06060191 CITY OF CUPERTINOa ?d `*=
BUILDING DIVISION PERMITCUNLRAGFQRIIURMATIt)l+�i�
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BUILDING ADDRESS: WINDOWS PERMIT N0106060191
6772 JOHN DR
OWNER'S NAME: PERMIT ISSUE DATE
ALICE HUONG 551 INDUSTRIAL RD 06/21/2006
NE: SANITARY NO. CONTROL NO.
(650) 622-0330
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
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Sop LICENSED CONTRACTOR'S DECLARATION lob Description
Gs 1 hereby affirm Nu I am licensed under provisions or Chapter 9(commencing P
IN Section 7MIl)of Division 3 of the Business and Proftamom Cads,and my Iicmnw Is
+� mmurarteandeR �2� S REPLACING WINDOWS AND DOORS : 5 RETROFIT, 2 NF/
Z Lkenw
R— Date - Conester STUCCO, 1 NF/STUCCO WITH WALL CUT DOWN, 1 DOOR
B ARCHITECr3DECado!N SLIDER, 1 DOUBLE ENTRY DOOR.
I understand my plans shall be used as public records
J U
d u
Licensed Professional
EO OWNER-BUILDER DECLARATION
'n i hereby Milan that 1 am uemps from the Contraaofa License law for nice
O o (ollnwlnp mason.(Section 7031.3,Business and Profession Cade:Any city at county
$fvi which requires a permit in comuuct,alkr.Improve,dcmolsh,or repair any structure
prior in its iauance,alw requires the applicant for such permit m file a signed statement
pp al Nat he is licensed pursuant totbeprovisions oflheCommerofkL3wnmLuW(chapter 9 Sq.Ft. Floor Area Valuation
i $ (commeningwith Section 7ppinmub
)ofDivision3attheBusprofeuion,Cale)tar $8688
— that W is exempt therefrom and Ne bask for the anc&ed asempdon.My violation of
Section 7031.3 by any applicant for a permit subjects the applicant 10 a civil penalty of APN Number Occupancy Type
test mom dun Rn hundred dollars(W00).
1,as owner of ilia property.or my employees with wages na tbcirsule compenasdon,
will do the work.and dustrwtme knwmtenaadwofkred rwale(Sac.7044,Bumntas Required Ins actio
and Profaasian Coda The Conttanara License Law data act apply m an awn,or 9 P
property who builds or improv therean,end who doea such work himself or dueugh his
awn cmploycta,provideddtataueb Impmvem.s as oat inmeded woQemd farsme If.
builder,the building u improvement k cold wldid Out
year of wmple for pur .ower- /
builder win have the burden of proving that bo did tet NUId w improv far purpose of
akJ.
❑1,a owner of the property am eaclumvely canon tin&with licensed consracmm m
cantmCt d c pmjm(Sea.7044.Business and Pmfessian Cade:)The ConsracWs U- n
cone Law does not apply m an owner or property who builds Cr improv Neeson,and (/
who cones for such projects with a eonuaemr(a)licensed pursuam an the Contractor's
Lkaae Law.
❑I am"amp,under See .B k PC fes Nis some
OwnerDau
WORKER'S COMPENSATION DECLARATION
1 hereby sRUn under penalty of Perjury arc of the fallowing declaradon:
I have and will maintain a CerriOcam of Consent to self-room for Workers ComPan-
radon,as provided fes by Station 3700 of the Labw,Code,fes the Peffomatce of dte
w
ork�for which this permit s issued.
Lq'1 Mw and will maintain Worice.Compensation Insuaatue,as required by Suction
3700 or Ne Labor Code,for the perfam Lace of the work for which this permit s issued.
My Workees Compensation Insurance carrier and Polity number art:�Z�
Caniert Siut`e Cola7j>.+ I.F policy Ba.: 8x"'%'��
CERTIFICATEOFn0N FROM ORKER$'
COMPENSA7WN INSURANCE
(ThUsuctlnn wed anti ecampleted if the perch is fwow hundmAdollan($IM)
to,lea)
I unify that in the performance N the wart for which this permit is issued,I shall out
employ any person in any mannerso as to become subject to the WarkerY Compemstion
Laws of Cmil0mdL Dam
Applicant
NOTICE TO APPLICANT:If after making this Cer iRcam or Exception.you should
becames4bjC.m Ute Wohers Compensation pmvili.of the labor Code,you must
.J O
forthwith comply with such provision or this Permit shall he domed ranked.
z'tiCONSTRUCTION LENDING AGENCY
[n 1InmbyaOlm Nat Nem Is a conwnctiw lending agency festhe perfomace of
the work(or which this Permit s tssurm(see.NH's.CN.C.)
W Q Lenders Name
.a7- z Lenders Address
V 0 1 terrify that 1 ham mad this application and tum Na the above information Is
ly F correct.I agree to comply with alt city and county aNins nces and some laws relating to
0(, wildin&conxuuetion.and hereby aab.d.mpresenUtiv of Nis Cir,tocnter.,no til
W alwvc-memiancd rropemy for inspection pugaus
(Wc)agree toave,indemnify and keep hamlet dm City of Cupco ino 1001
CA liabilities judgmens,ants and eapeaaet which may N any boy accrue ajims,said Oly
fj In consequence of the&senting of this Permit. / 2
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date o'
S? REGUyyTONS. �7
�^ -3/a,.�z Ur;-21-c06 Re-roofs
Si& um of ppticenUCommactor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Use applicant Or(store building oamp.t amre or handle hmsadl material
as defined by Ute Cupertino Mum— 1 Cade.Chapter 9.13,and Ute Health and Safety
Code,Secdon 35l33(a)1 All roofs shall be inspected prior to any roofing material being installed.
❑Yes o
Will thou applicant or future building Occupant use equipment or dcviwa which If a roof is installed without first obtaining an inspection,I agree to remove
mit huamnw ter cwWniner s u deRwd by the Bay Area Air Quality Mangement all new materials for inspection.
District? ,a"���
❑Yes Lb^a
I ban mad the hwardswmaterials requirements underChep er6.95ofthe Calirm-
nk Heahh&Smelycade,SeNws35505,35533 am!15534.1 understand lha Kdte wilding
dna not currently ham a mnan1.de u my rtsponmMlity,m notify den occur.(of the
,orwhich nest aseWU of cco;Bea^moorroTcy.nC Signature of Applicant Date
Ownerunuthoriped agent Dam All roof coverings to be Class"B"or better