01010046 CITY OF CUPERTINO - -
•. BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING AUURI3SS. ' 1_FRMIT NO ,
10122 ADEL.HEID CT .."FLORES, REMODELING- " "' 01010046
OWNER'S NAME:- , - APPLICA'I ION SUB DATE ,
FISHER 781 JASPER ,ST `., 01/10/2001.
.
OWNER'S
- SANITARY NO CONTROL NO
(408,)298-4817
WOO ARCIII'1'F.C9'/F.NGINEF.R „ BURJNNG PERMIT INTO
"
BLDG EL= PIXMB MECH
H¢d
z z y z LICFNSFD COM.Id.ad,, ...CLARA HON Job DOSCCIphon
hereby 0).r mm 1 ant lithe R under phwl,lon..f C,Code,Irommencmg ^ '
.K_�° xitn s..h.n mum oroia,anr,d.nne noun=,,and rr.,r=+a...nde,;md lay h«n,= .. • .. BATHROOM' REMODEL
n mu filly end eft cO s'�•`ee
�0�- Lees+c Clro+ B UeM rLr�to �r�ma ` . FINALED ..
°>2 3 1 Dam d i •-iuV`�1 I— S DECLAl .
nRC holLeu,e DECLAR t000d ,
; 1 unJen,anJ my plan++hall be nceJ as puhlm reunJ.
o
Late n,oil Profe......rat ' JUL 2 0:2001
_a OWNER-BUILDER DECLARATION _ -
I nerehy.form that 1 nm exempt fiom the Comratroa,L Bose Law for the
Edlowpg re.uah tSOmmn 7031 5,Buanes,and Prol......m Cade Any city ar county ^
2 q which regmres a perms lo.nmtru.6 alter.I.,parvc;dcmol,sh,m repair any arucnuo, ,e BUILD
I�LG -• `
mC� p sort.h, "once,ul,nregmre,the"'I'anl lnnucnpennn m file a,,,e,d smrcmenr
a•3� that her,loen,ed punmpt to the Pno,00eof1h,Cealotc,or',Licen,h Law whapino S Sq. Ft. Floor Area v1 6, n,
Icommen.ug xllM1 Seni'n]WIII n TVininnrnf lh=Bu,inew nnJ Rnrc,voro Codcl 1$1.SrL1 _
labor he n exempt therefrom and the hall,Ior,M1..dagad toor prion Any violation t
ill Sechne 70315 by airy upPLcant fin a penal thbfna,the aprkam to a sell penalty
of ina,n.re Nao B,e handrail dollar,1551xn APN Number Occupancy Type
., ❑1.aaownerof the p,.,erly,I th,catch,)eel';Neag=,a be lll<.le,ompetn�taal. 35709025.
obit it,,the work:and the pauU a 1,not pleaded or ollemJ Ior,ale ISec ADD '-
Ba,ot,l,and Placation,Code.The Copacmr',Lacn+.Lax doe,hill aptly to all . Required.Inspections
mc of no,tayWhdhh,ld,mnapro,e, heoon,arel,ho dal.,act,work hh,,+ml ,101 ', — FOUNDATION ,
through his awn employee, pmvmed Nut apch rmprmehu nt,are an mrcnded a
oill...it for hl,.u,h.w.rvcr,the haadmg or naptmemctt is,.Id xmhm'.ne year or. ., 10 PIERS
m,mpl,t r:Ise own.rbwlder win nave the name..I pan in, hit,he Nd not bold hr
plo,e9npurp.+eor,ale,l , 103. — 1JFER'' .
'°I.ac.wncr of ate pf.pen&ame,m....dy ennna.m,g w nh h.en.ad eonna...l,m 404 - REBAR ,
Lmsile(,the prolecl ISto ]IHd,Bnaa...and Prides.......+Code.,The Cohnothor', '
,cerl Lawd.esner apply to ar,exhir.rplo,ed, no hudd-nallprnvI+m.re.n, 105, — ''ANCHOR BOLTS
and wh.contract,for act,ptor.m,wills a.nmm.l.rol l.cn,d rar.aam m lit`
L ..106 SEWER cC WATER'
Cun,ruclnr, r,hoa Lew. ,t. '
°I an e,enip,atmer See. B'4 P C to, 202 — UNDERFLOOR PLUMBING .
owner 'WORT:ER'SCOMI�NSATIONDECLARNGON 203 — UNDERFLOOR MECHANICAL
0I hereby aff i}m asde, nan,.t,,-,h,y.hc wptc lnnotatts dt6lindlnn, 1204, -' UNDERFLOOR FRAME
10"llopenlataill,i,et4thPj^hn AI a Cratkn of Cnernt,,elLeb�u coar.Walare ;205 UNDERFLOOR«INSULATION' ,
• led�.Imam-e.I he w.rk I.,when ml,pthtt1,l„ned 301 — ROUGH PLUMBING .
