08070058 CITY OF CUPERTINO
BUILDING DIVISION PERMIT .kCOLVTR't�CTR�INk'�.RMAT9IO1V'� ;
BUILDING ADDRESS: PERMITNO.
22821 MEDINA LN APT A TBD — TO BE DETERMINED 08070058
IKER'S NAME: PERMIT ISSUE DATE
ROBERT & LISA PONCE 07/09/2008
PHONE: SANITARY NO. CONTROL NO.
ARC HITECM/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
900 LICENSED CONTRACTOR'S DECLARATION
m 1 hereby afftm that 1 am licensed under provisions of Chapter 9(commencing Job Description
�i with Section 7")of Diri on 3 or NC Busircnand ProfessimsCode,and my Rceaeu WNDW RPLCMNT FOR NEW VNYL WNDWS (ALLSIZE4SIZE) 6
<�w thfull Ton uWc
LunClass C.g ZS RTROFT WNDWS, 3PATIO DRS W/STUCCO PATCH INSTL.
oa '41-
th ARCHIIIEi D LARATION ALLBRAND WINDOWS & FASHIONS PD FOR NEW BUS LIC
U I un(rsm
cnd my plana About W aced As public mcoNn
lcG� Licensed Professional
`01 OWNER-BUILDER DECLARATION
ii f 1 hereby affirm that I am exempt from the Convector's License law for the
i O O fallowing mason.(Section 7031.5,Business and Professinm CorIC:Any city or county
$ which mquim a launch to commucl altar,improw,demolish,or¢pair any sticture
prior at its issuance.asto mquimn the applicant for such permit o rile a signed statement
< noun he is licensed pursuance the provisions of the COnuwmYs Lice.e Law(Chapm9 Sq.Ft. Floor Area Valuation
1 (commencing with Sceion]000)of Division 3 of the Business end Professions Codc)or $8412
Nat he is exempt thandfrom and the baso for the alleged exemption.My violation of
Sedan 7031.5 by any applicant for a permit subjects the applinnt to a civil pcnahy of Number
not morn than Rae hundred dollars(&M3423011 .AVA Occupancy P Y Type
Q 1,u owner of tit property,m my ervployw with wages asNeo mle compensation,
will do dmwark,and the shame u rotimeMed a ave dos an,Apply an est,Budnmt
and Professions Cade The COnIMO/a Mwho Law does nm apply fl rt awry of Required Inspections
propmnmpl WiklIs p,Aftdp l=him n,a wu notinswch wmt oroffaa1forsathu
awn ear.the
WpmHdcdthatsuch impmsemrnuart not ear of cmOrfuW for safer,
however.Ne building or burden
movinu said a within one year or completion,roc ose of
Wk.), TIB low Nm burden of proving roar W did Out build or improve for purgse of
lata.).
Q 1,As owner or the Porten,am exclusively contracting with Boosted convectors to
construct the pmjen(Sec.7014,Business am Pmfcaaions Cade:)The Coovmmr'a V-
cense,Law dean not apply to in owner of property who Wilda or improves Neuron.and
who contracts for such pmjem with a Monomania)licensed pursuant b die Conuacto's
License Law.
❑lameacmptunder See ,BBPCforthumam
40 m Dam
WORKER'S COMPENSATION DECLARATION
I hemby a1Mu under penalty,of perjury,one of ft following(ergaruioru
Q Ihzve aM willmunuinaCeniRcemaf Comentmself-inwrtfmWorker'sCompan-
canon,.provided fm by Section 3700 of the labor Code,fm dm perfomance of tW
weak for which this permit is issued.
Q 1 have aM will maintain Worker's Compensation Insurance,As restaurant by Sedan
377(10af the Tabor Code,fm Im pertomurce of the wart for which NU Pamir It issued '
My Wark^s Compcwuan hw'atuou easier and Policy numbernart:^1 �1
Cartier. T-OYw.¢h Is., -%Pclic No.:AO-!2757 {)
CERTIFICATE OFa PTI0N FROM WORKERS'
COMPENSATION INSURANCE '
(Thu sucOrn need rot hemenucted if the Permit is fm one hundred Bogan(SI00)
or leu)
I ccodfY Nat in the pmburnmee a tW wart fm which this Permit u imuct,l shall not
employ any pecan in my common,an,As N became subject N the Warean'Compensation
laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making Nis Cer irtute of Exemption.you shout
became subjon An Its Wmates COmPareconso prosiniam of the labor Cade you most
.J O forthwith comply with such pmvTtimu m Nu permit shall W(Lamed marked
z y
CONSTRUCTION LENDING AGENCY
(-+ I hemhy affrm Nat Vert is a communion Lending agency fm tic performance of
Ki > the work for which this permit is issued(See 3091,Civ.C.)
QLender's Name
D z t<ndcr's Add=
V Q I certify Nat I have read this tpplieuion and sure thea Jur above infmmtom is
IT. Ftor¢.rl ago N comply with all city and county Ordinances and sum lawn telling In
QU building construction,and therebysutboris mpmxnuBses of Nu city m anter upon the
W move-mendoxd property far inspection purposes
„ CL (Wb).V"to ave,indemnify and tech harmless the City Ore 10=1 s agunst
fA iliabilities,cextame crts"n rm'.r un.s And pa which may u any way amue against aid City
U z A APPLICANT
ofthegrantingofthishumus
APPLICANT UNDERSTAND ND WILL COMPLY WRH ALL NON-POINT Issued by: Dale '-6�
SO��yR/�REGU/L(A�T/ONS.
1 - /3 b7
Stgnuart arnppliemuCanuanar�~ �^O�p� Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant.(alum Wilding occupm amen m handle harallons maoaind
u dellned by the Cupmu m Munici Code.Chapter 9.11.and the Health and safety
de,section 25532(a)1
QYn All roofs shall be inspected prior to any roofing material being installed.
No
Will the applicant or fumm Wilding occupant use equipment.dcvices which If a roof is installed without first obtaining an inspection,I agree to remove
e line Taro— am
air caminanu a fined by roc Bay Ame Air Quality Managenum all new materials for inspection.
0y.
o
I have mad the haraNwamateriau mquimmems under ChxNmrd93ofdre Calif.-
pitHealNk SeclyCah.Seem.25503,15533 xm125534.I unksmand dwif(te Wilting
dote not camndy neve a rerun theait u mponsinilitY re ratify roc onvpanl of Uc
requirec 1pdar uluacear,Cutira.taarOc Signature of Applicant Date
— �' ` ' All roof coverings to be Class'"or better
Owner or auNmmd agent �p