01070121 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
B INGA DRESS: PERMIT NO.
IL18400 E ESTATES DR WILLIAM FRY 01070121
Q\W�EIC SN4Mr.. FRY APPLIC TION 5 B DATE
W 1Uf1H1\'1 07,25/2001
PHONE: SANITARY NO. CONTROL NO.
tit O O ARCHITECT/ENGINEER: BUILDING PERMIT INTO
r u- BLDG ELECT PLUMB MECH
y<ea
LICENSED CON'TRACTOR'S DECLARATION
z H I hereby tram that 1 am licensed under p g Job Description
p z O .0 Ya provisions oCods, ad
NEW WATER LINE FROM ST.TO HOUSE .
vrFw with Section7")andefeDivisiont3 of the Business and Profenions Cale,and my license
sy F< is ce full!lace and effect.
z Datenu Class Conti be O e. Dam S DECLARATION"r a.w .{-i ARCHITECT'S DECLARATION
_a.0
m y g 1 undersand my plans shall be used as public records
wr
W ceu
O O Lieend Prnfes.sionel
c K o ffOWNER-BUILDER DECLARATION
to n I hereby afro that 1 An exempt from the Commea is License Law for the
c"?a fallowing reason(Section]!1315s
.Business and Professions Code Any city or county- $300
ce o which requires a permit us construct,alter,improve,demolish,or repair any stricture
i3 'poo1 as ox rice.also q the ippliam for per
such peaw file le a srgnm sum
aeem - -. -
that he is laaaroad urneringmtheprovisions,oftheCommencesLicenseliax(Chapter9 , ,,3 e�2 �r-8�ya r -. . Valuation
(cit 'ng with Sect ]000,of Division 3 afine Business and Professions Code) ",�' '. c. :, 1,. .#�.111. yL•i 1 J't''
or thin he is exempt therefrom and the basis for the allegro etemporm Any vi Elm. "" l
of Section]031.5 by any applicant for a permit subjecss the applicant to a civil penalty
of not more than five hundred dollars(55007. 106APNN.,,.,{,�jUfSR & WATER ll':,;Tf,.r Occupancy Type
❑l,as owner of the property.or my employees with wages an their sole compensation, 202 - UNDERFLOOR PL BING _
'will do the'work,'and the aructare'I5 not intended or offeredfor sale(Sec.-7(J44.- 3 01 - ROUGH P
Business and Professions Cade:The Contractor's License Law does not apply to an I rYW(pispection$' ' 'r•-r
ownc
r of property Who builds or improves thereon,rad no does such work himulf 3 02 - TUB & OR SHOWER(
or through his own employees.provided that such improvements are not,mein-or
-bRir2d for sold If.however: Wildin - ----- _ _. _._._ a -
ge improvementnsoldwithinone i or SO2' - FINAli—PLUMBING--ENERGY"--
mprove for
the owner builder will nave dre bumcn of proving thin he did not build or 506 - GAS TEST 1 a.
improve for purpose of side.).
O 1" e pf tlhe property am a v Icontracting 'tM1 licensed crs" 'ro. -507 =---FINAL'--PLUMBING. ''
mct(Sec 7044 Business and r f :iuns CA,)Tine Ci r crnr'a r
"-- -"--
License Law dues not apply so an owner f p p ny ha hu Id p es/-wenn
who mmtans far wch prmecrs.with. c t tons!I'ccnsed.pursuanLto rhe
Commn License
u U _
❑1 pt under
c�I rr R&PCf this m ('1'11.1 - rl lUf1 {y
Dan 1
' NORKL MPF1•SATIOY DECLARATION
1 hneby affirm rid a,. ,v f penury of the following dedamr ons
❑ 1 ha4bord will maintain"a'Cenlficme'of Consent m slf-insure for Worker's /
Compensation: ns provided for by-Section 3700 of the Labor Code for the
?-- - 'Performance of the work fur which this permit is Ixsum..
