07050243 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �N'TgLE>`GTQR IItTI0�1
PERMIT NO.
BUIL131h1(r,.p,MESP I RWOOD DR ARGONAUT[' WINDOW & DOOR 07050243
-R'S NAME: PERMIT ISSUE DATE
.3REG TOTH P 0 BOX 110338 05/24/2007
PHONE: (408) 373-4018 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o p
LICENSED CONTRACTOR'S DECLARATION
v 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
Zwith Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE WINDOWS & PATIO DOORS LIKE FOR LIKE.
a' in full force and effect.
j Z License Class Lic.#
[- Date Contractor
•J ARCHITECTS DECLARATION
7 e�C< I understand my plans shall be used as public records
)yU
U.y Licensed Professional
y OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
in o following 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
oZ y prior to its issuance,also requires the applicant for such permit to rile a signed statement
=o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3q.Ft.Floor Area Valuation
t— 0000
(commencing with Section 7000)of Division 3 of the Business and Professions Code)or 1
L that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of 3 4 2 3 3 0 4 ) Number Occupancy Type
not more than five hundred dollars($5110).
❑I,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 ns 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
sale.).
I,as owner of the property,am exclusively contracting with licensed contractors to
the project(Sec.7044.Business and Professions Code:)The Contractor's Li-
cense 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 Contractor's
License Law.
❑I am exempt er See B&P C for this reason
r Dale 54)Ltfb 7
W COMPENSATION DECLARATION
I hereby u r penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Consent to self-insurc 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.
❑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:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Chis section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any,person in any manner to Me s1ject to the Workers'Compensation
Laws of Califomi le
Applicant
NOTICE TO PP CA If,#T mallinidUtcrtificate of Exemption,you should
become subject to the Wo er's omperisation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
E-+ I hereby affirm that there is a construction lending agency for the performance of
C4> the work for which this permit is issued(See.3097,Civ.C.)
ALender's Name
2 Lender's Address
U J C) I certify that I have read this application and state that the above information is
' correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorirt representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
tF"t C11 liabilities,judgments,costs and expenses which may in any way accrue against said City
V Z in consequence of the granting of this permit.
t ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 7
SOURC EGULATIONS.
0'1 O Re-roofs
Signatu of Ap 27
an ntrac or Date
H ARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appli t or future building occupant store or handle hazardous material
iefincd by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new m�.terials for inspection.
District?
❑Yes KN.
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.t understand that if the building
docs not currently have a tenant,that it is my responsibility to notify the occupant of the
require is which must be met priorAto issuance of a Certificate of Oc9apancy. Signature t)f Applicant Date
/a� All roof coverings to be Class"B"or better
Owner or auth ztd int Date