07090203 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILINfj�¢p "MAR THREE DR HOLDER INC DBA ABLE GLASS P07090203
OWNER'S NAME: PERMIT ISSUE DATE
NALL KEITH M 1129 RICHARD AVE 09/27/2007
NE: (408) 7.9-8829 SANITARY NO. CONTROL NO.
-
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
O p LICENSED CONTRACTOR'S DECLARATION
v I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
;z with Section 7000)of Division 3 of the Business and Professions Code,and my license is WINDOW REPLACEMENT; LIKE-4—LIKE
t y in full force and cffecL
License Class Lic.B
F
to
Date Contractor
ARCHITECTS DECLARATION
aa I understand my plans shall he used as public records
)WU
U.y Licensed Professional
y OWNER-BUILDER DECLARATION
j< 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
:00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
e which requires a permit to construct,alter,improve,demolish,or repair any structure
Z} prior to its issuance,also requires the applicant for such permit to file a signed statement
=c that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area $8826
Valuation
q t•- (commencingwith Section 70D0)of Division 3 of the Business and Professions Code or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofNumber Occupancy Type
not more than five hundred dollars(5500). 3560703 tJ
8:
0 1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does oust apply to an owner of q P
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sate.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Conutactors Li-
ccnse Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
0 f am exempt u du Sec. B&Pe�C f r this
Owner Date `
T- WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 i have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued
My Workers Compensation Insurance carrier and Policy number are:
Carrier: Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars(S(00)
or less.)
I certify that in the performance of the work for which this permit is issued,l shall not
employ any person in any mann hec m b'e the Workers'Compensation of California.Date
Applicant -0 D/2
NOTICE TO APPLICA m ung ts uCi o Exemp n,you should
become subject to the Worker's Compensation provisions of the Labor Code.,you must
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
(-r►�+ I hereby affirm that there is a construction lending agency for the performance of
(� the work for which this permit is issued(Sec.3097,Civ.C.)
ALender's Name
z Lender's Address
U 0 1 certify that I have read this application and state that the above information is
LL.►- correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorize rcpresentativcs of this city to enter upon the
W above-mentioned property for inspection purposes.
�y (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments•costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit.
t- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by Date
SOURCE REGULATIONS.
Re-roofs
Signature of Applicam/Conuactor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? \ / All roofs Shall be inspected prior to any roofing material being installed.
❑Yes �JNo '
Will the applicant orfff(N' building occupant use equipment or devices which If a roof i;installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
0 Yes _�No �/2
I have read the ha72rrdous\materials requirements under Chapter 6.95 of the Califor- �nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building
acs not currently have a tenant,that it is my respo ndtry to notiry the pant of e
ircmcnts which mus met prior to u or to oforr .Sign ure of Applicant Dat
i d
.,cr or authorized agent Da All roof coverings to be Class"13 or better