l ❑1 have and will mountain Workers Compensation Inwmnce,as required by Section
_- 1]00 of rhe labor Cak:fur she performamc of the work for which this permit is
iisam:My Worker'sCompensation Insumnce cdnicr and Policy'numbcr arc:""
U. �.
Clime lSTn rE"/`a1¢n`l. ^'Por No
_ c
t
CE OF COMPENSATION
INSURANCE
1 WORKERS'\
,_„r.e -e' , ',. ... YOMPENSATION INSURANCE L..,,.r.., r..—_..__. .___..._._ .. ........... ..._._.,_ .__. -
r%i es 1 (This sec,nn need not he completed f the permit is for one hundred dollars --""-'—
is1 W)or less-1 '
• ..,....:. .,a::n, 'al. .site O�:`n,.n.,,Y:+l:.: .. I .. i
1 cenify that in th performancebf the work f which this 't - >.-.. :-,�: ... . ::.:.�. -
m I
snail net mploy any a s any marine so -tin become bl r the Workers l rl_y f!.,,.s:, t
Compe sat laws of California.Gore;— - •. .
-Apple -. r
OTICETOAPPLICANTIfh kin gth' C nfc t fExemption:- yo should r. --"-” ---
Z 'bN'ecome h do thew k Co pe 'torp sons of theWbb Cd yumusr '
0Q faithw th comply with ..h provisions or this perta t sholl he doemosed revoked. '
ti.Uj _ ..,-., _. . ..
CONSTRUCfION LENDING AGENCY
h reby a ffnn that th x con.t t l d' g g y farth performer e I ..J
sti
Gail .rzr of, orkC hch th pc t (So, Cl
LendersName,., >�. - .�........ ...........___.:...n.. _ _____..-_-__. ....-.. ._...__._.. .....--_.-- _. .....__- ___-. ._-._.._. .._
L.Q 'Lender's Addrell -
7.
.0 0 e:,,, 1 certify that I have read this applicationsand state that Bre above information is •'
correct.1 agree m comply,with all city.and county omimnees and state laws alining
:to nalmag construction,and hereby authorize repmsentati0es of this city to enter upon
�y.(10 .the ba t dp Rtyf pei rip Try V✓T`'�
Iiablr(W) 8 r e d nTy ink ph ItstheCtY fCpirn g i9
l dg a t. c e J expenses h h y city y g1 m.1 i.
U z City ey once 6f th j r ng of this perm t _
'APPLICANT tINpER$TAhDS AND\WILL COh1PLY'W'ITH ALL hON PONT ' /� ✓ /
SOURCE �c�pyk,BL� ;_. � . -7zs of Issued by: Date O
'Sigramreaf Apphc.an, .,or ;".,'^ _ Doc r' Re-roofs
HAZARDOU5h1ATERIALS DISCLOSURE - "
v +
All]the pplicam (ural,buedingocc pamstoomm dl hamniouemamnal. _.Type Of Roof. ..
as def ed by theCupen Municipal Cud Chapter-9 1 d th Health and Sure,, - ""`_ ' ' - - -•-^• •^•- -••
Coke Settler,25532m1 x,BfRoal rrlS" f 1'1S r r , • .cell
All.too fs,shall be.inspected.pnor to any.roofing material.being installed.-___ _
DiqwIIm pcoc_nt futuren II'al occupantause of i tl aMasw'mrn If a roof is Installed without first obtaining an inspection;'.Fagree to.remove
ui xM mm t: dfeed by the Bay ArcaA Quality Management
D1° 'oY - •. . all new materials for inspection. A_pplicant understands and comply with
p gtenant.
all non point source regulations
- II I hek reaJ rh Ihaz Nal r Isthe
y t unde Chm" 695 of
California Health&Safely Code SC Ions 2550525531 d255341and tandthat
if C the building does t n tly h a ten t thin t y responsibility t nary rh .-._- .......-- _.. -. _ ....
s - t ofsM1 eyu'remem<which muni be r pit m'sma ce f CenaOcm of - -" --
u
Oc p cY
� ?S-u l t . Signature of Applicant Date
�° o n tw :m g t 'U r, Dat All roof coverings to be Class "B" or better,
.- .._,. . OFFICE._. . _.. . .. . . . .