03010189 CITY OF CUPERTtNo I -
Itu1LU1NC DIVISION PERMIT =. CONTRAC°TOR INFORMATION,:,-
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But LDING A DURESS: FRED FRITSINGER PERMff NO.
10784 GASCIONGE DR
ER'S NAME: 10784 GASCIONGE DR. APPLICATION SUB DATE
FRED FRITSINGER 01/28/2003
F}IONF.: SANITARY NO. CONTROL NO,
ARCHUTC1'/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MPRH
0 0 0 0
+�I00 Lm that II a CONTRACT'OR'S DECLARATION
`2uj F 1 hereby aft,rte that I am joemacdBu under and
Proons of Chapter n(commencingsis lob Description
X252 with Section 11XX1)nI Division 3nl NC Business and Pntressinns Codc,and my license is
<5
OZinc601for. ad effect. ADD 121 SQ. FT.-Z LienseLiC.0
D ' Cor errm- 6
ARC)IITEC7'S DECLARNHON (n�
�iy < I understand my plans shall be used as public records APR "l 12003
urLLo Licensed Professional -
I1OWNER-BUILDER DECLARATION
tri<8 1 herchy x(liren that 1 am excerpt Bom the Contractor's License Law far the BUILDING
i 600 following reason.(Section 7031.5,Business and Professions CaM:Any city or county
x$fL which acquires a permit to construct,alter,improve•demolish,or repair any structure
so primer its issuance,also myuires the applicant for such Permit o file a signed statement v�.xn
�taIDtlOn
p that he is licu
ensed pursuant to m e provisions or the Culactor's Lice nLaw(Chapter 9 Sq. Ft. Floor Area $12F
e(�0 (commencing wi th Section 70(Xn of Division 3 of the Business and Professions Codr)it
y $ Nu he is exempt thcreUom and On basis for tht alleged earequiart.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mare Nan five hundred dollars($500). B Occupancy Type
❑basotuner.ftheproperty,nrmyemployeeswithwageeatheirmlecompenntion,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's License Law does note I to an owner of a ulred Inspections
progeny who builds or improves themon,and who docs such work hitmselfnnhraugh his 102 - PIERS q p
tun employees,provided that such improvements an not intended or offered for sale.If, 103 — UFER
however,the building or Improvement is sold within one year of completion.Be owner-
builJef will have the burden of proving that he did not build or improve for purpom of 104 - REBAR
sale.). 105 - ANCHOR BOLTS
[D 1.as owner of the property.am exclusively contracting with licensed contractors to 106 - SEWER & WATER
concoct the project(Sec.1614,Business and Profession Code:)The Contractor's Li
cense Law does not apply to an owner of progeny who builds or Improves thereon.and 202 - UNDERFLOOR PLUMBING
who contracts frn such projects with acnnuamm(a)licenscd pursuant to the Contractor's' 203 — UNDERFLOOR MECHANICAL
ors,Law.
I
am eu tinder's c. ,B&P C for this reason 204 - UNDERFLOOR FRAME
l� 1 2�c� 205 - UNDERFLOOR INSULATION
"e SAoy D L N 301 - ROUGH PLUMBING
Iherebyalfumuin a penaftyof perjury tonne mGnwior declarations: 302 — TUB & OR SHOWER
❑ Ihevc and will meinmina Cenifcem of Cnnsenun.ml4insure for Worker's Compeer
sari..,as provided for by Section 37W of the labor Code,for the performance of the 3 03 - ROUGH MECHANICAL
work for which this permit is issued. 304 - ROUGH ELECTRICAL
❑1 have and will maintain Worker's Compensation Insurance,az required by Section 305 — FRAME
31(X1 of the LaMf Coale,for the performance of the work fof which Nis permit is issued.
My worker's compensation Insurance carrier and Policy number am: 306 — HOLDOWNS
carrier: Poll,No.: 307 - INSULATION
CERTIFICATE OF EK EM P ION FROM WORKERS'
COMPENSATION INSURANCE 308 - SHEETROCK
(fhisixction need nmhecnmpleted it the permit enrnne hundreddollmsolfa) 309 - EXTERIOR LATH
Is..) 310 - INTERIOR LATH
1 cenify Net in Nr e"mmonee of the work}}rrrwFTs this permit is issue),I shall not
cerployany r nnynnnncrsaasmyFimmcsn ecuoNCWnrkcn.'Cnmpenotinn 311 - SCRATCH COAT
Lawanrcana 313 - ROOF NAIL
Apgqtic99m
NOO]SET A :IL fm kmgthisCeni)i roofExemption,you should
501 - FINAL ELECTRICAL ENERGY
O zhe c suhjcn N the Worker's Compensation provision nl Ne faMn Code,you must 5 02 - FINAL PLUMBING ENERGY
forthwith comply with such provisions or this permit shall be deemed meokeJ,
'Zz O CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
Ihereby a(fr.that Ntre is a construction lending agency for the perrnfrose,rlf 504 - FINAL BUILDING ENERGY
C? me work for which this permit is issued(Sec.San,Co,C.) 505 - FINAL ELECTRICAL
W Lender's Name
az Lende"Addm" 506 - GAS TEST
U O I cenify that 1 have read this application and state that the above information is 507 - FINAL PLUMBING
Wcorrect.I agree o comply with all city and county ordinances and state laws relating N r
f" building conswction.and hereby authoriserepresentatives ofNiscity mrare
rugmthe FINAL MECHANICAL
Waluvc-memioned progeny ter inspection purposes. 0 9 F IN
F4 (We)agree m save,indemnify and keep humless the City of Cupen(nn against
o-Fr h Z9,—GRADR /I
Iiabilitias,juJgmenu,cnsa end a axes which may a any way accrue again,said City 5 G
U "� incanseq,judgn cgrsts of tht omit.
^^ APPLIC ND ST DS A WILL COMPLY WITH ALL NO�J-POINT Issued by:51 WORKS Date
SOURC EG ON . r
L A
gz
Re-roofs
atu fApplics Comraunr 0 Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or Name building occupant sore or handle b rardWs material
Jeri ned by the Cupenino Municipal Cade,Chapter 9.12,and the IRalth and Safety
t,SOmCS 25532(x)? a (• All roofs shall be inspected prior to any roofing material being installed.
/� If a roof is installed without first obtainingn inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which ap g
emit haraNnus air conominams as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
C]Yet; No
1 have read the huraNnus materials requirements under Chapter 6.95 of the Callfor-
nixI halth&Safety Code,Scctinn 25505,25533 cod 25534.1 undersmnd Net if the lanlding
fires nm cu ve u moa s my resrysnihility m notify tM recupant of Ne
<quirem' swbich tier fin issuanceofaCerifcammoccupan=y. Signature of Applicant Date
—�v..��� - ` he
'awnc�raalltnrtzeJ ttg —� Date All roof coverings to be Class "B" or better