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CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO.
10174 RIEDEL PL
02010106
OWNER'S NAME
APPLI TION 5UH DATE
FRAKE SCOTT 0 AND LYNN K
01/28/2002
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECTTiNGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that l am licensed underpnsvisiam of Chapter 9(commencing
COPPER REPI PE.
wall TLl�)of Div'_siopp 3�ofthe Businpandp resp'ons Cpl mylicense
License Clio d`L`'XP un% C¢ L(P Y n
WATER MAIN.
Date Contras
�JQ//���j�7.� ARCHITECT'S DEC
1 6 &,,l nd my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hemby affirm that 1 am exempt from the Convacmr's License law for the
following reason. (Section 7031.5, Business and Professions Code: Any city orcounry,
which requires a pemtit a conswet, alter, improve, demolish, or repair any stratum
Poor to its issuance, also required he applicant foch Person to file a signedstamant.
-
did, belisl ensedputs a : to in. pre, mmax oftheContractors License Low (Chapter 9k
�Floor-Areax„ .f ,�
Valuation
(c ng,with Section70hKo (Dias 3 of the Businessand Pofessions Code)
I i
1
,
or that he is exempt thcmfrom and me basis for the alleged cxcmption. Any violation
,.
of Section 7031.5 by any applicant for a permit abjaa tW __ ... to a civil pcnelry
of not more than me hundred daunt (8510).
APN Number
1'• i h Occupancy Type
❑ I, as owner of the pmpery,o my employees with wages as their sole compensation,
r-
2 UNDERFLOOR PL
MBING
- -' -- - '- - ' -"-- -
301 - ROUGH P1.04MENThspections '• •'
wi11'do rom vak, and the structure is not Intended or offered for sale Sec: 7064;'
Business add ProCode: The CoThe Contractors Liana Law does not apply to an
owner of progeny Who builds or improves thereon, and who does such work himself
502 - FINAL PLUMBING ENERGY
or thmuggh his own anployces. provided that such improvements arc not intended or
offarod fo7ale: t. however:Ihe Wilding or improvement ii sold within one Year of
_ _ _
—""_..._ ._.... _. ... - ...._ ..._.... .._..... .._ ........_. __ ._, .....
507 - FINAL PLUMBING
completion, the ownm-buimerwill have the burden ofproving that hedid not build or
improve for purpose of sale.).
❑Losowner ofthe property, ame nvating withCWc:)ah<omrsmism
rt: `.' P•+` ''<'.
project(Sec. 7tWy Bus and Professions CodoO The tor s
Business and
consumer thedoes
impasses thereon,
Licence Law tact apply man owner progeny who Notes as improves thcieon.
and who fro, th
for.such protects.with.a.contisnsr(s)licrosed.punuam.m the_...._-..
._._-.._.... ..._. ._. .._. ...... ._..__._.._..._..
e,Licencontracts
License Law„
'.B&PCfor
.
01 am exempt this aazon
❑lamcacmptander Scc.l
Owner Date''
WORKER'S COMPENSATION DECLARATION
f�
I herebyafri int under penalty of pejury oneofthe inllowing do,lamtions: -
■�m�fe9l
d�INALE®
❑ 1 have -arid will monnoin a Certificate of Consent to self-mmm far Workers
Compensation, as provided for by Section 37W of the LaWr Cade, for be
JAN O 9002
pedormance'of the work rd
f1.or which this pemit is issu.
C
❑ 1 have and will iv i Worker's Cm,pensationlostreanrequired by licellmi
3700 of Ihe'Labor Code ar h perfammance of he mk far which this conni, is
BUILDIN
Hoed My Workers Compensation Insuranced P.Ifi,,yo tuber are:
G_
I 1'-. t,
't ;,,CERTIFICA'I ION Or, EXEMPTION' FROM,WORKERS S
t�5.1. _4.♦�,� a.�y"ik
COMPENSATION INSURANCE
(Thu.cson need not be completed f the permit i s for one hundred doll
•t
14100)or
1 certify that. th P f ty forco c pero't Is issued,1
f• •;i, •, ,,lss `
attic
ihall'not cmplo Y, tun m eny manner so os hecom suM1jat m tM1c Wodm
aualthe asi
°f�(alifomia.
'
CompcnsaiogL
NOTICEPSI. ar¢rmn,etimthis 'e 4 fE You Would
'
become subjenmthe war kers mpehsueon prtvixion o mLatinrCde, you must
bmdhm,T lCand
fonhwift comply with such provisions or this permit shall be deemed revoked.
' CONSTRUCTION LENDING AGENCY
1 hereby affirm that there s u mmums on lend',g -ug y lortlmperfhnoiarce
of the work for which this permh is issued (See. 3097, Civ. C,)'
Lender's Name'_ _.............._ •.:... _.
Lender's Address
i ..
lis •s.: I7'1
1 certify that I have read this application and state that the above infun ion is
fees [!agree to comply with all city and county,ordinances and state laws relating
inWilding conamnion, ahh�bmorixe rcpasenmtires of this city to corer upon
In<nbuve.memim,ep pmppati°n p"P(we)
ugrec uisavena keep namlco the Chy of Crxhia°''oaiw
liabilities,judgments, as.as which may in. any way serve a Bina sadCoftThis
permit.,
RS'I WI CotPLY WITH ALL N(1 -POI T
Issued by: Date
(N '• I Uz
Re -roofs /
si,n.the of Apphoura(C nrwtar V
- HAZARDOUS IATERIALS DISCLOSURE -.
wn�n ppm t rt building occupant amesrh dl Iia Nous marl
_.-Type ,of Roof .. -_. ..
as def ed DY the Cupcn Municipal Code Chapter 9.12. and the H hh and Safety
Cod Section 2553 •
i • l
(a) t
'CIY'. ' "° 1 �)+
inspectedapnor.to.any
I j "
ll roofs shall be roofing, material. being installed..,.•„
Will th,appl torfturebuldingoccupantuseequpmentordevaeswhich
lfaroof isinsfalled'withoutfirstobtaining aninspeetionjagree to`remove
c tho,mdousu-contaminants as a red by @e Bay Are. Air Qualty Management
Dnmcr'.. '...:.
all new materials for inspection_ A1.pplicant understands_ and will comply with
-Oyes : „ - ',O -- --' - "` " "'
_-. ... .. _ .
all nod-potht source regulations...; -
' °
I�hnvc'i<ad'Ihe In, mu . tectal ey rimans under Chapter 6.95 of the
California Mwlth & SSfcty We S tions 0 25533 and 25534. 1 undersand that
'if lh oe'otc ady seatp .t
Dcc'Pon oft ire n w ch must m y� to issuance of a Ccnifi te of
par
n«"?a
i
Signature of Applicant-„ Date
\
_ _
All roof coverings to be Class B or better '
sera qn °ria
aab<rt . ,tem
--OFFICE— --- '