06060209 CITY OF CUPERTINO
BUILDING DIVISION PERMIT WCONTRAC�TORIN1tQRMATIQN
BUILDING ADDRESS: CHEROKEE CONTRACTING CO. PERMIT NO.06060209
19900 STEVENS
ER'SNAME:' PERMIT ISSUE DATE
S .D. HOME SCANDINAVIAN DES GNS356 MAT
PHONE: SANITARY NO. CONTROL NO.
(408) 727-9850
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLOCELECT PLUMB MECH
0 t� 0
uoa LICENSED CONTRACTOR'S DECLARATION
O C 1 kreby affirm Nn 1 am licensed under provisions of Chapter 9(commencing Job Description
?Zw wide Sectwn]IX1U)of Divisionlof dee Buviartaz aaM Profcssiom Cadcand my li,9mass,
n<a Lranmmeanaerrm 33Sb�S PROPERTY LINE CLEANOU � KFLOW DEVICE
Liccrup q Lk.
F p Dam (.,\7(��1T'b —Contrxto KT-
7W ARC aLl he used
DECLARATION
W< I understand my plans shall k used u public records
c0U
'wt;
Licensed Professional
-mi OBUILDER DECLARATION ✓(/�a
aa;
I hereby affirm the,I am exempt from m Contractor's License law for mi y
q
❑O fallowing mason.(Section 703 1.1,Business and Pafeuiom Code:Any city or county O
K
29 which requires a permit to comuuc.Won.impm c,dcmOliah,Or mien any amountsuO
i prior m its issuance,also rtquirm the applicant for such permit to file a signed statement
FSG NatMulia=dpurmanttotkpmvisiomofU Conuacwr'sU¢=law(LTapm9 Sq.Ft. Floor Area F Valuation
x� (commancing with Scedon]000)o(Division 3 ofthe Buvnmand Profccsions Codc)or B
y
that k is exempt therefrom and dee bazis for the alleged exempdon.Any violation of
Section 7011.5 by ary applicant for a permit subjects the applicant m a civil penalty Of
not mom man fin hundred dollars(5SOUL ccupancy Type
L ot owner a(the property, re is employees wide wages az ak,(sole 044,Business siness
and P deework,and.e he C.M iscacusentended or offea.ed does ul apply 7044,n minor Required Inspections
and property
who
Code The Comumon.Liana Law doh not apply lf an owner it q p
propenywhobuilds idorsMkmogandwho doessuchende oroffiredthrough hit
awn cmr.On ees,provided inorithat such improvements arc not ear ofc mpledo .forsale.the comes-
builder
s-
f.
huilder Urebuildingor improvement usold within rote year of compkdon,deehase of
builder will bice the Wremt of proving con k did rot Wild or improve for purpose of
u0..).
1,as war of tk prapcny am exclusively contracting wide licenseA mnuacmrs in
comnuh me project(Sec.7044.Busir m and Parcaziom Cade:)Tk Cormacmri Li.
cense Law dots not apply to m owner of propeny who Wilds or improves Merton,and
who connote for such makers with a conuactor(a)licnmd pursuant to me Contncmr's
License law.
❑I am hemp,under Sea ,B&PC for this reunn
Dam
WORKER'S COMPENSATION DECLARATION
1 kreby an.under penalty of perjury.of the following declarat am:
❑1 ham and will!for by
-arms.3hm OfComentmCodsmure us Wahcfa omper- on ITARY�
ce of ave
urian,, provided!Or,fm mi Smuan 3]DO of Um Labor code.for dee perfonnance of Ute ',
work for which oris permit u Issued. � /jY
❑1 bee and will oda.ton Works C.of
thion Insurance,which required by Section !(/
My WothxtiSm Cade,(ar meprnce carom Dame wort(numbramu permit is ivued.
My Worker's ompeazauan Insurance carrier end Polity number arc
Carrier. coPolity NO.:
CERTIFICATE 0 EXEMPTION FROM WORKER '
COMPENSATION INSURANCE
( lusamton ncWnatkeampleted if the Permit is(moot hundred lotto;(SIW)
less.)
I certify that in the performance of Ute woes for which Or permit or Wm0.1 still but
employ any perms in any manrmr an as m become subject re the,Worka'Compemation
Laws of Califamia.Dam
Applicata
NOTICE TO APPLICANT:If,after making this Certificate o(Exempoon,you a,deld
become subject in the Worker's Compensation pmvW m or tk labor Code,you much
.,,Z forthwith comply with such provisions m this permit shall k dmmcd mvokd.
