02090051 (2) CITY
DNGUP I
BUILDING DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1451 S DE ANZA BLVD CHEROKEE CONTRACTING CO . 020900751
UB D
J "TN THE BOX HAMBERS 1220 COLEMAN AVE APPLICATION
09�
TR 09A/ 2002
r PHONE:
(408) 727-9850 SANITARY NO. CONTROL NO.
1
O O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
tad
8F m m LICENSED CONTRACTOR'S DECLARATION
o O m i I thereby, Birm that 1 am licensed unae p (commencing �, Job DEEP] tion
o U_o �prvdPxxI,wdcMa Chapter INSTALL 4 LATERAL
. g.
FrnFw with Section]WO)of DivisionJofthc Basin and ProfessionsC dc,dna myliccnu
_YEJ is in 11 ores eava elle
aic to a Licen J 1 Lic.
U Da O Comm o
w 3 w s ARCIfITECT'5 DE RATION
F=00 g I understand my plans shall W used as public records
3r
wap O Licensed Professional
c w o OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt form the Contractor's License Law for the $2000
r 3< following record.(Section]031.5.Business and Professions Cod,Any ciryor county
I":] which naPermit to construct,alter.improve,demolish,or relator y strucarc
i3 phrd
ct t t abs y the ppr mfor such permit o fifilea signed statement.
..... ...........
t to
(Ch
(commencing
dpam n70 promo. fthe Contractors iceand la Corte)
-,•r 3 .F<OAI�rrA aea Y s, ser' Valuation
or ecngiem;See ]fA'ar ofDivision3 fin Business cimldProfessions Code) (�i y-A t -.s.0`,Olis`T` '''Ys -1, a. s) -J.A'J
or Natio Is exempt mertfrom and the bans for the subjects
the exemption Any violation - J.
of Section 7031.5 iv any applicant for a Permit the applicant to a civil penalty
,of not mare man five hundred donors aslw). 106APNNgWlgR & WATER Occupancy Type
ol.as mwn,of he peope it y.or my employees x ith wages as their sok compensation. 202 - UNDERFLOOR PLUMBING
-Witt do'the work;and the structure isnot intended or offered for sale(Sec.7614; 3 O 1 - ROUGH P
Business add Porfcsions Code:The Contractor's racr's License Law docs not apply to an EWInspections'
owne
rof pmpeny Who builds,,,improves thereon,and who does such work himself 302 - TUB & OR SHOWER
of morugh his own employee,.a Imiided that such improvements are tw intended or _ .-___-7-17 7 _..71._-17._ \' _
offered for sale.IL hbwev<rf the l hast n den of leaving
n sold within not '-' FINAL - - --
eamletmn.me awn<r.Wmerwin have m�bu.a�nnr rearm 502._.- PLUMBING- ENERGY"_--_. rr•I;;,,.
p proving that M1c did not Wild or
improve for purpose nr.ale.). 506 - GAS TEST
7-1-1-1 - - - -- ' - -
pmpc Y Ycommcting with licence contractors..to.
- -FINAL-
._-._ . ._- -1 -1 . _.
777.
_-7777
lAta
inconsumer the does
no(Sec ]OMs,Business and Professions Cade)The Contrect s
L
r' Lc L e nor apply man ownerofprapcnY who builds or improes
uant too �pmp p ® •'t
Co h s License ,.such prvlecu xath.a commissions)Lcros<d.pursa,nt.t the
Contractors Li<en¢Law...,. -
---
OI a ssendersB&P C for this,reason ��� ^I' •.!SC. �" tui
Gwner os,< 13 2002
WORKER'S COMPENSATION DECLARATION
' -I hemby aRrm under penalty ofpequryyine of Ne following dalarmions:-- BUILDING
='/ ❑ I lm ve'ond will n ai-main a,Cenificam of Convent I.self-i...re for Worker's
_ Compensation.-as Provided far by Section 3700 of the labor Code, for the
_ perfoimanceofthewark,it ich Iml,cor it_isissuedis
,,, .
