06100214CITY OF CUPEKIA N V
BU;LDING DIVISION PERMIT
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BUILDING ADDRESS:
10864 DRYDEN AV
OWNER'S NAME:
GREENMAN WILLIAM F
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ARCHITECT/ENGINEER:
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and effect.
License Class Lic. 8
Date Contractor
ARCHITECTS DECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
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
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7000) 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 of
not more than five hundred dollars (5500).
❑ 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
and Professions Code: The Contractor's License Law dors not apply to an owner of
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
'cfttruct 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 p ' eta with a contractor(s) licensed pursuant to the Contractor's
License Law.
❑ lam exem un Se B & P C for this reason
Owner Data
SATION DECLARATION -42 /4 44--
I hereby affirm under penalty of perjury one of the following declarations:
❑ 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.
❑ 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 arc:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less.)
I certify that in the perform c of the work for which this permit is issued, l shall not
employ any pe ,n,n ny ner so as to become subject to the Workers' Compensation
Laws of Cal'
Applican
NOTIC . If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
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.)
Lenders Name
Lenders Address
1 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
building construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(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
in consequence Vqe granting of this permit.
APPLICANT; ENDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
HAZARDOUS MATERIALS DISCLOSURE
Will Yx applicant or future building occupant store or handle hazardous material
at defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑ Yes rul..
Will the applicant orbuilding occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District? `'
❑ Yes R1 Nu
1 have read the hazardo
//u
''s
��--materials requirements under Chaptcr 6.95 of the Califor-
nia Health & Safety Code, dons 25505, 25533 and 25534.1 understand that if the building
docs not currently te am , that it is my responsibility to notify the occupant of the
requimpemsyz� met prior to issuance of a Certificate of Occupanr�
WINDOW & DOOR
10624 S DE
(408)378-4018
PERMIT 110.06100214
PERMIT ISSUE DATE
10/30/2006
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB
Job Description
WINDOW REPLACEMENT (6) LIKE FOR LIKE
Sq. Ft. Floor Area
Required Inspections
Issued by:
Re -roofs
Type of Roof
Valuation
Occupancy Type
Date
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant
All roof coverings to be Class "B" or better
Date