07100025 CIT�' OF CUPERTINO ' h�
BUILDING DIVISION PERMIT ���� �T�� ����� `
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PERMiT NO.
BUILD � H ���� ES F'LORENCE DR ARGONAU�.' WINDOW & DOOR, INC 07100025 �
PERMIT LSSUE DATE
OWNER'S NAME:
LYNN LEHAN 1901 S l3ASCOM AVE STE 800 10 02 2007
SAMTARY NO. CONTROL NO.
iONE:
(408) 37�3-4018
BUILDING PERMIT INFO
ARCHITEC['/ENGINEER: BLDG ELECT PLUMB MECH
� 0 � �
i p p LICENSED CONTRACTOR'S DECLARATION JOb DeSCTl�]t10❑
:�� I hcrcby afGrm that I am licenscd unJcr provisions of Chaptcr 9(commencing
; Z� wim Sccrion 7000) o[Division 3 of thc Busincss and Pro(cssions Code, a d my Iiccnsc is REjvj� j 15 W I NDOW S & 2 DOOR S. RE PLAC E W/ NEW L I KE
�<°� in full Coece and e
��z LicenseClas ��.� D S _� SIZES� )1O STRUCTURAL� NO ELECTRICL� EXTER SIDIN G
� �,,, o Datc Contractor
� ARCHITECt'S DECLARATION b���Q� �/� T-111
i a a I undcrstand my plans shall bc uscd as public records
)yU
° u. y Liccnsed Pmfcssianal
: a � OWNER-BUILDER DECLARA"fION
� a� 1 hcrcby alTirm that 1 am cxcmp� Crom ihc Contractor's Liccnsc L.aw far thc
p O Collowing muan. (Sccuon 7(131.5, Busincss and Profcssians Codc: Any city or rnun�y
<$�i which requiccs a pcm�it to construct, altcr. impmvc. dcmo�ish. ar repair any strucwre
°" N prior ui i�s issuancc, also rcquires thc applicant for such pertnit to �Ic a signcd suicmcnt , Ft. FlOOi Are1 Valuation
�_ � thai hc is licenacd pursuant to thc pmvisio�s of thc Contracmr's Liccnsc L.aw (Chaptcr 9 '>q � 2 0 O O O
� F- (commencing wiih Scction 7000) of Division 3 oC ihc Busincss and Profcssians Cadc) or
y�� that he is ezempt thc�cfrom and the bazis Cor �he allegcd exemption. Any violaGon oC Occupancy Type
Secdon 7031.5 by any applicant for a permit subjects �he applicant to a civil penal[y of Number
not more than fiw hundred daRars (5500). 3 2 6 3 5 Q 3 3��
�[. as owner o[ tt�e properry. ar my cmployces with wages u their solc compensauon.
will do �hc work. and ihe suuctuce is notintendcd or ofk:ed for salc (Sec. 7044. Business Required Inspections
and Professians Code: The Conuactor's License Law dors no[ apply w an owner of
propeny who builds or improves thereon, and who does such work himsel[ or thcough his
own employces. providcd U�at such improvemen�s are not in�ended or oQered Cor sale. If.
hawever, the building or improvemml is sold within one yeer oC completion, the ownu-
builder will have the burden oC proving �hat he did no� build or improvc tor purpose of
salc.).
Q 1, as awner o[ the property, am ezclusively conuacting wilh licensed rnnuactors to
wnstruct the projett (Sec. 7044. Business and Profc"ssions Cade:) The Cootnctor's Li-
cense Law docs nol apply to an owner of property who Mtilds or improves thaeon, and ,
who convacls for such projects wi�h a contractor(s) licensed pursuant to �he Convactor's
License Law.
❑ I am exempt undu Sec. . B 8c P C for this reason
Ownu Date - •. -:
WORKER'S COMPENSATION DECLARATION
I hereby �rm under penalty a( perjury one o[ the following declacatians:
❑ I hs�e and will mainuin a CeniBcatc of Consent to self-insure (or Worte�s Compen-
sation, as providcd far by Secdan 3700 of the Labor Code, for �he pecformancc af �hc
work for which this permit is issucd.
❑ I have and will maintain Worker's Compensation Insunnce, u 2quired 6y Section .
3700 0( thc•Labor Codc, for thc performancc o( the work for which this pecmit is issued.
My Worke p Co�mpensauon Ins cartier and Policy number arc: �� 2
Carrier. / /v't'r �� �v Policy No.: � 0 ._Q �/�/-Q--� �SL�
CERTIFICATE OF EXEMP'I'ION FROM WORKERS'
COMPENSATIONiNSURANCE
(ihis sectian necd not bc completcd if the permit is foronc hundecd doUus (E100) .
nr IcssJ
( cenify that in thc performancc of �hc work for which ihis permit is issucd, l shall not
employ any person in any manncr so as lo bccomc subjcct to �he Workcrs' Compcnsation
Laws of Califomia. Datc
Applicant
NOTICE TO APPUCAM: If, aftcr making ihis Cenilica�e of Excmption, you should
bccome subject �o �hc Worker's Compcnstition provisions of thc La6or Codc, you mus�
, � forchwiiA comply with such provisions or this pecmi� shall6c dccmcd ccvokcd.
z � CONSTRUCIION LEMDWG AGENCY
[.�..� ►�-. 1 hcrcby aRrm Wat thcre is a construeunn Icnding agcncy Cor thc perCortnancc uC -
p�„ � thc wurk for which ihis pertni� is issucd (Sca. 3097, Civ. C.) ,
W Q Lendcr's Narnc
a z Lcnder's Address
U Q 1 certity lha� I havc rcad this applieation and s�aic tha� thc a6ovc infortnatiun is
�� corrcct. ! agree to comply with alI ci�y and county onlinances and s�a�e laws mlating to
0 U building conswctioa, and hcreby authori�e rcprescn�ativcs of ihis city to cntcr upon thc
aM1o�c-mcntioncd property for inspccdoa puqwses.
�"' a (Wc) agrce to save, indcmni(y and kecp harmlcss �he City of Cupcnino against
�� liabilitiu, judgmcn�5, costs and expcnscs which may in any way accruc agti�st said City
U"'� ia conuquence oC lhe granting o( �s permit. Date � 2 2/�
� APPLICAKf N RST NDS ND W LL CO PLY WITH ALL NON- OINT Issued by:
SOU GUL O .
: / o c 2. Re-roofs � /
i urc a Ap can n r '� T of F.00f ��/ v
H US MATERIALS D[SCLOSURE YP
Will the applicant w[uture building occupant storc or handlc harardous matcrial
as defincd by thc Cupenino Mu icipal Codc. Chaptcr 9.12, and t6e Hcalth and Safety
Codc, SecGon 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Ycs � •
f� If a roof s installed without first obtaining an inspection, I agree to remove
�11 thc applican� or Cuwrc building occupant usc eyuipment or deviccs which
cmit ha•rardous air contaminants u dcfincd by �he Bay Area Air QualitY Managcmcnt all new n iaterials for inspec;ion.
�s����
❑ Y� �
1 havc rcad the ha�arCous matcrials rcquircmcn�s un�icr Chap�cr6.95 of thc Califor-
nia Hcal�h & Safcty Codc, Scctions 25505, 25533 and 25534.1 undcrstand Uw� i(the building
docs not curten�ly h a an4 ihat i� my respons' ili�y ta noufy thc occupant of thc
rcyuirem wh' must m prior issu of �r�a�ar � Signature of Applicant 11 Date
/o OL O All roof coverings to be Class "B or better
O autho ird gcnl ��