01060115 CITY OF CUPERTINO - -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
1 BUILDING ADDRESS PERMIT NO
10110 ADELHEID CT FLORES REMODELING 01060115
OWNER'S NAME APPLICATION SUB DATE
I
• '*IFTRANKLE THOMAS L AND JANET L 781 JASPER ST 06/19/2001
0 . PHONE: SANITARY NO CONTROL NO
(408) 298-4817
uai O C ARCHITECT/ENGINEER. BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�w-
Ni� C'J L_1 L_J CI
Z S y z LICENSED CONTRACTOR'S DECLARATION Job Description
O Z= I hereby aff rat that I am licensed under provisions of Chapter 9(commencing
rryFw wihSection7000)hfD' n3flheBU+messandPro ai nee em REPLACE PLUMBING FIXTURES, &
J
a f J
Ism mil force and ell ,e f
ca' La CI C LteR FAN/LIGHT, & RETILE BATHROOM REMODEL.ca Date S GE54cr PI NA LE D
m 0 ca v A HITECT'S DEractor TIOp1(l
n to; I understand my plans shall be vse0 acb�h< yfJ S+ a ^!'��
pG Lensed Professional
Iv A _OiwdS'F JUL 2 O 2001
at OWNER-BUILDER CLARATION
1 hereby arcmt that I am exempt from the Contractor's License Law for the
E 3< following re ason (Section 70315,Buv,nas and Prefe....ad Cade:Any city or county
Y Z O which requires a permn to conswo,aloe,improve,demohsh,or report any structure �'
he cc pnnr,uitaI'didce,alsotellan 11 WC applicant toma:ch pcuhu he I)leatumuca Smm,nem- -- -
i3- i h a he ielhoarfyalinl d'i "atl.eprov,aumof,lm C, oactml l-n.env.l t Ch,ce.9 _ _ '�'�"
S ltd Moor red- a nation
momriice,stwnhseasonaaolbhl Dre¢mnJof the Buanwsana Protesnyviolation Cole) ap�'y )•'' i -
or ohm m ii 31 5 by tany apomcanJ the base fns the alleged a pliant t Any had,
of Secuon)OJISby any applicant forepermM1 subjects the applicant tnacrvil penalt, .3F7Q ^Nd ^e^ �'P
of not more than five hundred dollars(55000 HPN UmbeC �:' °"i/'. ' Occupancy e
❑I,as owner of the prepeny,or my employees with wages as their sole compensation, GT L _ TP TNTAT MTTTT r1TAT i
-will do the work,'and the structure is not intended or offersat sale(Sec 9044, Required IDS eCr10DS
Busmefs rml Professors CMe:The Contractor's License Law does not apply to an q p `
r through owner of property Who build or improves thereon,and who does such work himself t
or through hid own employees._piovided that such improvements t as Sol are not intended or
until comple for Saks IL hosvevde the budding a improvement m sold wrthm one year of
completion,the owner-boulder will have the burden of proving that he d,tl not budJ or
improve fw purpose of sale 1 t
_ .. . ..._ .__- . ._ -...._. . ... ....... .. ..
❑I,as her pr the property.am Business a comrdamg with Lce I The Com enoto 1 -, ., V.
_ instruct the present(Sec,]004, owner of and property Professions Cadet The improves tin rein,
License Law does not apply tar o owner of property who dAme se improves hto me
and who convects forsuch Protects with a commaorlc).hcensed pununm m the
Cemractor's License Law ., ,
❑Iem item nder S•• ' � `" � B&PC,for Chic reason 'di
Owner Data
WORKER'S COMPENSATION DECLARATION
WI hereby affirm under penally of Rep m,cancer the following declarations
❑ I have end will foantam d Cads icum of Consent to self-insure for Worker'e
Compensation, as provided for by-Secuon 3700 of the Labor Cade, for the
- performance of the work for whsh lh,s penmo is,,,aq.,
❑I have and will m Worker's
sat ton of Insurance,m rrymreJ by Section
370 of the Labor od f h rfo c f die work for which th s permit s
ited M War t W k s b artier P Y rare -
.! , RTIPICATION
' •' be compleieJ Jobe permn sfar one hundred dollars " ' � ^ i i- ,4'i:" ' r'-'
" rhSsecuon nccJ not _ - i
(81001 or less 1.
_ atoo
not cempl that the n nymann thework I,ircmmhhiece to to orke,1 ,.i i, li,a t..�,ey
shall not employ eny person r any manner so as m become pubje�[[o the Woikeri
i
Apphcan[Lion Laws of Coltlomi;i;Data
Compensation
z fonhwi[b w he M1rrovianns or his pesrmitors of Labor revoked
you should ... „
Z ho most
ti hectic hereby yJrc,.h nsknn noes ON EN NG GENCdy the
it of t6' +mein .. ._. .. -APPLICANT,IT,after making his enifum of Exe`[
r brkmr hog
ion,
a ' Lenders NamefO1M1 CONSTRUCTION Ne 30 perfonnunce ,
Tahoe,tab
e w w enJin tic 4 _ __ . .. .. . ....... .. _ ,. - ...
... `imoherehad lhsa 'a shot Y .--.- . . .. . . .._.
A N
v e c con rust
-;z Lcnifer's Aeeress
V �� Ice rtify that I have , application and state that the above mfomiaoon is
Wo F collect I agree to,ahmply,with a0 city and county ordinances and ata[e laws relating
OdV mhwldmgconaraction.and hereby umhonzt iepresente,hsal this city to enter upon
} W the above-ancrummed property for msponion putpo+es.
IWeh,mon, ,ve:mdemmf,radical ha7mess the City if&,.e,m n-o agams -
cn babel.....,Judgments,costs and erpemec which any a nay way accrue all said. l
V .Zi City m c equenct of the!ran""of his permit. 1. " -
- APPIC TUNDERSTADSAND WILLCO)IPLY WITHALL NON=POIN Issued by; l�
Apps _ Y' ��, hz— _� Date
oUR<`Vdi�ym�5..r U't,ERI DISCLOSURE'store; I '�,Dante Re-roofs v
'eern e by me c dram o Rat, g oC upant ad us materw- Type Of Roof _ . ..or Warn cHAZARDO
asa safety .... .. ...-._ _...._ .- ,_.__ ..
crude soeyOS.ss3_(al,:,.,.. o Ne:. ,u - fr; and All roofs shall be inspected prlor.to.an
ninpolCJ Chapmr9le ,
I y.roofing material being installed.-, ._ ..,....
will he Applicant rfuture budding occupantnze equipmentordesudswhich: If a roof is installedl'withoutfirstob tainingan'inspeetion"I agree'to remove
' Y Bay Area Art bl Muwgcmem ,
tits as defnedb he r Quay all new materials for inspection.. A licant understands and will comply with
Jeatix an eenta P . PP P.Y - .. ...
emu haze ma
Duval"
i, 71 No
- all non-point source regulations'..
"I hose read the hdzvr,tim,m'i'nute requvememi'under Chapter 6 95wf the
(/O ncebn uts m
H ealth adlt uhe&+
Safety n n Code. tnes n'aSnSt Oh,a
2t 5it-5 i3s 3 m and
nd 2G 5 o534 1 understand
nderstand y that
recap o,f the rc is„hich m ust be rte ihr m iss u,nnce of a Ce rtificate o/e f-
a '-
-S ignature of Applicant Date"' .
,
-
eraedagent : pate All roof coverings to be Class "B"or better
..,. ,., ;Zc. ..- _.,... OFFICE