08020023 CITY OF CUPERTINO r- :axwa't�' mr
BUILDING DIVISION PERMIT £COO NTIt eld INFORMA"CION *;
PERMIT NO.
awl.�.��� T'6-RAKE CT TBD — TO BE DETERMINED 08020023
WNER'S NAME: FERMrr UWE DATE
THOMPSON CHARLES F AND KAY E 02/04/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O 0
30p LICENSED CONTRACTOR'S DECLARATION IOb Description
I hereby AM.Nat 1 w licensed under provkiou of Chapter 9(commencing P
�z1 Nth5esan7OU)ofDi onJoftheButlnwaMRofsdonsCod.aMmylkesois REPLC 7' WNDWS LIKE4LIKE, 1 DOOR SIZE4SIZE
^�H of full force and
Liz use ass Lk.d FboZ-I ARETROFIT
„ Dam AR HITECT'SDDE D THD @ HOME SERVICES PD BSL 2/4/08
I .=d my plans¢ball he umd as public needs
5 c Licensed Professional '
y OWNER-exempt frDECLARATIONtheComun
0 0 I henry aRrm that 1 am exempt from the Casks.Co License Law for the
p� followingmoon. emtion cosd.Btulmuandw,de rens Code:Any city or county
which its Issuance,
.permit to fac stmm4 aline impmw,demolish.il repair ed atmdum
zSn
poor miuiensedpalso uantto the lMvisionsof for such onnousmitmfictsm signedstatement
�S0 tMheBlkgwithSrction7 Ncpmviriouofof the ftBuscrosandPrxlaw(Chapmr9 Sq.F[.Floor Area Valuation
Quat he(commencing with Sectlon70ndth basis
ofr the al Business and Prafesalon.Cade)of $9390
- dW io ts eaembt say a oro and the Ease for bj cts ft cumpdon.MY l faunally
of
W. 70713 by acy red dont for a permit subjects cot Applicant m a civil penally of Number Occupancy Type
W mom thea Bw hundred dollen(SSOOk 3 1632015 !ff p y yp
❑1,asownerofthe property,amy Naployces who wagesat thew sole compntution,
wilt do the work and the swclun u rot intended or offered for miles(Sm.7044,Business Required Inspections
And Professlaru Code:The CanuacmYs Lkcnu law dote cot apply m e an owner of q P
propenywho WIWar(mptaws thereon,and whodoessuch wark hica lfm through his
awn employees,prwAded mrtsuch Improvements an notintended aro@mM(mule.IL
however,the Wilding or improvement is sold within am year of camp ration,the owner-
builder will haw the Wrden of pmNng that M did not Wild a immune for purpose of
ul.j.
❑1,n owner of the property ata melmiwly contracting with licensed contractors in
consuum tW project(Sec.7044,Business and Professions Cade:)The CoouacmYs LI-
«ve law does not apply In co awmr of Properly who Wilds or improve demon.and.
who contacts for such projects with a conusdot(s)licensed immune in me Comactor's
u mtu law.
❑Iuneacmptunde See ,B,kPCfmtWmsson
Date
WORKER'S COMPENSATION DECLARATION
1 hereby a1Nso under panalty of perjury ate of the following dalarWans:
❑i haw sad wit mainby Section
3M of Gnssm,u Code.far
fa Wakefs Gammen-
utian.uprovided(m EY Sestian 171p of W tabor Code,far the perfannvnce of dm "
war or which Of.permit is issued. - -
L�)C[1k',Lhaw And will maintain Worker's Compensation Insurance,u required by Section
Jp00 of rite Labor Code.for the perform Ince of the wort for which this Farrah is issued.
My Wor e.Compenudon/Wenn easier and Policy number m:
Grrier PoNo.0921111:90
CERT, CATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
ante shim reed cothcompleted Ifthe permit isfinenchunNN do ues(Sim)
or kat)
1 certify Nat in the perfarmuce a the wart fm which Al.permit u issued.I shall mat
employ.any per�0P in snym rsoulRbcmme auhicmtmthe Wodten'Gmpensstim
Laws o(CalifduTApO
LAPlkant YY'`j
NOTICE TO APPLICANT.IL after making this edl of Exemption,you should
become subject to the Worker's Compensation ptmisiom of the labor Codc,you mum
wJO forthwith comply with such provfalnns of this permit stuff W restaed mwked.
z CONSTRUCTION LENDING AGENCY
C47
t•^ I Wnhy a111tm Nat them is a comtmNnn lending agency for the performance of
Gi > tiro wart for which this permit is used(Sec.3097,Civ.CI
W�0 Tendo',Nuns
z lenders Address
V Q 1 snooty that 1 haw mesd this application and sum thss the show Wrormmun is
IL^ correct.1 same m comply man N city and county o almrtas sM sou Ian nladng m
.O SV^ Wilding couwerion,and hemby auN^rla mmencrudwa of this city in neer upon 0u
W .lave-mendaned property fm inspection purposes.
p1t (We)agree to an.fndcmnify and keep hu bless the City of Cupertino against
y liabilities,judgmenu.casts and Ammons which may in my way accom against said City
V in consequence of the Smarting of this Permit. �.
^t -POINT Issued by:
APP ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON Date
5 KR REGUL IONS
—Y--LIze Re-roofs
Signmumof Appliesn m Date
ZAI USMATERIAL9DISCLOhVRE Type of Roof
Will tite applic r future Wilding ocouPutcome ar handle huxdnu material
As defined by due Cupertino Municipal Code-Chapter 9.12,and the Health and Safety -
mdc,Section 19sJ2(.)7
t]Yes D)Nu All roofs shall be inspected prior to any roofing material being installed.
Will the.pplleast or fume Wilding occupant use equipment m de.;ces which If a roof is installed without first obtaining an inspection,.1 agree to remove
emit hazardous air contamirenu As defend by the Bay Ana Air Quality Management all new materials for inspection.
Disuict7
❑Yu u
Ius.raW thaha.S memriatsnqu a and
rChatand ms if the Califon -
ntsHalthdrrentlSafety Code,A.WnshatitI my ted LiSJlty us Audi, thmifthe of the (per/I,T a ,n /t ly/
irug
n t currently taw a tenant That It is my ruponsihllity m notitY the ottupant of dte �'(�a�`'/ �— • '7,�
ants which Wmet 'ar les issuance of a cenipcam of Occupaay. Signature of Applicant u Date
Owner ar.mtharf sent Data All roof coverings to be Class"B"or better