01040099 CITY OF CUPERTINO
BUILDING DIVISION. PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N(1. ,
ARGONAUT GLASS & MIRROR 01.040099
OWNER'S NAME-: APPLICATION SUR DATE
OGA—SUh NYVAI_E RD04/1.9/2001
4 PHONE: SANI I'ARY NO. CONN rRO1.NO.
(401A) 777-8194
p OW z ARCHITIiCnENGINEER: BUILDING PERM'INFO
FOC RI.IR' ELECT PLUMB MECH
a��i —d I-1 CI CI
yay
5 H z uclaNSEn co"rxncrDR's ulscLnxno°N Job Descripl n
pZ_O 1 M1crehy nttirm Thin I am liccmnl under Provision.of Chapmr 9 ommencing
O''E Q w 11 Sce1 ;'100X)of 1)ivi.iun 3 of the Nµcinc.m i'n,fes.iuns Cute y license
E
(W p ,e I t c J n. Lia rs
55 a ill +,L�4i-lam/— Gnn; ; _
g`o nxuvlEcrsD LARATION CHANGE OUT 13 WINDOWS &
IanEeirshns yplansandlWtowdasp.bbc,eeords 1 PATIO DOOR.
w O O Licenced I'viis.cional
n cos OWNER-BUILDER DECLARATION
w B m I numb,ufit....deal I am exempt from the Cnmmanr'c Liernw I,aw for the
F'=< following rta un.(Seek en 7031.5.Business and Pmfesci ne,Code:Any city m amaty
x p which regaims a pI to comlomr,aIle,Improve,danoli.h,or repair any promote
u, Prior lu its i...love..1w.reynire.cn+capprcanl ursuch perrnino file.AimesLmamment
mel hei.ficemodpormamththe previsions ofthe Countries Licenwlnw(Chapter 9 Sy. Ft. Floor Area EDValuation
ma
( nn meing with Section TM)It proision 3 of mR
e .sinesc and pmrcv.iGdcl
nn.
or that he is exempt therefrom and the basis for the alleged excretions.Any violation
or Seen 17031,5 by any applicant kc,a piano: ah,co,die applicant m a vml Iwnaly.
It to),more than five hundred radius($5M). APN Number 0 ` 200Dccupancy Type
01.ar mor n,f me progeny.Or my etnple ce.with wngca e.mei—ele oln,er-lio.,
w'11 do line work, J the loicalre is nal intended agreed in,,sale Nev.9011
B."mr,,and ProdfieWco,L d t he C,odcri U1,ol Law J t Lppl,to a, Requi
w I property Wh build improves thercon,and who dcw.%such ti k tuelf
thloo,h bawl.o++:ply 1 droll d t 1 ' lnv.n noun, cit intended ,, 3561. 1.063. 00
Offered her role.If,however,rhe budding or improvement is.old within one year of
iur,f,ion,Incown—boilde,will have the humin of pmvina;hat he did not build or
mprove for purPow of.ale.).
°I.as owner othe propon,am exclusively contracting will+licensed cnmractnr.too 101 . — FOUNDATION
L+maria the proffer(See 1044,Rasinec,and Inufeseionn Cnde)The Comrwwr'. 102 — PIERS
iecnw I.uw does.....apply u,an owner urpmpony woo build.,or impmvcc Into r.
and who contract,for such pmj,�v%with a connections)ficeawd pursuant to me 103 — UFE R
Co;urnworI Ciccone blow,
0 l am exempt under sec. .If K P C to,,dr,mason 104 — REBAR
owner nate 105 — ANCHOR BOLTS
WORKER S COMPENSATION DECLARATION 1.06 — SEWER & WATER
I hcmbyarfinn undo,pe..It,of perfa,-ran,on he rel In,in,deelaramn.: ?_02. — UNDERFLOOR PLUMBING
0 1 have and will maintain a Cenilica¢of Cuero to self-imus Ibr Work
Compensation, as provided file by Sermon 3701 of the Labor Coda, for fle 203 — UNDERFLOOR MECHANICALperforooureconl+ewndl6,,.hichddapormh i.issued. 204 — UNDERFLOOR FRAME
0eve and will remote inWn.kersCompen.alioiIn.mrole.a,r., mdbySecan;; 205 — UNDERFLOOR INSULATION
at the Lube m
Code,for the perfO +ance of the work for which this permit is
shod,MyWorkel.cr.aq,,..innmamaneetanderandpolicy ntimber' 301 — ROUGH PLUMBING
Poficy Nr: 302 — TUB & OR SHOWER
CER7919CATION OF I101710moN FROM WORKERS'
COMPENSATION INSURANCE _ s03 — ROUGH MECHANICAL
('Mis section need not he completed if the permit is for one hundred dollars 304 — ROUGH ELECTRICAL
(911011 ur lenv.)
