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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
.,�i1NTRACTQ,R IN.It'OT.;MATION .-
5
BUILDINGADDRESS:
ARGONAUT WINDOW & DOOR
PER ""06090017
22931 VOSS AV
OWNER'S NAME:
PERMIT ISSUE DATE
CHIEN -'HEN CHEN
10624 S DE
E:
SANITARY NO. CONTROL NO.
(408)378-4018
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I Job Description
I kmby affirm Bowl 1 am licensed under provisions or Chapter 9 (commencing
P
with Section 7") of Division 3 of the Business and Profevsiam Code. and my license is
mfail mmaand arrea
REPLACING WINDOWS LIKEXFORKE
License Class IY. g
Dol: Comtiacmr
ARCHITECTS DECLARATION1 undersand my plans shall k used as public recordsLicensed
Pmfesawnal
R DECe ON
Oat
/
Conti
I krtby alTno Nm I am exempt from dte Contractors license Law for Ilse
I am cacrept
r
following moon. (Sceuon 7031.5, Business and Professions Code: Any city or county
which rtquira a permit of em.roct, alcor, improve, demolish. or repair any someone
$13963
! prior a its issuance. aLw requires the applicant forsuch permit in rile a signed suument
licensed Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he is pursnuu to the previsions of the
(commencing with Section 700(1) of Division 3 of the Business and Pmfessimu Code).,
that he is exempt therefrom and the basis for the alleged exemption. My violation of
Occupancy Type
P Y YP
Section 703 L5 by airy applicant fear. permit subjc.0 be applicant to a civil penalty of
not mom than five bundled dollars (5X10).
0 I, m owner of Ne pmperty, rr my employees with wages o 0cumle compenssdon,
Required Inspections
.illdo dmwolk. Nd tha eNIc1Ym is tam mended m OBCRd foraale ($IX.7BW, Bushel{
and Praised.. Cede The Contractus License law dao rot apply in an owner of
property who Wilds orimpmcs thereon, and whodoessuch work himtselfor enough his
own employe.. provided into such impro morenu>R ..at intended oraReral for sale, a.
however. the building Or improvement is sold within oro year of mmpledOn, the Owrce-
builder will have the burden of proving that k did not build or improve for purpose of
sale.).
It 1, as Owner of Ne property am exclusively contracting with licensed contractors m
construct the project (Sec. 70x4. Business and Pmfadons Cade:) The Conuacter's Li.
«.e law dors out apply In an owner of property who Wilds or nostrum dsrern, and.
who contracts for such projects with a e.ntractar(a) licensed paramount in the Canonicals
License Law.
n I am exempt under Sac B k P C for this reason
Data �S
WORKERS COMPENSATION DECLARATION
1 hereby affirm under pe.lty of perjury area of the following dedfuntlone:
0 1 hart and will maintain a CerdBasaf Consrnt m self-imuse fm Wakes Compen-
sation, o provided for by Section 3700 of one Labor Code, for dee performance of the
wok far which this permit is Wood.
0 1 have and will maintain Workers Compensation InmMce. a required by Section
37M of Ne labor Cade, for the pcd...cO.f the wok for which this permit is issued.
'
My Workers Compenssdan Wer. artier and Policy number art:
Cartier. Polity No.:
_
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section food monk completed lithe permit is fmone hundred dogmas ($109)
-
orless)
1 certify dim, in On. performance of the work for which this permit is ioucd. I anall nm
.oployany person in any man.( uu, O.-1,!.tltic Wakers'Complemadue
".of Calf a _
Applicant - —
,
NOTICE TO APPLICANT: If, after making this Cerdriate of Exemp1se. you sh.uW
become sobjea m Ne wort s Compensation provicio. Of the talar Code. you mum
'
foMwith comply with such FMASIo. of this permit shall k deemed mvokcd.
j CONSTRUCTION LENDING AGENCY
I hereby ice, lending agency for the performance of
Natnt
chrm
which i (S...
Ne wok fur which this permit u issued (Sec. X197, Civ. C1
Wood
Lenders Nene
Lenders Address
I certify that I have rad thus application and sum thu the aWw infOmudun is
'
torten. I agree to comply with all city and county ordinances and sure laws relating to
building construction, and hemby authorim mpremnutisrs of this city to enter upon the
aWvc-menuonodpropertyfor i npurposes.
(We) agree ro rave, indemnify and keep harmless Ne City or Cupertino against
st
judgments, ergo and cxpe.ea which may in any way aceruc agaiml said City
cx,,,
in coitiea,
m ePLICANT of the, granting of Nu permit
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCER ULTT(ON
Re -roofs �--
�n-r u'
Signaum Of Applicam/C.ntracmr Dam
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future Wilding otsupant some a ha dIc hafardous material
az defined by the Cupenim. Municipal Code. Chapter 9.13. and the Health and Safety
We. ❑ Ya Scotian""2(a)?
�NO
All roofs shall be inspected prior to any roofing material being installed.
Win the applicat or future Wilding occupant urs quipment.1 dc'mcs which
If a roof is installed without first obtaining an inspection, I agree to remove
emit havardno air conumi.nu. defined by the Bay Arta Air Quality Managcmcnl
all new materials for inspection.
District?
0Y. KN.
I have mad Ne hvardma materials .0rancru under Chapterti.95 Ofthe Califor.
nu Health k SafetyCode, Sccuats ViM5,25533 vu125534. Iundeemand thmiftk Wilting
dos mol,amemly has: a moan, the I IS my mspoembility in notify the occupant of the
ak
require whichmutpriormissaan rr comfmate.focapmq.
Signature of Applicant Date
s a S - C,
All roof coverings to be Class "B" or better
Owner m mho
tri, d agent Date