08030078CITY OF CUPERTINO-
BUILDING DIVISION PERNUT
CO1�,I,TRACTOR'�II`%PC1RA'IATIQI
,.�..
BUD.gn'c " DLELIGHT WAY
TBD !- TO BE DETERMINED
08030078
W NER'S NAME:
PERMIT ISSUE DATE
VAN ZEE GARY A AND CAROL A
03/14/2008
HONE:
SANITARY NO. CONTROL NO.
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
Bo "0
o 0
LICENSED CONRIACTOR'S DECLARATION
Chapter
Job Description
1 hereby art.. that 1 m famed Milprevision or previsof 9 (Commencing
with Section 70M) of Division 3 of that Business and Profcadan Code. and my license is
LIKE FOR LIKE WINDOW REPLACEMENT
in full farts and effort
License Out Lie. Is
-
Date Contractor
ARCHITECT'S DECLARATION
I undemmnd my puns NYI W dead u public reCoNt
Licensed Pmfnsstonal
OWNER.BUILDER DECLARATION
1 bcmhy alarm thal 1 am cumpt from fe ConUactafs license Law for the
following rune. (Section 7W I.5, Buffinu and Professions Cade: Any city M county
which mgWa1 a permit b comments. shot. Improve. demolish, or tartar my s Wnum
prier d its issuance, alto requirns the applicant forach permit to Ne asigned smemem
is licensed the of use Contractor's UmMc Law 9
Sq. Ft. Floor Area
Valuation
that W Fontenot o provision (Charter
$5000
(Commencing with section 7000) of Division 3 or the Business and Pafanan Code) M
this he k exempt therefrom and the bask for the alleged eamp tom Any violation of
e.��T Number
36224053 PMNumber
- Occupancy e
arc T
y yp
Section 7071.5 by dry applicant fns a permit subjects the applicant to a civil Penalty of
imleamethao0wbmdned"IM(SM
I,uwmer df the pmpaty,Mmy mployeu with mgnuNekak Compewtion,
Required Inspections
willdo the wart, and thesuuesure is unintended or offered krsale (Sec. 70th, Business
ud Professlan Cade: not ComuacuYs LlceMe Law does not apply d an owner of
property who builds M impmvu theaom, and who does such work himself or tlwugh his
awn mploytel pnovidW that such improvements art not intended MoRued ferule If.
howevoe the heading orian annmm is told within ae year of Completion. Ne owner-
hulder will have, the Indian of prm ng that he did rot hdd M improve fns purpose of
"Is.).
❑ 1, as swan of the property, am exclusively canuuoing with licensed conuutou to
Connma the project (Sec. 7064. Business add ProRaeions Code:) The ConuactoYs U.
ceob Law does not sit ly u an mucr grpropeny who builds of Improve thenCon, and,
who Contracts for as rojects wi onuaewn(q licensed perawm at the Contractors
License Law.
❑Imexe pt .B&PC rthis n
wnv - E
ORKPRS COMPB(y� ON DECLaRAT10
1 hekby siRsm under peMlty, a tory arc of Ne felt. decuationse
❑ I haw and will msinWn a Certifiate a(Canentlo self-IMdro (sir Workers Compeer
mi.. an provided far by Section 7700 of the Labor Cade, far the par(.. of the
work fn which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance, u required by Second
3R0 ofthe LaWrCodc. fns the performance ofthe were for which this Permit Is uuerL
'
My Worhrk Computation Inurana artier and Policy number aea:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mus needed reed Inst h: completed If the permit is form hundred dollars (SIOM
or lcu)
I anify that In the pear o for whi Nie Fcmpt la issu d, l shall oat
employ any Pe non in r oma Warks mite Won
Laws of Califomi
AppBant
NOTICE APP . IL after making this nilad of % th d
beeame subjectiethe WorkeM1 Compensitian kion of Ne Cade, you mate
...
forthwith comply with ash provWnns or Nb pcfmiL shall M decmcd ranked.
CONSrRUcnoN LENDING AGENCY
1 hereby affirm that fart tea co struninn lending agency far ft perfomsnce of
the works for which this permit k issu�d (Sec. 309'1, Civ. C.)
Lender's Name
,
Lender's Addncss
I sonify that I have red this application and me that, the than information in
'
correct. 1 agree In Comply with all city and county ordinances and tete laws rkting In
bufding construction. and hereby authorise rpne eastiwe of this city ro anter open thC
show-mm dond property for inspection purpruea
(We) agree to an, indemnify and keep hatmless ft City of Cupertino against
Ilabillou,Jud{monk, Mu andeapenw which Coq In anyway ucae tgsinq said City
in consequence of irantin{af pe it.
APPLICANT U Sit A D ILL COMPLY WITH ALL NO INT
Issued by: Date �t{�
SOURCE RE
Re-roofs _
Type of Roof
kczz
Sigmatu p H ARDOU ALS DISCLO RE Dtd
Will f applicant or tet ding oavpant atom addle haadom national
u deRoed by the Cupenied Municipal Code. Chapter 9.12 and ft Health and Safety
cede. Section
n xss3x(.)±
All roofs shall be inspected prior to any roofing material being installed.
❑YM ❑No
If a roof is installed without first obtaining an inspection, I agree to remove
WIII the applicant or future building occupant on equipment or devices which
emit haudou air cmkminants as dented by the Bay Area Air Quality ManagcnlCal
all new materials for Inspection.
Dimict7
❑rex ON.
I have mai the haurdoM maurisis mquimmems under Chapur 695 oftie Califor.
rte HedlthkSsielyc Seedons255 , 25533and M536.1umkntsndN if& ullding
dans not cunentiy h a ant. t k m ponlhilitY u notify acuP s of Ne
ompt cnuwhi PC m ,Cutilkatear
Signature of Applicant Date
All roof coverings to be Class 'RV' or better
Ownerar Dow
anthoneed agent