04070172CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
CONTRACTOR INFUY2MATION
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BUILDING ADDRESS:
THE WINDOW BROKER
Pa""IIT"°04070172
OWNER'S NAME:
PERMIT ISSUE DATE
KATHY STAN
P ONE:
SANITARY NO. CL NO.
ONTRO
(800)639=4527
HIT[Cf/BNGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECN
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LICENSED CON'TRACTOR'S DECLARATION
Job De
I haffirm ereby arm Nat I am llceruan under provisions of Chapter 9 (commencing
whh Section 7") of Division Sof lM Be. few Coh,'andmylicevels
in full dcff k Q
WINDOW REPLACEMENT
Dayam ' `romer�OT
ARCHITECTS DEC N
AUG yo 2004
reand my plans shall be used as public records
Licensed
OWNER -BUILDER DECLARATION
BUILDING
1 hmom affirm that 1 License Low for the
herebyexempt from the Cssion
Business and Profession Cods: Any city nr county
following .caro.. (Section 7 L Car
which mwenti
ho a Permit I. tnnswa, alter, improve, dcmoluA nr.a.ir any
its atecmm
priormitscensed phonemic the prevision o farsuchpermiuo Oles Law suumem
licensed pursuantmthePmvialomoftheCemracmhVecmeLaw(Chapmr9
Sq. Ft. Floor Area
Valuation
(commencing with Section 70)0) of Division 3 of the vi latMt7 or
(wiser
cues and
cpd on.Any
Jut he 'u exempt therefrom and the buts (m the alleged emmption. Any violation of
3 MN8,I]h@16er 0 0
Occupancy Type
p y pr'f p
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom Nan five hundred dollen (5500),
❑ I, as owner ofthe pm,amy. Or my employees with wages as their foie cumpmsation,
Required Inspections
will do the wank, end Neswctum is not intended uroRemd forsale (Sm.7014, Business
and Profnslons Code: The Commuters; License Law doe; not apply m an owner or
property who but ids or improves thereon, end who does auch work himself or through his
Own emplayces, provided that such improvements are not intended aroRered for sale. If,
however, the building or improvement is sold within one year of completion, the Owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, as owner of the property, am aaclusively roomnaing with licensed moussen, to
comuuct the pmjm (Sec. 7814. Buriness and Professiam Code:) The Commences Li.
come Law don not apply to an owner of progeny who builds or improv thereon, and,
who contracts for such projects with a conuanmr00 licensed pursuant o the Contruvorb
License Law.
❑ I am exempt under Stt. . B k P C far this maven
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby a(nrm under penalty of perjury mu of the following dalantions:
I have and will maintain a Certificate of Consent no sel4insuro for Workers Compen-
ion, as provided for by Section 3700 of the Labor Code, for the performance of the
ark for which this permit is human.
1 have and will maintain Worker's OmParo a mot Insu mot, u acquired by Section
3700 of the Labor Code. for Jen performance of the work forwhich this permit is issued.
My Worker's Cnmpematim ineunoee crer and te her am:
+ how inn. I6IG 1 7.0
rAagycr. e C- Poliry .:
CERTIFI ATE OFPXEMPnON FROM WORKERS'
+
k/ COMPENSATION INSURANCE
Cline sectitm need not bceompleand If the Permit is foram hundred dollen (51010
or lna.)
I unify that in the performance of the work for which this permit is issued. I shell not
employ any person in any manner an as on become subject to the Workers'Compensation
Laws of California. Dam
Applicant
NOTICE TO APPLICANT. If, after making this Certlfmate of Exemption, you should
become subject m me Worker's Compensation provisions of the Labor Code, you must
foMwith comply with such provisions or this permit shall be deemed rewked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that then Is a comtroction lending agency for the Performance of
the work for which Nis permit is issued (Sec. 3017, Ch, C.)
Lenders Name
Undet's Address
1 ceNfy that I have read W application and sum that the above infotmadun is
correct. L agree to comply with all city and county ordinances and some laws relating to
building construction, and hereby authmim narmuenmiv of this city to enter upon the
abow-mentioned property for inspection purposes.
(We) agree he save. indemnify and keep memories, the City of Cupertino against
lishilidn.judgmem,casu and expenses, which may in any way •acne against mid City
x'�/
in eomequence of Ne granting of this permit.
//
APPLI UNDERSTAND$.AND WILL COMPLY WITH ALL NON -POINT
Issued by: Dae (i
SOU GU ONS. `( ^ -2
Joe
Re -roofs
Dam
Si um tdApplicaHAZA
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will thn applicant or future building Occupant stem or handle hamAous material
Us defined by the Cupenioo Municipal Code. Chapter 9.12. and the Health and Safety
Code. Section 25532(;)7All
❑ Yca ItAl
roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit he..do. air extu rumnu as defined by the Bay Am. Air Quality Management
all new materials for inspection.
I D'smia7
0y" t�s�--/
I haw mad the hanrclout materials requirements under Chapmr6.95 of the Califor-
nia Health R Safety Code, Sections 25505,25533 and 25534,1 under mnd NatifJm building
Jots not curen0 haw a Nmen4 Naut my msprmihility u notify Jm occurrent of the
myuimmc chmua apran sauanea.f.Cenificam.facuants.
Signature Applicant Date
6. 07-2
of
All roof coverings to be Class "B" or better
rorwhodmd;gem D