07100114 CITY OF CUPERTINO y ^� " (`� R�
BUILDING DIVISION PERMIT �*��� ""��"" ���������* �
,: ,:, ;. .. ;:
PERMIT NO.
Bu�t°ir��q��ES�ASS PL FIVE ST��R WINDOWS 07100114 .
pERM1T LSSUE DATE
R'S NAME:
MCCARTHY MARYLIN M 1450 DEI �L AVE 10/16/2007
SANITARY NO. CONTROL NO.
P"oNE: (408)37(1-3331
BUILDING PERMiTINFO
ARCHITEGT/ENGINEER: BLDG E[,ECf PLUMB MECH
� 0 � 0
j p � LICENSED CONTRACTOR'S DECLARAT[ON JOU DCSCI1pL10❑
: v� I hcrcby �rm that I am liccnscd undcr provisions oC Chaptcr 9(commcncing
; z� with Scction 700U) af Div' 'on 3 of thc Busincss and Profcssiuns Codc, and my liccnse is RE PLAC E 8 W I NDOW S & 1 DOOR
�� y in full forcc and eC t _
� v� z Licensc Clus L�. *
-� ❑ Da�c Co
: F"' � ARCHITE ECL
j� .a
a 1 und rstanJ my plans shall as.public rcc s
)aU
' n. � Licensc P uio
;� a OW NER-B ER DECLARATION
� a� � h�rcby n� vm �hat 1 am cx pt Crom ihc Convactor's Liccnsc Law Cor �hc
L p O following �cuon. (Scction 7031.5, Busincss and Professions Calc: Any ei�y or county
u° � which rcquires a pertnit w conswct, altcr, impmve, dcmoliah, or eepair any swcture
prior ui i�s issuance. also requires the applican� (or such permi� to file a signed stalement �; Ft. Floor Area Valuation
� Z< �hat hc is IiccnscJ pursuant to thc pmvisions of thc Conuactor's Liccnsc Law (Chaptcr 9 � 6 O O O
� F� (commencing wiih Scction 7000) of Division 3 of �hc Busincss and Profcssions Codc) or
y�� that he is eaeempt thercfrom and Ihe basis for ihe allcgcd exempdon. Any violation aC
Section 7031.5 by a�ry applicant for a pumic subjccts the applicant to a civil penaity of 3 5 7 010 3:��� Number Oceupancy Type
no t m o r e t h a n fi w 6 u n d r e d d ollars (SS00).
❑ I. as owncr of ttie pmperty, or my employces with wages az their solc compensauon,
willaothewarkandiheswnureisnotinundedoraFteredforsa�(Sec. Required Inspeetions
and Pm(essions Cade: The Conuacwr's License Law does not apply w an owner of
propeny who builds a improves thercon, and who does such wort himself or through his
own employces. Provided �hat such improvemenls are not iNended ar ollered Cor sale. I[.
however, U�e building or improvement is sold within one year of compleaon, the owner•
builder will have the burdan o[ proving Ihat hc did not build or improvc for Qurpose af
saleJ.
❑ I, as owner of ihe property. am exclusivtly conlracGng wi�h licensed rnntnctors to
constnut the projett (Sec. 7044. Business and Pro[cssions Code:) The Contractnr's Li-
cense Law docs not apply to an owner of propeny v+ho builds ar improves lheieon, snd ,
who conuacts Cor such projec�s with a conaactorts) licensed pursuant to �he Convactors
License Law.
❑ I am ezempt undu Sec , B 8c P C for thu rcason
� Date _ . -
WORKER'S COMPENSATiON DECLARATION
1 hereby affi�m under penalry of perjury onc of ttie fallowing declaraGons:
❑ i hsve and will mainuin a Certificatc of Consenl lo sel(-insure for Workcr's Compen-
sation, u providcd far by Sec[ion 3700 of che Labor Code, for the performance ot the
work tor which ihis permit is issucd.
I havc and will maintain Workcr's Compensation Insurance, az reyuired by Scction .
3700 oC �he Labor Code, Cor the performance af We work for which this pecmi[ is issued
My Warkers Compe I�nsunncc carricr and Policy n mber �C: y �.. -_
Cartier.
.�,� �j � v r S Policy No.: f �1.. L
CERTIFICATE OF EXEMPftON FROM WORKERS'
COMPENSATIONINSURANCE
(This section nced not bc completed if the permit is !or onc hundred dollats ($100) .
or IcssJ
I cenify thm in Ihc per(ormancc of Ihc work [or which U�is permit is issucd, I shall not
employ any person in any manner so as to bccomc subject to �he Workcrs' Compensation
Laws of Cali(omia. Datc
Applicant
NOTICE TO APPLICAM: If, a(tcr making ihis CcniC�catc of Excmpdon, you shoulJ
bccome subjcct to �hc Worker's Compcnsation provisions of �hc Latwr Cc�dc. you must
, `Z (oMwith comply with such provisions or this pccmil shall bc dccmed revakcd.
z O CONS7RUCTION LENDING AGENCY
(.��r .�-� I hcrcby aff rtn U�at thcre is a construction Icnding agency for Uu perfortnance uf -
�., � U�c work fur which �his permit is issucd (Scc. 3097. Civ. C.) ,
LLl Q Lendcls Namc
� � L.eader's Address
(� � 1 certify that 1 havc rcad this application and statc �ha� thc abovc information is
w � cortcct. I agrce to comply with all city and county ordina�u:es and state laws relating �o
� U building conswction, and hereby authori�e represenutives of Uiis city to enter upon lhe
� W above-menuuned properry forinspecuon purposes.
a (Wc) agrce to save, indcmni(y and kecp harmless the City of Cupenino against
��/j liabilities, judgments, cos�s and expenses which may in any way accruc against said City /�
V,'� i� conseq cc ot Wc gnnting ot Ihis ��. Date �`� ���
►-� APPLIC UNDERST NDS A 1LL COMPLY WITH ALL NON-POINT Issued by
SOURCE T�� • ,O ( D
Re-roofs ��_
Signatu of ppl UConuact r �a T e of R oof /�/
HAZARD MATER[ALSDISCLOSURE YP i i� v
Will ' e ap licant or fut ilding acupant sarc or handlc ha•rardous ma�crial �
icfined by Cupenino Municipal Cadc. Chaptcr 9.12, and the Hcalth and Safety
:. Scction 25532(a)? o � All roofs shall be inspected prior to any roofing material being installed.
❑ Ycs -
Will thc applicant or futurc building occupant usc cyuipmcnt or dcvices which
If a roof is installed without first obtaining an inspection, agree to remove
emit harardous air con�aminan�s as cicfincd by the Bay Arca Air Quality Managcmcnt all new rr aterials for inspec�ion.
oistrict?
❑ Ycs �
I havc aci Uu ha�ardous mauerials rcyuircmcn�s undcrChap�cr 6.95 o(t6c CaliCor-
nia Hcalih & cty Codc. Secuons 25505, 33 and 25534. f undcrstand U�az iC ihc building
docs not cu a tcnan4 �a[ i� ' y rcsponsihility to notify thc cupant nf Nc
rcyui h must �c me rior cc ot a Ccnifica�c of �� D Signature of Applicant 11 Date
All roof coverings to be Class "B or better
Owncr author .ed a m Datc
