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06120071 CITY OF.CUPERTINO BUILDING DIVISION PERMIT ,�C�NTItACyT©RINFORMATION�` ar BUILDING ADDRESS: VOLHEIM & SONS CONSTRUCTI I MrTNO. 06120071 OWNER'S NAME: PERMIT ISSUE DATE JEFF & CHRIS PERRY 2096nnr SANITARY N0. CONTROL NO. (408).871-9427 ARCHI EC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description w I herby affirm tar 1 am Ihcnscd under provisions of Chapter 9(Commencing P wire SentionTOM)a(Division 3ofthc Business and Professions Coda.and my lkcnseu �� in full force andcfr«t REPLACE WINDOWS & PATIO DOOR LIKE FOR LIKE Liccnm Clan Lic.al 'Fp Dale GOnVMbr ' to ARCHITECTS DECLARATION j¢< I understand my plans shall he used as public reemds IyD LLo Licensed Proliesamal OWNER-BUILDER DECLARATION I hereby aRrm Dns I am exempt from the Contraeors Liecnsc 1Aw for the a O following mason.(Sccuon 7(131.5,Business and Pro(esdnns Code.:Any city ar county '29 which requires a Permit w sm cnrucve l.alar.narrow,Cons-lob.pr repair any structure3zi Morus its issuance.alw mquies dm applicant fersuch permitmrik asigneJ wmncm i C Wt he a licensedpurmanu.lbeProvisionsoftheConuator'sLicens.Law(Chaptv9 Sq. Ft.Floor Area Valuation (commencing with Section 700(1)of Division 3 of the Business and Professions Codc)or j $ Nat be is exempt therefrom and the basis for the alleged exemption.Any violation of $4044 Section 701.5 by airy applicant for a permit subjects the applicant h a civil penally of APN Number Occupancy Type nm mom than Bhundred dollars(SSW. P Y YP ❑1,u owner of tW property.ar my employees wire wages u he'tr sok campewtion, will do the work,and IhesWche u not inmMcd a aRcrW forsak(Sar.TOsd,Budncn and Pmlessiam Cade:The Comencmh License Law does Cot apply m an done,of and Inspections property who Wilds orimpraves thereon,and who doessuch work himself or through his own employee,provided than such improvements are not intended oraRered forsale If. - however,the Wilding or improvement is mid within oro year of cotopkuon.me owner. builder will nose the burden of proving mat he did=1 build or improve fur purpose of s— ale./). Uyl,as"am of the property am exclusively conuuvng with licensed Contractors w Constrocl the pmjcn(Sec.7064.Business and Professimts Code:)The Canmerors U. Note,Law docs not apply he an owner of property who Wilds or improves thereon,and who contracts for such projects with a con oe bods)licensed pursuant in the Contractor's License Law. ❑1 am cacmpt under S B&P C for hu won Owner 24emr,4Dau 5 RK'R'S CO. SATION DECLARATION I hereby>M.under pevalt perjury mm of the following declareuonc hsm u and will maintain a CeniOcaof Consent m self-insure for Workers Compen- sation.as provided for by Section 3700 of the Taber Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as equimd by Section 3700 of the labor Code.for me performance of the work for which this permit is issued. My Workers Co.,....Insurance carrier and Policy number art: Carrier. Polity No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This seetim need not W completed if he Permit is froom hundred dollars(SIMI in IcssJ 1 certify that in me performance of the work for which his permit is issued.l shall act cmplayany p000n in an manner soarer esu 51!: or rs'Compenedice Tawe of 6lifo Applicant m' f J NOTICE TO APP CAM:If,after Sing this Certificate of FAemplion,you should become subjm m he Warkeh C enation provisions of the labor Cede.you most .J z foMwith comply wih such proal t of hu permit shall be deemed evoked. ZZ) CONSTRUCTION LENDING AGENCY (—� Ihome,am.dna mce isoconsuucunn lendin',me,far the perrurmamcof C he work for which this Permit is issued(Sec.3097,Civ.C.) W Q Lender's Name jz lender's Add. O C) I certify ma 1 Mac read Nis application and sum me he shove information is U. cancer.I agree to comply with all city and county on inanca and state laws elating to �U building construction.and hereby authorio,Nprescroaaves m(his city to enter upon the 4k1 alq.o-mi judger property fon ile pe expenses purposes. fr-r G (We)agree to says.indemnify and keep harmless he City of eupcninn against h inconsequnce of thecaaumdgransing of this Permit. may in anyway accrue against said City U z APPLICANTcUNDE TANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date / SOURCEREG S. zl� 1-�S�7 Re-roofs / Signature of Ap icanUConR— Dam v HA7AR 5 MATERIALS DISCLOSURE Type of Roof Will heapplieanl orf Wilding occupant store or handle havardous material M dclined by the Cupertino Municipal Code.,Chapter 9.13.and the Health and Safety Code.SeNen zsmz(a)P ❑Yes a.( All roofs shall be inspected prior to any roofing material being installed. Will me."Jrr..,car future building occupant use cghpmenl or devices which If a roof is installed without first obtaining an inspection,I agree to remove n b.ardnus air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? — / I have mad he ha mohns maunals mquimmcnts under Chapter 6.95 of the Cuirar. ilia Hcalth&Safety Code.Sccuwss 25505,25533 anal U534.1 undersand that ifte Wilding onto not cwrtntly ham a tenant.that in is my remomi bility In entry the occupant of the mquimmenkswMa met pear to isaannce n(a Cenir.a QeuPuc. Signature of Applicant Date �� fJ All roof coverings to be Class"B"or better Owner or sumonin dagcnt pass CITY OF.CUPERTINO BUILDING DIVISION PERMIT ,�C�NTItACyT©RINFORMATION�` ar BUILDING ADDRESS: VOLHEIM & SONS CONSTRUCTI I MrTNO. 