08040110 CITY OF CUPERTINO Yy*,�Try st� a>�1q 's?/ p.I ��{"� '�`3I> >I•'�"' '- °°
BUILDING DIVISION PERMIT
BUILDING ADDRESS: PERMIT NO.
890 BRENT AVE BROTHERS HOME IMPROVEMENT 08040110
OWNER'S NAME: PERMIT SUE DATE
-AwkWILLEVER HARRY A AND THERESA D 2510 DOUGLAS BLVD 04/15/2008
NE: SANITARY NO. CONTROL NO.
ARCHrrECDP.NGINEER: BUILDING PERMIT INFO
REPLACE WINDOWS LIKE FOR BLEG ELECT PLUMB MECH
O O O O
3;; LICENSED CONTRACTOR'S DECLARATION ttKE,
Job Description
I hm N
ctcby affirm I ammiu
lied under pmu .--
vifimof Chapter 9(commencing --- —— ---—--
with Section 700)of Division 3 oflhe Business and Professions Code,am my license is
n in full Yoree and effect
�? LicenseLk.g �11�
3F DaDataut V Ivj GSDECr -
Q4 As shall W use DECLARATION
I undersand my plana W11 bo used as Public rtcoNa �'�te'f A~
ga Licensed PmfeaienaI -
Sct ONNER-BUILDER DECLARATION
9 1 hereby Arm that 1 am exempt from the Conbaeors License law for the
C D O rellowinp mason.(Section 7W 1.5.Business and Profcrsions Cade:Any City or county
S$ which requl.a Permit On construct.alter.improve.demolish.or repair any structure
_zy p6WWiUMana ., MqulrutheappliMi for such Permit OF file asigned sudici
<
Into Ito is licenced pursuant to the provisions of de,Conuacmrs license Law(Chapter 9 Sq.Ft.Floor Area Valuation
rE 3 (commencing with Section 7000)of Division 3 of the Business and Pmfessiona CmA or
S that he h exempt c homfrom am the basis rte Ne alleged csempdon.My violadm of
Section 7031.5 by airy applicant for a permit subjects dte applicant to•civil penalty of APN Number Occupancy
rent come don,five,hundred dollars,($500). P r EYPe
0 I.as owcer of die property,a my emplaycra with warp asthe rmlecompensadon,
wdldo thewok,anditsW u.la nal Mendedorafmd(weak(SQ.7044.BWmass
and Profers ons Cade:The Communes License Law does Out apply in an M.of Required Inspections
property,who build,orimprowthadcon,and whodoes such wart himse fecdwugh his
awn cmployaef,provided that such improvements are nal intended oroRered forests,U,
however,the building or improvement i,sold within ox year of complecon.to ownen-
builder will saw dw buAm of proving that has did Out build or improve for pure rm of
sale).
0 1.a"am of the property.am exclusively contracting wim licensed conbao0r,to
construct the project(Sec.70,11,Business and projections Coda:)The Contracmr's LI-
censo Law does not apply a an comer of property who builds or Improve Ibomm,ad
who contracts for such project,with a con armour s)licensed purecant to the Contractor's
Lim.Law.
❑I am emmpl under See .B R P C for this mason
Owner Dab
WORKERS COMPNISATIONDECLARATION '
1 hereby allirm under Penally of perjury oro of the following decHradome
1 ham aid will malow,a Cmtifiate or CoWenl to¢If-IWum forwarteYs Compere
amen-as provided for by Section 3700 of the labor Code.for the performance of the
watt for which Nis permit is issued.
0 1 have and will mountain Worker's Compmns on Iwummee,as requited by Section
3700 of One labs Core.for the performance of the work for which this permit is hared.
My Workersoompenati1on hum.ami.am be
Policy numr am:
Cartier. r0 Policy No.:Zadl 002Q!
CERTIFICATE OF EXEMPTION FROM WORKER
COMPENSATION INSURANCE
(TMsm i.need sotbocompleed ifthe permit is foram hundred dollars(SIM)
or Baia)
1 angry that in the pedurmame of the work for which this permit is Wood,I shall not
employ any Person in my meaner Far as to become subject to lbo Workeri Compensation
Law,of California.Da¢
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you Amid
become subject m the Workers Compenation provision,or the labor Code you am
.,ZO forthwith comply with such Provisions a this Permit shall W deemed revoked.
y CONSTRUCTION LENDING AGENCY
f~ I hereby alarm dw Nem is a construction lending aFncy for the performance of
a M the work rte which this Rork is lasted(See 3097.Civ.C.)
W Q Landers Num
.7. Z Landers Address
V Q I certify that 1 have tad this applications and sate thou the above information is
LL Fcortin 1 agree to comply with all city and county oMnuue,am awe law,relating to
V Wilding conssuelon,and hereby suthorine reprtseeutives of this city to cola upon the
W above-mentioned property for Inspeman putposea
G (We)agree to use.indemnify and keep haorlev the City of Cupertino agams,
07 Iimillda,J Wgmenu.cote am expenses which may in my way arm agaitut two City
V 7 In consequence of the granting of this permit.
r1- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature criMifficarmlCorturcespor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will W applicant or future building occupemuo e W handle baardous materia
a defimd by tie Cupertino Municipal Code.Chapter 9.11.and the Health and Suety
Cade.Section 21333(x)7
❑Yes IKN . All roofs shall be inspected prior to any roofing material being installed.
Will Ne applicant or rutum Wilding aaupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I haardous air cmwnivar s at defined by the Bay Ara Air Quality Management all new materials for inspection.
swell `
01b tONu
I have mad the handcus meeriasrog menancs umc,Cltsp1mr6.95of the Califor-
mat Halth&SMcty CLde Savor 25505.25533 eu125u31.I undvswd Was lfthc building
does cot curmndy hssu A OQL Nat 1 u my mxp mi,ty Id nmry the Occupant of de
regairemcnu whkn btet
e t I"-,- ar.Cetifesteor Lta Signature of Applicant Date
/ Y/rYoe
owns,mtunolocu. ret Dae All roof coverings to be Class'"or better