06090278 CITY OF CUPERTINO t a.
BUILDING DIVISIONPERMIT CCNTRACTQRINN,FORMATION
BUIL.DINGADDRESS: AMERICAN VISION WINDOWS 11 CRMITNo.06090278
6165 SHADYGROVE DR
OWNER'S NAME: PERMIT ISSUE DAIS
�RAHOL PANDIT 1050 E DUANE AVE STE H 09/29/2006
�4E: SANITARY NO. CONTROL NO.
(408) 617-0901
ARCHITECT/ENGINEER: BUILDING PERMRINFO
BLDG ELECT PLUME MECH
0 0 0 0
!oo LICENSED CONTRACTOR'S DECLARATION Job Description
W I Wreby affirm Nat I.m licensed under proviaoas.f Chapter 9(commencing P
MM I with
Comean0U)ofDlvlaOn3OftheBuacessand Pro(essiavCode,aMmyliccnseb CHANGING EXISTING (5) WINDOWS LIKE FOR LIKE
Z in full forte and of a
C Liccnx Cl 3 Lk.Is
,FC Data T. T`S DECLARATION
1 I� As hall use DECLARATION 5
i U I undcaanJ my plans shall W used as public recants
Licensed Professional
OWNER-BUILDER DECLARATION
<i I hereby affirm that I am exempt from the Contractor's Liccnx Law for the
0 O following reason.(Section 7031.5,Business and Professions Calc:My city or county
<m which requires a Permit b construct she,,improve,dcondush,or repair any stmemre
$3120
prior b its isusve,abuml.i.fle..p Irma Watchpc.iuo If]...igned sue
:mem
s< that he is licensed pmsusnuo the provisions of the Contractor's Lticente Law(Chapter 9 Sq.Ft.Floor Area Valuation
uh$ (commencing with Section IOW)of Division 3 of NC Business and Professions Colk)or
a — that he is exempt therefrom and the basis for the alleged exemption.Any vidhd, of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 RgilliNr Occupancy Type
not...than ftvc hundred d.11.(1500).
I,as owner of de pmpony..my wploym with wage as thevxlo compensation,
will do the work.and theswcbm It notintendcd or offered fersac(Sec.7014.Business Required Inspections
and Pmfaviov Cade:The Contractor's License Law does Out apply to an owner of q P
pmpeny who Wilds.improves the em.,sad whadoeseachwerkhimself er though his
Own employees,pmvidcd than such improvements are,not intended Mattered for ale,a.
however.the building or improvement is said within am year of completion,the owner n
builder will lave the bumert of proving that K did wt WSW a improve for pugxise of r� `„` ® �I 91
Wild). Ilu� ��,�`gJ1q tEt'Ip IFzI x
❑1,as Owner of the pmpenY am exclusively contracting with licensed ronuaeton b
covtma the project(Sce.7061.nosiness sad Profosi res Cade)The Contractors U.
owe law does sot apply to an ownar of property wW Wilds or improves thereon,and
who contracts far such pmjects with a con®mon(s)licensed pursuant b the:Cantracbh T�� 7^ �f111C
License Law. J 61� nng
(]I am acmpr under Sec .B&P C far this max.it I� p�(1�gy]57 \�i�1${(
Dae [{ ))� ygy�aD �a
WORKER'S COMPENSATION DECLARATION It�1�.Ss1/(11({.71AMtlit
1 hereby afi.under penalty of perjury nnc of Ne fallowing d.lartians:
❑I have and will maintain a Cemfeab of Conscm to sel6insom far Workers Camper
.tion,as provided Ire by Section 3700 of the Labor Code,for the perfo,mamx of the
work for which this permit is issued.
❑1 have and will maimain Worker's Compensation[..a.,as required by Section
37W of the IaWr Code.for use pmformance of the wart far which this permit is issued.
My Worker's Compensation Insurance,carrier and Policy number ax:
C.nim: %Wane.- IArdjfrAALQPomy No.: t7(el rv'I�(
CERTIFICATEOF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sect,..aced not xcompkbd if the permh is far ane hundred dollars(3100)
or lcm)
I certify the,in the perfiam acme of the work for which Nis permit is issued,l shall nut
employ any person in any manvrm as to become subject in the Workeri Compensation
Laws of Califom;a Data
Applicant
NOTICE TO APPLICANT:If,after making this Cernfieab of Exemption.You should
become subject to the Workers Compensation provisi.0 of the Labor Cade,you most
.Jz forthwith comply with such provisions or this permit shall W deemed mvokcd.
'ZO CONSTRUCTION LENDING AGENCY
'r+ 1 hereby alirot Nat Nem is a construction lending agency for the Performance of
Fi 7 Ne work fur which this permit b issued(Sec.3097,Ci,C.)
4 Q Lender's Name
Z Lcnde'sAddress
U0 1 certify that 1 haw read this application and stab Nn Ne shove infmmuion s
rcorrect.l agree to comply with all city and county ordinances and stab laws relating to
DU building construction.and hereby authorize sprvematiws of this city to enter upon the
,A aWvemc rml,ndproperty fon capection..purposes.
gy (We,)agree to save,indemnify and keep harmless the City of Cupertino against
fpr incoitiv,ryce of costs cxpcnsvmit. may in any way accme against said City
U 2 inconsequence of the UNDERSTANDS
of this permit, y
APPLICANT UNDERSTANDS AND WILL C MPLY p(ITH ALL NONPOINT Issued by: Date / "l F—d
SOURCE REE^U�ATIONS.
glzgl6u Re-roofs
Signatum of ApplicarNCantrxtorr Dare
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant.forum Wilding acapaat c om of handle baramous material
as deft.d by the Cupertino Municipal Code.Oapbr 9.13,and the Health and Safety
Code.Section 25532(.)?
Ayes ON. All roofs shall be inspected prior to any roofing material being installed.
Will the aPPliclm orIulure Wilding=Open(use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emir hovardnus air contaminants as defined by the Bay Axa Air Quality Management all new materials for inspection.
District?
❑Yea Yl (u
I have sad the havardeas cr atchals requirements under Ch2pmr6.95 of Ne Califon
nisi Health&SALayCede,S.W.25515,25533 and 25534.1 aWctmmb than irthe building
does Wt cantly haw a want.that it's my responsibility 10 notify Ne,occupant Of tW
requimmcm.wmchmualxm LIM. .ssuance ab ofOccupan Signature of Applicant Date
owner. Orme
lir' All roof coverings to be Class 'B" or better