06120104CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
CONTR?.GTQRINF0RMA�IQ.N&
vw ,
BUILDING ADDRESS:
PERMIT NO.
O ER'SNAME:
A
ILLOW DAVID C AND RANDI S
1157 DELL AVE.
12/20/2006
E:
SANITARY NO. CONTROL N0.
(408)378-2477
ARCHITEC rENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job D0SCi3ptlOn
I hcmby affirm Nal I am li¢nsd under provisions of Chapter 9 (commencing
who Section 7")of Division 3 of be Burrs aed Professions Code. and my lit.. u
INSTALLING 7 NEW WINDOWS, 1 PATIO DOOR
in fall paste and .nems.
License Class Lie.g
LIKE FOR LIKE
DateC..L.tar
ARCHITECTS DECLARATION
I understand my plans stall located as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I Wrchy affirm Not I am exempt from to Contractors Licence Law for the
following mason. (Section 703 L3, Business and Prefetsims Cade: Any city or county
which requis. a Permit m emm,ucs alter. Improve, demolish, at repair any structure
prior at its issuance. also requires to applicant for Such permit to rile a signed statement
Our be is licensed the Contractor's UsueseLaw (CM1apter9
Sq. Ft. Floor Area
Valuation
ptersmmtoOnpmvisio.of
$7487
(commencing art Sttdors70)0)aDivision 3ofBeBusiness and Professio.Code) or
Nat k u exempt therefrom and Ne basis far Ne alleged exemption. Any violat(an of
34233054: Number
Occupancy Type
P Y YP
Section 7031.5 by any appiksum for a p,unit Mbjecu the applicant to a civil penalty of
oat mart Nan five hundred deltas (g3110}
0 I, asowner of to Property, cr my employe. with wag. as Nei, sole compensation,
will do Ne work and Ne ssuctum it nal intended orofrered tarsale; (Sec. 7044, Business
Required Inspections
and Pmressians Code The Conformer Lima Law do. x71 apply m an awv. or
propeny who builds m improv. Norco n, and who does such work himself or though his
awn employees, provided Net such impmvemanu art not intended oroffesed for axle. If.
-
anwavar• to building or improvement u said within arc year of completion. to ownm.
builder will have the modest of proving Nat W did not build or improve for pu pose of
mora I.
I. v owner of Ne propcny. am eaclusively contracting with Rcmed mnmscmrs m
construct the project (Sec. ]044. Business and Praf.aotu Cade:) TW Contmcmrs Li-
cense Taw dms oat apply man owner of propcny wW Wilds ar improves Hereon, and.
'
who contracts far such projects; with a.....sts) hasstzd pursuant m time Contractees
License Law. /�
I em .cm der5een . B & PC far Ods season
//I
amj// .f,-, ��zr-eet l Data /� �.7J'�0C
WORKER'S COMPENSATION DECLARATION
1 hemby affirm under priority of perjury arc of te, following declarations:
❑ I W,a and will maintain riCaniO.m of Ccounh ua mlGi.um for Warkces Compen-
..arm.. provided for by Scrtion 3]00 of On Labor Code. far Ne pcAOsmance of the
work for which this permit is issued.
I have and will maintain Worker's Compensation Ineusame, w required by Smith
3700 of to latter Cade. far the peRarmam:e off. work far which Nu Permit u issued.
'
My Workers Compensation Insurance carrier and Policy number are:
Camey. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Cnmu seetim mrd tet W completed if the permit is Worm hundmd do0us (SIM)
or ]car)
I cen fy Nal in to perfommaoac of to work for which this permit u issued. I shall act
employ anS'person loan manncra mbecomcsub'cel in this Wafkefs'Canpenuuon
Laws of Califom — — b
Applicant Cr 6C/•'
_
'
NOTICE TO P C !T: If, ane, make g this CemBcate of Exemption, you should
bceome subject m IW Worhees Compensation provisions of Ne Labor Cnde, you most
comply wit such provisions or Nu permit shall W deemed revoked.
CONSTRULTON LENDING AGENCY
I hereby aObm that Nert iso canswctinn lending agency far to pe,formame of
the work for which this permit u Luucd (Sec. 3097, Civ, C.)
Lends,a Name
Underf Addrcv
I cenifY Net 1 have oral this application anal sum Nat the, aWve infomotm. is
-
I agree to comply wit all city and county mainances and sure laws relating to
building construction, and hereby authoriac mpresenuaives of Nie city to enter u,mn to
ahovcmcmmncd property ter inspection purp0aci.
(We) agree to save, indemnify and keep harmlcas tc City Of Cupcam. agaiou
andart.prOmit. may in any way accrue agai.tsaid City
1.biliti.,Judgmcnu,eosu
in eosuequcr��r����cccccmmmmmmof dm 8,anunL of Nis permit.
APP LICvA1JTv11NDER5'fANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOU CER�GULATIONS.
Re -roof
Sr attire of ApplicaData
HAZARDOUS
Type of Roof
Will dao or forum Wilding or handle
Cupertino
as de0ned by IW Cupertino Municipal Cade, Chapter 9.13. and Ne Health and Safety
e, Chapter Health and
de.SccOm 35533(.)?
All roofs shall be inspected prior to any roofing material being installed.Oyer ,
Will tc appiicantor future building occupant ra equipment ordevic. which
If a roof is installed without first obtaining an inspection, I agree to remove
emit harardow air conuminernu as defrncd by tW Bay Ams Air Quality Management
all new materials for inspection.
District?
❑Yes-'Dytvu
I have mad Ne haaartms materials requimmenu under Clopter Q95 of IW Califon
aia Health&SaZdty Code, Suctions 25505,25533 and 25534.1 undchrond thuiftr Wilding
does tet currmmaf{y have a tenam.. t it el.m powMlitY m notify tc'up., of to
� hicIt
ON m W met r m' Of s Cc.rC.w of Occupancy.
Signature of Applicant Date
/�It• /ale)��
All roof coverings to be Class "B" or better
Ownrlolsutamed.grat Date'