08060045 CITY OF CUP
ERTINO
BUILDING DIVISION PERMIT a CONTRACT'„(jR INZ<'ORMATIONN ,
BUILDING ADDRESS: PERMIT NO.
220d5 MC CLELLAN RD CREATIVE WINDOW CO 08060045
NER'S NAME: FERNUT ISSUE DATE
THERESA WILLIAMSON 720' NRCP ST 06/06/2008
PHONE: SANITARY NO, CONTROL NO.
ARCHI ECrfENGINEER: BUILDING PERMIT'INFO
REPLACE WINDOW AND PATIO BO ELECT PLO M-0 wfewfrfECH
uOp
LICENSED CONTRACTORS DECLARATION seeR, ' ._•IobDescription
1 hereby affirm that I me licensed under previsions of Chapar 9(commuting •--'-'^•• ^--".^ ^^^^ -
Z� with Suction 70M)of Dievim S ofthe Business and Prefusdura Code,and my license is
<<n' In full r..and areLt.
32_ License Class Lk.R
=Fp Dale Contractor
qq uy� ARCHrfECrS DECLARATION
W< I undersand my plans shall W used as public records
k�
Licensed Pmfesuonal
OWNER-BUILDER DECLARATION
R i I hcmhy o1Rm
that I am eurept form Ne Conuac m's License Law for the
C erpo following wan.(Suction IMI.S.Business and Profession Code:My city or county
ee which union ct a pcmit m cnnaroct,.lar,Wprow,dcmnliah,or tep.ir any structure
2i Primer is issuance.atsu reyures dxappliont far such permit in file.sigmd mim,cm
2
< that W is liccnwd pendent the pmvisima of Ne Counselor',License Law(Chapter 9 Sq.Ft. Floor Area Valuation
Ys-$ that WI.tennwith hretim 7f00)9andthi Divisionfor of Ne geinessand Professions Coda)of
Q�^
that W u eumpt therefrom and Ote buts for the singed eumption.My violation of
Section 70315 by any applicant for.permit subjects the applicwuo 1601 penalty of APNNumber Occupancy Type
not more done five hundred dollsos(ssoBh Pane Y YP
0 1,as owner of Ne property,or my employees wide wages u their w4 oten ensadon,
will do IW wo&and the structure Is not intended or offered for sale(Sec.7014,Business
and Professlons Code:The Canuacrors a" law Mass nal apply In an ower,of Required Inspections
property who builds orimprow es drrem.and who doessuch work himulfar Waugh his
own employes,provided Nat such improvements are cot our otc mollertd fmssk U.
bowler,the Wilding u dur of a ri is veld within one youm completion,p owner-
buiWer will have IW burden o(proving wt W did cot Wild m improve[m puryow of
.a4J.
1,a owner of the property,am eacl.,m],comfuting with licensed contract.b
nsmruct the project(Sec TOW.Business and Protections Code:)The Conuaemh Li-
ve law does not apply to an owner of property who Wilds or improves thereon,and.
who conwea for such"Jac,with a"amo,sq')licensed pursuant a the Conuacmh
License Law.
❑��emympm undo,See ,B d PC for this wan
, 1LLtdg A/A D.a V
WORKER'S COMPENSATION DECLARATION on
1 hereby affirm under penalty of perjury ane of ted following dacluation't:
0 1 hem and will maintain a Cartifi,m ofCovent m self-imune far Worker'sCompen.
salon,as paovidrA for by Section 3700 of Ne labor Code,for the perform.of IW
wort for which this permit is issued.
0 1 have and will maintain Worrkeh Compensation Ivurmcc,as nuyuimd by Section
3700.fdon lake'Cade,for the peddon waf Ne work forwhich this permit I.issued. '
My Workses Compevauon Insurance earth and Policy number arc:
Cmica, Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu aced.need not W complaad lithe permit is fmonc hundred dollen(SIM)
or less.)
1¢nih Nm in the performance of the.,it for which Nis permit is issued,l dull not
lapwsofan) ti�nyLasm�ery)a wbjetttoda Workea'Compcvation
Apprcan. _
NOTICE TdAPPLICANT.If.afar making Nu Certificate of Eaemption.you should
become subject he the Worker's Compcvition provisions of Inc Labor Cod,you muss
.JO forthwith comply with such provisions or Nu permit shall W doemed masked.
z h CONSTRUCTION LENDING AGENCY
F I Washy alfine thou Nene uacoe.troctim lending agency for the,peformwce of
C
the work for which this permit u issued(Ste.3097,Civ.C.)
