06070020 CITY OF CUPERTINO & +�,e ;P
BUILDING DIVISION PERMIT W,lihTTRACTORAN'FORMATION
RU1LDING ADDRESS: AMERICAN HOME RENEWAL INC PERMIT N006070020
351 SANTA PAULA AV
'R'S NAME: PERMIT ISSUE DATE
MARTIN KWANDOU 310 SHAW RD 07/06/2006
PHONE:
SANITARY NO. CONTROL NO.
(650) 553-9054
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
I� 0 0 0
i p C LICENSED CONTRACTOR'S DECLARATION Job Description
V C I hereby affnm that I Am licensed under pmvisimu of Chatty 9(rommencing P
as with So, 7gn))af Divi'on 3althe Business and Nol wimp Cade.and no license is
±�N mmnmraandeff art 11L0$$7 RETROFIT 10 WINDOWS, 2 DOORS, 2 ADDITIONAL WOOD
Lm.R'
C Emr
WINDOWS, NAIL FIN CONSTR.
y Dale O
£ ARCHfTE DE 1914
AMERICAN HOME RENEWAL PAID FOR BL 7/6/06
32<
1 understand my plans
p
`oG Licensed Professional
3 OWNER-BUILDER DECLARATION
I herchy alum that 1 am1. exempt from to Convns Cri I:A.,c law for the
O o fallowing moon.(Scc6on 71q 1.5.Business and Pmlevum CWC:Any city or many
i 4 tai which requires A permit in cnnswct Aller,improve.dcmali.N,or repair any met..
pd.,Or its issuancc.alsumquires thaapplicant far such permit on file A signedsummcm
-?< that W is licensed pursuant o the provisions of the Conrnorr's Liccnx Law(Chapter 9 Sq.Ft. Floor Area Valuation
4 (commencing with Section 7000)of Division 3 of the Businessand Professions Code)or $37260
y Nat ha u exempt tMrefmm and the,basis for Ne alleged exempoon.Any violation of
Section 7031.5 by any applicant far a permit mbjecu the applicant an a civil penalty of APN Number Occupancy Type
not come,tun five hundred dollars(ISOo).
0 1,az owner of to property,m my employees with wages in their sale compensetian.
will do lha work,and the smnure is not intended or offered for side(Sm.7044,Businw Required Ins ion
and Professions Code:The Conuaetm's License Law does roet apply m an owner of q p
pmpcny,who builds m improve thereon.and whodom Much work himself or through his
own employees,provided that such improvemmu are natimended or offered forsale.If.
however.the Wilding or imprevemmt is sold within ane year of mimpledan,the owner-
builder will brave the burden of proving Nat he did not Wild or improve for pupose of
/
O 1,As owner of she propeny,am exclusively convening Min licensed mmranmBusinessn
construct the project(Sec.?pan.Business and Pro hessiaCade:)The Cmnaemr's U
mass, V�
chose taw does not apply ina an owner of pmpcny who builds or anttosonthereon,and l/
who taco for ouch pmjccu with aconuacmrts)liccnxd pursuanlmdx Contractors
Leve Law.
1 an exempt under Sec. .B&P C for this rtazan
er Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury arc of the following declarations:
❑I have and will maintain a Certificate of Canxnl to self-insum for Workes
As provided for by Smtian 3700 of the Labor Code.for the performance of the
work for which Nis pcmit is issued. .ku have and will maintain Workch Compensation Irmrame,As required by Session
3710 of to Labor Cnde,for the perfamtance of the ware for which this permit is issued. '
My Worker's ompe Ii on Ininmm farrier and Policy num rate:
Grtier. V, Polity No.: /G F 77 6'10 1
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not he completed Irthe Permit is rmmh hundred dollars(5100)
ar less.)
I cosily Wet in the per formation of the work for which this permit is issued,1 shall not
employ my person in any mannerx az in become subject m the Wodaint Campenution
Laws of California.Date
Applicant
NOTICE TO APPLICANT.If.after making this Cenifieae of Exemption you should
become subject in the Warlices Compensation provisions of the Lands Codc,you must
.J. O forthwith comply with such provisions or this Permit shall be deemed revoked.
z'y CONSI-RUCnON LENDING AGENCY
PIhcrebyafGm dut then iso coetmetim lending Miens,for the potiormnceof
fY de work fm which that permit is isucd(Sec.3(397,Civ.C.)
Q Under's Name
D.
z Lmilea'a Address
U C) 1 certify that 1 haw mad this application and sum that the above information is
wren.l agree to comply with all city and county ominancesand sum lawuelating to
O V building construction.and hereby authorize representatives of this City to enter upon the
r W ahove mentioned pmpcny for inspection purposes.
(We)agree or saw,indemnify and keep humlcss the City of Cupenino against
C.7 z Liabilities.jud,nni costa and cxpc w which may in my way A..against said City
consequence in of the granting at this pennon.
APPLICANT U RSI'AND A LL COh LY W.TH ALL ON-POINT Issued by: Date 'a/'eG
SOURCE REG ATION 11L[2,
p
11 C L(a L Re-roofs
Signature of ApplicanVContnctor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
W:il the applicant or form building aceupmumx or handle hasommus maxrial
fined by the Cupenioe Municipal Cade.Chapter 9.12.and the Health and Safety
.Section 25532(a)?
❑vex qya� All roofs shall be inspected prior to any roofing material being installed.
Will We applicant or fumm building occupant on,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hozardow air contaminants az dcOned by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Ye pya�
I have mad the hvarduan moeriah,mquirtmenta under Chapter6.95 ofthe Califon.
atilWAlth&SarnyCade.Smoeru25505.25533 and255M.1 understood that ifthe Wilding
docs rot currently have a xnad,that it u my responsibility m acury the aav Ant or she
Iwuiremenu whie must Wmet poor seance or Char, Le or Ccc�an y. Signature of Applicant Date
Owner w Dow a 6 All roof coverings to be Class"B"or better