04060033 CITY OF CUPERTINO a "COR�&FN` Y ' TTBUILDING DIVISION PERT 6N't
n
BUILDING ADDRESS: ASPEN WINDOW & DOOR PERMITN004 060033
10960 SANTA TERESA T)R
OWNER'S NAME: PERMIT ISSUE DATE
MCHAN RAM P AND SHEI —897- INDEPENDENCE
SANITARY NO. CONTROL NO.
408) 431-3522
ARCHITECT(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� t�
X00 LICENSED CONTRACTOR'S DECLARATION Job DesC
I hereby affirm Nal 1 am licensed under provisions of Chapter 9(commencing
wish section 7000)of Division 3 of tete Business and P e m Code.and my license la
my in fun fora and affect. REPLACEMENT WINDOWS .
Ui License Class Lick 11- 1 NOV _ 200
Dao: Contractor
ARCHITECTS DEC
I understand my plana$hall he used As me a no s
is LL�n Licensed Pod eionel BUILDING
iC OWNER-BUILDER DECLARATION
q
1 benhy affirm that 1 am exempt from the Communes Liecmw Law for the
p o following mason.(Settlor 703 L5,Business and Profession Cade:Any city or county
5_9! which¢quires a permit to construct.Alan,.improve,demoliah,fir mPull any suumum
�at prior In in issuance,also requires the applicant forsueh permit to rile a signed statement
SSGthat heislicensed pursuantmNeprevisionsofNCContracwhLicenseLaw(Chapter9 Sq.Ft.Floor Area Valuation
I-� (commencing with Section)000)of Division 3 of the Beat.and Profession Code)or
that he is exempt therefrom and the basis for the alleged esemption.Any violation of
Section 7031.5 by any applicant for a permit subjects me applicant a s civil Penalty of aro 0 Occupancy e
mat man Nfidollars(5
Nan It.hundred 500). P Y TYP
❑I.as owner of the property,or my employees with wages an their sole compensation,
will do the work and the swetun is not Intended reoffered for (sec,7044,Business
and Profession Coda:The Conmctoles s License law donot apply men..at of Required Inspections
property who build(or i m proves thereon,a nd who does such work himself or through his
awn employe,.,provided thatwch improvements an not Intended oraRered forsale.If,
however.the building or improvement is sold within one year of completion,One owner
builder will have rite burden of proving that he did m,build or Improve for purpose of
sale.).
❑T,as owner of she property,am exclusively contracting with licensed contractors to
construct rite project(Sec.7044,Business and Profnsians Code:)TW Canlncmr'3 Li' .
cane law don not apply to in owner of pmpar y who builds or improves thereon.and
who concis for such projects with a conaacter(U licensed pursuant in the Contractor's
License Law.
❑1 Am exempt under Sec. ,B&P C for this reason
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
t�.have and will m ureal.a Certificate of Come.,to self-insure for Wmkeri CO.,..
.tion,As provided for by Section 3700 of the labor Code,fn she performance of she
work for which this permit Is issued.
❑1 have and will maintain Worker's Compensation Insurer=.as required by Section
3700 of the labor Code,for tho performance of the wart far which this Permit Is Issued.
My We es Comps I.onm nna 'u And Policy number art:
Carsier. f Policy No.: _
CER I^ A F (EMFnONFROM WORKERS'
COMPENSATION INSURANCE
(Dissection nand not becompleted ifft permit isforoao hundred dollars(SIM)
or ksa)
1 unify That in the performance of Ne work for which this Permit is issued.I shall not
employ any person in my manner an As in become wbject to the Worlem ComPenadon
Laws of C.1if.rd n Date
Applicant
NOTICE TO APPLICANT:If,after making this OCTUIECAM of Exemption,you should
become subject in Use Workers Compensation provisions of she Labor Code,you must
.J Q fonhwi,h comply with such prevision or this Permit shall W deemed revoked.
Z " CONSTRUCTION LENDING AGENCY
[-ice Ihembyalnm that then lea ronstroctinn kndingagemy fur rix lterfamana of
a the work for which this Permit is issued(Sec.3097,Ci,C.)
0.Q lender's Name
z Lender's Addruss
V Q 1 unify that I have read this application and suite Nal the above information is
(✓ comet.l agree te comply with all city and county Ordinances and auto taws miming to
V building construction.and hereby authorim mprewnwives of this city to enter upon me
W above-mentioned property for impaction purposes.
IN (We uve,indemnify and keep hamlen she City of Cupertino against
y li ilio dgments, nuand exKwAA which may in Any way nna a gain,said City
VJAPJ
raceof the arcing of this panda
A NDE ANDS AND WILL COMPLY WITH ALL NON-PO Issued by:S ��&w Date
R LATI S. V gsV Re-roofsA ptunVConuacmr Data `v
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WI rim applicant or future building occupant store or handle ha�uus material
as defined by the Cupertino Municipal Code.Chapter 9.12,and she Health and Safety
Code.Section-1 a53z(a)1 All roofs shall he inspected nor to an roofing material beim
—1 Yen ON. P P Y g being installed.
Will the appliun or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
hanrdous air contaminants as deftncd by the Bay Ana Air Quality Management all new materials for inspection.
District?
❑Yes ONu
hove ad ch a sus mmcriah mquiromcnu under Chapters.95 of the Califon
c & ,y Code last 25505.8533 and 25534.I undcmmnd that if she building
J ho c a nna that it u my maponibility,m needy rite up.,of me
rcyut `aa .1Priarmissuaneea(aCcmrcateof car ver. Signature of Applicant Date
n ', morivedagea, ate All roof coverings to be Class "B"or better