04110065 CITY OF CUPERTINO /yal°Iryfy� r,,yy'¢"(`'�3a{'�j�`�
BUILDING DIVISION PERMITBUILDING ADDRESS: PERMIT NO.
SEARS HOME IMPROVEMENT 04110065
'-)1902 R02ARIG AV.
OWNER'S NAME: PERMIT ISSUE DATE
NE: SANITARY OL NO.
ARCHITECnENGINEER: BUILDING PERMIT INFO
BLDG ELER PLUMB MECH
o- o
�oo LICENSED CON (ACTOR'S DECLARATION - _
hereby a1Rrm that 1 em 1lcemcit uWer pmNsioDD. f Clupur 9(commencing - L lob Description
with 'on] )of DlvWan3of tie Business OMP fCW s Code,andmylimusch, - ..
'a Ll..flifr eH '1 REPLACE WINDOWS/SLIDING- PATIO DOOR
5y��, Lken=� c l
n Data
— Conlncmr
f "AR Nt1ELTS OEC
' 1 undenunmmY'pdu shall M1e urea u publk ' � -- _. .._
6 ttC��T �j 000"'
Licensed Professional
OWNER-BUILDER DECLARATION
1 hcrthy affirm that 1 am
nthe
e Contravenes taw for the
following mature.(Section 7031.5.Bushms and Professions;Cade:My city m county
which rcquia a.permit to courtrct alms hnpmw,dcrmolW,nr aiany awaure
isnntnlus the farhachpermit u meligstatemem
V�L�C
Valuao
thatIm.lmmud paramount un provisions of the Grnreclrr'eumns law(Chapter Sq.F[.Floor Area ~
-
m $ (commencing with Section 7000)of Division 3 of the Business it Pmfcssiom Code)at -
.. Nat he is exempt therefrom and the bud for tie alleged exemption.Any violation of -
eumareNanfiw�02elticalnWarf3Wrmit SONKu Ne apptieanl to a civil penalty or 3525�]N3S9.�eD0 ' Occupancy T�'pe
I,as owner of the propany,army nexployces with wages u their wk compeautlon, -.
will lothemunts Codm.runundwls Lilums Law dots anapply.]O N,Busies Required Inspections
-
'end enywh(obu Cade:.The Cantnnon.Iaxue Law uch or apply lf rt owner or _. - - q p '
morenywhO bulprovidmprot sutihunterandwhadosseuctended relfroarlhmugh hal
f.
a however,
We
eWipoNthd Nn such improwmwuaro not Intended moQered fa owa r-
uilder ills building or Improvement h hall within one)star of mprove for
Ne owner-
bWldv will have Ne burtlan of proving Nu he dltl not build or Improve far WTece of
isle.).
O 1,u Owner of the property,am exclusively contracting with licensed mtnncm l to
consumer the project(Sec.7144.Business and Professions Cade:)The Con exCIA's L4
cense law doss am apply in an owner of property who builds ar Wpm.therm..and.
who concis for such projects with a contraclor(a)licensed pursuant to the ConinWata - '-
Livens Law.
O lamuemptundu Sec, .116PCfmlhdmuoa
Owner Dem
WORKER'S COMPENSATION DECLARATION
I hereby aMan under penalty of perjury an.of the following declarations: ,
1 have and will ram uin•Cardinal:afC.M.11. If-WomeforWarkelaCompin-
cation,as provided for by Section 3700 of the labor Code.fm the performance of the
work for which this permit is Issued.
OJ1 have and will maintain WmkeM1 Compenudon Insurance,u maximum!by Section -
3700 of the labor Code,far du performance of the work forwhich this permit is Issue&
My Wmb Compensation Wmulm curler end Polity number am: 1l�
Cartier. i Illy No•t��i.�--0(I�T -
CERTIFICA EOF EXEMPnON "Kg `
COMPENSATION INSURANCE
mus auction need notbecompleted lithe permit is for one hundrtddollen($103)
or 1131.)
I certify Not In Ne performance of the work for which this permit is ismed,l shall not
employ any person in any manner an as In become subject to de Worken'Compewtion -
Laws of Califrmia.Dam
Applicant -
NOTICE TO APPLICANT:IL•tier making Nil COADceu of Exemption,you should
become subject to the Wallace,Cam scinuu n proviuou of the Labor Code.yen muss
QD forthwith comply with such provision or this permil shall he domed revoked.
ZN CONSTRUCTION LENDING AGENCY
(.r I hereby affirm that them is a construction lending.pemy for Ne performance of
a> Ne work for which this permit Is issued(Sec.3097,Civ.C.)
aA Landers NLender' ame
IX,z comasAddress
U 0 1 certify that 1 low read do&application and tum that the above Information u
0 borrom I agrce m comply with all city and county ordinances and sum des mixing e
above-mendaned construction,and hereby authori7euoses. fives of Nd city reenter upon the
D7 show-mentioned property for demnify and kupou
(we)agree u cost,indemnify and keep may
in an 01st City of Cupertino against /
rg Ihbiliarquengmenu,eranand expenses which may in anywya<aue against oil City '
C),'Z A consequN'T UNDERSTANDS
N ERST ng Nor this D WILL
Date
^' AP NT UND IONS. Ds AND WILL COMPLY WITH ALL NON-POINT Issued by:
E REGU ATIONs. �' 1 —�
Imo ) �
(1`l '7 Re-roofs j
Signature of Applicam/COnlruur Data
HAZARDOUS MATERIAL DISCLOSURE Type of Roof
Will Ih1•ppllesnt m fretum Ddlding aavpanl core orhandlc huardous material
ss&need by the Cupenmo Mum I Code.Chapter 9.13,and the Health and Safely
Cada.Seaton 25532(0 All roofs shall be inspected prior to any roofing material being installed.
7DhafOyu r
Will the applicant or future building occupant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ictl
it havamotl all conumicams u nncd by Ne Bay Asea Air Quality Management all new materials for inspection,
❑YesI haw read the haraNmsmaudad uquimmenu undurCluper6.95aflie Califor-
Hcaldt,k SafelyCode,Secdons 25505,25533 md25534.1 understand thatiflhe building
a not currently haw a tenant that it d my maponsmaty m notify the occupant of the
uirtmcv hkhmust mapdor "ssulnmofacouthimeoromu���'3 Signature of Applicant Date
w ecrrhaNadr casco Dam All roof coverings to be Class"B"or better