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0405011729Z o 3 a•Or^ �00 f t WWCcD 63$ W Uy7a CITY OF CUPERTINO �L�y-,�/�'"�°�- '��z�''' BUILDING DIVISION PERMIT !!ggs�v�py*�+���v..yy..//'��b "CONTIRI ITORIt\,CIIW 01`I . -A BUILDING ADDRESS: CRW INDUSTRIES PERMITN040SO117 OWNER'S NAME: PERMIT ISSUE DATE PAUL DAVIS/9,004 NE: SANITARY NO. CONTROL NO. (408)378-2477 ARCHITECr7ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Z 0 LICENSED CONTRACTOR'S DECLARATION GMpltr 9lcommcneing Job Description p I Mmby ffirm that I em licensed unJ(rJPovision of with Sad n7 )off Diivision3of Ne Buu'nevkSAd Profeatlum Cade. and my license la info"Tae effep '/02464 WINDOW REPLACEMENT Licenu e D Lte.a Deo: Conhaclao, ARCHMECTSD ATION \ {yndo, myplans shall M used as public raced, Liceand Professional OWNER -BUILDER DECLARATION I hereby afOrm I e1. mumps from the COMMON'S License Law for IM maso at Code: Any city or county following mason. (Section icon L4 Business and which ow, d moll or masa any swctum s a permit re construct, able impmw, do paw m its ten ed p also at I. the the isim am for suchCrest permit m . a slaw(sutamcm its issuance. Permit 1 Sq. Ft. Floor Area Valuation (fault comate cttnwitpSeNenlloth)pmviaish 3lMCanusiness ndPnorIJw(sCoamr9 (commencing with Section 7000) of Division of the and Profess vi Code) or saw r Net he is mempt th)rtfrom and rite basis for Ute alleged eumption. My violation of alleged e10 Occupancy Type Section 7031.5 by any applicant for • permit subjects the applicant m a civil penalty of not more than Five hundred dollars (5500). ❑ I, as owner of the pmpeny, or my employees with wages to their sole compensation, Required Inspections will do the work. and theawrura is Mt intended or offered for sale (Sec. 7044. Business and Professions Code: TM Commoner' License Law does tut apply 0 an owner of Q p property who builds or improves timmon.endwhoai msuchwork himselfm thcough his ownemploycm.pmvidedthasuehlmprowmanuarenotintwWMoioffmdfoi WC If,�--- n however. Ne building or improvement is old within one year of completion. the owner. If n builder will haw the Mrden of praving that M did not build or improve for purpose of ala.). 1 ❑ I. as owner of Ne property. em coommu rely conuuting with I empower cothe project Iger. 7044, Business and Professlans Code: Conrnc LI J;� �7jr�+Js at�tgy�f)and apply mmownerafpmperty whored who Thor contracts retouch pmjeca withaconuuloKU llunsedpurwam Axhgofa whoclawdounouch U La License Law. - 4" F ❑ I ern exempt under Sec , B & P C for this net Date WORKER'S COMPENSATION DECLARATION , 1 hereby eMm under penally of perjury ane of me following decoasa0ana: ❑ I haw and will maintain a Certificate ofConsemtowit-insure for Workers Compen- sation. as provided for by Section 3700 of the Label Code. far the Performance of the work for which Nis permit is iuued. ❑ 1 haw and will maintain Worker's Compensation Imuran¢, as tvquired by Section 3700 of the labor, Code, for the performaneeof Mae wok for which this Permit f, issued. My Worker's Compensadon Insurance carter and Policy number are: CP.—mrlc FV N 49 PolicyNo.: 'rs�1—ter IO87B '�Po3 CEIMFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURAN films mmim notMcomPleted need iftbeR forone hundred doll= (SIM) nr Mss) I certify that In the performance of Ne work for which this permit is issued. I shall not employ any pcnon in my meaner u u b become subject to the Workcri Compcnsadon Laws of California. Dam Applicant NOTICE TO APPLICANT: IL after making that Certificate of Exemption, you should become subject to the Worker's Compensation pmvimoo of the Labor Code you most foMwim comply with such provisions or this Permit shall he lamed revalued. CONSTRUCTION LENDING AGENCY 1 hcmby afErm that there is • com0uctim lending ogmsy far the poifamma of Mae work fur which Nu pewit is issued (Sec. 3097, CO. C.) Lender's Name Lender's Add. I certify that 1 haw need this application and sum that the %Mw information is town. l agree to comply with all city sme county ordinances and sou lawn muding to building construction, and hereby aut odor mpresenatives or this city to enter upon Ne above-meMunrd property for inspection Purposes (We) agree to saw, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costa and expenses which may in any way accrue agalmt said City in consequence of the granting of this permit. APPLICANT UNDEISTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date soulcu Re -roofs Type of Roof Slipoodin,/of ApptianVContnnor Dam HAZARDOUS MATERIALS DISCLOSURE Will ties applicant or future Wilding occupmbtow or handle lurudous material . to dcfincd by the Cupertino Municipal Cade. Chapter 9.12. ad ties Health and Safety Cad), Section 25532(a)7All ❑ Yes roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtainingan inspection, I agree to remove p Will the applicant or future building atopens sou equipment a devises which g It hanothous air contaminants r dein( by tite Bay Area Air Quality Maaagenteai all new materials for inspection. Dinner? ❑Ycs bl No ,' a I have mad the hrardnua mucrie1s raquitemena under Chapter S95 of the Califon nice Health SafryCode, Seecons 25505,25533 and 75534.1 undersand that if the Wilding umm y Mw a tense, thatit u my mspomihility u notify the =upmt of Ne �Mqmahlch must W mer prior m issuance ofs Ceniecamof Signature of Applicant Date laumorae All roof coverings to be Class "B" or better apem Date CITY OF CUPERTINO #°'`<. �°''+'•"'"� ' INF.ORM�ON? BUILDING DIVISION PER CONTRACTOR BUILDING ADDRESS: 10792 PRO RWRI-1, DR CRW INDUSTRIES PERMIT Ntb4fl50117 W NER'S NAME: PERMIT ISSUE DATE PAUL DAVIS 1197 DELL AVE nc;/:lR/2oo4 PHONE: SANITARY NO. CONTROL NO. 408)378-2477 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION 1 hereby firm that I limnscit an .visions of Chapter 9 (commencing Job De5Cr1 [IOn am withsem a5 ) ofoivi.ia.3.rtheaa: dproreasirn. caae,,ne mrhansc is _ fie® in roam errtet y�z�BJ Ini WINDOW REPLACEMENT L6Fo FINAL Lice. a Gummed'. Dale cunt ARCH DE ATION \ ly_14nny plans shall he used as public records JU�) Oq L asOa L d Professional OWNER -BUILDER DECLARATION 1 hereby alarm that 1 am exempt from the Contractor's License Law for the fallowing reason. (Section 71131.5. Business and Professions Cnde: Any City Or county which requires a Permit t. construct, alter, improve, demolish, or repair any shuctum ! poor to its issuance. also requires the applicant for such Permit to fie a signed statement Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation that he is licensed pursuant n the provisions of the (commencing with Section 70W) or Division 3.f the Business and Professions Cade) or : that he is exempt therefrom and the basis for the alleged caemption. Any violation of 3 ISM24NLBribe 0 Occupancy Type Section 7031.5 by any applicant (or a permit subjects the applicant o a civil Penalty Of not more than fw hundred dollars (SSW). 01, as owner of the priperry, or my employees with wages ass their sole compensation, Required Inspections will do the work, and the structure, is not intended or offered for sale (Sec. IDM, Business and Proposal... Code: The Contmco&a Lianas taw data not apply to an owner of property who builds or improves Wreon,and who does such work himselfar thm igh his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will how the burden of proving that he did not build .r improve for purpose of tole.). 0 I, as owner of the properly. am delusively contracting with licensed contractors to construct the project (See. 7044. Business and Professions Code:)The Contractor's U. .. se Law does not apply to an owner of property who builds or improves thereon, and . who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License taw. '❑ l am exempt ander Sec. ,B&P C for this reawn toner i Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury ane of the following declarations: ❑ I have and will maintain a CcoMcam of Consent to self-inmm for WorkersCompen- s idon, as provided for by Scotian 37W of the Iabm Code, for the performance of the work for which this Permit is issued. 0 I have and will maintain Workers Compensation Insurance, as required by Section 37M of the labor Code. for the pcRoorm nce or the work for which this Permit is issued. My Worker's Compensation Insurance carrier and Policy number are: clrr;�:.Si7a 6um0 Poll, No.: Sr�'� /0g7f, -T?po3 V" CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURAN Gnmaim need not bccompletcd Telae perm' foronchundreddollars(S1W) es or Icss) 1 certify door in the performance of the work for which this Permit is issued. 1 shall not employ any person in any manner sat as in become subject a tM Workers Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If. Deter making this Ccnificate of Emmpti.n• you should become subject ro the Worker's Compensation provisions of d,c tarn, Code, you must ry forthwith comply with such provisions or this permit shall to deemed rooked. CONSTRUCTION LENDING AGENCY 1 hereby aMrm Nat Ncre is a coaswninn lending agcnry par the Nrrarm.Of the work for which this permit is issued (Sec. 3097. Civ. C.) Lenders Name Lender's Address s 5 1 certify thn I have read this application and scale that the above information is — cored I agree to comply with all city and county ordinances and slate laws relating to building coruuucti.n, and hereby audoori. represenulives of Nis city m cater upon Ne Ll above-mcndmmul property for impection propnsex L, (We) agree to save, indemnify and keep h rmless Ne City or Cuperin. against O liabilities, judgments, costs and expenses which may in any way see= against said City / /j(/ in consequence of the gmming of this permit. ([7) AP PL CANT UNDE SANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Dale / sources -�% S�H/Zen/ ( Re -roofs Type of Roof Signature, of ApplicanUConurror Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hi rardo d, material . defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety c, Section 35532(.)7 ils� All roofs shall be inspected prior to an roofing material being installed.❑Yes Will future building devices If a roof is installed without first obtaining an inspection, I agree to remove the applicant or occupant use equipments which t emit harardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District' i1 ❑Yes Na I have real the hmaNnus materials requirements under Chapter 6.95 of the Califon nit Hcaih & Safcty C.dc, Secu.m 25505.25533 and25534.I or dmmtmd thlif thc building does not currently haw a Tern, that it is my resWnsibility to noufy the occupant of the rectats hrchm.:txmetpnortei.uana.faCcnmeam.roaa,r{aae Signature of Applicant Date -- 'S &N All roof coverings to be Class "B" or better -w owt�ix t « A § � R =-D C31q � glh� T71 m % , n ki \ \ Rf a . k{ \\J\E; ' \ \a&#,I �7aiR■7# \( � . #. £» 0 § « A § � R =-D C31q � glh� T71 m % , n ki 2[[af§ \ Rf a . k{ \\J\E; ' \ \a&#,I �7aiR■7# � #. £» 0 § % , n $ \ \ . ! � � �\ » kE $ �