04040037 CITY OF CUPERTINO +�,s'"`^Ig�k '
BUILDING DIVISION PERMIT 1,.�G\ Rt� TOIYx; ' I, 1\
BUILDING AfRESS:T. PERMIT"'040400.37 '
91A
ER'S NAME: PERMIT ISSUE DATE
DANNY W N
ONE: SANITARY 0 OL NO.
ARCHIECUENGTNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
u0o LICENSED CONTRACTOR'S DECLARATION Job Description
1 With,affirm(be[1 am licensed under p dvi dme of Chapter 9(cammcndng
with Section 7")of Division 3 of[k Business and I4ofcutons Code,and my license is
„ mm0(om..nderfecs REVISION--EX.WINDOW MODIF. INTER.
5 s clea
License n Lw11
Dam Contractor WALL REMODEL/ORIG. #04020108
ARCHITECTS DECLARATION
�i 1 understand my plans shall k used as public records
�yU
ju Licensed Professional
C OWNER-BUILDER DECLARATION
CoulpON
I hereby.(Sere Nat 11. exempt from the larders,Co License Law for the O
$ which r g reason.(Section]1131.5,Bolter, and improve.
dcrou Calc:Any city or county
which its issue a permit re cooswc4 alms impmu,demolish,or mash ed statement pooraits lensed poaltsflbe me also applicant for suchpermitufies Low
CFF=A Not he islicensedpursuant 7")provisions of the Commcuhnd Pretensions
(C Code)or Sq.Ft.Floor Area Valuation r0 ..
C (commencing with Section]000)of Divisi.n3o(Ihe BusinesamdProfcaiona CoGe)or V
an $ Nat k la exempt therefrom and the hunt for[le alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
act mom than Ru hundred dollars(5500). -
❑I,aowne,.fthe property,or my employees with wage,utheir cele compensation, 35702049 . 00'
willdothiwork.andthaawcturel...li.m.&daroReredfo,salc(Scc.7W.Business Required Inspections
and Profutiou Code:The Commences License Law does not apply u e an owner of 9 P
property who build,or i m proves thereon,and who does such work himal f or through his
own employees,provided thatsuch improvementsare notimmnded oroRered forsak.If,
however,the building or improvement is sold within one you of completion,Ne owner.
builder will haw to burden of proving that k did not Wild or improve for purpose of
",a,).
It 1,as my of the property,am exclusively contrutin with licensed commuc Um to
rnuwct[k p ect(Sec.76.4,Business and Pmfessia ode:)The Contractor's Li
cats.law does apPly I.en mune,of property who do or improv mese..,and
who contracts( . hperjec[swi[hac uacur(Oli dpemommthe mmoome,
License Taw.
❑lam axe tun S.C. ,B&.PC for ism n
er am 0
WORKER'S CO N CLA ATION
I kmby fro under pon ty of perjuryou cf lb declarations:
Ihaveand will maintains NfcateofConunlu F surefor Workers Compen.
scion,as provided far by Se 'an 3700 of the faWr ,for the performance of[k
work for which this permit i issued.
❑1 haw and will mrint Workers Compensation buunnce,as requited by Section
3700of,WU1or Code, rthe performance of the work for which this permit is issued.
My Workers Compensation Insurance artier and Policy number are:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not W completed if[k permits foranc hundred dollars(SIM)
or Mss.)
I certify that in the performance of the work for which this Permit is issued,l shall not
employ any person in any maneram as to become subject u EkWorkers'Compensation
Laws of Ctliforom.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
theme subject in the Worker's Compensation provisions of the labor Code,you mus[
.JO fordwith comply with such provisions u aW this permit shll deemed revoked.
zti CONSTRUCTION LENDING AGENCY
(r k for which
that them isoed(Se.constructionlending agency for the performance of
L4> the work(ser which Nis permit is issued(Sec.7097,Civ.C.)
Q
C6 LndeName
=z Leundeersn Add[,,
V 0 1 certify that 1 have mad this application and slate that me above information is
Dr F cored 1 agree to comply with all city and county ordinances and sate laws relating to
0 building construction,and hereby aumorice mprcunutivcs of this city m order upon me
U
W.-ma tioaed property laterite unit
parpesea
(W agree m save, halyard keep hermle a City of Cupertino against
tF"y r/I liabilitles,j menu,cosuandespenses which may a y way.come against and City
U A7 in conuqu cafthegrantinga(thisp mit.
APPLIC UNDERSTANDS AN WILL C LY WITH ALL NP Issued by: Date
SOURC R ULATIONS. t� 7 0
Re-roofs
c Applic recce
HAZA -
enter 5MATERIALSDI OSURE Type of Roof
Will thcapPlicanL or Wildingoccupam mhandlchaardoes maerid
u de0aed by me Cupenin chatpd Code.Chap r .12,and me Health and Safety
Sued..25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yu o
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hootolm s air c6nurnina[s out defined by the Bay Area Air Quality Management all new materials for inspection.
Dis 7 G
Yes X.
I hav mcWurdnusmeerials requiromen ndcrChepurd.95c(thcCalifar-
nisHc.lth& tyco4,sccduu 25 5,25533 and .Iundcrs[and mazilthc building
docs nota m he a unanL mat' is my Me ilhy he nosily axupat of the
requimmon w must be met poor its Ccmratein0foc a - 7SignatureofApplicant Date
1
n auth 'sed agent ,e All roof coverings to be Class "B"or better