08090154 (2) CITY OF CUPERTINO 'r -�.x -;asp.F.a,,„;•,' sub-M _`+v ts'«I
BUILDING DIVISION PERT C tYIiLLR� QR �- �51 'F"""'A
BUILDIN DRESS: PERMIT NO. -
l�f�� POPPY WAY BROTHERS HOME IMPROVEMENT 08090154
WR'S NAME: PERMIT ISSUE DATE
YOSHIKAWA SAM-M AND CONSTANCE 2510 DOUGLAS BLVD 09/24/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 295-0680
ARCHITECT/ENGtNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u to LICENSED CONTRACTOR'S DECLARATION
to I hereby affirm W11 un li¢nscd mWcr pmvidons of Chapter 9(commJob Description
p
wiOs don7")ofolmaon3armceani^^••a ofessiomC .eamylicenseis REPLACE 14 WINDOWS & 2 PATIO DOORS LIKE FOR LIKE
d m m full forte arm Tal
ueenRfvl�1�_Lie.N O STRAIGHT RETRO FIT INSTALLATION
t• Date !j Contractor tIMThm la
ARCHITECT'S DECLARATION
U I understand my pians shall he used as Public resords
s G Licensed Professional
OWNER-BUILDER DECLARATION
.1 1 hereby alTirm that 1 am exempt fvm to Contractor's License Law far Oe
C a O (allowing reason.(Section 7031.5.Business and Pmfessmas Codc:Any city m county
mit
which requires a Perto cmanomm.Ates imPmve,demalW,Or RPar eery suunure
_Zy poor N In Issuance.also requlmf IIIc applicants for Such Permit in File a Signed alalectud
E m
that he is licensed Pursuant in Ne Provisions of de Contractor's Lircme Law(ChaPmr 9 Sq.Ft. Floor Area Valuation
'10 (commencing with Section 10(10)of Division 3 of the Business and Pm $11000fessiam Code)car
ERE that he Is exempt therefrom ane the basis fm Ik alleged exemption.Any violation of
Section 7031.5 by arty applicant for•permit subjcsu the applicant he•cavil penalty ofNumber Occas
not mem man flue hundred dollars(ssao). 36615038 . � Occupancy Type
❑I,n owner of the pmporty,or my employees with warn as Slash sole sompewuon,
will do the work.and me strunuR h net lmeMed monered for Use(Sec 1014,Busi.
and limitations
Code:The Conuacmr's License law does Mt apply in an owner of Required Inspections
Property ww builds ori s roves thancon,and who doessuchworkhimselforthrough his
own emPloycv,provided that such impmtemenu are not intended or offered for We.IL
however,me building or improvement u Sold within one year of cumpleuon.the owvr.
builder will have the Eundm of proving that he did nut build or improve for purpose of
US.).
❑1,as Owner of the Property,am exclusively contracting with Rceved cenusmn in
ronstmct the pmjen(Sac.7W.Business and Pmfessiom Code:)The Contractor's Li-
cave Law does not apply in an owner of pmpeny who builds or impmvv thereon.and
who contracts for such pmjecu with a comrtcnon(s)licensed pursuam in US Cann achns
Licence law,
lam vemptunder See ,B&PCfm,hcS am
Data
WORKER'S COMPENSATION DECLARATION
1 hereby Sir.Yndsr Family of perjury mot of de fallowing declarations:
❑I ham and will maintain a Car ificamof Cansent tu lelf.imum for Worker's Compere
scion,as Provided for by Section 37M Of the Labor Code,for dte performance of the
won,for wMeb this Permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as mquimd by Section
3Ma IM Labor Code,far the performance of um work for'which this Fermis is Wund.
My Workee^ss C-ampuJtilon losura�carrier and Policy number are:
Carries: 11'(C6�1 Policy No.: L%'(a 6060 r7 1m -ZlS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Crbissectirn need notbecmnpleted ifIh`Permit Is farone hundred dollars($1U0)
or hu)
1 amity dist in Use performance of the work for which this Permit IS issued.I chal not
employ any person in any mmmr an as in become Subject to the Workers Compersadon
Laws of C,OIOMOL Data
Applicans
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should
become subject in the Workner Compensation provisions of the labor Cade,you miss
0 z faMwith comity wire such Provisions or this Permit shall W deenmd reeked.
z CONSTRUCTION LENDING AGENCY
[-�r I hereby alarm that them,u a consuuctan lendingfor the,
TL . .)
Undoes Name pMmmance of
Um work for which this
aQ Fermin u issued(See.7091,Civ.C.)
z Lender's Address
U Q 1 certify that 1 love Rad this application sand sum mat the above informatiu,is
Uy corecL 1 agree In cmmPlY with all city and county ominances ane surf laws relining to
C) building construction,and hereby minion RpRsenuuvea of this city IS enter upon the
aMve.menuoned Property for ins,celian pis,nuaL
H y (We)agree m ssR,indemnify and kceP harmless the City of CupMino against
VLn liabilities,judgmemu.cocas andespenses which ma i way accrue.gams saO City
z in covequmme of the germing of suis rmil
^' APPLICA STAN LL COMPLY WITH ALL ON-POINT Issued by: Date
SOU E
of AppticantlCum"cor me Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the cespa
iapplicant or run.building ont nm oor handleu
hardom materia
and by Ik Colson.Municipal Code.Chapter 9.12,and me Heath and Safety
.section zss3z(,)1
Dy. At No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future wilding document are equipment or device,which If a roof is installed without first obtaining an inspection,I agree to remove
emitt ern hoom-v r commumnas de0ncd by the Bay Arc.Air Cosily Management all new materials for inspection.
❑Yca RN.
I have read the hanmmu materiaUmquimm roes under CTapeo6.95 of de Califon
nu Health&SarnyCOdc.Scctiw 255()5.25533 and25534.Iundcnund thatifmc wilding
ams Tat corm w a mnml data i1 u my Rapovibility m notify She occupant of the
reyviemc w mus rte vatmcara m, O Signature of Applicant Date
ow raYtharisdsem D,te All roof coverings to be Class'W'or better