06050127. CITY OF CUPERTINOr
BUILDING DIVISION PERMIT
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��CONTRACQR'%NkU.IY,MIrTIO,N�
BUILDING ADDRESS:
ALLBRAND WINDOWS
PERMIT NO. o6OS6127
7778 LILAC WX
OWNER'S NAME:
PERMIT ISSUE DATE
SANDRA DUNBAR
551 INDUSTRIAL ED
ljr,,12oor
PMME:
SANITARY NO. CONTROL NO.
(650).622-0330
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLARATION
Job Description
I hereby afire that 1 am licensed umler POWLSOm of Chapter 9 (scrammingp
with Smtion70(X0)uf Div on3ofthc Busimua ofeuiom Cade. Andre 11 ersseis
Inrallraacanaarcnr I� 2 4
REPLACING WINDOWS: 7 RETROFIT, 1 WITH BUILD-UP,
LessD tete r3u5^t���Contncmr
to
2 WITH CUT DOWN, 1 WITH REFRAMING, 2 DOORS
ARCHITECTS DECLARATION
I understated my plans shall be used an public records
Licensed Pmfessonal
OWNER -BUILDER DECURA71ON
1 hereby atTum that 1 am exempt from the Contractors License Law for the
following mamn. (Saction 7031.5. Buatteu and Pmfoasiou Cade: My City or county
which mquiva a permit m canWm e, alter. narrow. dcmollnh, or mpNr try summers
prim m i4 tuwncc, Wu eget= On applicant for such permit to file a signed uatemom
Conuacter'a Limme law(ChaPmr 9
Sq. Ft. Floor Area
Valua� =159
thus he 4 licensed pursuant M the pmvialom of the
(commencing with Section 700C) of Division 3 of the Busimmand Professions Codc) or
that he 4 exempt themfoom and Or but, for the alleged exenp tom Any nomm, of
APN Number
Occupancy Type
Section 7031.5 by airy appliant far a permit subjem t the applicant to a Civil penalty of
out team than Rw hundred dallua (SSW).
35906003.00
01,aownuof Ulapmpmty,mmyemploycawithwyautheirmleco W=Uan,
Required Inspections
p
win lode work, and am mosenase 6 tetmmnaed moRered narrow (SM. 7044. Bu,imas
and Pleum laCade The Chromosomes Llceme Law does tet apply 0 an want Of
m
q
property vho indles Or impmwt them se, and who dmauch work himuedfm Wough his
awe employes, provided thatauch impmwmenu am not intended oroaered Ire We. if.
bonds,.the building mimpmwmem4mid decrepitude. teose
(f�II p r�
tswithin did rust vforor
builder will haw Ote burden of proving that ha did nm build or Improve fm purpose of
tLY'r�_a,
ule.).
r(Ur/ rgy+11 1glBiryleav"�
❑ 1, as owns of the property. am eacludwly cenuaming with licensed anuaman m
Ire
construct the pmjem (sec. 7044. Business and Pmfesdom Cada:) Te Con somwel Li -
ones law does not apply as who ddidearimpmwsthetmn. and,
J� ,5006
mjec n with aeonuacBoosted puont the Conuurl
who contract, for such pmr(O mm u
.,��� L
License law.
❑lam uempt under see ,B&PC fm now mamn
Dam
�� YI^
m^
MuhI'I
WORKERS COMPENSATON DECUBATION
1 hereby Unnot under penalty of perjury one of the following deelanmom:
IJ �J
❑ I haw and well maintain a Ced frau of Con¢m m self-Insum for Worea`3 Compen-
mion, as provided for by Section 37W of the labor Code, for the pedannance of the
work far which this permit is issuN.
❑ I haw and will mainWn Worker's Compensation Insurance, an mqumed by Schon
37W ofde labr Cad,:, for the prowned a er Ne work for which 444 permit or"wd
'
My Wadwe1s Compensation instrumentcarrier and Polity member//r�ase��:jj�� ,, ��
CarderSTa.'rG� Co�..,T. I• r Polity No.:
06&Z25
ERTIFICA O7'�7nom FROM 0.KER3'
CERTIFICATE
COMPENSATON INSURANCE
(T usseCilm Mad amaeeompleed Bute permit 4 ram hundred dollar ($100)
or len)
1 certify that in the performance at the work for which this permit is issued. I shall ant
employ mypermn in any mmdorm as m become subjmt m the Worlwef CumpemWon
Laws of Cslifamis. Dam
Applicant
NOTICE TO APPLICANT. If. after making this Certificate of Exemption, you Armin
become subject m the Workers Compensation provision, of de Lakor Code. you MusD
foMwith comply with rush provisions or this permit shall be dcemed reeked.
ON tENDINO AGENCY
CONSTRUCTION
Iherebyaffirm Is a c lending agcnry for the performance of
Nemis•mtaSM.
30
the work fa which Wes permit 4 imaA (Sm. 3097. Or. C.)
Pe
'
Le does Name
Lenders Md.
I aN(y that I haw mad this appliance and sum That the show memaxOm is
' artmt. I agree to comply with all city and county oNtmdom aha sum Ian misting to
building construction, and hereby authorize reprmentadws of this city to enter upon the
for imlrnian
alww-mcndoncd property parpmei
(We) agree I.uw, indemnify and keep hand. On City of Ceporm against
i liabilities, judgments. costo and expeme, which may in any way acme against said City
I. comeganc. of On goods, of this plain.
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
souacEul l�sops.G QS_ )6 ��
Re -roofs
Type of Roof
Si{rmuumoffAppliCan�uCm-zmamar DM
HAZARDOUS MATERIALS DISCLOSURE
Will me spinant or fume building dempantancm or handle hazardous mamrW
as deBmd by Be CupeNno Municipal Code, Chapter 9.11, and On Health Md Safety
Scotian 75532(a)7
All roofs shall be inspected prior to any roofing material being installed.
QYm
If a roof is installed without first obtaining an inspection, I agree to remove
Will the, Rant car rmmm b iluin sate
Pp { punt use equipment or devices which
emit hauNous air comm umnm an standout by the Bay Ama Air Quality Management
all new materials for inspection.
Disuin7 --'�/
[3 Yes YJ^V
I haw mad the hamrdmsmemdalsrequmemcnuumder CMpmr6.95offt Uifor-
nis HealthkSafmy Cade. Sadmu15505.15533 and 75534.1 undersmrm thus tribe building
does not currency haw a meant, that it 4 my responsibility In nodfy On accupmt of da
num Pandora,nicnc `mipdo"uanccofaceruk'5?Panry.
Signature of Applicant Date
: "" """ O5' I�
All roof coverings to be Class "B" or better
owner or suthadueaa m Dam'