08030009 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACTt�R IIYI ORMATIOPI
PERMR NO.
BUILDAI4q{s�DRTIDERWOOD CT ALLBRAND WINDOWS 08030009
E0./'SbNUAME: PERMIT ISSUE DATE
MELINAUSKAS ADOLFAS AND 23312 CABOT BLVD 03/03/2008
PHONE! mon SANITARY NO. CONTROL NO.
(650) 622-0330
ARCHITELTIENGINEER: - BUILDING PERMR INFO
BLDG ELECT PLUMB MECH
O z LICENSED CONTRACTOR'S DECLARATION lob Description
a
U❑ 1 iontheme,70 affirm Net 1 am liccnud under providons of Chapter 9 l(,...,ads,myIt1,
zU wiFallr.on7daexDivision]ofNCBusincvandProfcssiuruCode.endmylicevcis q,71\7DW REPLCMMT(LIKE4LIKE) X15 RETROFT WINDWSr2PATI0
r< in full(Orel and effect
iq? Lieenu Class - opQ274 75 DRS
Contractor
k,q Delc r
p7W ARCNffECI'S SDECDECLARAT ON
i y< 1 undcrsunJ my plans¢hall W used az public rtenrN
iyU
Cin Licensed Professional
OWNER-BUILDER DECLARATION
9to
I hereby affirm Not I am exempt from the Contractors License Law for Ne
i2 O following reason.(Section 7031.5,Business and Professions Cade:Any city or county
e m which requires a permit to construct,Altar.improve,demolish,or repair any suucturc
prior an its issuance.also uquirea the applicant for such permit o 0leasigaNautamc I
Natal ulieevcJ pursoanuo Nc provisious of thv ConuuorilJttnu law(Chm A Sq.Ft. Floor Area C Valuation
`�$ (commencing wiN Sation7WO)MDivuion3or the Business and Profevsiam Code)or $7925
`;.•
that W At exempt ftnefrom and the basis for the alleged oempdoa Any violas an of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil Penalty of A�}pyt Number Occupancy Type
oat more Wan five hundred dalton(ML 35929015
I,As owner offt property,army employee with wages as their sale compensation.
willdathcwock,and We,mutumisaotinundedoroffemdlarial.(Sm.7044,Business Required Inspections
and Professions Cade:The Cantractars Liave Law does Dol apply toe An Owner of q P
property who builds orimpom Nercon,end whodoessuch work him¢elfar Wough his
own cmployeat.provided that such improvements are not intended oroReral for tela If.
however.the building or improvement is sold within one yea of completion.du owner-
builder will have the When of poring that W did Art Mid or improv for purpose of
Asia.).
1,as owner of We propert,am eulurively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Cade:)The Contractor,Li-
ccnse law docs not apply As in owner of property who Wilds or improm Wemon,and,
who contracts for ouch projects with aeomnctor(s)licensed pursuant An tita Contrsotors
License law.
❑I am exempt under Sec .B&P C for Nis reame
Dau
011 WORKERS COMPENSATION DECLARATION
I busby affirm under perWty of perjury oro of the fallowing de anti[ .
❑1 haw and will maintain aCardficau of Comentw ulr4usure fa Woders Compero
radon,As p.vhkd for by Section 3700 of in,labor Cade,for am xifman.of the,
work far which this permit is issued.
Q 1 have and will maintain Workers Compensation Insurance,As required by Section
3700 0l the Labor Code,far the perfmorman,of On it far which rhia permit is issued. '
My Workers ComprinsratioA Insurance ca a and Policy number are:
-� Policy No.Z66B9E710 Z
CERTIFICATE OF EXEM PTION FROM ORKERS'
COMPENSATION INSURANCE
films section need not W completed iliac Permit Is(atone hundred amAm($10))
ar lust.)
I certify,that in the performance of the work for which this permit is issued,)shall net
employ any person in any manner so az to become subject to the Workers Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL afar making the Cenifcem of Exemption.you should
become subject in that Workers Compensation provisions of tW labor Code.you muss
.JO faMwith comply with such this or Nu pc TilihAl W devoted rewked. '
Z N CONSTRUCTION LENDING AGENCY '
F-t I hereby affirm that Nem is a cousuuctmo lending agency for the performance of
rl,> the work for which this Permit is issued(Sec.3097.Civ.C.)
PWi Q Lenders Nvnc
] z Le rs AddM..
U 0 1 unify that 1 haw read Nis application rand sue Nn Ne above information is
ry F correct.1 agree An comply with all city and county ordinan¢s and sum laws minting to
0U building construction.and hereby autharim mpmummim orans city to enter upon de
W aliovc-memiuned popery for inspection purposes.
(We)agree to san,indemnify and keep harmiess Ne City a1 Cupertino agaient
habiliva,judgments,cases and expenses which may in any way see=against said Gry
U Z in mmsequenee of the granting of this permit. 7
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 3,3
SOURCr�gGUL S. -.p -
P'' 'j �-0T&.. VOP Re-roofs lI/
Signaum of ApplieanUConnaeor g u+an
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding aaupanlstare or luMk he ardaus manorial
ddred by the Cupertino Municipal Code.Chapter 9.11,and 0.Health and Safety
.Section 25531(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes t§
If a roof IS installed without first obtaining an inspection,I agree IO remove
Will the applicant of more building occupant use equipment or devices which -
emh havamous air comvminants As dclincd by the Bay Arca All Quality Management all new materials for inspection.
Diarict7
❑Yes
I have mad the Maamuu materials requireotvms under Chapter 6.95 ofdta fabler- -
nis Health&Sarctycodc,Sectiam 25505,25533 and 25534.1 unam stand ones iftie binding
does noscurrently hew Atenant Net' ' my maponnlility to notify the occurpeat 0(de
req ' hich mel t x.. (aCcrtiWa. r assay. Signature of Applicant Date
All roof coverings to be Class"B"or better
Owner or a.thmocd Agent Da