05100140 CITY OF CUPERTWO
BUILDING DIVISION PERMIT CONTRACTOR INFORM.ATIQN
BUILDING ADDRESS: PERMITNO()510 014 0
10550 RED FTR CT
OWNER'S NAME: PERMIT ISSUE DATE
MAHON ROBERT B AND EMILY Y TRU 1 2005
E: SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
.0, LICENSED CONTRACTOR'S DECLARATION
UC I hereby affirm Nat I am I'ncnacd under provisions of Chapter 9(commencing Job Description
b with Scction]IXNn of Division 3o(NC Businev and Professions Code.end mylicenx is
^ dinfail(a.,and Officer. REPLACEMENT WINDOWS
,y,E License Class Lic.If
'-p Date Contractor
',` ARCHITECTS DECLARATION
w< 1 undcrsund my plans&hall he used as public records
Jy
o y Lk:cnxd Pmfessional
S OWNER-BUILDER DECLARATION V
I I hereby.(firm on 1 1. canal from de,Coniraetah License Law for the
p O (allowing mason.(Suitt 7031.5, t.alter, and improve.
de am Code:Any City at county \✓
$s- which its requires a permit re contums the elan improve,h Permit t fie a sig any uncture 14 7 5
y that
prior m its issuance.r also rectums the shovisiappo s o for Contractor',
file Bawd suumcm
<
(commencing
with
ction7 h)ofDiviomnfNcComnanestai¢nulaonsCo(Charter Sq. Ft. Floor Area Valuation
Y�G (commencing with Section 7")of Divisionlnf the Business and Professions Cob)or
i $
that he is exempt tMtafrom and the basis fm be,alleged exemption.Any violation of
Section 7031.5 by any applicant for•permit subjects be applicant to a civil penalty of
ot
nmora Nan five hundred doll.(stud). or Occupancy Type
❑has owner ofdm property,or my employee with wagesu Heir salt compevatlOn,
will do be work and the&o mmrt is nos intended uroRemd foraalc(Sec.]OCG,Business
and Professiasu Codc:The Contractor's License Law dose, at apply to an awncr of Required Inspections
propertywho buildsorimprove thereon,and who doessachwork mofffor through his
own verb thasprovided that inch improvements eta not intended.,offered for sale.If.
huilder.be building orimprovemminis Baldwithinone year of mproefor,Ne.ween
builder will have be burden of proving that he did not build or improve for purpose of
sale.).
1�1 1.as Owner of the propeny,am exclusively contracting with licensed manicotti w
onswct the project(Sec.7044.Business and Professions Cade:)The Comractori LL
cense Law doe not apply to an owner of propeny.who builds or improves themon,and
who contracts for such projects with a contractor(s)licensed pursuant o dto Conrractofs
License Law.
OImn.mm sunder Sec .B&PClmthiarcawn
Owner Date MICI id
WORKERS COMPENSATION DECLARATION
1 hereby arm under penalty of perjury One of the following declinations: _
❑1 ham and will maintain aCcrtificate of Consent to self-insure fm Worker's Compen-
sation.as provided for by Section 37M of the Labor Code.for be performanm of the
work Ira which Nis permit is ieucd.
❑i have and will maintain Workers Compensation Insurance,ss required by Section
37OO of be labor Code,for tom perfonamme of he work for which Nu permit is Wood.
My Worker's Compensation Insurance carrier and Policy number am:
Comer. Policy No.:
CERTIFICATE OFF FMPrION FROM WORKERS'
COMPENSATION INSURANCE
(Thusecdon need not be completed 0Ne permit isforonc hundred Collars($100)
or mail
1 certify dual in Ne Mr...of hha work four which this permit is Word.I shall not
employanypersoninany manncrsfou ty hgamesuj o Ne Workers'Compensatian
Laws of Califomi.,,Q{tc
NOTIC n�ICj�— —�n(L
NOTICE TO APPLICANT:Ih a e,making this Cishaut of of E Labor
on,you should
become f comp to the Wehcro Compensation provisions of she labor Code,you muv
.J O faMwiN comply with such previsions or this permit shell M Cmmcd revoked.
z o CONSTRUCTION LENDING AGENCY
(ti I hemhy all'rm that theta is a construction lending agency for the performance of
G: the work for which this permit is issued(Sec.3x97,Civ.C.)
(] Under's Name
D z Lcmice,Addles
U C) I certify Nn 1 have read this application and sum that the above information is -
F' coned I agree to comply with all city and county ordinances and state laws talating m
U building construction,and hereby authadm representative of Nis city to curer up.the
shove-mcnudgm pmpc costs
for inspection purpoaus which may
H y (We)agree to save.indemnify and keep harmless thc City of Cupertino against
fA in
eunce of be
and of
prohich racy in any way eccme against said City
UZ in consequence of Ne gaming O(thu permit
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 19 j-U S'
SO60UR EREGULAy�NS. W
_ :9 k, _ 7v�at.A_ 6 I c� Re-roofs J L
Signasurc olAppli< unanchor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant start or handle hmardous material
u darned by the Cupertino Municipal Code,Charlie,9.13,aM the Health and Safety
Castle. 11
❑1yes 35532(a)] All roofs shall be inspected prior to any roofing material being installed.
Yes �tu
rrIf a roof is installed without first obtaining an inspection,I
Will be applicant or forum building attupant tau equipment or Jcvice which g agree to remove P
emit ha>ardous air contaminants u defined by the Bay Arca Air Quality Managcmcnt all new materials for inspection.
C]Yes Ddu
1 have read the brood oe mamrials mquimmcw under Chapter 6.95 of the Califor.
nix liralth&Safety Code,sections 25505.25533 and 25534.1 understand Net if the building
docs not currently ham a¢rant that it is my easponsi hit ity to notify the occupant of the
rcquiremen which muR be met prior to issuance of a Ceor""of panty.
Pe /� Signature of Applicant Date
Owner or authorb,cd agent N D,m All roof coverings to be Class"B"or better