08010043 CITY OF CUPERTINO
BUILDING DIVISION PERMIT C()1! T12ACQR�U,RMMATIQ
BUILDING ADDRESS; PERMIT NO.
21072 RED FIR CT ARGONAUT WINDOW & DOOR, INC 08010043
R'S NAME: PERMIT ISSUE DATE
KYLE SYLVIA A 1901 S BASCOM AVE STE 800 01/08/2008
PHONE: (408) 378-4018 SANITARY NO. CONTROL NO.
ARCHITEC MNGINEER: BUILDING PERMITINFO
-BLDG ELECT PLUMB MECH
0 0 0 0
�oO LICENSED CONTRACTOR'S DECLARATION - JOb Description
rd u I Wmby afflrm that 1 an licensed ns under provisioof Chapter 9(commencing
z�y
with Section 7O01)nfDivuitn3oftheBudneaand Profesdons Code,and my[i...is RMV 4 WNDWS & 2 PATIO DOORS,REPLACE W/NEW
H in f 1 Inge BM erfeel/ t l�O
�ZZ License Clm ` Lie.x i LIKE4LIKE,NO STRCTRL,NO ELCT,TEMP EGRESS WHERE
n Dam + CSiD CL Q
ARC all Im u e DECLARATION REQ d D
1 understand my plans shall he used as public¢eordw
a,
50 Licensed Professional
g OWNER—BUILDER DECLARATION
9< I hereby alarm that 1 am1. exempt from the Commoners o License Law for the
1 O G following muoa.Permit
t 7M LS,Business and ere,Ouons Code:Any city or county
$ which requires n e.also re cnmwcL altar improve,h permiil t of repair soy awdum
zi primmita unesedpuruamgo theres theapplicantof for Cork Permrtmcensele sew statement
< Netheucingwitpuraanttothe9Diviuns 3the On
ndPreflaw(CloPter9 Sq.Ft.Floor Area $6000 Valuation
$ that M is exempt
t SeNto and the Wallin 3 then Business and on.Any vi Gwe)or 6 0 0 0
Net he u 31.5 b therefrom and the aura for the alleged exemption.Any violation of
Seton than five
airy red dont for a permit subjects the applicant m a civil penalty of V(p Number Occupancy Type
not mom thus five hundmd dollars 155001. 3S9OSOSH :V17� p y •'p
❑I'm owner of the Property,or my employees with wages u their sols compensation,
willdotheworkademstructumunotimmndedma@mdfonale(Sec.7W,Bu nns
aW Professions Code:The Contemner License Law don not apply in an owner of Required Inspections
pmpeny who builds m i remove Nelson.and who does such work himsel f or through his
own employes,provided that such improvements am no intended mortared formale.If.
however,the building or Improvement is sold within one yew of completion,the owner.
builder will have the burden of proving that he did sat build or improve for purpose of
ate.).
0 1.as owner of the property,am exclusively contracting with Ilcnued contractors to
convect tin project(Sec.7oaa,Businw and Prof tendons Cotler)The Cmeramw's LI- .
came Law don not apply in an owner of property who builds or improve dumon,and,
who conuaets for such projects with aeonlrsenKs)licensed pursuant in the Contractor's
License Law.
I am exempt under Sec ,B At P C for this reams
r Dam
WORKER'S COMPENSATION DECLARATION
I hereby aRirm under penalty of perjury con of Out following declamtiou:
❑I have and w01 maintain a Ceniftcamof Consent to selbinsum forWorker'sCompsn-
ration,as provided for by Smdon 3700 of the Labor Code,for Ne performance of On
work for which this permit is issued.
❑I have and will msinum Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which Nis permit a is,netl.
My Work�aer'os Compensation In unm,carrier and Policy number sm:
c,mer:[1V4C/�KA11rA� Policy No.; no LLOY -m3
CERTIFICATE OF �P ION FROM WORKERS'
COMPENSATION INSURANCE
(Thu auction need net he completed]fine pandit Is forone hundred dollars($1010
m Ins)
1 certify Out in the performance of the work Per which this permit is iatned,l shall not
employ any pesos in any..or an as In became subject to the Workers'Compensation
Law,of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Car iftcale of Exemption,you should
become subject on the Worker's Compensation provisions of the Labor Code.you must
rJ O forthwith mmply with such provisions or this permit shall he deam.d revoked.
rrN.dCONSTRUCTION LENDING AGENCY
[—� 1 hereby Aft Nat them is a construction lending agency for the performance of
a the work for which thin permit i,issued(Sec.3097,Civ.CJ
Ul Q Lcohn's Nam. .
Z L.Mces AM. ,
U Q 1 cmdfy Nat I have roti this app0ndon and mw that the whom information I,
Is.F corms I agree in comply with all city and county ordinances and sow laws retailing to '
QU building construction,and hereby athoda representatives of this city to enter upon the
above-mentioned property for Inspection purposes
(We)agree In ave,indemnify and keep harmless the City of Cupertino against
h liabilities,judgments,costs and expenses which may in my way acerae against said City
C)Z in consequence or the grating of this Permit.
APPLICA UND RSTANDS A D WILL CO PLY WITH ALL NON-POINT Issued by: Date
5 CE UL ON 9
1_�g-0 Re-roofs
Si um fAp n r Date
H OUS MATERIALS DISCLOSURE Type of Roof
Will the plicant or future building occupant atom orhandle bacrdous material
Rned by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Se y"s 255320)?❑Yes �Ay� ' All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equlpmrnt or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardons air contaminants as deflud by the Bay AMR Air Quality Management all new materials for inspection.
Diauict7 �/
❑Yes C/Pct,
1 have mal the h sarduns mac sols requirements under Chapter 6.95 or the Caller.
niaHcalth@Safety Cod,Se-dom25505,25533and255M.lwnM dNalfde Wilding
docs out currently ham...40
it u my roxponsiM1ilitY m notify doe occupant of the
M u remen hi must he mel rioitesentlicelf.Ccrifimic.fOccupancY.
�
Signature ofApplicant Date
.o —0
Da
All roof coverings to be Class"B"or better
er aro oda I m' g
r