I lemi1Y m.a in the performance of;he work ori whim this pociir,issued,I 305' — FRAME
aha n employ any town in:my r,+4 'it +a,m necnme arinlem to me W"ke^' 306 — HOLDOWNS
-non" .
o(Cu..n.....I lhm
I'll it 307 — INSULATION
tyrlCli TO APY,"" ,ILMI,leaking nhi.Ccniticme of Exemption,you xhould
beeomOmb ,,'he W..kre,emnPensmion provIonsoune Libor C,dc.yon mu.t - 300 — SHEETROCK
Q 0 tonhwinn can+py with.such powi,iou Or this permit shall he deemed evoked.
z co"srxucnoNLlsNnwcnce"cY 309 — EXTERIOR LATH
aIhembyallinn1hu1there isncnnswnicelending agency for the performence, 310 — INTERIOR LATH
of the wark I is whitlnhls pertain is issued(Set.3(197.Civ.C.) s —
y p Lende..Name 311 SCRATCH COAT
7 z Condor',Addres. � —
U O I verify that 1 ewe rend in,apprmafmn nnd.uuc that me.abow mrorn:mon is 313 ROOF NAIL
r+ E.. coemet.Iagmeu+comply Isithall city and cuuntyordinancesonduatelaw.relating 50 NAL ELE ICAL ENERGY
O V m hording eon.nnedon,unit hereby anthml®mpeocntntioes of this city to enter urym _
y heinswo-menromedpmil,<nyfwimecrnnpap 2 F RI_ F'I_I_ ING ENERGY
(We)agree saves minuend Iit Iced- the City Of Criterion against —
rn Iiani ..ptngmont..cop,amt ext. ., molt,oar n+troy way acnme again.t.aid 503 I RL M HAN I CAL ENE Y
U Z ei r.+ n. aenoe or mograaro +rani.pemdn.
our ne`c1� ntr . SY, DWI OMPLY WITH AI.i./(�4YIINr Issued by: 5@4 — AL J �_DIN�a NER
.i�nat a ; - icanmconn cmr - �� nal //— Re-roofs
bob —IGAL
HAZARDOUS mxri7RiA[.S DISCLOSURE 50 — GA TEST ,
W+fid,e.ppficamnrmmreWddlng,cc.pant>romorhannlena,achm, Caudal Type'ofRoof 5 — FINAL PLUMBING
no refined ed by the Copcnino Mounrp:d Ede,Chapter 9.12,and the Health and Safety
cede. 0 ye, ^3532cm:' QI F{ (�In jrjI I H Ui Cf9l.
°tin 0 N All roofs shall be ' c8ted pilo y t 1 tela being installed.
Will the applicant or future Wilding occulam u.e equipment or devices which If a roof is insta , tQlout fi�llIlr�ini ection, 1 agree to remove
„cith.,,ardou.in,,rnonilan,o mdefinr!by the nay Area An,Qualiry nem+gement I �p��,
• ia.mcr. � .111 new materials fo5i ;t{r}3e'ctic�. WHlic —17TTQe srt�t�ds •tad will comply with
°Ya °Na alln -point sour 5tgul' 'o PUBLIC WORKS
1 a He read one haaaroca. maenals reg.iremwa,under C.1 on h to of rbc
if,he rnildingm% Sul co comedy haven
that 55sJnal ym%p3q.lundcrntail that
if,he eav,urr nom,w ich lot be nthm it iuny...a me or ay m nrriy toe ♦ /
cnpx of mo regrtirotnenn..which trop be r,+or rdnr to ix.a;mee of a comxemo or
Uric an 'ig ature of Applicant Date
Owner or aathmi,ed age., Dare All roof coverings to be Class `B"or better
OFFICE