04090225 CITY OF CUPERTINO ` °+^e n �k=e " �' r
BUILDING DIVISION PERMIT k CONTRACTORINFORMATION.f
BUILDINGADDRESS: CRYSTAL CLEAR WINDOWS & DO RTND04090225
R157 T4YANNTqP(-)T?T DR
W NER'S NAME: PERMIT ISSUE DATE
CHARD
NE: SANITARY O. ONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMU INFO
SLOG ELECT PLUMB MECH
0 0 0 0
wap LICENSED CONTRACTOR s DECLARATION - -"" -- Job Description
WUp 1 hereby affirm Nal 1 am licommi under provisions of Chamen
pter 9(comcing
iW wiNSemion]0(IU)af Division 3.fthe eusirinu and Pmfessiun,Code,andmylicenm is
-'a in full forts and cff=L
-'a in License Class Lica WINDOW REFLACytpY5,ggR�N0r �ry�I ESS)
o1-S Dam TS DECLARATION Ir /,=,\11
€ty ARCHI Contion,tur TION N 111111111111 VVV//// NNkI�
I uMersunJ my plans.hall he used as public rtmma
Ota
=o„ LicenJPorfcuionel OCT S 2004
3 0WNE0.-BUILDER DECLARATION
<� I hereby affirm that I am exempt form the Contractor's Licenm Law for tbe
c0 following reason.(Section 703 L5.Business and Perfessi.0 Cale:Any city lir county
$tai which requires a permit to construct,alter.improve,demolish,or repair any stmcmm 40 0 _
prior to its issuance.also requires the applicant forsuch permit to file a signed summent
that he is licensed pursuant to mu
the pvisioof Nru
Ne Commr',license Law(Chapter 9 Sq.Ft.Floes ValuaClon
�F$
that
he
exempt
ofDiviaion3 MtheB ed excand Any
A,Calc)or
— Nat he u e.mpt therefrom and the bus far Ne alleged exemption.Any violation of - - -
Section 7031.5 by any applicant for a permit subjects the applicant to acivil penalty of 3 Mjgj,pifteyo 0 Occupancy Type
not mart than five hundred dollars(S5W).
❑1,u owna of IW pmpeny,w my employeeswith wages a their mle campenution,
will do the work and thesweture i,notimmndcd or offered forsak(Sec.]OEC,Business
and Professions Code:no Contractor's License law does Out apply to an owns of Required Inspections
propcnywho builds orimproxes Hereon,and who doessuch work himself orthrough his
son employ=.provided that such improvements arc not intended oroRrsed forule.If,
however.the building or improvement is sold within ow year of completion,are Owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
I,as owner of dm propcny,am exclusively contracting with liccned conommn to
onanict the project(Sec.]OCC,Business and Professions Code)The Contractor's Li-
tie Law dors not apply to an owner ofproperty who Wild,or improves dormant.and
who conmets for such projects with a eontrictor(s)liaued pursuant to Ne Coro acones
License Law.
❑l am exempt der Sea .B&P C r is reason
e• �f 1.�, .%moi Dam 0 .
n 7—'WORKE SCOMPENSATION DECLARATION
1 hereby a(rrm under penalty of perjury arc of the f Ito da]aratiou:
0]ham and will maintain a Certificate of Consent to self-insure for Workers Cum en.
cation,as provided for by Seetion 3700 of the labor Code,for Ne performance of the
work for which Of,permit n owed.
1 have and will maintain Worker's Compensation Insurance,u required by Section
3700 of the labar Code,for Na performentt of one work for which this permit is issued.
My Workers Compensation Insu ante carrier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(his section wed not W completed if the permit is form chundrtd dollars(SIM)
lir ins)
I certify that in the performance of the work for which Nis permit is issued.]shat]not
employ any person in any manner an as m become subject to the Warkcia Compenution
Laws of Califomia.Data
Applicant
NOTICE TO APPLICANT:If,after making this Cmifnm of Exemption,you should
become subject to the Worker's Compensation provisions of Ne Labor Code,you must
.JO forthproor
with comply with such visions.,his pomiun beeemed re
hadvoked.
Z .�`. CONSTRUCTION LENDING AGENCY
'r. 1 hereby affirm that Nem is a comwction lending agency lot he Performanw of
(Lr
the wart for which this permit u issued(Stu.309].Civ.C.)
V.1 Lenders Namc
z Lender's Addnus
U C) 1 certify that 1 have read this application and sum Nn thc above information u .
U Fcorrect.I ague to comply with all city and county ordinances and sum laws relining in
C)U building connection,and hereby..,hurt.rtpremminives of Nis ci ty to enter upon Ne
Y'W .have-mentioned pmperty for inspection puga
mse
CL (Wc)agree to save,indemnl fy and keep harmless the City of Cupenino against
nF.y liabilities.judgments.costs and expenses which may in any way scenic against said City
U Z APPLICANT UNDER4TANDStAND TWILL COMPLY WITH ALL NON-POINT Issued by: Date 77
SOURCE E LATIONS_SK .
0 V Re-roofs
gnats of APPlican A_RDOUS MATERIALS DISCLOSURE am Type of Roof
Will the applicant or future building occupantswm or W khuallova matenal
az defined by Nm Cupertino Municipal Code.Chapter 9.12.and t e.1111N and Safety
Code,Section 25532(a)] All roofs shall be inspected prior to any roofing material being installed.
❑Yn X.
Will the applicant or future Wilding occupant..equipment.r device,which If a roof is installed without first obtaining an inspection,I agree to remove
mit ha>ardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Distna?
❑Yes (XNo
to
ave mal the hvan,nu mammals requirements under Chapter fi.95 oftbe Califory
nia Health&Safety Code.Se6on25505,25533.d25534.1undersundthatildm Wilding
dw not cumcndy has.a mnanl Nat it u my rnp.mibility to nodly dm occupant of Nc
rtqui n which mug mmet poor toiss.ameofaCcrormaseofOccupancy. Signature of Applicant Date
owners e.Nond enc Date All roof coverings to be Class "B"or better