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CITY OF CUPERTINO
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BUILDING DIVISION PERMITCO1�TR.-C�T'OitYNFORMr*,.TII�
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BUILDING ADDRESS:
V DON CONSTRUCTION
PERMIT No.06010051
R'S NAME;
PERMIT L4IIE DATE
JAME FINCH
1469 AMBERGROVE DR
01 10 2006
E:
P_1
SANITARY NO. CONTROL NO. .
(510)882-2404
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDO EO LELr PLO MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby &Man that 1 am licensed under Provisions of Chapter (commencing
with Section 70ixt, of Division 3 of a Business and Professions Cade, and my license, is
In fun force a ildlan.
REFRAME AND REPLACE.WINDOW AND RESTUCCO
License Clens Lm N
Dab 7 — I—Co .,
As DECLARATION
hitt useT'S
I underetsnd my plan smll IE used u publicDECLARATION
records
Lictmctl Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contravenes License Law for the
following tesmn. (Station 713 LS. Business and Protections Cade,: Any city or county
/4
which require W a permit eoWtWc4 alter, Improv:, demolish, , or repair any tiructu
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prior W its issuance, also requires the applicant for such permit W rile a signed statement
that he is licensed pursuant W the provisions of the Conuaar'sLmvc law(Chapor 9
Sq. Ft. Floor Area
Val6ation
(commencing with Section 7000) of Division 3 of Ne Business and Profession Cade) or
that he Is exempt t etefrom and the basis for the allegad ..I don. Any vial Won of
Section 7031.5 by any applicant for a permit subjects the applicant in a civil penally of
tot more Nan Ove hundred dollars ($500),
r
J A'I sj' CR upancy Type
tsoleenmpensation,
❑ Lasonpfthe property. my employees with .&aa detr
wuar
[eliOj/ P
Required Inspections k,
will do the wart. ad die sWCWn is at intended araBered far sale (Sm. 7044, Business
and Professions Cod.; The Conummrs Liam 4w docs not apply to an owner of
-
property who belittler imprmea tbmeon, and who doe such work hims elf or duough his
own employum, provided thatsuch improvements arc not intended orolfaed fonds. If,
bowevm. the building or improvement Is said within arc year of completion, the owner.
builder will have the burden of proving that he did not Wild or Improve for purpose of
ole.).
❑ I, as owner of the property, am exclusively contracting with licensed eom isms W
caramel Bb pmjm (See. 7044, Bustrteas and Professions Code:) The Contractors U.
cove Law docs not apply to an owner of propeny.who Wilds o improv thereon, ad,
who conarecta far such projects with acontraturms) licensed Formal W the Contractors
License Law.
❑ I am exempt undo Sec ,B d PC far this sewn
ner Date
WORKERS COMPENSATION DECLARATION
1 hemby mEmn under penury of perjury am of the following declarations:
I haw and will msinrsin is Cardrinb of cmamm W self -masers for WerkcrsCompco-
mtion, n provided for by Section 3700 of the Labor Cade, for the performance of the
wok for which this permit is Leaned.
❑ I have and will maintain Workers Compensation Insurance, n required by Section
3700 of Ne LabarCom. far the performance of the work forwhich this permit is issued,
My Worker's Compensation Iran= anise rad Policy number sce:
Carrier. Policy Na,:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
,
(This sacolon need amt be completed If the permit is for one hundred dollars ($101))
or ]as.)
1 certify that in the performance of the work for which this permit D issued, I shall not
employ anym mn in any manner m as to became subject to the Worked Compensation
Laws of Califamia. Dam
ApplWam
NOTICE TO APPLICANT: IL after making this Cenilicam of Exemption. you should
became subject W de Worker's Compensation provisions of the later Code, you moa
forthwith comply with such provision or this permlt shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby WrI m that dere is a mnsuuctinn lending agency for de performance of
the work for which this permit Is issmd (Sec. 3097, Civ. C.)
Underh Name
Undera Address
I century that I Woe teed this application and tote am the above information 4
comet, I agree to comply with all city rad county ordinances end ale laws misting to
building construction. and hereby authodre repnsenmmi of this city W enter upon the
aWve-mentioned properly for inspection purpOWL
(We) agres W save, indemnify rad keep harmless the City of Cupertino against
liabilities. judgments, costs and expenses which may In any way amus against said City
in nuence of the of
APPPLICANT UNDERSTANDS AIND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Type pf Roof
:PoN - t)- f -10-04r,
Signature of AppliceintlConmcmr Dee
HAZARDOUS MATERIALS DISCLOSURE
Will de applicant or future Wilding occupant mom orhandia hazardous material
es defined by the Cupertino Municipal Code, Cbapbr 9.12. and the Health and Safety
otic, O:u 25332(s)T M(N.
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection, I agree to remove
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Will the applicant or town Willing occupant use equipment or devices which
it harudnn air conuminnts a defined by the Bay Area Air Quality Management
all new materials for inspection.
I.
DY-1 IPN.
I haft t read the hnudan materials mquiremcnts ander. Chapter 6.95 of the Califon
ria Ha m” Safety Code, Smile. 25705,25533 and 25534.1 mularn lthan ifthc Wilding
Jura Ma currently have a IMML that it Is my respombilhy 0 notify the mupant of the
mqulmmtnut which must be met prior Wwuance of a Catalina, of occupancy.
Signature of Applicant Date
-POO ✓ I - I n - o t.
All roof coverings to be Class "B" or better
Owner
or authorizend agentt Data