08030080 Farry OF CUPERTINO a •� `E'u " _"�° � ', �,BUILDING DIVISION PERNIIT "LTfiVY'RORTHSHORE SQ ALLBRAND WINDOWS P�08030080
NER'S NAME: PEMdrr ISSUE DATE
ROSEN MAY TRUSTEE 23312 CABOT BLVD 03/14/2008
ONE: SANITARY NO. CONTROL NO.
ARCHITECTPENGINEER: BURRING PERMIT INFO
REPLACE 5 WNDWS, 2SLDNG DOOR 'BLDG ELP,LT PLUMB MECH
O O O O
900 LICENSED CONTRACTOR'S DECLARATION
v6 tad 1 bermy"oro that 1 m IkxwN under provinions of chapter (CommencingIOb Description
.T1 MN section 7")ol'Diviuon3oflhe Busircu and Pmfcariow Code,ared my limoscu
letrAOCxup four anti
jN2 LicLk.g F.7r
Dam Comudr
rr
ARCH Con DECLARATION
1 understand my plane Mall be sued as public reenrde
{tad Licensed Pmfessionel
b OWNER-BUILDER DECLARATION
a� 5 1 henhy alnm that I m exempt from Ne Contractors License Law for the
p 0 following muon.(Section 7(15 L5,Business and Pronasions Cork:My city w county
L$lis which requim�a Permit to constrw,alcor.Improve,demolish,or repair any structure
prior w is issuance.also requires dleappliCMI ter such Permit b Rk a Signed JWCmCr1
�< thus the is licensed phommi to On provisions of the Connanwllxense Law(ChaP¢r9 Sq,Ft.Floor Area Valuation
3 (commencing with section 7000)of Division 3 of the Business and Professions Code)or
than he Is exempt Otheirom and Ne basis for the alleged casmption.Any v(olWme(
Schon 70313 by arty applicant for a permit subiem the applicant no a civil Pointy Of APN Number Occupancy Type
.1 mune Nano Bw hooded dollars(S500i
❑I.as owner of the property.Or my unploym with wage As thele sole compenvtion,
will do the work,and the suunure is not Imended OroRentd for sale(Sec.7014.Business
and Pmfesaiuus Code:The ComacNra Limtae Law dm m1 apply As an saner of Required Inspections
property who hullde or Ire pmvn Neon,and who tlws sorb work nimxelf w tluau{h his
own employs,provided Nat such Improvemmta manot himuled oroffered forssle.It.
however,Ne building w impmwmenl la aoltl within caw yw oFmmpletion.the owner-
builder will lune On human of proving Na K did Out build or improve for puryoxe of
isle.).
❑1.As weer of the property.me exelusintly ormauesm,with Bmnsed mnusnon to
conslrRn Ne pnotion(Sec.7044.Buttressed Professions Cade:)The Cwuacmra U.
cense Law dos rot apply to an owns eF propery who milds or improves Neon,and, .
who cwtrams for suck projects with amntracmrtU Ilm sed porraim he the Contractors
Limmum sew.
❑I ant.."order See ,B 6:P C for this muon
ora Dan
WORKER'S COMPENSATION DECLARATION
I thereby aR)rm under penally of perjury one of On following declwtions;
❑1 have and will maintains CaniBcata ofCowent 10 TIF-inmre Ins WOrker,Cwopen-
orlon,As provided for by Section 37M of the Labor Code,For the performanm of thc
work for which this permit is issued.
❑1 haw and will maintain Workers Compensation luttnnm,As required by Section
=ofthelabor Code.fortheperformance Of the wart for which this permit 41uwd. '
My Worker's Compensation Wuranm erier and Policynumberane:
Canaitr.Zj,J �aliry No.�4+�5 4/6.2
CERTIFICATE 0 EMFnON FROM WORKERS
COMPENSATION INSURANCE
(Thisxecdw need nethecompletedirlhe pemitDrwos anNrGdoum(x100)
or lest)
1 certfy that In the perfumewo of dm.,it for which this pem11 is broad,I shall am
employ any person in my manes,.u b becomes subject m the Werken'Compensation
Law,of California.Dam
APPllau
NOTICE TO APPUCAN3.If,alk,making this Certificate of Exemption,you should
dxane subject to the Workers Compensation provisions of On IAhw Code•you mus
O O forthwith mreply what such Provisions or this introit Nall the deemW tnmkcd.
Z y CONSTRUCTION LENDINGAGENCY
[-t I hereby dfom Nan Nem mai construction lending agency for the pMmmarnc of
!Yi> the,wurk for which this permit k iuuW(Sec.3()91,Civ.C.) '
131 Q lender,Name
.7 z lender,MOCCA
U O 1 testify that l have read this application mul sum Na dm abow informadun Is
tL E comet.I agree in comply with all city and county ondusems and sum taws testing m
O SV-: WildingConstruction,and hereby amhrfln mpreeenmtivr or this city to cost upon Ne
til show-mentioned property for inspection purpors.
�" gy (Wel ague to save,indemnify and keep homeless the City of Cupertino against
zy lianillde;Judrmenu.cwuandexRwmwhich may Inmyway amrveagainst sudCity
U a+ APPLin ICANT UNDEtaunce of the FSM5TTjjS..NDS ANDOf WILLWILL COMPLY WITH ALL NON-POINT Issued by: Date Jam(
souRJCC�IjE�6lRS.
'/7��,,��G Dam
HAZARDOUS
Re-roofs
um of IicaHAZARDOU Dam /
FIA2Orful. MATERIALS
,moupaDISCLOSURE Type of Roof
WilltheApplicant ms(alum bpalCgempanlsmmwMMle harNowmaimrial
As defend by(he CupeninR Municipal Cade.GaPmr 9.13.soul Ne Heslth and Safety
ora.sectmn zss3z(.)7 6 o All roofs shall be inspected prior to any roofing material being installed.
❑Yu
WIII tho applicant w fulum building arupant use cyuiPmmt w deHm which If a roof is installed without first obtaining an inspection,I agree to remove
cmil nwndous air contaminunta As dc0wd by the Bay Arm Air Quality Mmagemcre all new materials for inspection.
District?
0Yes BNo
I bane mad Ne hmsdau maunsis mquhemenu underChspmr6.95 fthe Califrr.
nice Health&Safety Code,Sections 35505,35533 sent 25534.1 undcmW tiro if On Wilding
dm not ewrendY hair a it u my responsibility m nmtify the occupant of the
lcgdmmon n tprior ini,suanmofaCcnifaamo(Ocmpamy. Signature of Applicant Date
-fit All roof coverings to be Class'% or better
Ow aulhometl em Dam'