03010012 (3) CITY OF CUPERTINO
BUmUf NG DIVISION PERMIT �CONTRACT,ORINFORMATION •''.
BUILDINGADDRISS: SMART WINDOWS & DOORS PERMIT NO.
10114 E ESTATES DR 03010012
VNER'S NAME: 6305 DOUGHERTY RD APPLICATION SUB DATE
RAJENDRA LIMZYE — 01/03/2003
PHONE: 925) 556-6010 SANITARY NO. CONTROL.NO,
ARCHITEC'NENGINEER: BUILDING PERMIT INFO
RLDG ELECT PLUMB MECII
0 0 0
p�00 LICENSED CONTRACnderp DECLARATION
yO Pt, I hereby affirm than 1 am licenmd under provisions of Chapter Y(commencing Job Description
a Zu] with Section 7000)of Division 3 of the Businea and Professions Cale.and my limue is
<` i" o- on aH 5563
:eq= [.It for Ka.dc�� 3 Vli 5 WINDOWS & 1 PATIO DOOR. W�Cw�kB� B
2 Liccnsc Cl ■ 'tl V9�alun�®
ARCHITECTS DE RATION
¢ I understand my plans shall he used as public records
apw0
t 3a.
OLicensed Professional APR
I—w g
OWNERBUILDERDECLARATION 2 4 2003
a1 M1crchy att3rm that I am exempt from theCnmractor'a License Law fur the
d 00 following must,(Section 7011,5.Business and Professions Code:Any city or county
yne m� which mquim.x a Permit to construct.alter,improve,demolish,or repair any structure RI
F_6 prior In its ismance.also requires Or applicant for such permit o file a signed statement
Q4¢0 that he is licensed pursuannnthe provisions Ofthe Contractor'sLicense Law(Chapter 9 Sq. Ft. Floor Area �Ition
aC (commencing with Section 700))of Division 3 of the Business and Prnfevsions Code)or
i 3 that M1e is exempt therefrom and the heads for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of
net more than five hundred dollars(s503). Occupancy Type
El I,ss owner Of the propenY•or MY employees with wages u their sole compensation,
will do the work,and the structure is nut intended Oro]firmul for sale(Sec.704,Business
and Professions Code:The Contractor's Liveruc law does not apply to an owner of 102 — PIER r_ equtred Inspections
property who builds or improves themon,and who d.essuch work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If. 103 — UFER
however.the building or impiumment is sold within one year of completion.she owner.
builder will have the burden of proving mat he did not wild or improve for purpose of 104 — REBAR
sale')' 105 — ANCHOR BOLTS
E]1,as owner of the properly.am exclusively contracting with licensed contractors to 106 — SEWER & WATER
¢.nswm the propel(Sec.7044,Business and Professions Code:)The Contractor's Li-
nse law dms not apply to an owner of property who wilds or improves thereon.and. 202 — UNDERFLOOR PLUMBING
wh.mntncta for such projects with acontramor(s)licensed pursuant to fire Contraaorlx
Licc..ol Law. 203 — UNDERFLOOR MECHANICAL
❑I am exempt under Sea. ,B&P C for this reason 204 — UNDERFLOOR FRAME
Ver Date 205 — UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of Perjury one of the following declarations: 3 01 — ROUGH PLUMBING
❑ 1have and will maintain a Cenificate of Consenuo self-insure for Worker's Cooper. 302 — TUB & OR SHOWER
.,tion,as....idled for by Section 37x0 of the Labor node,for he percm u nce of the 3 03 — ROUGH MECHANICAL
work for which chis prmuisissued. 304 — ROUGH ELECTRICAL
❑1 have and will maintain Worker's Compensation Insurance,as required by Section 305 — FRAME
3701 of me labor Cale,for the performance of me work for which this Permit is issued.
My Worker'a Compensation Insurance carrier and Policy�1y.�be ro: 306 — HOLDOWNS
cavi, T uN Polmy+o¢� 51(— b'1, 307 — INSULATION
CERTIFICATE OF FX EM PITON FROM WORKERS'
COMPENSATION INSURANCE 308 — SHEETROCK
(Thksscoiun mednotwcoopletediftle'MoLisforoachu ducild.H.O10) 309 — EXTERIOR LATH
iitecsj 310 — INTERIOR LATH
a
I certify that ethe performance of the boob for which this Permit is issued,a snm employ
n311 — SCRATCH COAT
`mny any person a
nn in any manners. ve subject m wcoc subject Inc Workers'Compensation
Laws of California.Dam
Applicant 313 — ROOF NAIL
NOTICE TO APPLICAN.II..after making this Ceti licam of Exemption.you shnuW 501 — FINAL ELECTRICAL ENERGY
become subject to the Worker:`Compensation provisions o]the labor Code,you must
0 Z forthwimcomply with such provisions ami,5 Permit shanwdeemedmvoked. 502 — FINAL PLUMBING ENERGY
No
CONSTRUCTION 503 — FINAL MECHANICAL ENERGY
N
7I hereby affirm that dome is a construction lending agency for the Performance of 504 — FINAL BUILDING ENERGY
C' >
the work
Name aNmwMenNisixrtnhLsissued(see3tr+7,ay.c
btl ) 505 — FINAL ELECTRICAL
F Lender
� Z U.dc:sAddress 506 — GAS TEST
U O 1 certify that 1 have read this application and stile that the above information is 507 — FINAL PLUMBING
{L F., correct.a agree to comply with all city and county ordinances and sure laws rclatingm 5
�U building mstruaion,and hereby authorise representatives of this city to enter upon the FINAL MECHANICAL
r above.mentioned property for ins,echon p..pnses. O 9 FIN
F0. (We)agtm to save.indemnify and keep harmless be City of Cupcnino against
in Iirim litics,judgments,costs and expenses which may in any way ammo against said City 55 N G
U z APPLICANT ofDERSTNgoS AND mit Issued b 51 — WORKS Date
t-. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT �s
SOURC� EGU.ATIONS.
033 Re-roofs
Salvatore of AppbcanVCnnbactor Dam
HAZARDOUS MATERIAL DISCLOSURE Type of Roof
Will the applicant or furore building decuPa.t store or handle firt.d..material
defined by the Cupertino Municipal Code.Chapter 9,12,and the Health and Safety
c.Section 25s72(a)7 �'/N All roofs shall be inspected prior to an roofing material bei.
❑Yes P P Y g g installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
coir hf,,idous air mmaminane defined by the Bay Area Air Quality Management all new materials for inspection.
Diode!
❑Ycs No
e have mad Ne harallous mamrod,requircmenc,under Chapter 6.95 of the Califor.
nix health&Safety Coce.Smdtays 25505,25533 and 255}1,1 undcrstaM that if NI wilding
Nes t cu.mntly hast a tenant,mat it is my rcxpmsiM1ility m m ilY tw,gmPant of Nc
n is which rest met Nim m issumw of a CcnlBam O ancy
Signature of Applicant Dale
aum..ima agent Date' All roof coverings to be Class "B" or better