06050239 ;,UIILDING
Y OF CUPERTINO ;q.e ''"n .-.a�7 BUILDING DIVISION PERMIT pXONTRXOTOR�I1�Tµ'�ORM'9'TIf. Nr .
ADDRESS: PELLA WINDOW & DOOR CO. PERMIT"x'06050239
38 V PT
R'S NAME: PERMIT ISSUE DATE
DORIT ROM 6999 SOUTT4VPQN1T PT)
E: SANITARY NO. CONTROL NO.
925) 245-4470
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i o o LICENSED CONTRACTOR'S DECLARATION
�9 CC 1 hereby affirm this 1 am licensed under provisions of Chapter 9(commencing lob Description
£�W with Section 7")of Division 3 of the Business and Profoanom Cade,and my lkenxa
'tarn nfallfweemd p t t PULL 2 WINDOWS AND 2 DOORS . REPLACE ALL BUT 1 L
i Z Lteense Class
lw Lk.I
s Date o Conuacmr LL++ FOR LIKE.
ARCHfIECI-SDECI BN
U1 undersand my plans shall k used u public
e tor.J7, Licensed Professional
kO3 OWNER-BUILDERp ION
m
<E 1 hereby ahem that 1 amL aempt from the r Canons,Co License Law for me
O e following Tenon.(Section]U311.Badness and are.dem li Coln:My city or rn lure
53e which regainer n permit 1.m ui mmc4 alter,hnpmw,deerwit t fi repair any Rtmnme
-zy pdormiaiansed e.Fine requite tkvisio of finsuch the Conpetor'sa Rku,Law sammem
pp G Ihubui¢IlccnxJpurwentlothe providomoftiteConuacar'sUcameUw(Chapter 9 Sq.Ft. Floor Area Valu$ikd417
Y�$
(cm
mendni with Section 7000)of Division 3ofthc Busima nd Profession,Code)o
this bs is exempt thertfmm and the basis for site alleged eaempdon.My violation of
Section 7031.3byany applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
trot mom than five hundred dclars ISM 35624002 . 00
❑I.asawuerof Neprvperty.wmyuaployeawidlwgauthekxekcompenadon,
will do thewark,and thestructue 4 nothuned initiated forsale(Sec.70u,Business Required Inspections
and Profusions Code:The Contraen com e
mr's License Law dot apply as owner of q P
property who buildswimpmves thereon andwho dasmchwwklaimaelfor through his
own employee,provided that such Improvements art multiheaded wagered for sale IL
however.me building or Improvement isxld within ane year of mmpletian,the owner-
builder wall haw site burden of proving mat he did rot build or Improve for purpose of
saw,). Co
❑1,as owner of Na PropcnY,am uclmiwlY contracting with licensed conuactaa to
construct the project(Sac.70x4.Business and Promasiam Cade:)The Contractor's U. f�
come law doe add apply w an owner of property who builds or bnproves Merton.and. V
who contracts for such projects with aconuaeamW Ikemed pursuant in the Contractah
License Law. /\
❑lam aempt under Bee .BAPC fw this moon41
v
caner DataWORKER'S COMPENSATION DECLARATION
I kmby&Rrm under penalty of Perjury ane of tic following declarations
El IhamandwillmalnWna Ccn Bmwof Carocntwwlf-inumfar War SCompe-
satlon,as provided for by section 3700 of the Labor Cade,fw the perPomtame of site
work for which this permit is limned
❑I have and will maintain Worker's Compensation Insurance,as required by section
3700 of the Labor Cad..for the performance ofthe work fwwhich mia pemnit is Wood. '
My Worker's Compemadon htsuran¢carrier&ms Policy number T
Carrier. VJ%s IJA� PoR No: J lS06 0
CERTIFICATE OF EXEMP ION FROM WORKERS
COMPENSATION INSURANCE
I
(rho socams aced rot k camphacd ifft permit Is fwate hundreddollan(5100)
teas)
I enify that in the perfomtanom of the wort for which ibis permit a issued I mail am
employ any person in my anchor an as to became subject m the Wor icrf Cnmpesuation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Ccldlicam of exemption.you should
became subject to me Wmrt s Compemadim provisions of the tabor Code you most
.J O forthwith comply with Rush pmvWam or mu permit mail k deemed revoked.
zt CONMUC ION LENDING AGENCY
^
(+ 1kmby$a m Nat then is a comtmctim loading agency for the pedarmarrec of
D:> the work for which WR permit Is issued(Sec.307.CN.C.) .
4 Q lender's Name
z Lendees Address
U C) 1 coldly nen I have mad this application and sum Nat the shove InformNun is
U.F correct I agme in comply wish all city and county ordinances and sane laws relating to ,
O U building comuucOon,and hereby milsodae representatives ofmis city to enter upon lk
W above-mentioned pmpeny for iropection purposes
(We)agree to saw.indemnify and keep harmless the City of Cupertino again
fan Ihbilltiesjudgments.coatsandespemes which may in my wayacerue agalnstaaid City
U Z- in COmequente of the granting of this P=iL
yr APPLICANT UNDERSTANDS ND WILL COMPLY WITH ALL NON-POINT Issued by: Date J, 9
SOURCEGULATIO
G o �— Re-roofs
Si uurt ofA IicanVConuacmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me pplkant arfulure building aacupaummw Mndlehuudous materia
u deg Cupeldw Municipal Cade.Chapter 9.12,and the Halm and Safety
ode.section 255320Y? kAll roofs shall be inspected prior to any roofing material being installed.
para , No
WIN the applicam or future building assupant use equipment or dovlm which If a roof is installed without first obtaining an inspection,I agree to remove
emit huaNnm air conabolumas u deRned by tic Bay Arta Air Quality Masgcmcnt all new materials for inspection.
District?
❑Yue )':�Nu
1 have mol the It.armwma edals requimments underCbspe r6,93 of the Cdifur-
niaHulmASafctyCam,Swd m25505.25533md25534.1unJ old LhUirme building
dwa not currently Mw a tenant that it Is my responsibility in nodry site a¢upast of the
require nts which eau be met prior m issuance of a CcNlicate of Occupancy. Signature of Applicant Date
C�-" All roof coverings to be Class"B"or better
Ow rorihorindgct Dam