Lender's Name
z LcndeYSAddw
U Q 1 certify that 1 haw mad this application and sate Nat the.Wes information is
LT.P comm I agree to comply with all city add county n dinarces and sea laws retain,to
OU building consnumion,and hereby amhons,mprewnuuss of Wthucitym cnar upon Ne
W ave-mcnGomal property for he".pw'n
F py
(We)agree d ssan indemnify and keep harmless the City of Cuperlina again V V
h Iiabilidu,judgments,core and lapaures which may in any way acme against said City
es
Uz APFLLANfaUNDEof on RSTa No AND WILL COMPLY WITH ALL NON-POINT Issuedby: Date
SOU EREGUI.ATION . 1. `
Re-roofs
goaurtof Apphoa dContracmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof �-
WIII the aPpikeel or forum building decupeel s o e m handle huamdou.material
u defused by the CapeN.O Municipal Code.Ctd Pref 9.12.and the Health and Safety
Uc,
Section 25532(.)?
YeaAll roofs shall be inspected prior to any roofing material being installed.
s
�J�` If a roof is installed without first obtaininginspection,I a
� Will one applicant or erre Wilding occupant sew cyvipment m Jcvius which an Tee to remove P g
mslum``ardnw umn u air conmindefined by Ne Bay Asa Air Quality Management all new materials for inspection.
O Yes XNo
I haw read!door hant, matrials reyuimmenaunder Chapterh.95oftheCalifor-
niaHealNkSafctyCode,Sections25505.25533 and 25534.1 dedenmrd Nair Ne Wilding
docs no commly lues a a tam,Wt it u my resPonsihility a-dry the occupant of Ne
aqui nawhich most m tpnardissuwce or.Certificate ofaavp Signature of Applicant Date
rmwNoriveA agent D,a All roof coverings to be Class'n'or better
CITY OF CUP
ERTINO
BUILDING DIVISION PERMIT a CONTRACT'„(jR INZ<'ORMATIONN ,
BUILDING ADDRESS: PERMIT NO.
220d5 MC CLELLAN RD CREATIVE WINDOW CO 08060045
NER'S NAME: FERNUT ISSUE DATE
THERESA WILLIAMSON 720' NRCP ST 06/06/2008
PHONE: SANITARY NO, CONTROL NO.
ARCHI ECrfENGINEER: BUILDING PERMIT'INFO
REPLACE WINDOW AND PATIO BO ELECT PLO M-0 wfewfrfECH
uOp
LICENSED CONTRACTORS DECLARATION seeR, ' ._•IobDescription
1 hereby affirm that I me licensed under previsions of Chapar 9(commuting •--'-'^•• ^--".^ ^^^^ -
Z� with Suction 70M)of Dievim S ofthe Business and Prefusdura Code,and my license is
<<n' In full r..and areLt.
32_ License Class Lk.R
=Fp Dale Contractor
qq uy� ARCHrfECrS DECLARATION
W< I undersand my plans shall W used as public records
k�
Licensed Pmfesuonal
OWNER-BUILDER DECLARATION
R i I hcmhy o1Rm
that I am eurept form Ne Conuac m's License Law for the
C erpo following wan.(Suction IMI.S.Business and Profession Code:My city or county
ee which union ct a pcmit m cnnaroct,.lar,Wprow,dcmnliah,or tep.ir any structure
2i Primer is issuance.atsu reyures dxappliont far such permit in file.sigmd mim,cm
2
< that W is liccnwd pendent the pmvisima of Ne Counselor',License Law(Chapter 9 Sq.Ft. Floor Area Valuation
Ys-$ that WI.tennwith hretim 7f00)9andthi Divisionfor of Ne geinessand Professions Coda)of
Q�^
that W u eumpt therefrom and Ote buts for the singed eumption.My violation of
Section 70315 by any applicant for.permit subjects the applicwuo 1601 penalty of APNNumber Occupancy Type
not more done five hundred dollsos(ssoBh Pane Y YP
0 1,as owner of Ne property,or my employees wide wages u their w4 oten ensadon,
will do IW wo&and the structure Is not intended or offered for sale(Sec.7014,Business
and Professlons Code:The Canuacrors a" law Mass nal apply In an ower,of Required Inspections
property who builds orimprow es drrem.and who doessuch work himulfar Waugh his
own employes,provided Nat such improvements are cot our otc mollertd fmssk U.
bowler,the Wilding u dur of a ri is veld within one youm completion,p owner-
buiWer will have IW burden o(proving wt W did cot Wild m improve[m puryow of
.a4J.
