08090156ZzC
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CITY OF CUPERTINOBUILDING
DIVISION PERMITr�Ci1NTRAGTORINF,}�O'RMrkTION
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BUILDING ADDRESS:
11670 TIMBER SPRING CT
BROTHERS HOME IMPROVEMENT
PERMIT NO.
08090156
R'S NAME:
PERMIT ISSUE DATE '
SANITARY NO. CONTROL NO.
(408)295-0680
ARCH=/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
P
eby ares that I am licensed under provisions of Chapter 9 (commencing
1 herf
with Sccw.7(I(10).f Divliijnloftbe Businevand Professions Code. sed my license is
REPLACE 16 WINDOWS & PATIO DOORS LIKE FOR LIKE
in full fora and
Liana Cl.1 Lk. N
Dam contractorP
f
ARCHt1RCTSDECLA ADD
1 uncommon] my plans shall W used as public mcards
Licensed Professional
OWNER -BUILDER DECLARATION
pt from the Canoe. Lkena Law far the
I am cmtrm
I hcmby affirm that u
fallowing mean. (Section 71313, Business and Pmfa tom Code: Any city or county
which m luims a permit to cannoneer, alcor. improve, demolish, or repair any mucum
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prior bio issuarnce. alo m pons; ted applie., far such permit to fit. signed wement
that he is licensed puhmmE to the provisions of the Conmcturs License law (Chap cr 9
Sq. Ft. Floor Area
Valuation
`
e)
(cantonment; with with Section 71XKD of Division 3 of die Russ.and Prolusions Cadser
117 3 $
that he is except therefrom and the baso fa the Ykgcd caemptimt My violadon of
pp Number
36654092
Occupancy Type
Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty Of
ora come dun for handled dollars($500).
V(
I,ssownv of dm pmperty.mmy employee with wages, Heir eek campcnatian,
Required Inspections
aid dotheweak and theWOmuwt,Licens Lawdoforeek(Sec. 7044, Budn•..
and cad¢ The ce Liana Law div not apply lf rt ratter of
museum. his
Property who builds orireprove chicon, and who dessuchwok himself
ertywhobu
edthrough
not tuanofdmoQvedfie sal B.
owneer
due iproWdeddotsohimprovemanlsart
however, the Wilding or improvement 4 cold within ane )ear or mpro a far the
Ase of
builder will have the Wree of proving that k did not build or improve (a purpose a(
sale.).
0 I. as ower of the property, am exclusively contracting with licensed contracl.rs to
mruental the project (Sec. 7064. Both. and Pro(es4ons Cods,) The Controtnr's W-
certme Law does not apply to an owner of Property aha boilds or improm themon, and
who contracts for such pmjccu with a contractor(s) licensed pursuant to ce Conuattors
Wave Law.
l am exempt uneer See . B A P C lou this meson
Date
WORKER'S COMPENSATION DECLARATION
i hembY N -um under peaty of perjury oro of ce (allwing declanhome
0 1 nam and will maintain a Carurnk orconttnt to self -insure rorwohcrscompen.
mire, u provided for by Section 3700 of the Labor Code. far On peliomas, of the
wart fm which this Permit is iauud.
0 I ban and will maintain Workers Compensation Insurance, as sequined by Section
3700.17 the Lmcr Code. run the Puformarce of the work for which this permit is issued.
,
My Walker& Compensation Insurance carrier and Policy number am:
Currier. Aron d Polic No.: M —C'1 0600.1"-o
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J
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
'
(rhkaeim need net W completed if the Permit Is foram: hundred dollars ($100)
or Ina)
I amity that in the Wannarce of the work for which this permit is issued. I shall not
employ any person in any manor so M In become object to the Walkers' Campenatim
Laws of Califomia Dam
Applicant
NOTICE TO APPLICANT: If. After making this Carnfram of Exemption, you should
became object to de Workers Compensation Provisions of the Lsbo Co c, you am
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hamby aRsm that them is a cmomction lending agency for alto Performance of
the work for which thts permit Is issued (Som. 3097, Civ. C.)
Lenders Name
Lenders Address
I amity that I haw rod this wacatim and state that the salve Information 0
'
Correa 1 agree to comply with all city and county .Ninances and sum laws mlating to
Wilding emmuetian, and hereby •udurim repremnudws of thiscity to mor upon the
aWw-mcntiored property fm ivPenian purposes
(We) ¢gree to save, indemnify and keep harmlw the City of Cupertino against
liabilims. judgments, costs and,.parmat which may ire any my para against said City
in eomegmnce of the granting of this Amit
APPLI NDERSTA A D WILL COMPLY WITH ALL NON -POINT
-s p
Issued by: 2�(;&
S
Date
EGU
Re -roofs
Type of Roof
um oi'MpncanYCamtractar k
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding Occupant store or handle Imemmv manorial
ted by the Cupertino MmiciPal Code. CWpter 9.12. and also Health and Safety
.semimzss3ua>7
❑Yom WeAll
roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant as which
g p
Quality
If a roof is installed without first obtainingan inspection, I agree to remove
P
a.pp
air contaminants u defined by the Bay Arm Air Quality Management
mAil arta
all new materials for inspection.
P
DiuhaauNnus
DistricR
El Yes j;gNo
I haw mad the haak a an materials mquiromcros under Chapter 6.95 of the Califor.
nia Heal" Safety Code, Section 25505.25533 and 25534. I understand this ifthe bolding
does not e. am an .¢ndust it 4my ns.11.Ybmdfy the occupant of Ne
nknm m.r 'mamma
n oa anry.
Signature of Applicant Date
6
All roof coverings to be Class 'W' or better
rmaalhoriaadagee Dam