03090054'CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION �'
BuaolNcnDDRess:
CHEROKEE CONTRACTING CO.
PERMIT NO
OWNER'S NAME:
r,y('F.R WALTER r MAYA
1220 COLEMAN AVE
PERMIT ISSUE DATE
NE:
(408)727-9850
SANITARY N0. CONTROL NO.
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Clnprer 9
OeSCTIp
Ib Description
I hereby afOrm Thai Into liamed undm pmvisi.N.r ( mmencing
With Section 7IXKBof Division 3of NC Busing .e d N.7ficasi... Cede.and ylomosafa
FINe4LEt71
Limas mine end off
fol
Licenu s Lic. kj 5^�S
REPLACE 4" LATERAL GAO
Dat - Coa oN r —bo GL
SDECLARATION=d
SEP 1 6 2003
crstanJ mySARCHI hcute c
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IL OPlu!' x
Liccnu) Pmfcssinnel
OWNER -BUILDER DECLARATION
1 hMaso a(Rrm thin 1 exempt from the Contractor', Law for my
Any
W Al
Co : c
ng mason. IrDLA Business and inoli Code: Any tiny county
1.
whichfollow
which ve de
ms a pctmit re c.nmuct, alter, improve demolish, s
error 1 h, alBmmm
its fi ,.d, cd
priorrosuicinedpaltorequires neeIisimoamfor suchpactor. fileseLaw(mmmcm
that he is liccrucd pursuantns the pmviaiem of the Conuactori License hw(Chapmr9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3.17 the Businca.ml Foci Cndc) ser
than ha u exempt therefrom and the basis for Ne alleged exemption. Any violation of36907005.00
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mme Nan Eve hundred doll... (SAID).
❑ 1, M owner of the property, ar my employees with wages m their sale compensation,
— EWER pp
�$itS
will dote work, and lheswctum is not intended nruff e..d(... 1.(Sec. 7044. Business
Md Professions Code: The Conmacmri License Law does not apply to an owner of
q actions
property who builds orimproves thereon, and who doessuch work himself or brought his
202 - UNDERFLOOR PLUMBING
ownemployces, provided thtsuch tmprovemenuae not intended moffertd formic. If,
3OI — ROUGH PLUMBING
however, the building or improvement is sold within one year of Complction, the nwner-
builder. will have the burden of proving Na he did not build or improve for purpose of
302 - TUB & OR SHOWER
misJ.
502 - FINAL PLUMBING ENERGY
per y, am contracting with licensed mattress
❑ I, as owner or the property,
esivnd i-
censwawdoesnjecalSee.7inownerofp ndProfessionsCooe:7TheCsMemon, Li-
Se Business
5O6 — GAS TEST
not apply teen thereon,vnd
tlmsr ofpropcny whobuddaauant
507 - FINAL PLUMBING
who cones
to
whocontractsLaw for such projects wish a contractor(s) licensed pursuant m Ne Contractor's
such with
-
UCeve Law.
❑ 1 am exempt under Sec. . B k P C Tor this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of Perjury ON of the following declarations:
1 haw and will mainuin a Certificate of Content to at Nature for Workers Cumpen-
scion, u provided for by Section 3700 of the Labor Code, far Ne performance of the
work for which this permit is tamed.
❑ 1 ban and will meinnain Wmketi Compensation Insurance, as required by Section
371M of the Labor Cole, for the performance of Ne work for which this pcont, is saved.
'
My Worker's Compensation/IInsurance ca.nm and Policy number art:
Canter. A�.. UQ/wifi:t ryNoyQ(dhr-i
ER (FICA 0"(EM ON FRO.1 W RK R
!{/C_�l7
COMPENSATION INSURANCE
(The aced., need not hecomplcmd If the permit is foronc hundred dollars (SIM)
'
or less.
1 certify thea in the perromrrmce of the work for which this hemi, u Bawd, I shall out
employ any person in any manner an as m become abject m she Workers' Compcmation
Laws of Caltrood.. Date
.
Applicant
NOTICE TO APPLICANT: If. after making this Cenifcam of Exemption, you should
become mhjWt no the Worker's Compensation previsions of the Labor Code, you must
Forthwith comply with such provisions or this permit hall M deemed revoked.
t
CONSTRUCTION LENDING AGENCY
1 hereby Affirm that them is a consuuCBnn lending agency for the performance of
be work for Which Nis permit is issued (Sec. 3097. Civ. C.)
Lenders Name
Lender's Address
1 certify Nan 1 have read Nis app lmifir t and sine that the shove information is
"
correct 1 agree to comply with all and Courcy ordinances cute laws relating
UM oru is
building construction,neend hereby amhona repreunutives or Nis City m enter upon NC
e
vhove- nmdtosaproperty for impcctdan
(We)
(We) egme m cove, and ex No and kith hay in a the City or against against
keep N
gaming ex Noses which may in any way accree against cid City
^
inconsequence of
of thegamingof this permit.
e(fiV/t O
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
A APPLICANT
Issued by: Date
SO RE ULAT NS. s
Re -roofs
Type of Roof -
Si.tore of Appldca lJComraomr D e
HAZARDOUS MATERIALS DISCLOSURE
WIINcapplicanturfuturebuilJingoccummistoreorbmllchm uusmatedal
as defined by the Cupertino Municipal Code, Chapter 9.12, and Ne Health and Safety
Calc, Section 25532(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑y. �`Nu
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment ordcvucs which
it hanrdous air conumtnanu ilei d by the Bay Area Air Quality Management
all new materials for inspection.
istrin?
❑ Yes
1 have mW Ne hasmdms mathrials requirements ub&rChxpw, 6.95 of the Califor.
iia Health @ Safe,y Code, Sceeum 25505, 25533 and 25534.1 unJerstmd that if the huillog
dos not cumenlly hove a ¢nem. Nat it u my MSNMihiliny m notilY IN meas an('If IN
req cmewhich mstlrm ne.wiaseanaenceni r span
Signature ofApplicant Date
All roof coverings to be Class "B" or better
Own
ser awhonvnd agcm Date
iCUPERTINO
11
•
CITY OF CUPERTINO O 3
REPIPE/SEWERS/MAIN SERVICE
PERMIT APPLICATION FORM
APN #
Q
Plumbing Permit Issuance
Da •i
6' i�5 3
Building Ad ress:
is 1�s6
D7
PLUMBING
Owner's Name:
� xV�
t�VPl�a
BUILDING
BPFIXTURE
Phone�#�Z O
tracto :
PF
J
72�
License�3� S
Contact:
Phone:
PLUMBING
Cupertino Business License #:
Building Permit Info:
PLUMBING
BUSLIC
Business License
BUILDING
/
Bldg ❑
Elect ❑
Plumb IY�
Job Description:
1-2
`(6txc2A G �e
Residential
Commercial ❑
Cost of Project:
J
Qty. if
Aoolioabie Fee Ili
Foo tlrcrrintinn
Pro (lrnnn
X23207/
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
X23207/