08080206�z
C
Si >
r
�z
JC
L~
DL
N IZ
�z
CITY OF CUPERTINO
:.. .,::.. .. .
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO.
8053 PARK VILLA CIR
ARGONAUT WINDOW & DOOR, INC
08080206
OWNER'S NAME:
FER11d1T ISSUE DATE
1901 S BASCOM AVE STE 800
08/26/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHrrE fENGINEiR:
BUILDING PERMIT INFO
REPLACE 6 WINDOWS LIKE FOR
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
WINDOWS
Job Description
1 hereby affirm war I am licen&ed under provisions of chapter 9 (commencing
with Section 70rill) of Division of the B=* , and Pro Code and my license is
in full force and eff_ L7
License Class Lie- N V
Contractord IU
Date
ARCHITECTS D TI
1 understand my plans dull be used its public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alta, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed stalement
that he is licensed pursuant to the provisions of the contractors Licansn Law (Chapter 9
Sq. Ft.. Floor Area
Valuation
(commencing with Section 7000) of Division 3 or the Business and Professions Code) or
- -
that he s exempt therefrom and the hada for the alleged esemptin. Any violation of
--- - -- -- - -
APN Number
Occupancy Type
P y yp
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (5500).
❑ 1, as owner of the property, or my employers with wages as their sok compensation,
will do the wort, and the structure is not intended or offered for sale (Sec. 7044, Business
Required Inspections
and Professions Code: The Commictnrs License Law does not apply o an owner or
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not Intended or offered for sale If,
however, the building or improvement is sold within one year of completion, the owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ L as owner of the property. am exclusively contracting with licensed contractors to
Construct the project (SEs. 7044, Business and Professions Code:) The Comlactoes U-
ccnse Law does not apply to an owner of property who build& or improves thereon, and ,
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
License raw.
❑ I am exempt under Sec . B & P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby afrum under penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Conscnt to self -insure for Workd& Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
1 have and will maintain Workees Compensation Insurance, as required by Section
211
700 of the Labor Code, for the performance of the work for which this permit is intrA
My Workeer tion Insurance curia and Policy number are:
Carrie: Policy No.:
CERIT ICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCEa
N cQ
(This section need not he completed if the permit is foronc hundred dollars (5100)
•\
or less.)
.
I certify that in the performance of the work for which this permit is issued, I shall not—Zai
employ any person in any manner so as o become subject o t the Workcrs' Compesation
— 2 % 7
Laws of California. Due
Applicant
NOTICE TO APPLICANT. If, after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is & construction lending agency for the performance of
the work for which this permit is issued (ace. 3097, Civ. C.)
Lenders Name
'
Lenders Address
1 certify that 1 have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, cosu and expenses which may in anyway accrue against said City
in consequence of the granting of this permit.
�t
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Type of Roof
Signature of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant sore or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health card Safety
Code. section 25532(a)?
All roofs shall be inspected to any roofing material being installed.
E] Yes C] No
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes ❑ No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Hcalth& SafetyCode, S=dom 25505, 25533 and 25534.1 udcratand waif the building
does not currently have a tenant, that It is my responsibility to notify the occupant of the
requirements which must be met prior to issuance of a Certificate of Occupancy.
Signature of Applicant Date
All roof coverings to be Class in" or better
Owner or authorized agent Date