06080225 (2) a
CITY OF.CUPERTINO �'
BUILDING DIVISION PERMITC04`I1[riVIA� l �y ' C
BUILDING ADDRESS: TODD LLOYD CONSTRUCTION 1ER11 '06080225
21608 FLINTSHIRE ST
0 NEIL'S NAME: PERMIT ISSUE DATE
DOWD NANCY A AND WILLIAM F 1363 ST
r E: SANITARY NO. CONTROL NO.
(408) 260-0206
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
o a LICENSED CONTRACTOR'S DECLARATION lob Description
FFy I hereby affirm Jut 1 sm loomed under provisions of Chapter 9(commcocing P
6 with Sem1an70(N)of Division 3.f 9.Business and Professors Code,and my It....is
�u nfullfomeandnffat. REPLACE EXISTING WINDOW WITH NEW BAY WINDOW.
Z License C e Lo.N
CenDECLARAe RELOCATE EXISTING RECEPTICLE TO NEW LOCATION.
Ivq' ARCHITECTS DECLARATION
dProfuund my Plansahail he used upublic records �ry r� ry ���
1 to IUSyi tg6rt„\�jVgp■fl
'i6,.t', Licensed Pro(anionai
sod OWNER-BUILDER DECLARATION
<2 1 hemby affirm that I am exempt from the Conuactofs license Law for the
00
(allowing reason.(section 7031.7.Bectme.and Proossinn Code:Any city of county
f_ which regot.
a parmit to cnnaru",aiur.impmw,demuffsh.mar RPair any struetuRr pi,r•
.Zi• prior m its issuance.also requires the applicant(ortuch permit m file a signed smemenl -z
-€<
that he is licensed pumeral to do provision of the Contractor's License law(Chapter 9 Sq.Ft. Floor Area Valuatipg 0 0 0
(commencing with section 7")of Division 3 of the Business it Protwian Codec Or
—
Out be u camp,therefrom and the baste f"the Jugal esempdon.My violation ofm
Satan 7031.5 by any applicant far a permit subjects the applicant In a civil penalty of APN Num - Occupancy Type
ant mom Nan fin hundred dollars($300). 35 6 2 0 0 2
❑1,u owues Of the pRpeny,of my=play—with wage u their oak compenadon,
will do the Sack,and thimstramamis atinRtaedoroffered fanae(sa.7Bu,Burnes Required Inspections
and Pmofesslan Cade:The Cdnnclafa Lkemue Law does not apply o an owmr of 9 P
property who Wilkin or improves demand,and who does sucb weak himself or though his
awn employees,provided thmanch Improvements are communist aroRered forafle IL
however.the building or improvement undid within one year of eampletim.the owner-
builder Ma haw Je burden of proving that K did an,build Or Improve for purpose of
o e.).
❑1.an owner of the property,am exclusively contracting with licensed contractors an
convect the pmjca(Sec.7014,Business and Professors Cade)The CmOaon!U-
muse Law dao no,apply in an away ar pmpenY who Wilds or ImproW deRan,and,
who contracts for such projects with a contractor(s)licensed pursuant in the Committees
License law.
❑1 am exempt under Sec. .B 9 P C for this moon
der Dau
WORKERS COMPENSATION DECLARATION
1 hereby&Mian under penalty of perjury am of the following declamation:
❑I ham and will maintain aCerdfinuaf Consento Rlf-irsumforWarkefsCompen-
ntim.an provided far by Salon 3700 of She labor Code,far de penmmance of the
work far which this permit is issued.
❑1 haw and will maintain Worker's ComPersa,lon Irsuwa,as required by Scetion
3700 of the labor Code,far the performance of the work f"which this permit is Issued '
My Warkeh Compensatim lnura,rce nri am Policy number are:
Cartier, �ri'C f Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tots saaon reed not hecompleted If ilia permit Is f"o m,hundmddollars($10)
or un)
I certify that in the performance of the work far which this permit is Lewd,1 shall no,
employ any person in any in ran gvo subject to the Warkers'Compmuadon '
lawsof Cmifami Dam
Applicant - Yr^�
NOTICE TO APPLICANT:If.afar making this Certificate of Exemption.you should
become Subject m Ne Worker's Cmdpersation provisions of the Labor Code,you must
0z
forthwith comply with ouch provision or this Pemiuhall W deemed mmkcd.
zCONSTRUCTION LENDING AGENCY
[-+ 1 hereby a1Bm that deo Is a eonawatin lending aamY(mar de Nations.of
Qi > the work for which this Permit is issued(Sex.3ML Civ.C.)
�W Q Lemde/s Name
a z Linde'sAddma
U6 I cenify that I haw mad this applizedn.and ante that ate show intonation.IS
H.F' comet.I agree to comply with all city and county ordinances and sum laws mining to
0U building construction,and hereby amharire rtpmaenmiwsaf this city to cnurumn the
r LLl ahom mentioned property for inspection Purposes.
W (We)as.,to save.indemnify and keep heartless the City of Cupertino!plus,
„E'lA Iiabiliticsjudgments,eosn and upon=which may In any way accrue against said City
U in canregmnmofthe twang dfthts perch.
^ APPLICANT UNDERSTANDS AND WILL CO PLY WITH ALL NON-POINT Issued by: Date O
SOURCE REGULATION
od-06 Re-roofs ��—
SIt ppllwsC Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum building"cupanuom or handle hrnrdous moral
n defined by de Copeman Municipal Code.Chapter 9.13,and the Health and Safety
ode,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
[:3y. \
Will the applicant or future building notation,use equipmmt"devlcea which If a roof IS Installed without first obtaining an inspection,I agree to remove
emh hmaN00 alt amumirsnu u de0ned by the Bay Area Air Quality Management all new materials for Inspection.
District
Ye,
Qa
I hew mad the hvtoousmatedasmquimmenu under Chapter 6.93of the Califor.
ria Haalth&SafmyCadg Sccasn25305,25533and25534.1undcrsund Jutifde buildut
dm not currently ham•omni,in.,It is any ruspamihility in nod'y the occupant of the
requirements which must be met pho umcc aryCcrtifcade of Occupancy. Signature of Applicant Date
o / / -06-06
Owmr au,horiscd stem Dale All roof coverings to be Class"B"or better