08020110 CITY OF
CUPERTINO w . �}y�Q. y
G 'a��.=k♦rwi:Sf^ R�a"�°k'"` �*r�^I '
BUILDING DIVISION PERMIT '"k�oNTl�t> Lfr ���1}
Buliplt+q.�pj�R PPERMIT N0.
ACIFICA DR ALLBRAND WINDOWS 08020110
W NEERU'sUNA/MdE: PERMIT ISSUE DATE
TAFZIL PETRUS B ET AL 23312 CABOT BLVD 02/19/2008
PHONE: SANITARY NO, CONTROL NO.
(650) 622-0330
ARCHITECf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
foo LICENSED CONTRACTOR'S DECLARATION Job Description
hereby afrlrm tut 1 am thousand under provisions of Chapter 9(commencing
with Section 7")of Division 3 of to Business and Professiuns Coda,and my licemcu REPLC 12 WNDWS & *2 FRNCH DRS LIKE4LIKE IN SUN RM
n in full force and eff"L XZ�4'�
cepLicenu am Lk.•
JJ Dau ConlraMr
ARCHnECrS DECLARATID
I understand my plane mail he stud as public mcnNa
e8tn Licensed Professional
y,5 OWNER-BUILDER DECLARATION
I hereby aRinn Nu 1 am exempt from the Conuecmr's Licenu Law for the
COO follawinp mason.(Sado.701_5,Business and limitations Code:Any city.r county
9 tem which requires a Permit to marmot.alter.improv.dcmulhh,or repair any "Mo.
prior to its iuuanm,axis requires the applicant far such permit to flle a signed uaument
pp zFp< that he is licensed pursuant to Use provisions of are Conuavor's Licenu law(Chap=9 Sq.Ft. Floor AreaValuation
m
Y38 (comnestwitSection7010)of Division 3ofamBusiness and Profndd�onsCode)or $7000
3 tat he la aumt t
pemfmm and the basis far to alleged exempHan.Any violation of
Section 7031.5 by any applicant fa a permit subjects to applicant to a civil penalty ofNumber Occupancy Type
rwr mote than 0w hundred dollars(SM(S 3 6 9 2 8 0 2 6 .
RN 0 I,a owner of die property,or my employees with wages as their sole eampensadon,
will Protestants,
r tewnh,andNenmcwrt icurenundedoraw dos apply
to in Owner
of Required Inspections
and arty wh bis case:The m disco n, nd whoLocconce Law Imes not apply if in owner of 9 p
propertywhobuildsviireprove+Lemon,sed who saessohwork
himulrhis
awn a provided that such improvements ase not oro@ed for We Ir,
however.the Wilding or mprovemntismid withinlearofcomf ,toomv-
builder NB aw to burden of proving Out he did not bWW a Impmusopurpose of
ab.).
0 1.u ower m the Property,w mmualvly conuaning with Resume mnuamn in
comtra5 to project(Sec.7044,Busineas and PTafesdons Cade:)The Cocusnar's u-
exme Law does act apply to an owner of Property who builds or Improves Leman,and -
wait contracts for such projects wit aconuacmr(s)licensed paramount to the Commanor's
License Law.
0 lamexemptunderSee .Bl PCfathhmason
nes
Data
WORKER'S COMPENSATON DECLARATION
1 hereby aflBm under penalty of perjury age of to following declarations:
❑I haw and will maintain&Caralk na mconsenuo half-huum for Worker's Compen-
sa0on,as provided for by Section 370D or to labor Code.for this performance of the
work for which this permit is issued.
0 1 have and will maintain Womm's CamPensmian Insurance,as rationed by Sacumn
37W of to labor Code,for to Perform""of to wort for which this permit is issued.
My Worker's Compenaulon�1�anior and Polk,number are:
Cartierz-EIUI`tk1 1I fN-tD Policy N..:zo 6Rq� _
CERTIFlG O6 .MON FROM WORKER
s'
COMPENSATION INSURANCE
nTh modest ased nut becanplewl lithe Permit is frcone hundred danan($10131
or Rau)
1 certify Out In to perfonnaao of the work fa which this permit is lamed.l still not
employ any pawn in any marurha a in become subject to to Waritue Compcmaton
Laws of California.Dau
Appllcun
NOTICE TO APPLICANT:If,afar making this Certificate of Exemption,you should
become Subject at the Worker's Compmwtion provisions of to Lahr Code,you most
vJ z forthwith comply with such provisions or this permit shall he deemed mwkcd.
zoO CONSIRUCION LENDING AGENCY
[r Iherebyapron tet Cert is a concentration lendinS.pney for to performance of
E
to work fur which this Permit in;issue[(Sec.3097,Civ.C.) '
Q Ureter's Name ,
0 z lender's Add.
U 0 1 certify that 1 haw nail this application and sues that to above information u
Iy E correct.1 agree b comply with all city and county on inms and sum Ism relating u
-O CS'J building covwnion.W thereby mtorim reprnrautives of this city to enter upon the
Dow-mNYmmd property far inspection purposes.
F y
(Wo)ague in saw,indemnify and keep hamlets am City of Cupertino agLimt
fA IiabRima,judgatmes.mass std Ispemec which may 1.any myamue against said City
f
C)z APPLICANT UNDERSTANDS AIND WWILL COMPLY WITH ALL NON-POINT Issued byDate 2 �(
SOURcP�REGUtell()Nfl '
A A- 1) 2'0-02 Re-roofs '
SiNuurt of Appli V1�nI¢tor Dow
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof �-
WIII Ihe applicam or future Wilding accupsm sm.orlundlc hicamom material
as dcMed by the Cupertino Municipal Cade,Chapter 9.11,ad the Health and Safety
ode,Schon 25532(&)? All roofs shall be inspected prior to any roofing material being installed.
DYmNa
Will the applicant or future building occupant use cquipmenl a devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haamom air conuminsnu u dcrined by to Bay Am.Air Quality Management all new materials for inspection.
District?
0Yes 'Q No
I have rein to haaNa s materials mquiremems undar Chapur 6.95 of rhe uifa-
at.Next"Satiety Cab.Satlau 2550525533 and 23534.I unbraaM that lfthe holding
ones at currently have a unam to it h my respectability to Mary to aecupant of the
mquimmenuwhkh aRW=Iprior iniamnaar,caths roc` Signature of Applicant Date
A 1_6
owns ar.mtnsmi>.a&gem Dam
All roof coverings to be Class"B"or better
� . .