07100075 CITY OF CUPERTINO '
BUILDINGDIVISIOiV PERMIT ������:Q�����'�'����
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: _.__. ._ .
PERMIT NO.
BUILD �vr�3�g�ES�ILFORD DR HOLDER :=NC DBA ABLE GLASS 07100075 .
PERMIT LSSUE DATE
R'S NAME: .
KATE FINN 1129 RI(:HARD AVE 10/09/2007
SANITARY NO. CON7ROL NO.
PHONE: � 4OH � �I3 :�-8829
BUILDING PERMIT INFO
ARCHITECTlENGINEER: BLIX; E[.ECT PLUMH MECH
� � � �
i p � LICENSED CONTRACTOR'S DECLARATION JOb DeSCilptlOfl
%�" I hcrcb affirm thal I am licenscd undcr provisions aC Chaptcr 9(commcncing
�z� wi�hScction7000)ofDivision3ofthcBusincssandPro REPLACE WINDOWS & PATIO DOORS LIKE FOR LIKE & TO
��a inluuforeeande ' MEET EG:tESS
j� z Licensc Class L�. �
p Datc " Conlruwr
: F � AR H[TEGTS DECLARATIO
j a
a I undcrstand my plans shatl bc uscd as public rcrnrds
)yU
' u. y Licensed Profcssional
: � a OWNER-BUILDER DECLARATION
� Vl .�
1 hcrcby alTirm �hat 1 am cxcmpt from ihc CanUaaor's Liccnsc Law ar �hc
Z o O following rcason. (Scction 7031.5, Busincss and Profcuians Calc: Any city or rnunty
�$�i which requiros a pcmiit to conswct. altcr, improve. demolish, nr cepair any stnictucc
°" y prior w i1s issuancc, alw rcquircs ihc applicant for such pertnit to filc a signed statcment „ Valuation
"? a �hat hc is Iiccnscd pursuant to �hc provisions of thc Convactur's Li��cnsc taw (Chaptcr 9 ,>q. Ft. Floor Area $ 610 0
r F� (commcncing with Scction 7000) of Division 3 of �hc Busincss and Profcssions Codc) or
y 3� that he is e:empt theicfrom and the bazu for the allcgcd exempdon. Any violaGon o(
Section 7031.5 by a�ry applicam tor a pem�ic subjccu U+e applicant to a civil penalty of 3 2 6 4110 L�� Number Occupancy Type
no t morc � h a n f i v c 6 u n d red dollars (5500).
❑ I. as owner o[ [I�e propertY. or my employca with wages u thc'v salc compensadon,
willdoihewor7:.andthestructumisnotinteadcdorofte Required Inspections
and Professions Code: The Con�racWr's License Law docs not apply to an owner of
property who builds or improves thacon, and who daes such wark himselt or tlwugh his
owa employces, providcd that such improvements are not imended or o[fered for sala I[.
however, lhe building or improvement is sold within one year of compledon, t6e ownu-
builder will have the burden oC proving that he did not build or improve for pu�pose ot
saleJ.
� I, as awner of the proQeny, am uclusively contcacting with licensed rnnaactors a
consuuct the pcojm (Sec. 7044. Business and ProCessions Cade:) The Cootrxwrs Li•
cense Law docs not apply to an owncr of propeny who builds or impmves tde�eon, and .
who comracts for such projects with a contractoKs) Iicensed pursuant w �he Contnc[ars
License [aw.
n I am eacempt under Sec , B dc P C for �his reawn
;� Da�e _.. _
WORKER'S COMPENSATION DECLARATION
16ercby �cm under penalty of perjury onc of �he following dalantions:
❑ I hsve a� will maimain a CectiGcate ot Cansent to self-insure for Workefs Compen-
satian, as provided for 6y Section 3700 ot the Labor Code. far the perfamance o[ the
work for which this pertnit is issucd.
❑[ have and will maintain Workcr's Compensation Insunnce, as mquired by Scction .
3700 oC U�c Labar Codc, for thc performance of �he work for which this permit is istued.
My Wor s Comp nsatio nsurancc carcicr and Policy number arc:
Grtier. Policy No.:
CE 1C E CEMPTION FROM WORK S'
COMPENSATION INSURANCE
(This section necd no[ Ac completed i( the permit is for onc hundred dollars (5100) ,
o� IcssJ
I cenify th.t in the performance ot the work for which Wis permit is issucd. [ shall not
e.^.�ploy any person in any manner so as to become subject to the Workcrs' Compensation
Laws o( Cali(omia. Da�c
Applicant
NOTICE TO APPLICANT: If, aftcr making �his CcniGca�c of ExcmpGon, you should
become subject to �he Worker's Compensatlon provisions of the Labor Code, you must
� O foMwiih comply wi�h such provisions or this pccmit shall bc dccmcd mrolccd.
Z �"' CONSTRUCI'ION LENDWG AGENCY
[.�.� ►�-. I here6y alTirm �hat there is a consuuctinn Icnding agency Cor the per(ormar�ce uf
^.r., � ihc work [ur which ihis permi� is iuucd (Scc. 3091, Civ. C.) ,
W Q L.endcr's Namc
� � L.ender's Address
V Q I certify ihat 1 havc rcad �his application and staic tha� thc abovc informauon is
w ►-� cortect. 1 agree to comply with all city and county orttinances and state laws relaang w
� J 6uilding conswction, and hcreby authori�t represcn�ativcs of ihis ci�y to cntcr u�mn thc
� a aAove-meniioned propeny (or inspecuon purposes.
(We) agree to save, indcmm(y and kecp harmless �he Ciry of Cupcnino against
��",, � liabilitiu, judgmen�s, cos�s and expenses which may in any way accrue againsl said City �
U z in conuquencc oC thc granling of this permiL D$Ce /C/ ��-�- /
� APPLICANT UN STANDS AND WII.L COMPLY W1TH ALL NON-POINT Issued by:
SOURCE REG ONS.
C - - Re-roofs �����
SignawrcofA �candConuactor �� T e of F.00f
HAZARDOUS MATERIALS DISCLOSURE YP �
wll thc applicant or futurc building occupant storc or handlc ha•rardous mucrial
'cfincd by the Cupertino Municipal Codc. C6aptcr 9.I2. and the Hcalth and Safc�y
�. Section 25532(a)? —1 All roofs shall be inspected prior to any roofing material being installed.
� Ycs l J�'�O •
,/ If a roof is installed without first obtaining an inspection, I agree to remove
�II thc applicant or Cuturc building occupant usc cyuipmcnt or dcviccs which
cmit harardous air rnniaminan�s as dcfincd 6y the Bay Area Air Quality Manascmrni all new rr,aterials for inspection.
District?
� Ycs Nu
I havc rcaJ �he hvardcws ma�crials requitcmcn�s undcrChap�cr6.95 of �hc Cali[or-
nia Hcalth & Safcty Codc, Sccdons Z5505, 25533 anJ 25534. ! undcrstand that iCihc hui�ding
docs not curtcntly_havc a tcnant, �hat it is my responSibility to notify Ux accupaict of ihc
rcyuircmcnts �� n� �� v�a<<o �u��� or a c�,;r�a� oro�N�x Signature of Applicant Date
�� � All roof coverings to be Class "B" or better
Owncr o uthorizcd agcnt Daic