❑1 have and will maintain Weiker's Compensation Insurance,as required by Section
370Y1 of de lab,,-Carle f m pe fomunc f m work f which this pct- t
sed Wk 's Compensation I-sun c cannot andRly nun,
�f ;� •'I'I .__ -- ,. :, -1-1-1-1:, _ -1-1 -1-1
✓�• !:�"CIITIICAIII 51E MPTf011AIC WORKERS
M $' v_• I;Ia jy.y t-n ll. r�1a v ti !i.i \l, rh ••
u
COPENSATIOY MSURANCE' -
L .eaion need nm W LomPlei d Rhe permit is for one hundred dollars 'r ..'..
IS or W)or lessl '
nn ly that in er Performance ofthe rk for which m perm i` ed,I '_� '•••_r-•*.•-••--1-1-1-1..
i6a11 not imploy aryi persornin anyte r s io became.wh)cct m me ,
Workem - �'y'' �' .,: t�
Compensation Laws of C I fomta.Dara -
r
NOTICE TO APPLICthis s t
_. ---
Z
ter .king his
ou should
zbee subject t he pyWorkers C pen tnp s onsof the Coe youmust
fanhwith cumplY with such por i or th s perm t shall Ws deentod msroked.z -- _ _1
_ _...._ ._.
... _. ... ...._.--17 -17__ .._..._.-.
_. -' -177-1..-_- . . .. _. .. ---
iZ) t " "`CONSTRUCTION LENDING AGENCY -
C I heby Ron m t th sumer on lending agency! the perfotim s t
gI,r: ohh i k for which m—e t .issued(See'309L Civ C) '
0..Q lender s N me-_ .___ _ .. - .. L.. . a.._ .._. ... .. ...._ .
..__.... .. -_ ........ . __- .. _
wiZ Lknd Add _
Is en fy mat 1 havencrofwith al s application dna sum trot the ebov<maws mtiooi is
=[.. wrrece I agree to comply with all cap'and county ordinances and cute laws relating
to building construction,and hercby'authorim representatives of this city to enter upon
the above-mentioned rr for ins ptpoees.,
P!spe y inspection u -
t-:.:Z) g come to deuti ,ormc,fy and which
h rmle s he Cty ofC penfpdnit aid
tq Clliabilities,I e e I. d pensa h ch m y in any y cc gainzt said
V z City nsq nk of meg nfng of thsprmt
SAPP \T UNDER TA\DSA ND WILL COMPLY'WTTHAQ Y-Pp Issuedby� DLvT"' Vat/�'•
OU EG AT(�>�V ':O
'U� a : oj. S• /a1 ate
gaamrc of ApprcarmCommeim _ �-,' �.." Date Re-roofs
t HAZARDOUS MATERIA DISCLOSURE
Will m applicant or future building caseco,amL store or handle hazvdpu ma,I .
bond Type Of Roof.
a defined b>th Cupcn no. c .Cade Charter 9 12 a d theHealth d Safety - ' -- - - '--= -
Cod S t n2551 O I .f �a a fa'i't y jL_ r / t
aY All roofs shall.be inspected prior to.any roofing material eing installed.. _ _ _
Will th ppl^rlaa, (t rc W g«c p t cqu p t e wn h If a roof is installed'without first obtaining an inspection,,ii6ree;io remove
coo h b t t. fined by th B y Area A Q I ty M Management
nt
District? all new materials for inspection._Applicant understands and will comply,with.
yen- '' 'N 911non--pointsolirceregulahons . - - '
.I h ad the h' and us nmeauls requirements and CM1 pt .6.95 of the -
Cal fo m Health&Safety Code Sections 3505;3533 and 23534 1 understand ohm
,if the building does poi cameraYtime n¢namithm it is - '- -
_ occupant f the«quire is which must be Met p y rc po 'bl ty t notify the
Oce r to issuance f C nificme of
7 n ...:
Signature of,__pAplicant., Date
t' o ,qtn eeag t Dtic 1 All roof coverings to be Class B or.better '
- --OFFICE.-..