IJT'have and x;n lall poit Wm Mr',C.mp.n..amh la,arance. retained by seen.. 1','302 — TUB - 8 OR SHOWER
.3700 of the Labor Code,for the performance of the work for,wh;ch(hit p.rrall it — .
,n¢ld,My Wodcr',Cmnpen.mloa Inwnutcc currier and Policy nhinber the - ' 303 ROUGH MECHANICAL
obey NO, /�/ y'B 'r/3^UGI 304 -, ROUGH ELECTRICAL.
CE[mTICAUON OPEXEMPHON PRN�t INDRKBRS 305 - FRAME
' COMPENSATION INSURANCE - +
" ?ran .cG'.necell.Ine ninpmredirme rinitl,Inr.nentlndiedd.Hm, 306 HOL_DOWNS '
tglBm.i le.,d 307 — INSULATION .
m,lfya,m hello pe,hann.ee of the xoak R,r whsn Ihit pe,hllt l+„,coca,l 308 .—. SHEETROCN,' k
,hall mil employ uhy r,r,on Ia an,me r,.a.a,hnnme able,,In the Work.,:
c.Inpen.:IN,n Lux+ol cahf.mla.D,n.np 309 — EXTERIOR LATH .
Arphr ant _ -
NOTICETOAPPMCAN9'Ir,after n,akmg d,u cennlc:nc.f E...,pn.g,y.I should 310 :- INTERIOR LATH `
z0Gnecome,ublect u,the Worker,Con;remmmn pm%no n,(it the Labor code,yon halo
1..pw;III eohiplyxnh+ashNoo,Ron,mlm,permha,aHbedeemed I,.k,d - 311 '— SCRATCH COAL' .” .
^ vti
CONS'IRUCI'ION LENUINGAC1iNCY '^ - 313 — ROOF NAIL " •,
.1 a' I hn eby al rich,that I here e;acon.vo.mhlending agency for the performance -
t the wo,krmwmt hNl,p=oh,,, +,.edlSee.w.7.Col C.) " 501 " • FINAL ELECTRICAL' ENERGY
chat, n"aprc,+ '502 — FINAL PLUMBING'''ENERGY .
U O 'a I..InlyNailnu III leadrm,apphc,m,paid+welliol the oho,otehnmmmni, 503 — FINAL MECHANICAL_ ENERGY '
QW. F ..heel Iogree,rn..,n,I, ath all chynnd.all,,orah m.e,and'wela" eluling 504 FINAL" BUILDING ENERGY '
V I.building conarue,ion,and Inertia,lath.rvc re""On'o,a,'frills npr to enter upon
the abn, menll.a.d ph,,rl,fm;mp.dion pun"'..., T 505 FIN
rn AL' ELECTRICAL
i y (We).gree to v,ve,mdmnmfyand kaep hahnll(,the Cnyof Cupenin..puma +
hanNO.,,ihdgmem,:c'o+arm e.pen+a,which may in any way account againa sold - 506 TEST
U 4 City,.wn,eyuenec or the grannng of N,+permit. '
APPLICANT UNp�RSTANDS AND WILL COMPLY WITH ALL NON-POINT �� �(
XXX' SouxcRRECUV 1r Nq,s _ Issued by:507 —/ F I L PLUMBING Date•/ Y' v I`
' sgnatare nrnp�[iVnt//C..ontrauerr - -Date Re-roofs nv-Id - ` F 1NHI_ IrIt1.,t9HIV 11JHl..,
1/ HAZARDOUS MATERIALS DISCLOSURE 9 •- FINAL GRADE' -L
W,n,n,a beam or fimmc htald,n ,aam a,handle h:and...healenal
rr so-.Chall Type of Ri3
mderined bymeCapaaim,hw,tl.Irare.a..champ d.IZ and the Ideal and Sa'f1y 510 FINAL 'PLANNING
-L Cnde;Sebum 25532(u)^
❑Yc, El No All roofs 5A14be-infJ3QL ri(PhlBiln�PodWAVitk%rial being installed.'
WJI'I In':appI nor6'r'L ,ehudd a,hocapanl ate edmrvm.mnrdevl.e.wh.,h If-a roof is installed without first obtaining an inspection, I agree to remove
nhazuMnus atrcoift... ue,JCfineJ by the Bay Arlo An Quakily lidmaprom r
all new materials for inspection. Applicant understands and will comply,with`
°Y`+ °N" all non-point source regulations.
I I...e read the ar,rholent,mote' y repent,under maple,a 95 of the r -
Cm;foma Health at Safety Code,Seohor.25505,^3533 and 25534.I a.dentand that
if the banking doe,nor en.caay bloc a moon,:that il 1,at,re,r.a+Inday In a.nfy the .
.cupent of the it lenI 'Inch malt be ban pour n,nwance of a Cemli.ma of
O"c'er.y dry' 1 ..
/ .I� �1p,��,r�� Signature of Applicant ' Date
oxner.raabo�gall. /?; .Do it,
All roof coverings to he Class "B"or better -
V OFFICE' '