06120071 OWNER'S NAME: PERMIT ISSUE DATE JEFF & CHRIS PERRY 2096nnr SANITARY N0. CONTROL NO. (408).871-9427 ARCHI EC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description w I herby affirm tar 1 am Ihcnscd under provisions of Chapter 9(Commencing P wire SentionTOM)a(Division 3ofthc Business and Professions Coda.and my lkcnseu �� in full force andcfr«t REPLACE WINDOWS & PATIO DOOR LIKE FOR LIKE Liccnm Clan Lic.al 'Fp Dale GOnVMbr ' to ARCHITECTS DECLARATION j¢< I understand my plans shall he used as public reemds IyD LLo Licensed Proliesamal OWNER-BUILDER DECLARATION I hereby aRrm Dns I am exempt from the Contraeors Liecnsc 1Aw for the a O following mason.(Sccuon 7(131.5,Business and Pro(esdnns Code.:Any city ar county '29 which requires a Permit w sm cnrucve l.alar.narrow,Cons-lob.pr repair any structure3zi Morus its issuance.alw mquies dm applicant fersuch permitmrik asigneJ wmncm i C Wt he a licensedpurmanu.lbeProvisionsoftheConuator'sLicens.Law(Chaptv9 Sq. Ft.Floor Area Valuation (commencing with Section 700(1)of Division 3 of the Business and Professions Codc)or j $ Nat be is exempt therefrom and the basis for the alleged exemption.Any violation of $4044 Section 701.5 by airy applicant for a permit subjects the applicant h a civil penally of APN Number Occupancy Type nm mom than Bhundred dollars(SSW. P Y YP ❑1,u owner of tW property.ar my employees wire wages u he'tr sok campewtion, will do the work,and IhesWche u not inmMcd a aRcrW forsak(Sar.TOsd,Budncn and Pmlessiam Cade:The Comencmh License Law does Cot apply m an done,of and Inspections property who Wilds orimpraves thereon,and who doessuch work himself or through his own employee,provided than such improvements are not intended oraRered forsale If. - however,the Wilding or improvement is mid within oro year of cotopkuon.me owner. builder will nose the burden of proving mat he did=1 build or improve fur purpose of s— ale./). Uyl,as"am of the property am exclusively conuuvng with licensed Contractors w Constrocl the pmjcn(Sec.7064.Business and Professimts Code:)The Canmerors U. Note,Law docs not apply he an owner of property who Wilds or improves thereon,and who contracts for such projects with a con oe bods)licensed pursuant in the Contractor's License Law. ❑1 am cacmpt under S B&P C for hu won Owner 24emr,4Dau 5 RK'R'S CO. SATION DECLARATION I hereby>M.under pevalt perjury mm of the following declareuonc hsm u and will maintain a CeniOcaof Consent m self-insure for Workers Compen- sation.as provided for by Section 3700 of the Taber Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as equimd by Section 3700 of the labor Code.for me performance of the work for which this permit is issued. My Workers Co.,....Insurance carrier and Policy number art: Carrier. Polity No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This seetim need not W completed if he Permit is froom hundred dollars(SIMI in IcssJ 1 certify that in me performance of the work for which his permit is issued.l shall act cmplayany p000n in an manner soarer esu 51!: or rs'Compenedice Tawe of 6lifo Applicant m' f J NOTICE TO APP CAM:If,after Sing this Certificate of FAemplion,you should become subjm m he Warkeh C enation provisions of the labor Cede.you most .J z foMwith comply wih such proal t of hu permit shall be deemed evoked. ZZ) CONSTRUCTION LENDING AGENCY (—� Ihome,am.dna mce isoconsuucunn lendin',me,far the perrurmamcof C he work for which this Permit is issued(Sec.3097,Civ.C.) W Q Lender's Name jz lender's Add. O C) I certify ma 1 Mac read Nis application and sum me he shove information is U. cancer.I agree to comply with all city and county on inanca and state laws elating to �U building construction.and hereby authorio,Nprescroaaves m(his city to enter upon the 4k1 alq.o-mi judger property fon ile pe expenses purposes. fr-r G (We)agree to says.indemnify and keep harmless he City of eupcninn against h inconsequnce of thecaaumdgransing of this Permit. may in anyway accrue against said City U z APPLICANTcUNDE TANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date / SOURCEREG S. zl� 1-�S�7 Re-roofs / Signature of Ap icanUConR— Dam v HA7AR 5 MATERIALS DISCLOSURE Type of Roof Will heapplieanl orf Wilding occupant store or handle havardous material M dclined by the Cupertino Municipal Code.,Chapter 9.13.and the Health and Safety Code.SeNen zsmz(a)P ❑Yes a.( All roofs shall be inspected prior to any roofing material being installed. Will me."Jrr..,car future building occupant use cghpmenl or devices which If a roof is installed without first obtaining an inspection,I agree to remove n b.ardnus air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? — / I have mad he ha mohns maunals mquimmcnts under Chapter 6.95 of the Cuirar. ilia Hcalth&Safety Code.Sccuwss 25505,25533 anal U534.1 undersand that ifte Wilding onto not cwrtntly ham a tenant.that in is my remomi bility In entry the occupant of the mquimmenkswMa met pear to isaannce n(a Cenir.a QeuPuc. Signature of Applicant Date �� fJ All roof coverings to be Class"B"or better Owner or sumonin dagcnt pass