01070019 CITY OF CUPERTINO -
BUILDING DIVISION 'PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
19971 LINDENBROOK LA EXTERIOR SOLUTIONS 01070019
OW S NAME: APPLICATION SUB DATE
• I�L�NUT F V AND SOPHIE K TRUSTE 1771 SMITH AVE 07/09/2001
PHONE: SANITARY NO. CONTROL NO.
\ (408) 358-1233
COOrARCHI=�NGINEER:NGINEER: BUILDING PERMIT INFO
to C LDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION rfirm mat I am licensed under Job Descri tion
oN=' y. pmvpronssiorvCche.anommecenseINSTALL 16 WINDOWS & 22 SLIDING DOORS .
1-- etJand of DirisionJof the Rosiness anJ,Prolessimns Cae.and my lizenul� and a. •Si-k C,'z¢a°'OwOCommcmr,
g a.
se0 .fi ARCHITECT'S DECLAR ION GLUT '
}g I understand my plans shall be used es public rtcoNs asYC
e
ila.i�'p c Licensed Professional
OWNER-BUILDER DECLARATION
u�"-u• 1 hereby affirm that I am exempt from the Contmetor's License Law for she
?< following reason.(Section 7031.5.Business and Professions Code:Any city or county $15000
E x C which requires a cornit m construct.alter,improve,demolish,or repair any structure
sv Its issuance,also re v
m t- „Prior requires she applicant for such peamt ro file asgned stat -- -- - - - - - - -- - ---- -as—
flat 3- he is 1 cenud puts i f the p inions of the Convumis License Law IChapt r 9
(commencing with Section 700f of Division J of the Business and Professions Coded >_`o , �36°312F30 Valuation
or that he is exempt zom`anJ the bass for the alleged exemption.Any violation
any a I
or Section]DJ LS by any pPlican fmropcnnit mbjcnsthe applicam mocivil penahy
Inramt tmmre man Eyehumrea dml,ra lssfwe 516APNYT1AL BUILDIN j �" Occupancy Type
Cl I.as owner of the property,o my employees with wages as their sole compensation,
--wise no the wm ls,sad me s[mnme'i.rnot mteaded'orofered for sale(See: Hde' Required Inspec[io
H nd'P fes S Code The Contractor's L Lo does not apply to an
owner ofProperty Who builds or p e'threon and who does such workhmself ,
or through his own employeesprovided that such imparvenicals are not intended or , ._ _ .. . .... .. .. ... ... ... . .`_.
.off ed f.rWic.Illi tie he badldirg,"4 hripowcamem ii suldwallin one tar of --
'emao"am,the owner-mild will have the b le f provingth S he did ntbld r �•
improve for pa'swe if sale.) O
❑1 f the property,anexsin lacontracting ml SShe Csmirw S
recuseconstruct theprojectTapp IIldd,owns o dertywio b Cnde)Thevothereon,
- - License Law tact .f apply m in owner of property who builds or sed pursuant
a thereon,
:i I: CmurvcareLvho co Licens foosuch,Prmjecu with.o comrannr(s) licensed pursuam m the ...___ ... _..... ..__._ ._. .. ..._ ._..-_....__..., .1... _.. ...._ .
01 a.oe License Low. "
- ❑lam exempt under See. ,B&PCfor this reexmn j,u
Owner' Dote "I `
WORKER'S COMPENSATION DECLARATION
,. I nertby affirm under penult of perjury one of the following declarations:
❑ 1 hove and will maintain o Cenifici to of CununS to ulf-insube for Worker's
Compensation, as provided for by Section 3700 of She isWr Code, for the
v - _ performance of the work for which this permit is issued.
have and-will maintain Worker's Compcnution lnsumnce,u act by Section
'r ZJ] of the labor Code for th pedmm 5c f Sh work for h ch his permit it
issuetl lily Wq.r�k,efs spr at u Insu c er d P'11'y bar rc:
Carrrcr'= .s Pol'yN. WC /'qj 5 ua ' - l,y,p:. 5 a _ ..,'s•,, ;: .... _ .
,.f"1'CERTIFICATION OF EXEMPT ION FROM WORKERS.'
..SIL _.-..-.,.. _. CC1h/PENSAT10N,INSURANCE
's "'(This secti:m'iiiad'not be completed if She permit is for one hundred dollars
(51f10)or less,) ,•.,
s fy Shat in She perfommnae of the A fni which sh pc m t '' . - - -_"
ins odl i' ct sl.i '
shall nos employ am'perwin in any manner sit as to kerm'subject to me Workers '
Compensation Laws mf California,Data,
Applicant. .... .. . . -
becomes TO APPLICANT:Worker's
suisovisio s of bf LabortCror, u should most '
become subject m the Worker's Colons o,uon provisions of She eebbd revoked,you mon
Q Q forthwith<omDly with such provisions or jets permit snnll be deemed revoked.
CONS rRUC ON LENDING AGENCY
a. t he l,by an!,.Sh t h construction lending agency for thf fon -
of[h workswhichtM1 P �'
OW Q -Lead,'
s Nome ' - ' Si. t sucdlSe tlU] C. C I
. .._t..."
J ALiI t
Q Le
U!� I certify that I rand this application mJ stme that She above information Is
'fit.F cooect.Initial to simply with all city and aunty nrdinannen and state laws mlating'
to budding construe,Inn,and areby....I fixe rcpmsmnmlves of to,cit wetter upon
me n enmmt'.wd p:I, t _lot inw,abampio, ct. ..
fWe) c m Iemi'fy and keep I
pia nti ng
the Cly fCpe Cupertino ntnst
Ft h Iiub l', J dg nu t d e.p Ise hill,, ty in uny ay me.giol sa d
U Z City c cot i th La hung I'tl
'APP-It,. NTt DERSTAND t IPI W HALLNON.P INT
sou E / Issued by rte
Si ser 1'ApplicaMcnntmewr .', ..')".: DOE, Re-roofs
, LAZARDOUS MATERIA LS UISCLOS UR E'
d,. fell the applicant or ftd budding occupant dom isrhamll haznNousma I Type of Roof, .. ,.
as defined by theCupertino Municipal Cod Chapter 9.12; d theHealth and Safety - _
cite s nqn zip I I ;'' t'l, a Ifla roof tsltnstalled spe Lit .: = f g .. st - ...
❑Y r N ' . c ' . c
c y roofing materia being install d
Will the.applicant orfuture b Id g occupant use equipment de,ces which [obtaining an lnspecti6n'J agree to remove
r to an o 1
,
em,;t hoz dos air contaminantsas defined by me Buy Arca Air Quality Management' firs
Distinct' t all new rials fo i sp cti 'cat understands and will comply with
13 Yes Nn: - - - "all non- o' t source g ati s. I - -
y .
- 1 have read me bu" s numn requtrcmmSr order Chapter 695 of She
CJl Tom th&Safety Cod Sections 25505 25533 d 255Ja 1 understand that ^ /
iftheti'Bn does tutu rtentl h ILS t t us S resµ sb'IIyS notify ihd
oma
So emquircmemt) r tPi S eo(a Ccnif am
rc
p _ Applicant Dae _
_., ! Si azure o A li t
All roof coverings to be Class "B"or better ;'
. ._. ..... .t _..... .: .
. _ ... .OFFICE. .._ . . . . .. .. .. .. .:.