'Z O CONSTRUCTION LENDING AGENCY
Thereby-Dins that mem it.camwc0an lending agency for the pd,fOmm..f
a.fir me..,it for which this permit is issued(Sec.3097,Civ.C.)
W�A lender(Namc
a z La cox Add.
U O 1 certify that I have read ibis application and sum that the above infotmatiu t is -
D, F correct.I agree to comply with all city and county-Nim nms and sem laws relating to
C)U building concoction.and hemby authorise reprearmatims of oris city m enter upon the,
ahuve-raeruMsed property nor Ma,mrMn purlmses.
H y (We)agree a son.indemnify and keep harmlm the City of Cupeninoagainal
rn Iiabiliticsjudgmcnts,cents arta expemh which may in any way avenue agaimt=it City
U,Z in consegmnee Of the grounding of this permit, �r
'--' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 6 — 2 Ci0
LATI
SO REGUNS.
vul- �L1/1 126 /o t Re-roofs /
Stgnamm ol'Applfcan o m 2
ucor Dem a �
HAZARDOUS MATERfAES DISCLOSURE Type of Roof
Will dee applicem m forum Wilding uccupontnom m handle havrdous material
defined by the Cupertino Municipal Cade.Chapter 9.13,and the Health and Safety
.section zsslz(a)]
❑Yon myar All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding amupana me equipment or UcAnce which If a roof is installed without first obtaining an inspection,I agree to remove
emit hovadom air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Diaumn / P
❑Yes ptfu
1 have real the hararmms materials mquirtmem undcrCbpter6.95 of dee Califon
.in Health&Safety CWc,Secumm 25505.25533 and 25534.Iundcmmnd mutifmc Wilding
docs not currently ham a mnam,Orion is my respomibility m notify the OmUpam of me
mq ' nu whmhm tWmct pilar uance ora Certificate.( cupanryry. Signature of Applicant Date
M=c' `S b �7CleC
Owner or authorixed agent Dote All roof coverings to be Class "B"or better
Community Development
0 Torre Avenue
CupeOrtino CA 95014
" Telephone(408) 777-3228
CITY
Fax(408)777-3333
IRU
Building Deartme/nt
JOB ADDRESS:� Rr SS:'� ��� V PERMIT o Z) o' O 2?�
OWNER'S NAME: — ,('. �y��h Z �1J to PHONE # L
GENERAL CONTRACTOR: J1 rdaKigr- FAX # p 7
I am not using any subcontractors: &I _ 2
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
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
ad
Plum L CITYM-ER HEAT IRNO
OCUPEkiNO PERMIT APPLICATION FORM
APN # 3co� Date:
— b�- o3�
Building Address:
qq 0o SJt_UeW 069clz 664
Owns e:, �y Phone#:
s ,-V V n ;
Cn actor: Phone: License#:
M
€ q_6 Kkj�_ C 7 _9 s o SS6
Contact: Phone: Cupertino Business License#:
i�" u RS r,
Building
Permit fo: /
BldgL��" Elect El —Plumb __ Mech ❑
Job Description:
C U Gv G
Residential rl Commercial
Cost of Project:
Strapped Li On Platform LJ Bonded ❑
New Location ❑ Replacement Lam'
Qty. if
Applicable. Fee ID Fee Description Fee Group
R Water Heater/Vent BUILDING
PPERMTTFEE Plumbing Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING
I PSGWe12-
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CITY OF CUPERTINO
ITEm 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36905038.00
DATE ISSUED. . . . . . . : 06/26/2006
RECEIPT #. . . . . . . . . : 35012
REFERENCE ID # . . . : 06060209
SITE ADDRESS . . . . . : 19900 STEVENS CREEK BLVD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : S.D. HOME SCANDINAVIAN DESIGNS
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : ROBERT RUIZ
CONTRACTOR . . . . . . . : YATES, JAMES H LIC # 702 ,
COMPANY . ... . . . . . . . : CHEROKEE CONTRACTING CO. -
ADDRESS . . . . . . . . . . : 356 MATHEW STEET
CITY/STATE/ZIP,... : SANTA CLARA, CA . 95050
• TELEPHONE . . . . . . : (408) 727-9850
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL_
__________ _____________ __________ __________ __________ __________ __________
BENERGY PERMIT FEE 1.00 34 .86 0.00 34.86 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 94.81 0.00 94 .81 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ____----____-__---
OTHER 94 .81 MASTERCARD
TOTAL RECEIPT 94.81
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
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