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CITY OF CUPERTINO
CONTRACTOR INFORMATION '�
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
ARGONAUT WINDOW & DOOR
PERMIT No. O 5080261
OWNER'S NAME:
PERMIT ISSUE DATE
ROBERT WONG
E
5
PHONE:
SANITARY NO. CONTROL NO.
408)996-9670
.J HITECfIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR S DECLARATION
Job Description
I larceny affirm that 1 am licensed under pmvisions of Chapter 9 (commencing
p
With Section 70OB of D'viaion 3 of the Busino_<s and Professions Code. and my liecnse is
thmlimmej
-
and ermme_g
15 WINDOWS/2 DOORS/EGRESS
License Cluyy Lin. M
Date^'SU •-J Convector
ARCHITECPS DECLARATION
1 understand my plans shall he used as public records
`
Liconsd Professional
OWNER -BUILDER DECLARATION
1 hereby Affirm that 1 am exempt from the Contractor's License Law for the
following mason. (Secfiun 7031.5, Business and Professions Code: Any city or county
which requims a Permit 111 Construct, alter. narrow. demo) sh, or repair any structure
$10000
prior to its issuance, also rtquioes the applicant fat such Permit to file a signed autemem
FL Floor Area
Valuation
that he is licensed pursuant m the Provisions of the COmmolor's License Law (Chapter 9
Sq.
(commencing with Section 701 M Division 3 of the Business aha Professions Code) or
Nat he u exempt thcaftom and the basis for the alleged exemption. Any violation of
3 A014 N9ZFF nOccupancy
Type
Section 7031.5 by any applicant for a Permit subjects the applicant o a civil penalty Of
not mom Nan Ova hundedd dollars (5500).
0 has..,of the prepcny,mmy cmploye,es with wag. As Nei, role com'asinkn.
Required Iingpections
will der tee work, and Ne swctum is not immided oreRered tarsale (Sec. 7014, Business
and Pmfcssiom Calc: The Conmcmr's Live Law doe nut apply in in owner of
property who buildsor improvs themon, and whodoes such work himselfor thorough his
pv
Own employees provided Nat such improvements am not intended or offered for sale, if.
e/
however, Ne building or improvement is sold within one year of completion, the owner.
jl
builder will haw the burden of proving that he did not Wild or improve, for purpose of
sate.)
❑ 1. a owner Be, Property. uconvacling with convectors i-
:) Theed
the project ($CC. told. . Business and Li -
rj
come
Code:) Theves
La wneofand ray he
come Law does not apply a an owner of protons who builds or improves theaon, and
ftn on,
for such projects wiNaconvamor(s)Iicensedpursuant to the Contractors
whence
r}+
Lace
License Law.
❑lam exempt AnderSec. .B&PC (or Nis rtaon
Owner Data
b'
V
WORKER'S COMPENSATION DECLARATION
I hereby smrm under penalty of perjury orm of Be following declarations:
and will maintain a Cenificam of Consent to self-insum for Worker's Compon-
u pmvided for by Section 3700 of the labor Code,, for the performance of Be
for which Ibis permit is issued.
0 1 have and will maintain Worker's Compc.ation Insurance, as acquired by Section
3700 of the labor Code, for the performance of Ne woe for which Ibis permit is issued.
My Workcea Compemalian Insurance carrier and Policy numthr arc:
S"'l-cr 066 2-114 '2u
Caber. {= Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W complcad if the Permit is foronc hundred dollars ($100)
or I.s.)
I anify that in the performaneo of the work for which this permit is issued. I shall not
employ any person in any manner an As to become subject to the Workeri Comts.arion
Laws of Califs '. a
Applicam
NOTICEt, 0 APPLICA r making Nis of Exemption, you should
Ano a Object to Ne Worker's Compensation provisions of the labor Code, you must
fo with comply with such provisions or thio permit shall W deemed aveked.
t
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction ]ending agency for the Performance of
the work for which this permit is issued (Sec. 3(N7, Civ. C.)
Lenders name
Underi Addts
{ 1 certify that I have read this application and tuts Ibat the above information is
with ailcityand countyordin n and sue laws slating
coma 1 agree m comply with all city and county ordinances
to
building construction. and a of e
of this city in enter upon Ne,
/v J
above mentioned property for inspection purposes
(We) agree m saw, indemnify and keep harmless the City of Cupertino against
j liabilities. judgments. Costs and expenses which may in any vwy accrue agefnsl said City
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ineonanu ccofthegrantingof Ibispc A.
JJJJJJ
APPLICANT UND R NDS A ILL COM Y WITH ALL NON -POINT
Issued by: Date
SOURCE REG TIO
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Re -roofs
ignat ofAVE ma Con Date
AZAR OUS MATERIALS DISCLOSURE
Type of Roof
Will thea cant or future Wilding occupant store or handle hazardous material
,
As defmN by Bra Cupertino Municipal Code, Cramer 9.12. and the Health and Safety
Cou,. Scotion 255320)T
All roofs shall be inspected to any roofing material being installed.
❑ ret
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the aP,Iicant or future Wildingoceopana use equipment or devices which
" hazardous air contaminants As defined by the Bay Area Air Quality Management
all new materials for inspection.
ct?
❑secs �]TJu
I have sad the hanNnusm``ao:rials requirements under Chaper6.95 ofthe Califor-
/s
nixF-alN&Safcty Code.S.dona25505,25533.dU534. trade dIbmif IbC Wilding
docs not cumendy have a m M, that itis mspo am ity to notify the occupant of the
rcyvimments which a or poorti anccofa Ccrti e,mprOcCupeney.
reo A Date
licanAll
3o
roof coverings to be Class "B" or better
tuner thori. e t Dam