06090039 CITY OF CUPERTINO
BUILDING DIVISION PERMITSCO .TjUelmRT 'FQ' MA'CIt N
BUILDING ADDRESS: ALLBRAND WINDOWS PERMR Nth.06090039
1002 KENMORE CT
OWNER'S NAME: PERMIT ISSUE DATE
MOYANO FRANK D AND LINDA 551 INDUSTRIAL ED n9/n6/2nn6
E: SANITARY NO. CONTROL NO.
(650) 622-0330
ARCHITECTIENGINEER: BUIIDINO PERMR INFO
BLDG ELECT PLUMB MECH
ions LICENSED CONTRACTOR'S DECLARATION IObDaSCrI tion
U 1 hereby air,.Nat 1 me license under provbiou of Cb.,.9(mmmcteing P
Mn Secuon7OW)of DivWoo3ofine Buri st NO(esswns Code.andre Ire<nseu
i0 fellfaree ae girl, REPLACING 5 WINDOWS . RETROFIT, 1 DOOR SLIDER NF
;p z ueenm C a - I conte
�Fq Dau Conuaewr '
7W ARCHrMCPS DECLARATION
i I uodemund my Plana shell he used as public roemm
t6
G
Licensed Professional
y Oat I am exempt
from
the RATION
Common
n C I hereby.(sem on I em exempt from Liu Cnrnins CoLicense: Law far the
p o which re tenon.(Scotian 703 teare Business and Professions Calc:Any city or county
5_tai which requires a permit to canstoc4 aloe Imprnvc,demolish,or repair any almcture $4048
-i< prior in is imumm,,alsu mquirm moapplicant(at such permit to fim.signed suumem
o
that be is licensed pursuant to dm previsions of We Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
i (commencing with Section 70M)of Division 3 of the Business and Pmfcssinm Code)or
met he is exempt Ihemfmm and me bah for me alleged exemption.Any violation of
Section 7031.5 by my applicant in,a permit subjects me applicant le a civil penalty of p U v Occupancy Type
fiat more than five hundred doll.,($500).
❑I,as owner of the property,or my employm with wage,at their sole cempenadon,
will do the work,and deswmure b not Intended or Offered for sau(See.70N,Business Required Inspections
and Professions Cam:The Conaecmfs License Law doth not apply to an owner of q P
Impeny who builds ar Improves mereon,and who daes,uch work himself or though his
own employees,provided met such improvements wa not inunded or offered forsam.If,
however.the building or ImProvemant is old within one year Oi canptetitn,me owner-
builder will have the burden of proving that he did ms Mid fir improve for purpose of
sou.).
❑1,u owner of des property,am exclusively contracting with license conuacttss in
canstmct the project(Sec.7044,Both.and Proftasiau Code:)The Contractors Li.
cense law data not apply in m owner of popery who Will or Improves thereon,ad.
who contracts forsuch projects with a emteaToNs)licensed purmam in me Committees
License Law.
❑lamtaemptunda Set ,B&PCformi,reasm
0"
Dau
WORKER'S COMPENSATION DECLARATION
I hereby a01ro under peulty of perhary arc arms:following dochresdou:
❑Iham and will maintain sCuniOcete of Consent to selhhnsumforWorkmesCompo-
saHan.a Provided An by Section 3700 of Ie Labra Cau;tar me part...of the
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,u required by Smith
3700 of me labor Code,tar the performance of ma work for which this permit is Issued
My Workers CId Policy number
Carrier...5� �olky Na.: I 8'�2 S
CERTIFICATE OFE EM MON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed]fine permit Is foranc hundred dollars(SIM)
.,less.)
1 cenify that In me performance of me work fa which this permit is blued,I shall not
employ any person in any manner so u to become subject to me Workcri Compensation
Laws of California.Dem
Applicant
NOTICE TO APPLICANT:If,after making this Cenificam of Exemption,you should
become subject m the Workers Compensation provision,of me labor Coda you mut
.,O foMwith comply with such provisions or this permit be doomed revoked.
Z VICONSTRUCTION LENDING AGENCY
F-t I hereby alfran that them is a consuuNnn lending agency for me performance of
a> the work for which Ids permit b issued(See.3097,Civ.C.)
Obi CI undoes Name
M z (cadets Address
U0 1 cenify that 1 have read this application and ante Nat the above information is
fU, correct]agree m comply wire all city and county ordinances and sum laws relating to
OO building construction.and hereby amhonm representatives of this city to cruor upon me
r Ual om mentmrecd property for inspection purpeses
F G (We)agree to ave,indemnify and kap lournma me City of C.Purlmo against
rn Iiabiliuu,judgmenu.eosu and expenses which may in anywayxc.ue against said City
U incon,equenceormegrmlingofthupermil,
APPLICANT UNDERSTANDS AN ILL COMPLY WITH ALL NON-POINT Issued by: Date g U
souREcuunygs. / j
(/�.� O 9�OG• OG Re-roofs
sigutu s Of Appliwudoom mor Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant gore or handle hatemous material
as dented by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
ale,Section 25532(,)+ All roofs shall be inspected prior to any roofing material being installed.
❑Yes N
Will me applicant or future building Occupant uac equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Omit hovudnus air conumtnana u defined by the Ray Area Air Quality Management all new materials for inspection.
District?
❑Yes LWro
I have mad In.hnmrmms materiels requimmunm under Chapurd.95 of the Califor-
niaHcal"SafetyCode,Secuons25505,25533 and 25534.1 understand meti( is building
dace not currently haves a anent that it is m rcsponsihility o nudity me atupant of the
mqulm( ichmyy-by�fp�i t�acetdficaeoroc piney. Signature of Applicant Date
1�� X06 06 All roof coverings to be Class"B"or better
Owner m iumorired egcm Date