; -- -Z 53' 9
Cc t r:
Phone:
License #:
ID
Sewers
PLUMBING
Cont& t:
, Phone:
Cupertino Business License #:
BUSLIC
Business License
BUILDING
Building Permit Info:
Bldg ❑
Elect ❑ Plumb ❑
Job Descr Nft
Residential
Commercial ❑
Cost of Projec :
-2-
Qty.
Qty. if,/
Aoolicable 1 Fee M
Fee Tlecrrinhinn
FPe (:rnnn
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
.ZG3`f
$ i 2 7. 7
l
r
sm 1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........ : 36907019.00
DATE ISSUED.......: 07/19/2004
RECEIPT #.........: 26340
REFERENCE ID # ...: 04070096
SITE ADDRESS ..... 10336 E ESTATES DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA ......
OWNER ANDREW GROH
ADDRESS ..........:
OPERATOR: conniew
COPY # : 2
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-3305
RECEIVED FROM ....: ROBERT RUIZ
CONTRACTOR .......: YATES, JAMES H LIC # 702
COMPANY ..........: CHEROKEE CONTRACTING CO.
ADDRESS ..........: 1220 COLEMAN AVE
CITY/STATE/ZIP ...: SANTA CLARA, CA 95050
TELEPHONE ........: (408)727-9850
IREE ID UNIT QUANTITY AMOUNT
PD -TO -DT THIS REC NEW BAL
BPSEWAGE UNITS
1.00
67.14
0.00
67.14
0.00
BPSEWER SEWER SYSTEM
1.00
21.58
0.00
21.58
0.00
PPERMITFEE FLAT RATE
1.00
38.37
0.00
38.37
0.00
TOTAL PERMIT
--------------
127.09
0.00
----------
----
127.09
0.00
METHOD OF PAYMENT
-----------------
AMOUNT
NUMBER
------------
OTHER
127.09
------- -----
M/C
TOTAL RECEIPT
127.09
VOICE ID DESCRIPTION
VOICE ID
DESCRIPTION
106 SEWER & WATER
202
UNDERFLOOR
PLUMBING
301 ROUGH PLUMBING
302
TUB
& OR
SHOWER
502 FINAL PLUMBING
ENERGY
506
GAS
TEST
507 FINAL PLUMBING
CITY OF CUPERTINO�.+�nss"^e':>t
BUILDING DIVISION
CONTRACTOM NFORMATION
^�.'.: Yr�.R%hC� . '�4'.gv.S. L•.�
BUILDING ADDRESS:
CHEROKEE CONTRACTING CO.
PERMIT N904070096
10336 E EaTATFS DR
OWNER'S NAME:
PERMITLSUEDATE
ANDREW GROH
1220
ONE:
SANITARY NO. CONTROL NO.
(408)727-9850
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDGELECr PLUMB MECH
0 t E
LICENSED CONTRACTOR'S DECLARATION
I Mosby affirm that I am licensed under provisions or Chapter 9 (commencing
Job Description O�n
�/ t�
with Saban 700gpo1Division 3ofthe Basi ficsrimu Corck, anderyliccnxm
Or sun m a if
CLEAN OUT
Liao Lie.' J
✓VC
Dau Contras
_%G \/
ARCHHECPS DEC N
1 undecorated my plans shall k used as public reanrda
v
Q
p v
• �4
QUI
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby .(Sere our 1 exempt from Ne Comnerols License Law far the
s�
1. Cods: city Of County
following¢uoa (Section 7fn LA Business; and
se. deruu ..1Any
which requires permit ler alar, impose. demoRN, sir repair any
n prim,construct, tamcure
applicant for such Permit mfile asigned naumem
priormits issuance,aimntto
FL Floor Area
Valuation
the pr Llaoxcomas Law
thmkis licensed pursuanttothe provisions of the
Sq.
Capxl9
Sation7(100) of Division, of theeusinuaand Pfaferx vi Codd of
(commencing he Business
the k is exempt therefrom and the buss far the alleged exemption. Any violation of
that ne I, pt
et0 0
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicaot to a civil penalty of
not more Nan five hundred dollars (5500).
I,uo =ofth pmpwy.mmyemploy=wiNwMuftFwlemmpcnauon,
Required Inspections
will do the work and thcewcwm 0 not inuMed ofoffcnd tarsale (Sec. 7044, Beaircss
and Profusions Cade: The Con ercmr's Liranx Law does not apply to an owner of
propenywho buildsorim 'micas Ihenon, and who does such work himself or through his
own employes, provided that such improvements tee not intended oroRered for We. If,
however, the building or imperv=ment is sold within one you of completion, the owner -
builder will have the thunders of proving that he did not build or improve for purpose of
sale.).
CD h as sinner of din property, am exclusively contracting with licensed contractors to
construct the project (See. 7044, Business and Professions Code:) The Contracwr's L;-
_
cense taw does not apply in an owner of progeny who Wilds or improver Merton, and
who contracts for such projects with a eonuactor(s) licanxd purauam w the Commiserates
License taw.
-
❑ 1 am exempt under Sec. . B & P C for this mason
Owncr Dale
WORKER'S COMPENSATION DECLARATION
1 kreby affirm under penalty of perjury one of Ilse following decorations:
I have and will maintain a Certificates of Consent to elf -insure for Worker's Compcn-
Wion, as provides for by Section 3700 of the Labor Cade, for the pantomimic of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the labor Code, for the paformatict, of the work for which this permit is issued.
