06120015 CITY OF CUPERTINO
BUILDINGDIVISION PERMIT CONTRAC'�T( RINFOx,RMATION\?
BUILDING ADDRESS: BROTHERS HOME IMPROVEMENT -"'"0612001521601 REGNAR D
OWNER'S NAME: PERMITL%n DAM
TAO CHEN 188 STAUFFER BLVD 12 /OS/2006
14 NE: SANITARY NO. CONTROL NO.
(408) 295-0.68`0
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
too LICENSED CONTRACTOR'S DECLARATION
u
C 1 hereby affirm that I un li¢iucd under pmm
viumos Of Chapter 9(commencing Job Description
U with Section 7M1y)of Divmm 3 ofdse Busiomeand Professions CoM,W my license is
'�`n in foil romeand L REPLACE 11 WINDOWS AND 2 PATIO DOORS LIKE FOR L
;�� License Glass eic�L .. t�99 ooq
1„p Dam fa._f Contrum��i"1N
ARCHrtECI'S DECLARATION
i e 1 understand my plans shall M umd as public reeoNa
)yU
°0� Licenced professional
OWNER-BUILDER DECLARATION
f I homily affirm that I am exempt fmm the Conwaars Liccnm Law for the
-
no following mason.section 7W I.S.Business and Professions Coda:My city art Or,,
$ which¢quires a Permit m conswc4 alms.improve,demniteh,or¢pair any ince¢¢ $10100
He,w its issuance.alm mquires the applicant for such permit a Gk a signed statement
that lm is licensed paramount to the provisions of dm Commcmrs License Law(Chapter 9 Sq.Ft. Floor Area Valuation
aFe (commencing with Section 7000)of Division 3 of Ne Business and Prolesoiom Code)or '
,59 that he is exempt tMmfmm and the baso for the alleged eaempuon.Any violation of
Section 703 1.5 by any applicant for a permit subjects the applicann to a civil penalty of a Occupancy Type
not mom Nam five hundred dollars(5500).
❑1,cowmrofthe property,amy employees with wages,their solo comport=tion, '
will dothewart.Coale:
sdmwmutethtendcd w Law
does
an Badness
ma Prt,who W code:The.tt era..License law dao tet apply lf,t owner is Required Inspections
property who b,ponvirimprova Nemon,and who memor marbled
himselfor Olrough his
awnwm.mtha,provided Nm smbimprm id within
not intendedaro@on.f ower.
builder,,Ne Wilding ha improwman u that
within one Scar or imm mmfor the owes.
builder will low Ne burden of proving Nat K did stat Wild m improve far purpose of
sale.).
❑I,as Owner a the property,am coclusiwly contracting with licensed comuactors to
construct the project(Sec.7014,Business and Professions Code:)The Conuaeasts U.
come law does not apply to an owner of property who Wilds or improves Nemon,and.
who contracts for such projects with a conumus(s)licensed pursuant W one,eonuaccoYs
License taw.
71 I am exempt undo,Sec B A,P C for this recon
Owner Dam .'
WORKER'S COMPENSATION DECLARATION
40 1 hemby aRrm under penalty of perjury one of she following commitments:
❑I hawand will maintain aCerdfiateof Content mself-insurefmWmkeYsCamp.-
=tion,as provided for by Section 3700 of the taWr Cade,for the performance of the
work for which this permit is issued.
❑I haw and will maintain Workers Compensation Inver=cc,as requited by Section
3700 of lW labor Code.fm Ne pe,farmancc of Ne works for which this permit is issued.
My Workers Compen=uon Insurance carries and Policy number am:
Cartier. clr—Dlra Polity Na.:B Bl�x�CC=O1
CERTIFICATE OF EXEMPTION FROM'. RXERS'
COMPENSATION INSURANCE
(Mis aeaion nem not he completed if Ne Permit is foram,hundred onilars(SIM)
or less)
I certify that in de performance of the work for which this permit is issued.I she]not
employ any Person in any manner so c to Wcomc subject o the Workcri Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject in th,Worker's Compcn=tion promions of Ne Labor Code,you must
.J 0 forthwith comply with such provisions at Nu permit shall be deemed milked.
'z uS CONSTRUCTION LENDING AGENCY
ince 1 hereby alion that there is eatauuction lending agecy for the performance of
D:> the wark for which this awit is Lowed(Sae 3097,Civ.C.)
W A Lenin's Name
Z Lenders Address
U0 1 cenify Nat I haw rad this application and sum Net the above informant..is
Iy F' correct.I.,me to comply with all city and cmm y mcumom,and state laws¢king to
U building construction, m
ction.and hereby authorin,mpmmmiw of this city to enter upon Ne
[s7 abuvc.mentioned pmpeny for inspccuon pto cros.
LL (We)agme Io=wa,indemnify and kap hmmlec Um City of Cupertino against
(n liabilities.judgments,costs and cxNnme which may in any way accrue against=id City
U Z in consequence of the gnmung of this pc,miL
�-•' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:. Date
SOUR RE/GU-L3A�ONS
SI uRofApplimmuConummr Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will theapplicanmrfumm building accupmtstmcm MMkhaallons material
az derived by tic Cop overs Municipal Code.Chapter 9.13,and the Health and Safety
Code, pre,25532(a)7 GRN. All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
N911 the applicant or future Wilding by the D y A ea Air a or devices which p g
emit harardnus air contaminants az defined by the Bry Arca Air Quality Managemcm all new materials for inspection.
Dis dn7
❑Ya No
I have mad the h=hlous materials requirements under Chapmr6.95 of the Califor.
nuH fiat h SafmyCade,Sndoes 25505.25533 sod 25534.1 adsoand dutiHW Wilding
does not m mmly haw a mnanL that it u my moponsibility m t o t y dm ottupam of Nc
mgayrn x parmiamnaofaC,nnateofaeupaney. Signature of Applicant Date
O/ 0-5-0(oAll roof coverings to be Class "B"or better
OOW mauNarizcdagcm Date'