07060149 CITY OF CUPERTINO
BUILDING DIVISION PERMITI ' ?i
BUILDING ADDRESS: PERMIT NO.
10450 GLENVIEW AVE ARGONAUT WINDOW & DOOR 07060149
OWNER'S NAME: PERMIT ISSUE DATE
SANITARY NO. CONTROL NO.
(408) 378-4018
ABUILDING PERMIT INFO
RCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
0 0O LICENSED CONTRACTOR'S DECLARATIONJob Description
4.1
P 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
z w with Scction 7000)of Division 3 of the Business and Professions Codc,and my license is WINDOW R E PALC EMENT-NO STRUCTURAL.
y in full force and effect.
? License Class Lic.N
WDate Contractor
J ARCHITECTS DECLARATION
i a e I understand my plans shall he used as public records
m y Licensed Professional
t a OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
p O fallowing reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure
?Z y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
?=o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 S q.Ft.Floor Area
I. (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $5000
9 that he is exempt therefrom and the basis for the alleged exemption.Any violation of qp
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 36911017
:U Number Occupancy Type
not more than five hundred dollars($500).
0 1,as owner of the property,or my employees with wages as their sok 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 not apply to an owner of 9 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 sale.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
sate.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's U.
cense taw docs 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 Contractor's
License Law.
0 I am exempt under Sec B&P C for this reason
Owner
T WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 1 have and will maintain a Certificate of Consent to self-insure for Worker's 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 1 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 Worker's Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
(Phis section need not be completed if the permit is for one hundred dollars($100)
or less.)
1 certify that in the performance
Laws of California.Date U�
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code•you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
z— CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of _
y. the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
.7 z L.cndees Address
U 0 1 certify that 1 have read this application and state that the above information is
LL," correct.1 agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorise representatives of this city to enter upon the
a above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
co) liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date
r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued
SOURCE
A Da T ofRcof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as dcrrncd by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs scall be inspected prior to any roofing material being installed.
❑Yes [moo
Will the applicant or future building occupant use equipment or devices which
If a roof is 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
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building
does
D