My War aCom gsato I surence carter and Policy nundi a,=
a, icy
CERTIFI A Xi AiPIION WORKERS' - a,g•l
,
COM NSATIONINSURANCE 6 I `
(This satire( need not he completed if tk permit is for one hundred dollars (SIM)
or I..)
1 coney that in On performance of the work for which this permit is issued. l shall not
employ anyperson in any manner so a to become subject o the Workers Compensation
Laws of California. Dau
Applicant
NOTICE To APPLICANT: If, after making this Certificate of Exemption, you should
become subject in tk Worker's Compenssuon provisions of the labor Code. you main
roMwith comply with such provisions or Nu permit shall be dammed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby off thi that iss Construction lending agency for the perfarmance of
ethem
ed
the work for which this permit is issued (See. )097, Co, CJ
Lender's Name
tender's Aatlress
j I certify that I have mad this application and sum Net the aWve information is
'
' comm. I agree in comply with all city and county ondmorams and sum laws minding to
building co wsction. and hereby authome ¢prescnutivics of this city to enter upon the
I about -mentioned I. ortysave rinemnify and
npumpsha against
(s ju agree s. Chin, indemnify and kap harmless w City accrue
and .which may in anyway accrue againstsold City
j lncmities,jumc
of the
to of thO of this permi'.
of this
UNDERSTANDS
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
APPLICANT
Issued by: Date
CE R G ATIONS.
Re -roofs
Type of Roof
_ b2 d (i
;S1
ore ofApplicandContrect�~� Dau f
HAZARDOUS MATERIALS DISCLOSURE
Will One applicant or future Wilding occupant store or handle hazardous melena]
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
cotle. section zss3z(a)7
Yes
All roofs shall be inspected prior to any roofing material being installe .
If a roof is installed without first obtaining an inspection, I agree to remove
Will thea Beam sir future builmn t can equipment or deviaa which
pp dbytheB
Prior harardnus sit c^numinanu az dc0ncd by the Bay Arca Air Quality Management
all new materials for inspection.
District? \
❑Yes Lya4�
1 have mad the haaandnus materials requirements under Chapter 6.95 O1 the CaSfnr-
^ia Hcelth &Safety CWd , Sceuou 25N15,25533 and 25534.1 undcmund thm if tk Wilding
Jars nal emsemly haves a icrunl, that it n my rcaponsibility w navy Inc aeupmt of tk
regain 0 warm be, iasuan=eoraceniecateoroccupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
o eraraumari sere^t Daw
i
CITY OF
�UPEkTINO
JOB ADDRESS:
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
PERMIT
OWNER'S NAME: r.,2o k I PHONE # Z�7� �9 $
GENERAL CONTRACTOR W " 4I7. _ 1 FAX #
I am not using any subcontractors: K- tom- +u% t is /jr
Signature —� Date
Please check applicable subcontractors and complete the following information
eri�/Con Signature
/ /�/a
Date
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
eri�/Con Signature
/ /�/a
Date
4
•
CITY OF CUPERTINO 0 y, 76074
qw REPIPE/SEWERS/MAIN SERVICE
CUPERTINO PERMIT APPLICATION FORM
APN3# 9 U ?v
g
Dat --7111 /
Building Address:
Re i e of Fixtures
PLUMBING
BPERMFEE
Bldg. Permit Fees
BUILDING
Ow sI e:
E�
Phone #:
5; -- -Z 53' 9
Cc t r:
Phone:
License #:
ID
Sewers
PLUMBING
Cont& t:
, Phone:
Cupertino Business License #:
BUSLIC
Business License
BUILDING
Building Permit Info:
Bldg ❑
Elect ❑ Plumb ❑
Job Descr Nft
Residential
Commercial ❑
Cost of Projec :
-2-
Qty.
Qty. if,/
Aoolicable 1 Fee M
Fee Tlecrrinhinn
FPe (:rnnn
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
.ZG3`f
$ i 2 7. 7
l
r
sm 1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........ : 36907019.00
DATE ISSUED.......: 07/19/2004
RECEIPT #.........: 26340
REFERENCE ID # ...: 04070096
SITE ADDRESS ..... 10336 E ESTATES DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA ......
OWNER ANDREW GROH
ADDRESS ..........:
OPERATOR: conniew
COPY # : 2
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-3305
RECEIVED FROM ....: ROBERT RUIZ
CONTRACTOR .......: YATES, JAMES H LIC # 702
COMPANY ..........: CHEROKEE CONTRACTING CO.
ADDRESS ..........: 1220 COLEMAN AVE
CITY/STATE/ZIP ...: SANTA CLARA, CA 95050
TELEPHONE ........: (408)727-9850
IREE ID UNIT QUANTITY AMOUNT
PD -TO -DT THIS REC NEW BAL
BPSEWAGE UNITS
1.00
67.14
0.00
67.14
0.00
BPSEWER SEWER SYSTEM
1.00
21.58
0.00
21.58
0.00
PPERMITFEE FLAT RATE
1.00
38.37
0.00
38.37
0.00
TOTAL PERMIT
--------------
127.09
0.00
----------
----
127.09
0.00
METHOD OF PAYMENT
-----------------
AMOUNT
NUMBER
------------
OTHER
127.09
------- -----
M/C
TOTAL RECEIPT
127.09
VOICE ID DESCRIPTION
VOICE ID
DESCRIPTION
106 SEWER & WATER
202
UNDERFLOOR
PLUMBING
301 ROUGH PLUMBING
302
TUB
& OR
SHOWER
502 FINAL PLUMBING
ENERGY
506
GAS
TEST
507 FINAL PLUMBING