01020057CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT' NO,
1118 YORKSHIRE DR
FRITSINGER FRED J
AND HELEN M01.020057
OWNER'S NAME.
APPLICATION SUB DATE
FRITSINGER FRED J AND HELEN
M
02/13/2001
INE:
SANITARY NO, CONI Rol. NO.
IITECT-MIsGINBER:
BUILDING PERMIT IFO
7ZARCI
BLDG I?LIiC1' I'LUMIf MECH
ICENSED CONTRACTOR'S DECLARATION
Job Description
1vrunynithut 1 sent licensed underpruvisiuns of Cha,mr 9 (conn....m n,
h Section 7001) of Division 3 ofthe Business and Prolossions Code, and my license
n ILII ❑ace unA effeel.ice.
PANEL UP GRADE
Class Lien
U Date Comranor
y ARCIIITECI'S I)[-CLARA'I'ION
5 1 understand my plati—Wil be used as public mcoNs
CLicensed Pron,uiunal
OWNER -BUILDER DECLARATION
vo 1 herchy union that I a,ennpt Iwo, the Cnaua,io. License La. lo, 1h.
rollowing maven (Senion 7031.5.allusine,, and l'ndessions Glc: Any cil a ,,out,
rn
a which rcoui a per nit i cnitnlmm, ober, intpnnn, dcmnllsh. or repairany anure
signed snuentem
prior m its iguana,.1... require, the applicant for such permit m file. si
Sq. Ft. Floor Area
'Valuation
— that he is iamcdp... ant tome po,i of meCmnamnhLfccnseLaw (Ch.pter9
om:neaeing with Section 7000) al Div...on 3 01 the ILuine,, and ProteW...is Code)
or than he is exempt merzfmm and the basis for the alleged exemption. Any violation
of Senion 7031.5 by any nPPllaun Ibr a pemnit subjects the applicant to a civil penally
APN Number
Occupancy Type
of not mom than Five hundred dollars (s50R.
❑ 1, u, owner of the Nopcny or my employees is !,It wages as their ode enngcns Limn.
—
Required Inspections
xill do the wad, and the structure is not intended or offered for sale sec. 704p,
Business and Pmlcssiom Cosic: The Contractor's Licmue Law does nor apply to an
Wild, or impnxcs (here and who docs such wort: himself
or of property Who r
.
r t rough his own employees. provided that such improvements are not intended or
304 — ROUGH ELECTRICAL
council for .ale If however, the building or Impnnrmv n is sold within one year of
completion, the ownmrhuilder will have the burden of proving that he did not build or
501. — FINAL ELECTRICAL_ ENERGY
inyvovcl Purpose of,dr.),
vS
505 — FINAL ELECTRICAL
I, as ct crane Pmpc. nmtmcing Chcen,e R,
7 L. B.,nevely hanmm,ms
ret the no flee 71110, o and profession, GdoJ Conthereo ,
Ilm
does intoner edywho mpr
License Law arcs nor apply man owner of property woo builds m jmPmvm thereon,
111
and who enntrnutx for such Pmjctiv with u cnntrunnr(n) lis'cmcd purmuun m the
Conrrunn fs Liaise L w
❑ I inn cx � �. B & P C lin this rcuson
2rON
Own _ c-
W )I1KER'S Cf 1'IiNSA'II(1N UIiCLANATT(lN
I hereby mfirm muter penalty of perjury one of the following dednratione
)
J 1 have and will maintain a Certificate of Consent ar self -insure for Worker's
Cmnpemmjon, a, pnoi l,d for by Sectio,, 3700 of the Lang, C01c, roc the
l
petlinmance of the wort for which ,his permit is i,weJ.
❑ 1 have and will nwin.in Workd, Connprnmtion Insurance, as "Tired by Section
37001 of the Labor Code, for he performance of he work for which this permit is
wed. My Worker's Connpcmaacn ln.wra.ce currier and Policy nnmhcr Ire'.
Cartier: Policy No.:
CEKIIIRC(1'ION Olt EXEMPT ]ON FROM WORKERS'
COMPENSAI [ON INSURANCE.
mus senior need not N completed if the perina is for one hundred dollar
1$1011.. less.)
I ocnify mar in me perfonnnncr of the work lin which his permit is issued. 1
shall ma employ any Lenon io an, manner so is nn bceonm sady,l to the Worker,
Compensation Laws of California. Date
Applicant
NOI ICE IT) AI'1'LICANT: If, after making this Certilieme of Etentlamn, you should
bcsvnne subject n the Wohcr's Connpensution provision%of the Labor Code. you must
forthwith comply with .on Proski(., oe his permit shall he denied revoked.
/l CONS'RUCI ION LENDING AGENCY
I hereby about that hem Not compaction lending agency lin he perfummucc
nLhc work for whjch his penis is iswcd 15uc. 31X7, Civ. C.)
Lender', Name
Lsmdcr's Address
1 cemly that 1 have mad this application and stare that the atone information is
cormCt.I agrov to comply widi all city and county ordinances and state laws relating
J mbuld k t t Ill by at p c t cv lA city in eme. pan
set the idmo,onvolimsed property for, no,pip q
L (W) 1 b.. d to andk " h.nollell'I" City ILPrt' gust
n liatu r las t. r. ounall p,.,c, whielt may in any way ecmc ago na : and
city in ser tse"noce of rhe grana thu Per
APPLICANT' UNDERSTA AN PI,YWI'TIIALLNONPDINT
�I
..[O
Issued b Date
Y'
\ SOURCE REGULATIONS��
Re -roofs
Sjgnato. of Applicant/Co bosT — Dam
HAZARDOUS MX11 i.IALS I SCLOSURE
Will one applicant or fmure Building ..pam.rare or handle ha.wlowmaarcol
Type of Roof
as deftned by the Cupertino Mipal Code, Chapter 9.12, and the Health and Safety
Code, Senion 25532007
%No
°Yet
All roofs shall be inspected prior to any rooting material being installed:
Will me applicantmfmam lmddingrccupmn use c,uipmem ordevim, wIt,',
It•a roof is installed without first obtaining an inspection, I agree to remove
it haurdous it contammu defined by the Buy Area Air Quality Mewgemem
7 ..
all new materials for inspection. Applicant understands and will comply with
°Yes '`N.
all non -point source regulations.
I Bare prod the Wraulous materials requjmnams under, Chapter 695 of me
'
Culjlbmia HC.IIh k Safety Cide, Sections 25505, 25.533 and 25534. 1 undeamd that
If the i,. Ing dans not cunx d In nemm�.ha' 11 is my C.pon.ihility ser.city(he
,raPant of the reyuimmem., x h n ser br t pn u, i,wana of a Cetsiliare o1
'
OLeUp1NCY'
Signature of Applicant Date
..E„
All roof coverings to be Class or better
owm,or imthnd,rd .sera,
OFFICE