01060037 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10370 LINDSAY AV CHEROKEE CONTRACTING CO. 01060037
OWNER'S NAME: APPLICATION SUB DATE
• KEATING JERROLD K AND LOUISE F 1220 COLEMAN AVE 06/07/2001
PHONE: SANITARY NO, CONTROL NO.
(408) 727-9850
O O ARCHITEC(ENGINEER: BUILDING PERMIT IN
BLDG ELECT PLU MECH
Z 5 N= LICENSED COWRACTOR'S DECLARATION -Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
P,ml_w with Scnion]0001ofDiown3ofthe Businesaand PerfeaionsCode,andmy license '
a y y ism f 0 fiioce and ofyct.' ,
do�� a nreCTa -'em INSTALL LATERAL C.O.
as��1-7��f Contmc or r
a O ARCHITCf.T'g DECLARATION
h- g 1 u iSmnJ plans shall Jas pu)lic rcrnNs
z�aS �i ❑O Liccnutl Pro asiona
OWNER-BUILDER DECLARATION O/
up-Z, 1 hereby v(Erm on I..exempt from the Contractor's .Any c Law Room
!-Z so following reason.(Section]ons m Business and Professions Cade:Any city or county
❑ which requires n permit re consumed,alter,improve,demolish,erre a sig any structure
i3
so which
tsupsissuance.al 9 the pll' tf ahPetinuicense Law(Chaptned er
9. - - - --- ,-- ----- ------battle is ingwi Sectionlt 16
si of the theBCwturrusinesL selawonsCor9 S F'[ F1oorArea uation
Ido m ee'ngwnh5 uon"ntraid Division 3 ftheBusm pPnt.AnyviCode) C t I :SLG 1�_ ,• _. a- kij4•• : I ; $B
or that he is exempt therefrom and the basrs for bar alleged Compliant.Any violation '•
of Section 70313 by any applicant for a Permit subjects the applicant to Civil pcnahy Occupancy Type
3 6 9`Z � t'�0
.ef ma more than five howled dollars 1!500).
°1,as owner of the property,or my employees with wages us their sale compensation.
will do the work,and the smctope is not intended or offered for sale(Sec.7044,
'•Buiiness'and Professions Code:The Convector's License Law does not apply to an 106 - SEWER & IjgAI5p5E5gpinspectionsn'
owner of properly Who builds or improves thereon,and who does such work himself
or throat h his own employees.provided that such improvements are not intended err, .UNDERFLOOR._PLUMBING
completion.
sole. wer buildethebuildinge imen of sold did one year or ,,, ,�• �,;
ocompletion,the
ur,som ownerbuilderwill Kase the burden of proving that he did not build or 301 - ROUGH PLUMBING -
improve for puryuu of sale.), i
--- _.tuft- -- -... ------' -- - _ -302__- _TUB. & OR-SHOWER, - - - -- -
z I9 I. ownerofthe pmpeny,am exclusively contracting with IicemNe Clamors to 'S::.i. •_•-•ot:c O
dimmertheaw oejeetIappl]toa, owinnstoo
ertywhobsewe:)Thevesthereons 502 - FINAL PLUMBING ENERGY a
ra cense Law Anes not apply to an owner of properly who)lids se puramoth n,
..and who cont acts,(r such.Projects.with o convacmgs),I ceased pursuant m the. ... ___ rj 0.6..._.-......GAS,.TEST_ t
exempt
License Law.
[II exe
❑ am mppundd
t Scc. "" '' B•&PCfor this reason 507 - FINAL PLUMBING 'ire''
Ownei" - t'Daic' -
_ WORKER'S COMPENSATION DECLARATION
I hereby offrm under penalty of perjury one of the following declarations:
❑ I have and will maintain v CcgiMbie of Consent to self-image for Wader's
c:v;•_• :' Compensation,'as provided for by Section 37M of the Labor Code, for the
performance title work for which this Permit is issued7. .,, ,
°1 have and will•miomon Wmker'i Campenimmm Insurance,m required by Section
'3]00edshor of thCode,for the performance of the work for which this permit is
"tee yeker'e,Compensate 1tr carrier and Policy numberarc:, W
-,, I•{'tw !.a ri.Pl yNo. (' 3 c 7 . ,-npl - i '1'.1",,:r , k] ... _.. -� .. .
Welker
ERT I KATION OF.EXEMI TION FROMYORK RS +• s •. ( !.
COMPENSATION INSURANCC
e
't h s trusts need not)e compllcdif the permit is for one hundred Copan,
IS 100)or las.)
I clarddg that in the performance r the wok for'which this permits issued 1 ••�•� •~. •. .r-�^ --•� _ f.tet
shall noYemploy any person in any banner so is to became subject in that Workers'
Compenactma Luwsof Culilmriz.Dam '
^NOTICE TdAPPLICANT It after making this Cenircaie f Exemptilm,you dWa11
r "
Z 'b o bjdu the' Worker,Cnpen t nP st nc of th WtdrCode you most
flab N c n ply ill h p ons or this conot shall he decumd reviled.'
u.nt
a
CONSTRUCTION d T ., �i
1 h Aeby off hich th he,t) n d(t n 1 97 g agency fo th pertarmntrce 'W
W •of thek f - hich ih pc' t issued(g Ufl]Civ C t —
.1 "Lehder s Namc
Z Linde,s'AJdmss,. - , .. .,. .,. _.: :.` •:IDI:
V 0 .I certify that 1 have read thissupplication and state that the above Information ie
codmccl agree to comply with all City and county ordinances and start laws relating
to Wildiageonstruction.aid hereby arbonic reprcuntdtivcs ofthiacity metnerupon '
,he a)ove mentioned propany for inspection purposes. ,
F'I 0., (Wei g •em mdemnify and keeph I ss'th City fCupcnitm against
h 'it,in C judgments posts and expcau which may-n.any way acme against said.
V-� 'it,
sy ncc (the gmnnng'nfth la t
IAPPL AYhUNDF.RSTA ' NDI�y�J1,LCOMPLYwrrHAL NON-POINT" ]SSuedby: L Date
SigmumerdAprlicandContmcmr. •.! ' - ";.. li.; ;Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
u
Will the applicant"Room budding Well*[ tore in hamllh `Wss mate al .- .Type-O OOT-,as deflated by theCupcn Municipal Code Chapter 9.12, d theHealth and Sister
t F
_.,. - ..
,. .'t.l 1 .'. ..
.Code Sato 2551111 T .
�.
°Ye °N roofs.shatl.beInspectedprior.to.anyroofing.material.bemg.mstatled..
'. ;,,Will the ppl' t future building ocp m secq pm nt de ice,which If a roof is Installedwithout first obtainingan ins ectlon 'I'a-ree't0'rcmove
c t hazardous u r contaminants as def d by the Bay Arca Air Quality Manager nt P a
Dstnm" all new materials for inspection._,Applicant understands and will comply with
-'- .
°Yes.' 0No
� �' r all non- lint source re uhtions....,,
".I have,iead the lu iardoui;,maedals require. ems under Chapter 6.95 of the
C.1iflo iiq Health&S act c:Cw Section 25505.25533 and 25531 1understand that
I f th "Id gddu.nt tlyM1 ea tthtt' my .pe 'bltytonotfythe'
o p m of the equ e r h ch nail be t i prior to c f CjnificaIC Cyr
of
„ /O.� Signature of Applicant Date
.......
Owner or ambotizeJ g m Dam All roof coverings to be Class "B" or b6tter
t _ _ -... .. .._. - ___. . ....._. ___ ... . .... . .. ..
" - OFFICE'