03090213 (3) CITY OF CUPERTINO
BUILDING DIVISION PERMIT C0NTRACTOR4NFORMATION:
G,HLDING ADDRESS: PERMIT NO0 3 0 9 0 2 13
.R'S NAME: PERMIT ISSUE DATE
,STEPHA E P 0
NE: SANITARY NO. CONTROL NO,
ARCHITECTMNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+00 LICENSED CONTRACTOR'S DECLARATION
mF I hereby affirm that I am licenxa under provisions n(Chapkr 9(commencing Job Description
.Z f with SxcjOn,70KQmfDivhmp3ofdIAcB andprrfeuinmCod.andmylotmeeis
sad infullfo ana t.
jDt4: Liven 1mA L .k �7"3�)o`f WINDOW REPLACEMENT
Dow ARCHITECrff
t.ARATION CONTRACTOR: ALL BRAND WINDOWS
i is //,l5bc sal m CVm�s public records !7 _
.0 mfcssionat
3 OWNER-BUILDER DECLARATION
<Y I hereby affirm that I Am exempt form be Contractor's License Law for the
OD following reason.(Section 7031.5,Business and Ponkormm Code:Any City or county
5$ which requires a permit to construct,elks,improve,demolish,or repair Any storctum
-iy prior In its issuance,also requires the applicant for such permiuu file a signed statement
cis that he is licensed pursuant to the provigionS Of the Contractor's Liccnm Law(Chapter 9 Sq. Ft. Floor Area ValuatOg300
2FD (commencing with Sorban TIDO)of Division 3 of the Business and Professions Chat or
59 Nat he is exempt therefrom and the baja for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of - 3�Effi OaPildl6erO0 - Occupancy Type
not more Nan Grc hundred dollars($500)). --- p Y --
❑ L a owner work,the preperty,or my cmnwith wages u ala(Se.compenation,
will Ph romhe ne,and the he Core is not intended iccoor offered wdoes
Loan,Business Re
and enywhiobu Code:The Cantremon.and
Law docs net apply lf an owner of 101 - FOUNDAT 2t��ed Inspections
own eery who builds or improvu thcmon,and who Ares such work fooffe ar NtoAde his
however,life
or Ithatmmentisch vements Amd within
not ear ofdmoRered for Aide.If. 102' — PIERS
however,Ne buil the or Improvement i,hold within Out
year of c prove for the owmo
builder will bare the burden of proving Nu he did not builA or improve for purpose of 103 — UFE R
ale')' 104 — REBAR
01.a owner of the property,am exclusively contracting with licensed contractors to 105 — .ANCHOR BOLTS
consumerNe project(Sec.70&1,Business and professions Code:)The Contractor',U.
cense Law Area not apply to an owner of property who Wilds of im proves thereon,and 106 - SEWER & WATER
who contracts for such projects with a contractor(s)licamed purmanrao the Contractor)
License law. 202 — UNDERFLOOR PLUMBING
I am exempt under Sec. ,B&PCfor this remain 203 '-"UNDERFLOOR MECHANICAL
I Dow 204 UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury,ane of the following declarnma: _ 205 — UNDERFLOOR INSULATION
I bare and will maintain a Canifiak of Common to self-imam far Wartime,Coalition. 301 — ROUGH PLUMBING
ati in,As pevided for by Section 3700 of the Labor Code.for Ne performance of the 3 02 . TUB & OR SHOWER
work for which thin permit is issued.
I haw and will maintain Worker's Compensation Insurance,As notified by Section 303 — ROUGH MECHANICAL
3]BB of the labor Code,for the parromnanee of the work for which this permit Issued. 304 ROUGH ELECTRICAL
My Worker,Compensations lamourime�Tarricreq add PP icy numMq.m- - 305 — FRAME
G^�G.n GCERT'/'ICAn OF F.Xs�Frr;NH0tOMWOR6KKERS' J�J.•!! 306 — HOLDOWNS
COMPENSATION INSURANCE 307 — INSULATION
orless.)(Thu action And non W Completed fine permit is fns one hundred Anllm($100) 308 — SHEETROCK
certify that in themsmof the work for which this permit u Issued.I shell no, 309 — EXTERIOR LATH
employ anypcnon in any anymanearranutolkcame,ubjectm the worhri Compensnion 310 — INTERIOR LATH
Law,of California.Dow
Applicant 311 SCRATCH COAT
NOTICE TO APPLICANT.If.Arm,making this Cenificate of Exemption.you should 313 - ROOF NAIL
become subject to the Workcla Compensation pmvisirm of the Labor Craig,you must
z formwiincomply with such provisions orthis Permit shall hedeemed mvokcd. 501 FINAL ELECTRICAL ENERGY
zC) CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY
I hcmby ARrmthat them is A construction lending agency far the perfurmanecof 503 — FINAL MECHANICAL ENERGY
Yi rte. the work fur which thi,permit is Issued(Sec.3041,Civ.C.)
ere p Looder'aName 504 — FINAL BUILDING ENERGY
�
Z Lnaer'sAedma 505 — FINAL ELECTRICAL
p 1 anify Nat 1 bare read this application And,uAw in..the shout information is 506 — GAS TEST
F torten.I agree to comply with all city and county ordinances and auk laws misting to
�J+U building construction,and hereby authorsemativcs of this citymemerupon the FIN PLMG
above.mcnt pmpny rinapemionporashes
O8 FI L
Way Agree to ave,indemnify and hop hasmlea the City of Cupertino Against
r N
liabilities judgments,costs and expcaes which may In any way accuse against aid City
J7a, in consequence of 0.gremingofthis Permi6
SPPLICAN GUNDERSTANDS AND WILL COMPLY WITH AL�ON.P INT Issued by: 5 IN
Date
AG!/�3 Re-roofs
jd.rIhod
of AppbcanrConmactor nit
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
ill the applicant or future Duliding occupant nom or handle It. lows mown.)
by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
nion 35532(x)? All roofs shall be inspected prior to any roofing material being installed.
Yat 'tilin the applicant or suture building Occupant urea equipment or device,which If a roof is installed without first obtaining an inspection,I agree to remove
rdnus sit mouminanu a defined by the Bay Area Air Quility Managementall new materials for inspection.
❑Yes 101.
I have mad the hanrdnms malcrials requirements under Chapier6.95 of the Caliroo-
.is Health A Sarcycode,Seaone 255(15.25533 ape 3553 I undeuund lbw if the building
docs not cu a knamfthathamym.,con ywmtti fy dre oaon.,
of Ne
cath nuwhkn no fact ....race Bea toapancy. Signature of Applicant Date
gen, D® All roof coverings to be Class "B" or better