1,a owner of the property,am eacl.,m],comfuting with licensed contract.b
nsmruct the project(Sec TOW.Business and Protections Code:)The Conuaemh Li-
ve law does not apply to an owner of property who Wilds or improves thereon,and.
who conwea for such"Jac,with a"amo,sq')licensed pursuant a the Conuacmh
License Law.
❑��emympm undo,See ,B d PC for this wan
, 1LLtdg A/A D.a V
WORKER'S COMPENSATION DECLARATION on
1 hereby affirm under penalty of perjury ane of ted following dacluation't:
0 1 hem and will maintain a Cartifi,m ofCovent m self-imune far Worker'sCompen.
salon,as paovidrA for by Section 3700 of Ne labor Code,for the perform.of IW
wort for which this permit is issued.
0 1 have and will maintain Worrkeh Compensation Ivurmcc,as nuyuimd by Section
3700.fdon lake'Cade,for the peddon waf Ne work forwhich this permit I.issued. '
My Workses Compevauon Insurance earth and Policy number arc:
Cmica, Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu aced.need not W complaad lithe permit is fmonc hundred dollen(SIM)
or less.)
1¢nih Nm in the performance of the.,it for which Nis permit is issued,l dull not
lapwsofan) ti�nyLasm�ery)a wbjetttoda Workea'Compcvation
Apprcan. _
NOTICE TdAPPLICANT.If.afar making Nu Certificate of Eaemption.you should
become subject he the Worker's Compcvition provisions of Inc Labor Cod,you muss
.JO forthwith comply with such provisions or Nu permit shall W doemed masked.
z h CONSTRUCTION LENDING AGENCY
F I Washy alfine thou Nene uacoe.troctim lending agency for the,peformwce of
C
the work for which this permit u issued(Ste.3097,Civ.C.)
Lender's Name
z LcndeYSAddw
U Q 1 certify that 1 haw mad this application and sate Nat the.Wes information is
LT.P comm I agree to comply with all city add county n dinarces and sea laws retain,to
OU building consnumion,and hereby amhons,mprewnuuss of Wthucitym cnar upon Ne
W ave-mcnGomal property for he".pw'n
F py
(We)agree d ssan indemnify and keep harmless the City of Cuperlina again V V
h Iiabilidu,judgments,core and lapaures which may in any way acme against said City
es
Uz APFLLANfaUNDEof on RSTa No AND WILL COMPLY WITH ALL NON-POINT Issuedby: Date
SOU EREGUI.ATION . 1. `
Re-roofs
goaurtof Apphoa dContracmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof �-
WIII the aPpikeel or forum building decupeel s o e m handle huamdou.material
u defused by the CapeN.O Municipal Code.Ctd Pref 9.12.and the Health and Safety
Uc,
Section 25532(.)?
YeaAll roofs shall be inspected prior to any roofing material being installed.
s
�J�` If a roof is installed without first obtaininginspection,I a
� Will one applicant or erre Wilding occupant sew cyvipment m Jcvius which an Tee to remove P g
mslum``ardnw umn u air conmindefined by Ne Bay Asa Air Quality Management all new materials for inspection.
O Yes XNo
I haw read!door hant, matrials reyuimmenaunder Chapterh.95oftheCalifor-
niaHealNkSafctyCode,Sections25505.25533 and 25534.1 dedenmrd Nair Ne Wilding
docs no commly lues a a tam,Wt it u my resPonsihility a-dry the occupant of Ne
aqui nawhich most m tpnardissuwce or.Certificate ofaavp Signature of Applicant Date
rmwNoriveA agent D,a All roof coverings to be Class'n'or better