06090250 (2) CITY OFCUPERTIIYO m,7 * *
BUILDING DIVISION PERNIIT `CON iq 01ON' 'ORMAe[TON-�
T� „ e,E,n " b✓wt<S.fi*'fir" Nfi wc. �ti.
BUILDING ADDRESS: F AR WINDOWS PERMIT N0.06090250
10370 FARALLONE DR
R'S NAME: PERMIT ISSUE DAIS
GRIMM RICHARD 1450 DELL AVE 09/27/2006
i P. NE: SANITARY NO. CONTROL NO.
(408) 370-3331
ARCHnER/ENGINEER: BLEG ELECT PLUMB BUILDING PERMfTINFO
MECHO
Io9 LICENSED CONTRACTOR'S DECLARATIONIOb Description
1 hereby arrirm tha,1 am licensed under Pmvi man of Chapur 9 rmmmrachng
U with Smmn70nU).rDivW.r3afdm Business and Profeasro Cade.aedmylicenacb
inrallreceand t REPLACE (8) WINDOWS .AND (3) PATIO DOORS LIKE
Licensee Lk,B Commmin FOR LIKE. NO ALTERATIONS .
Dein RCHnECi'S DECLA A 1
t 1 understand my plana Nall he used as public meends
aw Licensed Pmrculonal
e D Oat I am attempt
DECLARATION
1 Mmhy allures on I am uempt rase Um Cssion, o License Taw for the
no (allowing reran.permit
t 7 on1.0.Business and improve,
Profession,Cade:Any city of county _
$
which requiresa Penni,re cnuwet.aafter.pplicant
improve,h pr oad,u il repair any mecum
that he
its iensedpalmncqulrn proapionsof .omuitro�il.Law(Cha:men, VaIU ib674
pp NalheulicensedpunuanttoIMofDivisioofNenBuactalaIdceonilaw(Clupmr9 Sq.Ft.Floor Area
d� (commencing with Section 70(q)af Division 3 o the Business and Profcuio.Cnde)ur
that he u eeempt therefrom and the basks for the alleged eaemptim.Any violation of pk�n,1s.�i/���iyQ1
Section 7031.5 by say applicent for a parent subjects the applicant N a civil penalty of 3 O 7 G 7 V 1�er 0 0 Occupancy Type
trot mart Nan fiw hundred dollars(5500).
I,a owmr or Nie Pmpny,m my employm withmrA u Neb mlt eomperadm,
wifido NewarL nd thea mm wtmmtdedoroQecedror, e(S..7044,Bm races Required Inspections
and Profusion CadCommerce,Cade The Cerce,License law don —1not apply m an r of tl P
Property who builds or impovnt .,sed whodaes,mhwarkhimuJ(.through his
awn employment,provided Natauch improvements am mtinmMed malered foram B.
however.the building or improvement i,sold within c m year otwopletion.Ne owner- _
builder will have the mandril of proving Nat he did ant boom or improve for purpose,of
ask.).
0 I.as owner of the popery,am eacmaively conuusing with Ben.,.-a emntrcron to
corwn Ne project(Sec.70th.Business and PredictioN Cade:)The Commmes u.
care law don aot apply he an owner of properly when builds or unpmves thereon.and.
who contracts for such p odecu with aco mcmr(s)licensed puramnt m Ne Contractors .
License law.
❑lameaemptunder See .Bg:PCr.thishei
Dae
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of popsy none of du following declaralione:
❑I ham and will maintain a Comfcam of Camemm SelRbau a fa Worker,Campo-
.ifan,as provided for by Sedan 3700 of On Lab.Code.for the performance of On
work for which thin Permit is humid.
1 haw and will maintain Workers Compmatlon Imunnce,as required by Section
of the Labor Cade,for the performance of the work for which this Permit is hasmd.
My arkers mparamount Insurance cemicr and PoImy L
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WO ERS'
COMPENSATION INSURANCE
(Thu section need otbecompleted if the permit is foram hundreddollan(SI00)
or kis)
I¢nify that in the performance at the.,it for which Of.Photo,is issued.I shall am
employ my person in my mmmrso u in increase subject to tK Worked Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making Nu Cc uncele of Exemption,you thei
become subject in the Worker,Compensation provisions of tic labor Code,you most
.J O forthwith comply wide such novism.or this permit"I be deemed revoked.
Z a CONSTRUCTION LENDING AGENCY
t-.t Ihereby affirm ft.them h,a coumuninn lending agency,for the Performance of
E4
> the work for which this Permit is burned(Sec.3077,Civ.C.)
rT] Q L adi Name '
.a7. Lendeea Add.Add
U Q I certify Nn I have new this application and sum Nat the show information is
Fcorrect.I agree to comply with all city and county ordinances and sum laws mating 10
V hunditg construction,and hereby aunhome representatives of this city m enter upon the
W above-mcmiuncd properly for inspection purposes.
W (We)agree to uve,indemnify and keep hmre len the City or Cupnino against
fp maMlitiu, dgmenu,cosuandnpe ich may in any way amrm again said City
(„)7 inch ch
ramingofth' per L
rte• APPLIC DERST DS ILL COMPLY WITH A L NON DINT Issued by: Date
SOU ON . /a -
`�l Re-roofs
signal of PPI UCan Dam
AAD U MATERIALS DISCLOSURE Type of Roof
Will eapplic torfut uildingaaupanttlom.haMleha wmAM69
as defined b rmms M tlpal Cade.Chapter 9.12.aM the Health and Safety
Section 25532(4)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yu No
WIII the applicant or rulum building occupnt um equipment or devicm which If a roof is installed without first obtaining an inspection,l agree to remove
colt hvardnu air contaminants as dented by the Bay Am Air Quality Management all new materials for inspection.
Dimm7
QYn
I mad NeFE
requEEO
rements un der .Chperd.95of Ne Caufon
nu Heal atetyCo5537 and25Nd.l urdcnunC that if the building
Ones era myre Op M bili,y m andfy dm aceupanI alt NC
mg91re
hot
mas aracerulkak;araeupanry. Signature of Applicant ' Date
All roof coverings to be Class"B"or better
Owner or au, iisa . o a