08040128 CITY OF CUPERTINO
BUILDING DIVISION PERNIIT CU1�IRA.CTO10INFURMA.TIQN
BUILDING ADDRESS: PERMITNO.
10366 HENEY CREEK PL ALLBRAND WINDOWS 08040128
R'S NAME: PERMrf ISSUE DATE
FEN CHOI 23312 CABOT BLVD 04/18/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILD No PERMIT INFO
REPLACEMENT OF 15 WINDOWS BLDG ELECT PLUMB MECH
3m O O O O
�c LICENSED CONTRACTORS DECLARATION Job Description
I hereby affirm that I am licensed under prorlsioa of Chapter 9(commencing ^^^ — —••^ P
S� wig Secdon7010)of Division 3.1'she Budnesa and Professions Code,and my license is
in full force aim e(f
m Lieeue to Lr.N
5 a D.m� camr.nar
ARCHITECTS DECLARATION
1 understand my plans"I he hand u public reeonds
tad Licensed Pmfteammal
5 OWNER-BUILDER DECLARATION
9 I bunchy in.Nu 1 am esempt from the Con homme,License Law for the
C O a following reason.secdon 7071.7.Business and Pmfesdon,Code:Any city or county
S$ which requires a permit to conwut,dun.improve,manalWL m mptir any umnum
S^ prior b its issuance.also requires me applicant forsnch permit to file a signed Comment
< mar he is licensed pursuant u the Provisions or the Comment's lueme Law(Chapar 9 Sq.Ft. Floor Area Valuation
9 (commenting with Section 7000)of Division 7 of the Business and ProksdnM Code)or
.. that he is exempt rt,^mfmm and the buls for toe dtoged eump0om Any violation of
Smums.7071.5 by toy applicant for a permit subjects the applicant he a civil penalty of APN Number Occupancy
bre mom data five hummed doles,(S51)[1), P Y�'Pe
0 1,u.of con property,or my employees with wager as them anm compeuWOn,
"I do the work,and the ummum B nut inmMed or Offered far same(Sec.7001.Business
and A Gem a u Code:The Combustors Lt.Law dean rat apply 0 an owm of Required Inspections
property who build+orimproses thereon,and who do enthwork binocular Waugh his
Own cmployeex,Provided thatsuch Improvements sm not Intended aro0cmd fursala If.
m m m,me building or improvement ts sold within ane year orcompledon,W awOcr-
Wilder .will haw the bander of paving mat Ise did rot Wild Or improve far pugmse of
sale.).
. 0 I.u arm of tin property.am acludwly conuwing with licensed Conuactm to
Constmet the project(Sea 7041.Business;am Pmfessiaes Cade:)Th Com emra U.
an=Law does not apply to an Owner of popeny who Wilds or improves daemon,and,
who can®cu for such pmjeeu with a eontranor(s)Iianmd pursuant to the Cannsetora
he law.
esempt undo See ,BhPCfar Ws moon
Data
WORKERS COMPENSATION DECLARATION
I hereby affirm under penally of perjury,arc of the following decimations
0 1 ban and will maintain a Cerdnettoof Consent to selFluum far Workers Compere-
w(on.
wr pmvidhi fpc by Section 37000f the labor Code,far W(xrlormance of
works
eworksfes which this prmil is lashed.
0 1 haw and will mdmain Workers Campevulan Iumsuce,as taxpared by sCoJon
7700ofine LammCann,fe,Can pRmmumt Ofthe work for which this,permit is luecd. '
My Workers Campemmtion Wunnce aria and Polity number
caomr216Uht4 IA1f ehlD Policy No.:
CEIfTIFlCATfi OF�PIION FROM WORKERS'
COMPENSATION INSURANCE
from mala and untbecompmemd if We permit Is forma hummed do0an(3100)
orients)
I cenify mat In the performance of the work for which this permit is issued.I Nail no, '
employ any Wasan In any manner an as to become subject to W Worked Compensation
laws of Califom(m.Dau
Applicant
NOTICE TO APPLICANT,If.after making this CertiOcam of Exemption,you should . .
mature eubject to the Worker's Comperation movYlom of the IabM COM you most
vJ O forthwith Comply with such provisions or mu Remit dull be dankd nvekad.
Zan 5; CONSTRUCTION LENDING AGENCY
[�v w+ Iherebyapim this men u a Connotation lending al for the perrmmartoe of
kX>
We wart for which Wer penes in iotad(ser.7097.Civ.Q
QLander,Name
Z Landers Address
U0 I malty that I have reed Nis application aim sum mad the show imfarm dut u
IL correct 1 apo to comply with all city and county ordinances and sum laws mWng to
building construction.and hereby authorim representatives of this city to enter upon the
Ix7 show-mcnthmod pmpeny far hoped.purposes
LL (We)agree to taw,indemnify and keep harmless Jm City of Cupertino agalut
A lubilitia,judgment,COW and expenses which may in sty way menus,agdulmid City
U Z in corsequenee of the granting Of this permit.
�••' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POOR Issued by: Date
SOUR REG LATIS.
SlgamneofAp i� ommator Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appliesm Of frame Wilding Occupant time Or handle haaNOus material
fined by the Cupeni o Municipal Code.Couper 9.12,and the Health and Safety
.
section 25572(.)7
C]Yen All roofs shall be inspected prior to any roofing material being installed.
�J o
Will me applicant or(Mature building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hualloa air contaminants u defined by me Bay Ana Air Quality Management all new materials for inspection.
District?
0 Yes
I have read the herndous Cour ts requirements under Chapter 6.97 efthe Califor- E
maHalth&SafetyCode.Sectiamx55M.x5577 an!25534.1understood that KtheWilding
dada an,eunendy have a mnmL that It u my no,omihility to notify the acoupant of the
requimmcma whr muss t poor to iuo,ncc of a CertiBcam of pan
5° � u`1 = Signature ofAp licant Date
Owner Owner All roof coverings to be Class'}W'or better
arauthomcd agent mm