03010195 COPY OF CUPEB'I-INO
BUILDING DIVISION PERMIT ` CON1aRAc�,TORIINFORMATION•
BUILDINGADDRESS: CHEROKEE CONTRACTING CO. PERMIT NO,
836 KIM ST 03010195
WNER'S NAME: 1220 COLEMAN AVE APPLICATION SUB DATE
RALPH PARK — 01/30/2003
ZONE. —F408) 727-9850 SANITARY NO. CONTROL NO,
ARCHITECT/I!NGINEER: BUILDING PERMIT INFO
❑LDG ELIiCI' PLUMB MECH
0 0 0 0
pOp LICENSEDCONIRACfOR'S DECLARATION
n F 1 hereby alum,Nal I am licensed under provixinnx of Chapter 9(confinement, Job Description
tai with$efdon YlMMnof u, 3 ofthe Businessand ofesslons Cndc.amJmylicemxis
fuufomeander "_ ,2;{SLf� 4 " LATERAL CLEAN OUT. �'tl ���..
Liccnw I [,it.M
F w C p DaS Cnnvandt
ARCIIITECT'S UIiCLW�YATION
Crosland lon"Ch.11beused asibialleecods FEB' 0 2003
3`
FLL 0',
ai
Licensed Pnmlcssinnal
OWNER-BUU.DI'R DECLARATION
to a y 1 hereby affirm Nat I am cacmPt from the Contractor s License Law for the MRJIL®IfVG
w ex p O following reason.(Section 7031.5.Business and Profe.sions Code:Any city or county
K m which requires a permit to conamct,altar,improve,demolish,or repair any structure
peionoirs isstence..len TeTurs lheeppheint for such Permian file.signednatement
thy he is license)pursuanto the• revisions of the Connector's License Law(Cha(Chapter S Ft. Floor Area
fop p p q. $1li(AAtion
(eat he is
(commencing therefroon m
and the
Division)ofthe ageBusiness empt on.Any
Codd lir
a 3$ the he is exempt therefrom and the basis for the allege)exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects The applicant to a civil penalty of
not more than five hundred dollars($5110). 6 Occupancy Type
❑1,as owner of Ne property,or my employees with wages as their role compensation,
will do the work,and the structure is not intended or offered for sale(Scc.]Ba4,Business — �,pp
and Professions Codc:The Contractors License Law docs not apply to an owner of 202 — UNDERF V V e � G
property who builds or improves thereon,and whodues sub work himaelfor through his
own employees.provided that such improvementa ata not intended mothered for sale.If, 301 – ROUGH PLUMBING
however,the building or improvement is sold within one year of completion,the owner-
Wilder will have the burden of proving Oat the did not Wild or improve finr purpose of 507 — FINAL PLUMBING
sale.).
❑1,as owner of the property,am exclusively enamoring with licensed contractors to
construct the project(Sec.744.Business and Professions Coal The Contacted's Li
ecrove law docs not apply to an owner of property who Wilds or improves thereon,and
who contracts for such projects with a contranor(a)licensed pursuant to the Contractor's
License Law.
I am exempt under Sec. ,B&PC for reason
net Data
WORKER'S COMPENSATION DECLARATION
`J I hereby allied,under penalty of perjury one of the following declarations:
`✓ I have and will maintain a Cerifcare of Co...,toselGinsure far Wadan-sCompre-
strust as provided fur by Section 3700 of he Ia Wr GWe,foe the performance of he
work for which this Permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of do,ISWr Code,for the Performance of the work for which This permit is issued.
My Work ECnm salmon lnsomncc varier and Polic numberamn:
Cariee�✓L Policy NnYWIR ERS'
/ CERTIF CATE F XTION ION FR WORKERS'
COMPENSATION INSURANCE
(This section need not he completed if tW Permit is foeonc hundred dollars(S lm)
lir Icss.)
1 verify Nat in be performance of Or,work far which this permit is issued.I shall rel
employ any Person in any manner m M In beummc Subject um the WorkersCompensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Lubar Code,you must
C) z forthwith comply with such provisions or this permit Shall be deemed revnked.
z O CONSTRUCTION LENDING AGENCY
F a herebNamyalfird,Nat Here is aconamclion lending agency lonhe performance of
ai the work lir which this pernsll is issued(Sec.3097.Civ.C.)
ft1 L.cndcr's Namc
U z Lcndcr's ABJ¢xS
U Q 1 certify Nat 1 haw mad this application and stare that Ne above information is
Hcored.1 agree to comply with all city and county ordinaries and state laws relating to
QU Wilding construction,and hereby autherim repmacntatives of this city to enter upon the a
above•mentioned properly for inspection purposes.
U C (We)agree he handles,indemnify and keep halethe City of Cupertino against
N ts
liabilitiesjudgmen ,coo and expm
expenses which may in any way accc against said City
U Z in ttmscyucncc Of the graining of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL1,NON POINT Issued by: Date
S CE REGULATIONS.
S
azure urnp �cunnelm 1 I n� Re-roofs
To
I IAZARDO S MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hvardous material
as
defined by the Curri ilio MunicipaI Code.Chapter 9.I2,and the Health and Safety
Co
seernm zss3z(a):e gN/ All roofs shall be inspected prior to an roofing material beim
�Y°' P P Y g g installed.
Will the a fdanl or future Wilde ocdu equipment If a roof is installed without first obtaining an inspection, I agree to remove
PP g Pam use c vi t or devices which g
it M1urardous air coulamine;a' lined by the Bay Arca Air Quality Management all new materials for inspection.
iyrict9
❑Yes
I have mad the havardousmaterials reyuiremcnrs under Cha1te16.95 of the Colton-
niallcalN&Salcty QSk.Sadorss 23N15.353J3 ymz53.W.1umkrsund rimy ifdc i]do,
docs inn currently hex a Moan.Nam it is my respnmsi diloy bin anuly the oecuPant I the
requi re xwIchmustbemetpoortoissuanceliracemrdate fadusandy. Signature of Applicant Date
p l 2 o r�'
0 a brand agent bit. All roof coverings to be Class "B" or better